In 2 prospective randomized trials, we showed that a nutrient-enriched diet in infancy increased fat mass later in childhood. These experimental data support a causal link between faster early weight gain and a later risk of obesity, have important implications for the management of infants born small for gestational age, and suggest that the primary prevention of obesity could begin in infancy.

The clinical characteristics of 16 neonates with malaria parasitaemia diagnosed on Giemsa stained smears were documented during a 3-month rainy season period in a tropical African city. The prevalence of neonatal malaria was 8 per cent. Seventy-five per cent of these neonates had congenital malaria, 13 per cent transfusional malaria, and 13 per cent had acquired malaria. Plasmodium falciparum was found in all positive smears. Bacterial cultures of blood, urine, and cerebrospinal fluid were sterile. The predominant clinical features were those of fever (88 per cent), respiratory distress (57 per cent), pallor and anaemia (38 per cent each), hepatomegaly (31 per cent), and jaundice and diarrhoea (25 per cent each). Twenty-five per cent of the neonates were resistant to chloroquine sulphate; 19 per cent of the chloroquine resistant babies were also resistant to quinine sulphate 13 per cent of whom responded to halofantrine hydrochloride. One died a day after completing a full course of quinine, with a post-mortem blood smear showing no change in the density of parasitaemia.

Background: Feed intolerance delays achievement of enteral feeding in preterm infants. Parenteral nutrition is associated with cholestasis and increased risk of sepsis. Glycerin suppositories have been used to promote gastrointestinal motility and feed tolerance. Objectives: To investigate whether daily glycerin suppositories (a) reduce the time to full enteral feeding in infants born at <32 weeks’ gestation, and (b) influence feed tolerance, incidence of sepsis or necrotizing enterocolitis, duration of oxygen requirement, growth or age at discharge. Methods: Design – prospective open randomized controlled trial; study population – preterm infants stratified into 2 subgroups, 24–27⁺⁶ weeks (24–27 weeks + 6 days) and 28–31⁺⁶ weeks; intervention – daily glycerin suppository for 10 days from 24 h of age, 250 mg (24–27⁺⁶ weeks subgroup) or 500 mg (two 250-mg suppositories; 28–31⁺⁶ weeks subgroup); controls – no intervention. The same feeding protocol and departmental guidelines for other aspects of neonatal intensive care were used in all subjects. Analysis was by intention to treat. Results: 54 babies were recruited (31 males), 29 randomized to receive suppositories; 48 achieved full enteral feeds. The median (range) time to full feeds was 1.6 days shorter in intervention group babies than controls, but not statistically significant: 7.4 (4.6–30.9) days versus 9.0 (4.4–13.3) days (p = 0.780; 95% confidence interval: –1.917, 2.166). No significant differences were observed in secondary outcomes. Intervention group babies passed their first stool earlier than controls (median: day 2 vs. day 4; p = 0.016). Conclusion: Regular glycerin suppositories did not reduce the time to full enteral feeds in infants born at <32 weeks’ gestation in our setting.

Malaria parasitemia was assessed in 312 placentae of singleton deliveries in Benin. The prevalence rate was 45.19%. The dominant infecting specie was Plasmodium falciparum. High density parasitemia of placental smear in 44.68% was associated with preterm delivery, low birthweight, intrauterine growth retardation and neonatal mortality. Placental histological diagnosis of malaria in 57.69% was more frequently associated with intrauterine growth retardation. Extraplacental parasitemia decreased but intraplacental parasitemia increased with gestational age.

In view of the problem of transfusional malaria, the prevalence of malaria parasitaemia in transfused donor blood was assessed. Blood film examination for malaria parasites on Giemsa-stained donor blood which was used for transfusion to neonates in Benin City, Nigeria was carried out over a 6-month period. Blood group O was the dominant blood type (17%). A high malarial parasite prevalence rate of 40% was noted in the transfused donor blood and Plasmodium falciparum was the dominant infecting species. All blood groups and rhesus factor types were infected with malarial parasites. There was no significantly increased malarial infection rate in any particular blood group type. The neonate, who is known to be immunologically naive, is at high risk of symptomatic malaria acquired through blood transfusion. All neonates who require blood transfusion should be given chloroquine sulphate soon after transfusion, at a dose of 5 mg/kg/day for 3 days, when the parasites are chloroquine-sensitive. In cases of chloroquine resistance, quinine sulphate or halofantrine hydrochloride is an acceptable alternative. Where feasible, donor blood screening for malaria should be carried out before transfusion to any neonate.