Ethical aspects of AIDS in childhood in England.

Among the special moral concerns applicable to the management of HIV infection in childhood are those relating to consent, confidentiality and the child's rights to medical care and to opportunities for normal development. There may be conflicts of interest between the parents and the child both in connection with natural parents (mother-infant transmission) or with legal guardians, particularly when parental rights have been transferred to state agencies. Although the number of children with HIV infection or suffering from AIDS and its related conditions is small, there is a need for more understanding and for more comprehensive guidance about the ethical problems arising in this group of victims.

Saliva aldosterone concentration in healthy infants.

Aldosterone and glucocorticoid (cortisol + cortisone) concentrations were measured in 106 saliva samples from healthy infants. Most aldosterone values fell within the adult range (0-0.15 nmol/l (0-5.4 micrograms/100 ml)), but 10 were greater than 0.2 nmol/l (7.2 micrograms/100 ml). Aldosterone concentration was not related to sex, ethnic origin, time of collection, distress, or cortisol concentration but decreased with age.

Study of special-care baby services in North-west Thames region.

During three months in 1975 admissions to 17 of the 21 special-care baby units in the North-west Thames region were analysed by birth weight and category of care. Of the 1,718 babies admitted, one-third needed only observation. Neonatal intensive care formed only a small proportion of the work load in most units. Considerable variation in the pattern of admissions was found. There was some evidence of concentration, about 100 babies being transferred for urgent medical or surgical reasons, and the work load of one unit suggested that it was serving as a referral centre. It is concluded that the quality of care given to some infants needing intensive care might be improved by greater concentration, and that some units should review their admission policies in order to prevent unnecessary postpartum separation of mother and baby.

Arrangements for special and intensive care of the newborn.

All the special care baby units in three Thames health regions completed a one-day census on the number of infants in the unit, staffing, and facilities. The results were assessed in the light of the recommendations of an expert group set up by the Department of Health and Social Security. Although the provision of cots (6.1-6.9 per 1000 live births) was more generous than the estimated need and the occupancy rate (59--63%) lower than suggested, some units did not have adequate trained nursing cover at night, some did not have resident paediatricians, and some lacked essential equipment. Some small units, on the other hand, had very expensive equipment that was probably underused. Relating this provision to the regional statistics on babies needing special care showed that there was room for the rationalisation of facilities for their care. Factors that should be considered in planning such care include the size of the child-bearing population, the percentage of infants of low birth weights, and the proximity of specialist paediatric and maternity units and pathology facilities. It is also essential to monitor the effectiveness of the care by assessing the outcome in babies admitted to special units, especially those of low birth weight.

Vitamin D and human lactation.

Circulating serum-25-hydroxyvitamin-D concentration was measured in recently delivered mothers who were breast-feeding and in those who were not. 4-6 weeks' lactation produced no significant change. Basal and 4-6-week values in the breast-feeding group were significantly higher than in those who were not breast-feeding. There was no evidence that lactation was an indication for supplementary vitamin D.

Speculations on the relevance of developmental psychology to paediatrics.

Many paediatricians are now interested in applying the concepts, theories and methods of developmental psychology to clinical practice. The new understanding so obtained should enable abnormalities of clinical importance to be detected earlier; it should also provide means for evaluating the outcome of some disease processes and medical procedures more fully than was hitherto possible. The genesis of the nurturing failure or deficiency which underlies many paediatric problems becomes explicable as the nature of the maternal bond is unravelled. New ways may thus be opened for the more effective prevention and treatment of child abuse, neglect and deprivation. Developmental psychology also promises to provide for the first time a framework on which child-rearing methods which will positively promote healthy psychological development can be based. However, some caution and critical interpretation, as well as much collaborative investigation, will be needed before the full relevance of developmental psychology to paediatrics is established with certainty.