screening for neonatal hypoglycÆmia

1251

indicate, however, that different sera have not necessarilythe same properties, and that each of them should betested separately.

P. KINNAERTR. PENNEMANM. DIRKS.

Department of Surgery,Hôpital Brugmann,

Université Libre de Bruxelles.

ANTIBODY PRODUCTION IN RECIPIENTS OFALLOGRAFTS

JOSHUA MILLER.

Department of Experimental Surgery,Walter Reed Army Institute of Research,

Washington, D.C.

SIR,-I was interested to read the report by Mr. Rowleyand his colleagues (Oct. 4, p. 708) about the depression ofIgG production in human recipients of renal transplantstreated with azathioprine and prednisolone. My instinctis that they draw the right conclusions; but I feel I mustpoint out that immunosuppression may possibly have hadlittle to do with their findings since, in laboratory animals,homotransplantation itself reduces primary and secondaryantibody production.

In 1964, we observed that immune responsiveness couldbe depressed, in inbred mice, by a variety of gram-negativeorganisms and by transplantation immunity.1-3 It would,of course, be impossible to conduct an investigation ofantibody responses in human transplant recipients in theabsence of immunosuppression, since this is necessaryfor transplant survival. Nevertheless, the possibility thattransplantation immunity itself may be responsible for thedepression of antiflagellin-antibody responses should beborne in mind.

SCREENING FOR NEONATAL

HYPOGLYCÆMIA

YRJÖ PARTANENKIRSTI HEINONEN.

Department of Pædiatrics,Central Hospital,Mikkeli, Finland.

SIR,-In order to determine the incidence of neonatalhypoglycaemia in a general hospital, comprehensivescreening of all live-born infants was started in the CentralHospital of Mikkeli, Finland (which serves a rural areawith a population of approximately 121,000). 2000 livebirths were registered during the period Nov. 15, 1967to June 26, 1969. 1787 were normal healthy newborns,and 213 needed special supervision or care for a varietyof perinatal disturbances.

Screening with the ’ Dextrostix ’ test (Ames Co.) wasperformed by the nursing staff according to the manu-facturer’s instructions. Capillary blood was obtained byheel puncture. All infants in the nursery were tested atthe age of 2-3 hours and 6-8 hours, and infants weighingunder 3000 g. were tested twice again during the 2nd dayof life. All infants needing resuscitation were tested inthe delivery room, in conjunction with emergencymeasurements.

The reliability of the dextrostix test was estimated by261 simultaneous blood-glucose determinations with boththe ortho-toluidine method (done by the clinical

laboratory) and dextrostix (done by the nursing staff).Dextrostix values of 40 mg. per 100 ml. or higher werefound to indicate a safe true blood-glucose level in a

newborn infant, and only values of " under 40 mg. per100 ml." needed to be verified with the ortho-toluidinemethod. With the strip method there was a considerablenumber of false-positives but practically no false negatives.The tendency of dextrostix to underestimate the blood-glucose concentration was regarded as a favourable feature1. Miller, J., Martinez, C., Good, R. A. J. Immun. 1964, 93, 342.2. Miller, J., Martinez, C., Good, R. A. Ann. N.Y. Acad. Sci. 1964,

120, 270.3. Teriono, E. O., Miller, J., Glenn, W. W. L. Surgery, St. Louis,

1964, 56, 256.

in a screening technique, and there was evidently no needto lower the sensitivity limit.The clinical laboratory was relieved of much work by

the use of dextrostix. The screening of 1787 apparentlyhealthy newborns could be accomplished in this way, andconfirmation of the true blood-glucose value with laboratorymethods was only needed for 166 infants who had dex-trostix readings of "under 40 mg. per 100 ml." Thetest is simple and rapid, and there is minimal risk oftechnical error, even in unskilled hands. After instructionin the method the nursing staff quickly adopted thescreening test as part of their daily routine, and therewere no complaints of extra work.Among 1787 apparently healthy newborns 4 cases of

significant hypoglycaemia were found. Among 213 patientsin the neonatal-care unit there were 15 cases of neonatalhypoglycaemia. Because of the screening system, mostcases were detected at a very early age, and it was oftenpossible to detect an asymptomatic period of hypoglyceemiabefore the onset of neurological symptoms. In view ofthe high incidence of neurological complications followingneonatal hypoglycxmia, we believe that blood-glucosescreening should be done in all newborn children.

BUYING HOSPITAL FURNITURE

A. ST. J. DIXON.Royal National Hospital forRheumatic Diseases, Bath.

SIR,-Your annotation (Nov. 22, p. 1115) could not bemore timely. There is scarcely an article of ward furniturewhich does not have some therapeutic implication. Safety,ease of nursing, speeding up of convalescence-all need tobe thought out in terms of the patients who are to use thefurniture. This is especially true of ward chairs. Now thatalmost all inpatients are nursed in a chair in the daytimeabout twice as early as ten years ago, the design of thehospital chair is increasingly important. It merits as much

thought and research as has been given to hospital beds-possibly more. Our administrators, in their urge to keepcosts down by central purchasing, will miss the point unlessguided. They will, indirectly, put costs up. The greatrevolution in hospitals in the past ten years has been thedaytime nursing of patients in chairs; but what sort ofchairs are we given to get our patients into ? It is increas-

ingly necessary for these to be purpose-designed.This hospital, in conjunction with the Bath Institute of

Medical Engineering at St. Martin’s Hospital, is one of

many centres where increasing attention is being paid tohospital chairs. We have identified a number of differentchairs which are needed now to help with sedentary nursingand early ambulation. These include a rising-seat chairwhich gets patients safely and smoothly from a comfortablelow armchair position to the standing position, a hemiplegicchair, which prevents loss of balance and arm-stiffness inpatients who have had strokes, and a " first-up " chair ofsuperlative comfort which allows patients to be moved frombed to bedside chair and yet continue with intensive

nursing procedures such as intravenous drips, catheters, anddrainage tubes.A major difficulty has been to find manufacturers willing

to take the risk of mass production of such chairs in the faceof the National Health Service’s near monopoly of hospitalpurchasing and its rigid central-purchasing philosophy. Yeta purpose-made chair, costing perhaps S20 more than acontract-obtained variety of domestic chair, could pay foritself in a month or two if it got the patients out an averageof a day per head earlier. But as you say, it is time forclinicians to voice their opinions. They are the ones bestable to see the problem as a whole.