Retrospective evaluation of a pilot eHealth/mHealth telewellness program for people with disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR)

BACKGROUND

People with disabilities have few options to participate in wellness programs that are tailored to their health, functional level, specific interests/needs, and available in the comfort of their home. To address this need, we evaluated a mobile health wellness program for people with physical disabilities.

METHODS

Retrospective pilot evaluation of MENTOR (Mindfulness, Exercise, and Nutrition To Optimize Resilience), an 8-week, 40-hour online telewellness program adapted from the peer reviewed literature on wellness. The three core wellness domains-mindfulness, exercise, and nutrition-were delivered via Zoom to groups of participants with a disability. Each group met weekly with an assigned health coach who responded to Q&A about the program and presented new material on several additional wellness domains that could impact their health (e.g., relationships, contribution to society/community, spending outdoor time in nature). Pre/post measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the UAB/Lakeshore Wellness Assessment (LWA). Participants were also interviewed and provided feedback after the program, which was thematically analyzed.

RESULTS

A total of 154 people from 15 states enrolled in the MENTOR program and 135 completed it (87.7% completers). Data were analyzed from a subset of participants (n=53) who were asked to complete a pre/post assessment and had complete data. Participants who were physically inactive at baseline improved their GLTEQ total activity (P=0.002; effect size =0.56) and moderate-to-vigorous activity scores (P=0.005; effect size =0.53). LWA results demonstrated that participants increased their exercise behavior (P=0.006; effect sizes =0.39) and contribution to society/community (P=0.013; effect size =0.37). Participants with low overall wellness (mental, physical & emotional health) at baseline had statistically significant improvements in exercise, nutrition, sleep, core values, self-care, hobbies, contribution to society/community, relationships, and overall wellness (all P<0.05 with effect sizes ranging from 0.43 to 1.07). Resultant qualitative themes were: (I) lifestyle transformation occurred through new positive experiences, physical and mental health benefits, and adoption of healthy behaviors; and (II) engagement through accessible online bonding through enjoyable and professional experiences.

CONCLUSIONS

A pilot telewellness program for people with disabilities is feasible and potentially effective in improving several domains of wellness. There is a need for precision-based mobile health (mHealth) programs that are tailored for people with disabilities and that can be accessed from various portable devices including their phone and/or tablet.

Inflammatory cytokines in juvenile idiopathic arthritis: effects on physical growth and the insulin-like-growth factor axis

OBJECTIVE

To investigate the relationship between markers of inflammation with physical growth and systemic markers of GH secretion in JIA.

DESIGN

This is a cross sectional prospective study of patients with JIA recruited during therapeutic arthrocentesis of 17 children with JIA (F,10): 8 oligoarticular (OJIA) and 9 polyarticular (PJIA).

RESULTS

Median adjusted height (AHt) SDS was -0.3 (-2.2 to 1.6). Serum ALS SDS (median -1.3, range -2.7 to -0.6) was reduced compared with serum IGFBP-3 SDS (median -0.5, range -7.7 to 2.3) and IGF-1 SDS (median -0.2, range -0.5 to 0.5). Log serum IL5 (95% CI -3.25, -0.81) and log serum IL15 (95% CI -9.58, -4.10) were independent factors associated with AHt SDS. Inflammatory cytokines individually showed no association with IGF-1, IGFBP-1, -2, -3 and ALS.

CONCLUSION

Children with JIA and mild degree of growth retardation show decreased ALS and IGFBP-3. Cytokines did not show an association to systemic markers of GH secretion. However, this study reports the novel, preliminary association between serum levels of IL5 and IL15 and the extent of short stature.

Stage I twin-twin transfusion syndrome: rates of progression and regression in relation to outcome

OBJECTIVES

Twin-twin transfusion syndrome (TTTS) results in high rates of perinatal mortality and neurological morbidity. Fetoscopic laser ablation of placental anastomoses is now established as the treatment of choice for advanced disease. However, there remains controversy about its use in early-stage TTTS, in which laser-related fetal losses need to be balanced against relatively favorable outcomes with more conservative approaches. We investigated rates of progression and regression in Stage I TTTS and determined factors influencing the course of the disease.

METHODS

We undertook a retrospective observational study of all TTTS cases referred to our tertiary referral fetal medicine service from 2000 to 2006. In patients presenting with Stage I TTTS, the following variables were evaluated for their ability to predict the course and progression of the disease: gestational age (GA) at presentation, amniotic fluid index, recipient and donor deepest vertical pool, presence of artery-artery anastomoses, small-sized bladder compared to normal donor bladder and fetal size discordance. Study end-points were disease regression or progression, and neonatal survival at 28 days.

