1595
2.4 pmoill, but chenodeoxycolic acid concentrations did not change (0-4 Jl11lolfl before and 03 Jl11lolfl after therapy). UDCA concentration in amniotic fluid was 01(imol/1 after a week of treatment. The patient did not show any adverse reaction. Fetal biometric indices, evaluated every week by ultrasonography, progressively increased but remained between the 5th and 10th percentile. Fetal wellbeing was monitored daily with cardiotocography. No signs of fetal distress were seen. Amniotic fluid quantity did not change. Treatment was maintained for 20 days. At fetal maturity (37 weeks), labour was induced and a 2670 g normal baby girl was delivered with Apgar scores of 9 and 10. We suggest that UDCA treatment has a role in improving biochemical results in late onset of intrahepatic cholestasis during pregnancy.
avoiding overheating and smoking had been offered. However, these figures indicate the need to treat with caution the argument that the dramatic reduction in deaths lately reported in countries such as New Zealand and Australia is largely attributable to a preceding public health intervention programme. Scottish Cot Death Trust, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK
ANGUS GIBSON HAZEL BROOKE JEAN KEELING
Respiratory syncytial virus in children’s hospitals
SIR,-Dr Stanton’s conclusion (Nov 2, p 1144) may not be justified. He shows that there was a significant reduction in sudden death in infancy (SIDS) during 1987-90 compared with the previous four years. He attributes this to parental awareness due to a "Keep Cool, Baby" campaign. However, deaths from other causes were also reduced during the same period. Had the campaign been specific in reducing SIDS deaths we would have expected deaths
SIR,-Dr Wilcox and colleagues (Oct 12, p 943) comment on the problems posed by annual epidemics of respiratory syncytial virus (RSV) infection, an experience all too familiar to paediatricians and virologists at the Children’s Hospital, Sydney. Every year more than 450 specimens-mainly nasopharyngeal aspirates, and principally from inpatients-are examined by immunofluorescence and culture. Epidemics of RSV infection occur in the colder months of every year, with very little viral activity in the first and last quarters of the year (figure). However, viral activity was in evidence during most months of 1981 and 1982.1 Epidemic peaks in the twelve years 1979-90 were in July (4), May (3), June (2), and April/May, July/August (1each), and alternation between early and later winter months, cited by Wilcox et al, was not seen. Epidemics also tended to vary in severity and scale. Alternation of major outbreaks with minor ones, as reported in Scandinavia, has not been our experienced Wilcox et al comment on the difficulties in planning for RSV epidemics because of variability in timing. The variability in peak incidence and severity that we have experienced means that we too are totally unable to predict likely epidemic patterns. Nor can we predict the proportion of infected children likely to need intensive care, which has ranged between5-7% (12/212)and 14-4% (15/104). This variation has been independent of the size of the epidemic, prompting speculation on the possible role of group A and group B
from other
RSV strains.3
Gastroenterology Unit, Istituto di Clinica Medica e Gastroenterologia, University of Bologna, 40138 Bologna, Italy, and Prenatal Pathophysiology Unit, Istituto di Clinica Ostetrica e Ginecologica, University of Bologna
GIUSEPPE MAZZELLA NICOLA RIZZO ANTONIO SALZETTA ROSSELLA IAMPIERI LUCIANO BOVICELLI ENRICO RODA
Storey GNB. Fetal outcome m obstetric cholestasis. Br J Obstet Gynaecol 1988; 95: 1137-43. 2. Shaw D, Frohlich J, Wittmann BAK, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. Am J Obstet Gynecol 1982; 15: 621-25. 3 Poupon R, Chretien YK, Poupon RE, Ballet F, Calmus Y, Darnis F. Is ursodeoxycholic acid an effective treatment for primary biliary cirrhosis? Lancet 1987; i: 834-36. 1. Fisk NM,
Overheating and cot death
causes to
be unaffected:
Stanton’s
pleasure in the significant reduction in post-neonatal mortality Scarborough compared with the rest of the Yorkshire region (=9-1, p
2.4 pmoill, but chenodeoxycolic acid concentrations did not change (0-4 Jl11lolfl before and 03 Jl11lolfl after therapy). UDCA concentration in amniotic fluid was 01(imol/1 after a week of treatment. The patient did not show any adverse reaction. Fetal biometric indices, evaluated every week by ultrasonography, progressively increased but remained between the 5th and 10th percentile. Fetal wellbeing was monitored daily with cardiotocography. No signs of fetal distress were seen. Amniotic fluid quantity did not change. Treatment was maintained for 20 days. At fetal maturity (37 weeks), labour was induced and a 2670 g normal baby girl was delivered with Apgar scores of 9 and 10. We suggest that UDCA treatment has a role in improving biochemical results in late onset of intrahepatic cholestasis during pregnancy.
