Following centralisation of paediatric intensive care, paediatric high dependency units (PHDUs) have been set up in some district general hospitals (DGHs) across the UK as recommended by the Department of Health.1 2 While children with a variety of acute illnesses are managed in PHDUs, their impact on health outcomes such as quality and cost of care remains unknown.2 3 Based on our experience, PHDUs may improve the care of children with an underlying diagnosis of epilepsy who present with seizures. Some of these children require a period of ventilation for airway management, support of …

Infantile hypertrophic pyloric stenosis (IHPS) is the most common inherited form of gastrointestinal obstruction in infancy. The disease is considered a paradigm for the sex-modified model of multifactorial inheritance and affects males four times more frequently than females. However, extended pedigrees consistent with autosomal dominant inheritance have been documented. We have analysed data from an extended IHPS family including eight affected individuals (five males and three females) and mapped the disease locus to chromosome 16q24 (LOD score=3.7) through an SNP-based genome wide scan. Fourteen additional multiplex pedigrees did not show evidence of linkage to this region, indicating locus heterogeneity.

Editor—Dr Nicholl raises some pertinent points in his letter1 regarding our paper.2 The nub of the matter is whether asymptomatic vesico-ureteric reflux (VUR), detected as a result of antenatal ultrasound findings is clinically important or not. The answer to this question is not yet known and will require a trial that looks at what, if any, difference treatment makes to outcome, as judged by the development of renal scars. Until this …

AIMS:To ascertain the outcome associated with antenatal renal pelvis dilatation; to recommend guidelines for postnatal investigation and determine an upper limit of normal for the anterioposterior dimensions of the fetal renal pelvis.METHODS:Infants whose antenatal ultrasound scan showed a fetal renal pelvis of 5 mm or greater were investigated using postnatal renal tract ultrasound and a micturating cystogram. Isotope studies were also performed, where appropriate.RESULTS:Vesicoureteric reflux (VUR), the most common diagnosis, was evident in 23/104 (22%). In 14 infants with VUR the postnatal ultrasound scan was normal. There was no evidence of renal scarring or dysplasia in any of the refluxing kidneys. Other diagnoses were pelviureteric junction obstruction, renal dysplasia, and idiopathic dilatation. Antenatal counselling and parental information facilitated postnatal assessment.CONCLUSIONS:Infants with antenatal renal pelvis measurements of 5 mm or greater should be investigated postnatally, as a significant percentage will have VUR. A normal postnatal ultrasound scan does not preclude the presence of VUR.

Editor—We were interested to see the article by Kallman et al ,1 who have elegantly demonstrated the role that defective polymorphonuclear leucocyte (PMNL) function and reduced opsonic capacity have, in sepsis caused by group …