showed lower serine palmitoyltransferase activity than control brains on P8, P10, P14 and P21. Conclusions: These results suggest that increase in serine palmitoyltransferase activity before myelin-specific protein expression may be an initial step in myelinogenesis and a decline in serine palmitoyltransferase activity in hypoxic-ischemic brains may be one of the major causes of delayed myelination.

The incidence of hypertrophic pyloric stenosis (HPS) is approximately 1 -3 per 1000 liveborn infants and is the most common indication for surgery during the fi rst 6 months of life. 1 HPS also occurs in approximately 10% of premature infants. Prior to this report, the lowest birthweight of a successfully treated HPS infant was 622 g (28 weeks of gestation). 2 Although male predominance (male : female ratio, 4 -5:1), familial recurrence and concordance of HPS in twins suggests some polygenetic relationship, 3 the pathogenesis and inheritance patterns underlying HPS remain relatively uncharacterized.There are many indications for administration of erythromycin, a macrolide antibiotic, in the neonatal period. These indications include promotion of gastrointestinal motility, 4 reduction of Ureaplasma urealyticum colonization in the respiratory tract 5 in preterm infants, and prophylaxis against pertussis infection. 6 Since the SanFilippo report in 1976, 7 however, several case series and cohort studies have suggested that early exposure to erythromycin increases the risk of HPS. 8 The present case report describes a set of male monozygotic twins born at 25 weeks of gestation who both received a course of erythromycin and subsequently developed HPS. Case reportMale twins at a gestational age of 25 weeks were born by cesarean section to a 41-year-old gravida 0, para 0 mother. No family history of HPS was present. The mother was admitted at 18 weeks of gestation for management of preterm labor. Therapy with ritodrine hydrochloride and magnesium was instituted, but an increase of serum creatine phosphokinase at 25 weeks of gestation necessitated discontinuation of the therapy, leading to subsequent delivery of the twin boys. Apgar scores were 3 and 7 (twin A) and 6 and 9 (twin B) at 1 and 5 min after birth, respectively, and birthweight was 764 g for twin A and 720 g for twin B. Histological examination of the placenta confi rmed the diagnosis of monochorionic, diamniotic twins. Both infants developed respiratory distress syndrome requiring surfactant replacement therapy and mechanical ventilation (41 days for twin A, 51 days for twin B). I.v. erythromycin (20 mg/kg per day) was given from day 1 to day 14 (twin A) and day 10 (twin B) for the treatment of gastrointestinal dysmotility and promotion of enteral feeding. Feeding was instituted with breast milk beginning at 24 h (twin A) and 48 h (twin B) after birth, with time to full feeds of 31 days (twin A) and 34 days (twin B) of life. Transpyloric feeding was not instituted.Both infants had onset of feeding intolerance, abdominal distention, loose stools, and post-prandial non-bilious vomiting with low activity levels at the 15th week of life (40 weeks of corrected age). No abdominal masses were palpable, and a diagnosis of gastroenteritis or milk allergy was suspected but laboratory data failed to corroborate these diagnoses. Plain abdominal radiography was unremarkable, and i.v. feeding was initiated. At 16 weeks of age abdominal ultrasonography of twin A showed a pyl...

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