avoiding overheating and smoking had been offered. However, these figures indicate the need to treat with caution the argument that the dramatic reduction in deaths lately reported in countries such as New Zealand and Australia is largely attributable to a preceding public health intervention programme. Scottish Cot Death Trust, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK
ANGUS GIBSON HAZEL BROOKE JEAN KEELING
Respiratory syncytial virus in children’s hospitals
SIR,-Dr Stanton’s conclusion (Nov 2, p 1144) may not be justified. He shows that there was a significant reduction in sudden death in infancy (SIDS) during 1987-90 compared with the previous four years. He attributes this to parental awareness due to a "Keep Cool, Baby" campaign. However, deaths from other causes were also reduced during the same period. Had the campaign been specific in reducing SIDS deaths we would have expected deaths
SIR,-Dr Wilcox and colleagues (Oct 12, p 943) comment on the problems posed by annual epidemics of respiratory syncytial virus (RSV) infection, an experience all too familiar to paediatricians and virologists at the Children’s Hospital, Sydney. Every year more than 450 specimens-mainly nasopharyngeal aspirates, and principally from inpatients-are examined by immunofluorescence and culture. Epidemics of RSV infection occur in the colder months of every year, with very little viral activity in the first and last quarters of the year (figure). However, viral activity was in evidence during most months of 1981 and 1982.1 Epidemic peaks in the twelve years 1979-90 were in July (4), May (3), June (2), and April/May, July/August (1each), and alternation between early and later winter months, cited by Wilcox et al, was not seen. Epidemics also tended to vary in severity and scale. Alternation of major outbreaks with minor ones, as reported in Scandinavia, has not been our experienced Wilcox et al comment on the difficulties in planning for RSV epidemics because of variability in timing. The variability in peak incidence and severity that we have experienced means that we too are totally unable to predict likely epidemic patterns. Nor can we predict the proportion of infected children likely to need intensive care, which has ranged between5-7% (12/212)and 14-4% (15/104). This variation has been independent of the size of the epidemic, prompting speculation on the possible role of group A and group B
from other
RSV strains.3
Gastroenterology Unit, Istituto di Clinica Medica e Gastroenterologia, University of Bologna, 40138 Bologna, Italy, and Prenatal Pathophysiology Unit, Istituto di Clinica Ostetrica e Ginecologica, University of Bologna
GIUSEPPE MAZZELLA NICOLA RIZZO ANTONIO SALZETTA ROSSELLA IAMPIERI LUCIANO BOVICELLI ENRICO RODA
Storey GNB. Fetal outcome m obstetric cholestasis. Br J Obstet Gynaecol 1988; 95: 1137-43. 2. Shaw D, Frohlich J, Wittmann BAK, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. Am J Obstet Gynecol 1982; 15: 621-25. 3 Poupon R, Chretien YK, Poupon RE, Ballet F, Calmus Y, Darnis F. Is ursodeoxycholic acid an effective treatment for primary biliary cirrhosis? Lancet 1987; i: 834-36. 1. Fisk NM,
Overheating and cot death
causes to
be unaffected:
Stanton’s
pleasure in the significant reduction in post-neonatal mortality Scarborough compared with the rest of the Yorkshire region (=9-1, p
