ent of foretelling which baby will not thrive, unless an older sibling has had problems with his formula; in this case the chance of a succeeding sibling having similar problems is 1 in 2.21 If all babies are to receive optimum protection against gastrointestinal and respiratory tract infections, and possibly against necrotizing enterocolitis and the sudden infant death syndrome, then all should be breast-fed, and all should have only breast milk for the first 6 months of life. When this is not possible, at least those at greatest risk should be given breast milk - the premature, babies raised in poor socioeconomic circumstances, and those with a sibling who could not tolerate cow's milk. JOHN W. GERRAiW, MD
Department of pediatrics University of Saskatchewan Saskatoon, Sask.
References 1. VAIsLQuIsT B: The transfer of antibodies from mother to offspring. Adv Pedjair 10:
305, 1958 2. BRAMBELL FWR: The transmission of passive immunity from mother to young, in Frontiers of Biology, edited by NEUBERGER A and
TATUM EL, Amsterdam, North-Holland, 1970, p 18 3. ARNON H, SALZBERGER M, OLrrzKs AL: The appearance of antibacterial and antitoxic antibodies in maternal sera, umbilical cord blood and milk: observations on the specificity of antibacterial antibodies in human sera. Pediatrics 23: 86, 1959
4. WINBERG J, WESSNF.R G: Does breast milk protect against septicaemia in the newborn? Lancet 1: 1091, 1971 5. WINTER ST: The age factor in acute diarrhoea during childhood. Clin Pediatr 13: 17, 1974 6. Ross CAC, DAwas EA: Resistance of the breast-fed infant to gastroenteritis. Lancet 1:
Breast and artificial feeding. JAMA 103: 735, 1934 11. WOODBURY RM: The relation between breast and artificial feeding and infant mortality. Am I Hyg 2: 668, 1922 12. GERRARD JW, MACKENZIE 3W, GOLUBOFF N,
13. 14. 15. 16. 17.
994, 1954 7. SMITH LDS, HOLDEMAN LV: The pathogenic
18.
Thomas, 1968 8. Svlstsscy-GRoss 5: Pathogenic strains of colt (0.111) among prematures and the use of human milk in controlling the outbreak of
19.
anaerobic
bacteria.
Springfield,
IL,
CC
diarrhea. Ann Pediatr 190: 109, 1958 9. TAssovArz B, KoTascif A: Le lait de femme et son action de protection contre les infections intestinales chez le nouveau-ne. Ann Pediat (Paris) 38: 286, 1961 10. GRULEE CG,
SANFORD
HN,
HERRON PH:
20.
et al: Cow's milk allergy: prevalence and manifestations in an unselected series of newborns. Acia Paediatr Scand ESuppl] 234: 1, 1973 SCHAEFER 0: Otitis media and bottle feeding. Can I Public Health 62: 478, 1971 CAMPBELL B, SARWAR M, PETERsEN WE: Diathelic immunization - a maternal-offspring relationship involving milk antibodies. Science 125: 932, 1957 MOHR JA, LEU R, MAaRY W: Colostral leukocytes. I Surg Oncol 2: 163, 1970 MOHR JA: The possible induction and/or acquisition of cellular hypersensitivity associated with ingestion of colostrum. I Pedlair 82: 1062, 1973 BARLOW B, SANTULLI TV, Hanm WC, et al: An experimental study of acute neonalal enterocolitis - the importance of breast milk. I Pedlair Surg 9: 587, 1974 PARIsH WE, BAmrr AM, CooMas RRA, et al: Hypersensitivity to milk and sudden death in infancy. Lancet 2: 1106, 1960 ROBAcK SA, FOKER 3, FRANrZ IF, et al: Necrotizing enterocolitis. Arch Surg 109: 314, 1974 Ram WD, SHANNON MP: Necrotizing enterocolitis - a medical approach to treatment. Can Med Assoc 1 108: 573, 1973
21. GERRARD 3W, Luaos MC, HARDY LW, et al:
Milk allergy: clinical picture and familial incidence. Can Med Assoc .! 97: 780, 1967
