Aim-To describe 21 cases of symptomatic rickets in adolescents. Methods-The setting was a primary and secondary care hospital in Saudi Arabia providing medical care to Saudi Arab company employees and their families. Cases of symptomatic rickets diagnosed between January 1996 and December 1997 in adolescents aged 10 to 15 years were assessed with respect to clinical presentation, biochemical and radiological evaluation, dietary assessment, and estimation of sun exposure. Results-Symptomatic rickets developed in 21 adolescents (20 females), with a prevalence rate of 68 per 100 000 children years. Presentation included carpopedal spasms (n = 12), diVuse limb pains (n = 6), lower limbs deformities (n = 2), and generalised weakness (n = 1). Biochemical findings included hypocalcaemia (n = 19), hypophosphoraemia (n = 9), raised serum alkaline phosphatase (n = 21) and parathormone (n = 7), and reduced 25-hydroxyvitamin D concentrations (n = 7). Radiological studies were suggestive of rickets in only eight children. All children had an inadequate dietary calcium and vitamin D intake. All but one had less than 60 minutes sun exposure per day. Conclusion-Even in sunny climates, adolescents, especially females, can be at risk of rickets. Hypocalcaemic tetany and limb pains were the most common presenting symptoms. Radiological evidence was not present in every case. (Arch Dis Child 2001;84:501-503)

The incidence of Down's syndrome was studied in 1870 infants of diabetic mothers out of 22 300 neonates born between January 1987 and April 1994 in our institution. All pregnancies were screened for diabetes and all cases of Down's syndrome were confirmed by chromosome analysis. Down's syndrome (all trisomy 21) was diagnosed in 35 infants: seven were born to mothers with gestational diabetes and 28 to non-diabetic mothers. The incidence of Down's syndrome was higher in infants of diabetic mothers (3.75 per 1000 v 1.36 per 1000) (p= 0.02) with a relative risk of 2.75. No significant diVerence was found in maternal age between both groups (p= 0.67) and the rate of Down's syndrome was higher in infants of diabetic mothers when compared with infants of non-diabetic mothers of similar age. Down's syndrome should be added to the congenital malformations already known to occur more frequently in infants of diabetic mothers.

The incidence of maternal, fetal and neonatal complications in GDM is similar to pre-GDM patients and their offspring. Both GDM and pre-GDM pregnancies and the offspring should, therefore, be monitored and managed identically.

Our data suggest that gastric lavage is not necessary in most neonates born with meconium-stained amniotic fluid, regardless of the thickness of the meconium-stained fluid, as no complications from meconium-containing gastric fluid were observed.

The incidence of type 1 diabetes increased markedly over the past 12 years, mainly in females and children over 10 years of age. The data confirm the need to develop a national registry and the need for further epidemiological research.