[A multidisciplinary approach is necessary in the neonatal withdrawal syndrome]. / Multidisciplinaire benadering nodig bij neonataal abstinentiesyndroom.

Two baby boys, born of mothers that were abusing drugs, were restless and hypertonic, typical symptoms of the neonatal withdrawal syndrome. The symptoms disappeared during treatment with phenobarbital and methadone. The children were then placed in a foster home. Symptoms of the neonatal withdrawal syndrome are excitation of the central nervous system, the gastrointestinal tract and the respiratory tract. For both legal and medical reasons it is essential to test the urine of the neonate for drugs. The Finnegan score is a useful tool to decide whether medical treatment is indicated. Medical treatment consists of the administration of phenobarbital and or methadone. The Child Protection Agency of the Ministry of Justice is notified of the child's birth. If parents that are abusing drugs have been shown not to be able to look after their children, they are limited in their right to parenthood.

Final height and hormonal function after bone marrow transplantation in children.

AIM: To analyze final height and hormonal function in long-term survivors of bone marrow transplantation (BMT). PATIENTS: Group 1 consisted of 16 patients (10 boys) with a hematologic malignancy, mostly leukemia, conditioned for BMT with total body irradiation (TBI), 7.5 to 12 Gy, and cyclophosphamide. Group 2 consisted of 14 patients (9 boys) with severe aplastic anemia, conditioned with chemotherapy only. RESULTS: In group 1, patients achieved a reduced final height after BMT. The difference between the height standard deviation score (SDS) at BMT and the height SDS at final height was -1.96 (0.82) SDS in boys and -0.92 (0.71) SDS in girls (p = 0.0001, and p = 0.02 respectively). Final height was also lower than target height (boys, p = 0.01; girls, p = 0.03). Prepubertal growth in the first 3 years after BMT was normal but pubertal height gain was decreased. The patients in group 2 achieved normal height. Thyroid function and adrenal function were normal in all patients, and no growth hormone deficiency was detected. Serum follicle-stimulating hormone values after BMT were increased in all group 1 patients, with return to normal in two patients. Serum luteinizing hormone values were increased in all group 1 girls, with recovery in one girl. Normal serum luteinizing hormone values and spontaneous puberty were found in all group 1 boys. In group 2, disturbances in gonadotropins were seen only in three boys and two girls. CONCLUSION: In patients treated in childhood with BMT after chemotherapy and TBI with 7.5 Gy or more, final height is compromised because of blunted growth in puberty. Patients who had not received TBI suffered no height loss. In the majority of patients, the combination of chemotherapy and TBI also resulted in irreversible disturbances of gonadal function.