Human growth hormone In the past, physicians gave little encouragement to children, and their families, who were faced with the problem of short stature. This failure to help was the result of three factors: (a) most of these patients were in relatively good health, aside from their lack of growth; (b) there was little available in the way of therapeutic agents; and (c) the severity of the psychologic and physical handicaps to the patient and the parents was not appreciated. The report by Guyda and associates in this issue of the Journal (page 1301) emphasizes that it is possible to increase the rate of linear growth in those children whose growth retardation is due to a deficiency of human growth hormone (hGH). The results of their study, conducted over a long period, confirm and extend previous findings of others. it is rewarding to see continuing progress in this difficult problem. But we are far from a complete solution. Some points seem to be clear at this time. The administration of hGH, either alone or in combination with anabolic steroids, increases the rate of linear growth in most children with
hGH deficiency. Whether such treatment will increase the height ultimately achieved by adulthood is not known. However, it does hasten the attainment of a satisfactory height, and this is of great psychologic benefit. There are disadvantages with this treatment. Extensive diagnostic studies are necessary to establish that the growth retardation in the patient is in fact caused by a deficiency of hGH. The treatment requires prolonged periods of medical supervision and frequent injections. Unfortunately, the supply of hGH is limited, so not all suitable candidates can be offered this treatment. Also, part of this limited supply must be reserved for further investigations; there is much yet to be learned about the role of hGH in the economy of the body. Although the problem of the shortstature child has not yet been solved completely, the results of studies we have to date are valuable for two reasons: in regard to medical practice, it is to be hoped that these findings will lead to more careful evaluation of these children by the attending physicians; in regard to the future, the success achieved thus far should stimulate addi-
1282 OMA JOURNAL/JUNE 7, 1975/VOL. 112
tional investigations of the many factors (some known and probably others unknown) that control growth. A.B. HAYLES, MD
Department of pediatrics Mayo Clinic Rochester, Minnesota
Erratum In the article "Mitral stenosis with posterior diastolic movement of posterior leaflet" by Berman and associates (Can Med Assoc J 112: 976, 1975) the footnote on page 976 should read: "*EF slope is the standard designation for the slope of the line joining the point of peak anterior motion (E) with the point of maximum early diastolic posterior motion (F) on the echocardiogram.3'12" Since this paper was published it has come to our attention that in the March 1975 issue of Circulation (page 511) Levison and colleagues have reported a similar finding in 16 of 167 patients with mitral stenosis.
Department of pediatrics University of Saskatchewan Saskatoon, Sask.
References 1. VAIsLQuIsT B: The transfer of antibodies from mother to offspring. Adv Pedjair 10:
305, 1958 2. BRAMBELL FWR: The transmission of passive immunity from mother to young, in Frontiers of Biology, edited by NEUBERGER A and
TATUM EL, Amsterdam, North-Holland, 1970, p 18 3. ARNON H, SALZBERGER M, OLrrzKs AL: The appearance of antibacterial and antitoxic antibodies in maternal sera, umbilical cord blood and milk: observations on the specificity of antibacterial antibodies in human sera. Pediatrics 23: 86, 1959
4. WINBERG J, WESSNF.R G: Does breast milk protect against septicaemia in the newborn? Lancet 1: 1091, 1971 5. WINTER ST: The age factor in acute diarrhoea during childhood. Clin Pediatr 13: 17, 1974 6. Ross CAC, DAwas EA: Resistance of the breast-fed infant to gastroenteritis. Lancet 1:
Breast and artificial feeding. JAMA 103: 735, 1934 11. WOODBURY RM: The relation between breast and artificial feeding and infant mortality. Am I Hyg 2: 668, 1922 12. GERRARD JW, MACKENZIE 3W, GOLUBOFF N,
13. 14. 15. 16. 17.
994, 1954 7. SMITH LDS, HOLDEMAN LV: The pathogenic
18.
Thomas, 1968 8. Svlstsscy-GRoss 5: Pathogenic strains of colt (0.111) among prematures and the use of human milk in controlling the outbreak of
19.
anaerobic
bacteria.
Springfield,
IL,
CC
diarrhea. Ann Pediatr 190: 109, 1958 9. TAssovArz B, KoTascif A: Le lait de femme et son action de protection contre les infections intestinales chez le nouveau-ne. Ann Pediat (Paris) 38: 286, 1961 10. GRULEE CG,
SANFORD
HN,
HERRON PH:
20.
et al: Cow's milk allergy: prevalence and manifestations in an unselected series of newborns. Acia Paediatr Scand ESuppl] 234: 1, 1973 SCHAEFER 0: Otitis media and bottle feeding. Can I Public Health 62: 478, 1971 CAMPBELL B, SARWAR M, PETERsEN WE: Diathelic immunization - a maternal-offspring relationship involving milk antibodies. Science 125: 932, 1957 MOHR JA, LEU R, MAaRY W: Colostral leukocytes. I Surg Oncol 2: 163, 1970 MOHR JA: The possible induction and/or acquisition of cellular hypersensitivity associated with ingestion of colostrum. I Pedlair 82: 1062, 1973 BARLOW B, SANTULLI TV, Hanm WC, et al: An experimental study of acute neonalal enterocolitis - the importance of breast milk. I Pedlair Surg 9: 587, 1974 PARIsH WE, BAmrr AM, CooMas RRA, et al: Hypersensitivity to milk and sudden death in infancy. Lancet 2: 1106, 1960 ROBAcK SA, FOKER 3, FRANrZ IF, et al: Necrotizing enterocolitis. Arch Surg 109: 314, 1974 Ram WD, SHANNON MP: Necrotizing enterocolitis - a medical approach to treatment. Can Med Assoc 1 108: 573, 1973
21. GERRARD 3W, Luaos MC, HARDY LW, et al:
Milk allergy: clinical picture and familial incidence. Can Med Assoc .! 97: 780, 1967
Human growth hormone In the past, physicians gave little encouragement to children, and their families, who were faced with the problem of short stature. This failure to help was the result of three factors: (a) most of these patients were in relatively good health, aside from their lack of growth; (b) there was little available in the way of therapeutic agents; and (c) the severity of the psychologic and physical handicaps to the patient and the parents was not appreciated. The report by Guyda and associates in this issue of the Journal (page 1301) emphasizes that it is possible to increase the rate of linear growth in those children whose growth retardation is due to a deficiency of human growth hormone (hGH). The results of their study, conducted over a long period, confirm and extend previous findings of others. it is rewarding to see continuing progress in this difficult problem. But we are far from a complete solution. Some points seem to be clear at this time. The administration of hGH, either alone or in combination with anabolic steroids, increases the rate of linear growth in most children with
hGH deficiency. Whether such treatment will increase the height ultimately achieved by adulthood is not known. However, it does hasten the attainment of a satisfactory height, and this is of great psychologic benefit. There are disadvantages with this treatment. Extensive diagnostic studies are necessary to establish that the growth retardation in the patient is in fact caused by a deficiency of hGH. The treatment requires prolonged periods of medical supervision and frequent injections. Unfortunately, the supply of hGH is limited, so not all suitable candidates can be offered this treatment. Also, part of this limited supply must be reserved for further investigations; there is much yet to be learned about the role of hGH in the economy of the body. Although the problem of the shortstature child has not yet been solved completely, the results of studies we have to date are valuable for two reasons: in regard to medical practice, it is to be hoped that these findings will lead to more careful evaluation of these children by the attending physicians; in regard to the future, the success achieved thus far should stimulate addi-
1282 OMA JOURNAL/JUNE 7, 1975/VOL. 112
tional investigations of the many factors (some known and probably others unknown) that control growth. A.B. HAYLES, MD
Department of pediatrics Mayo Clinic Rochester, Minnesota
Erratum In the article "Mitral stenosis with posterior diastolic movement of posterior leaflet" by Berman and associates (Can Med Assoc J 112: 976, 1975) the footnote on page 976 should read: "*EF slope is the standard designation for the slope of the line joining the point of peak anterior motion (E) with the point of maximum early diastolic posterior motion (F) on the echocardiogram.3'12" Since this paper was published it has come to our attention that in the March 1975 issue of Circulation (page 511) Levison and colleagues have reported a similar finding in 16 of 167 patients with mitral stenosis.