RESULTS

Among 132 consecutive cases of TTTS, 46 women presented with Stage I disease. In the majority (69.6%), disease remained stable (28.3%) or regressed (41.3%). Of cases that progressed, 79% did so within 2 weeks and 93% progressed to at least Stage III. No factor was significantly linked with progression or regression, although there was a trend towards the absence of an artery-artery anastomosis (P = 0.10) and the presence of a small rather than normal donor bladder (P = 0.10) influencing progression, and later GA at presentation (P = 0.07) influencing regression. At least one infant survived in 83% of cases and there was double survival in 59%. Perinatal outcome was significantly better in cases that regressed (the rates of at least one survivor and double survival being 89% and 89%, respectively) or remained Stage I (77% and 61%, respectively), compared with those cases that progressed (79% and 14%, respectively). Treatment with amnioreduction at first presentation did not influence progression or regression.

CONCLUSIONS

This study demonstrates that a high percentage of Stage I TTTS cases regress or remain early stage. Identification of factors predicting progression would facilitate the selection of patients for definitive therapy, while avoiding treatment-related morbidities in mild or transient disease.

Cytokine profiling and in vitro studies of murine bone growth using biological fluids from children with juvenile idiopathic arthritis

OBJECTIVE

Growth retardation in children with chronic inflammatory disease may be partly due to direct effects of pro-inflammatory cytokines on the growth plate and requires further investigation.

DESIGN

This study assessed the cytokine concentrations in serum and synovial fluid (SF) in juvenile idiopathic arthritis (JIA), and determined the effect of the biological fluid on cultured murine metatarsal growth.

PATIENTS

Serum and SF were obtained from four children attending for arthrocentesis (child A, systemic; children B, C and D, oligoarticular). In addition, serum samples were obtained from four more children (children E and F, polyarticular; child G, oligoarticular).

MEASUREMENTS

Anthropometry, cytokine levels and longitudinal bone growth were assessed.

RESULTS

Cytokines were elevated to a variable extent in the samples. Although all serum samples were associated with reduced metatarsal growth, only SF from child A and child B reduced metatarsal growth. Metatarsals treated with child A's SF showed reduced proliferation, reduced proliferative and mineralizing zone width, and increased hypertrophic zone width. Tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-6 concentrations were elevated in child A's SF. However, SF exposure with neutralizing antibodies to these cytokines or IGF-1 did not improve metatarsal growth.

CONCLUSION

SF and serum JIA samples can impair bone growth at the growth plate. In synovial fluid, the effect is variable but resistant to treatment with IL-1beta, IL-6 and TNF-alpha specific antibodies and IGF-1, suggesting that other factors in this biological fluid may also have an effect on longitudinal growth through IGF-1-independent mechanisms.

A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome

BACKGROUND

The incidence of neonatal abstinence syndrome (NAS) has increased 10-fold over the last decade in Glasgow. In the Princess Royal Maternity Hospital, it now accounts for 17% of special care baby unit (SCBU) admissions.

OBJECTIVE

To compare opiate replacement therapy (morphine sulphate) with the present standard treatment (phenobarbitone) for management of NAS. The primary study end point was duration of pharmaceutical treatment. Secondary end points were the requirement for additional drugs and the requirement for SCBU admission.

DESIGN

Double blind, randomised controlled clinical trial.

METHODS

Differential diagnoses were excluded, and two consecutive Lipsitz scores > 4 defined NAS requiring treatment. Infants were randomised to receive morphine sulphate or phenobarbitone. Treatments were identical in appearance, odour, and volume. Increments, decrements, and discontinuation of treatments were protocol driven.

RESULTS

Seventy five infants participated. All mothers received opiate replacement therapy (methadone) during pregnancy and most used other drugs (n = 62, 83%). No significant difference in maternal drug use patterns was observed between treatment groups. Median treatment duration was four days shorter with opiate replacement (8 v 12 days, Mann-Whitney U test, p = 0.02). Phenobarbitone treated infants tended to require second line treatment (47% v 35%, chi(2) test, p = 0.11) and SCBU admission (62% v 30%, chi(2) test, p = 0.04) more often.

CONCLUSIONS

Opiate replacement therapy appears to be superior for management of symptomatic NAS when maternal opiate use is prevalent. The shorter treatment duration and lower requirement for higher intensity nursing may have significant cost implications. Tailoring NAS treatment to local maternal drug use may result in similar benefits.

Neonatal abstinence syndrome at Glasgow Royal maternity hospital

OBJECTIVE

To get a clearer idea of the magnitude of the problem of Neonatal Abstinence Syndrome and, in particular, the number of cases and the severity and length of any withdrawal symptoms.

DESIGN

Retrospective review of casenotes.

SETTING

GRMH, Rottenrow Neonatal Unit Jan 1994-Aug. 1996.

SUBJECTS

Infants admitted to the Neonatal Unit with the label "Infant of a Drug Abusing Mother" and their mothers.

RESULTS

Sixty-four infants qualified for the audit i.e. on average two children per month. Most mothers had a polydrug habit taking both opiates and benzodiazepines. Thirty per cent of infants were premature and, as a group they were lighter and had a smaller OFC than the national average. Fifty-three infants suffered NEONATAL ABSTINENCE SYNDROME, 50 of these being "jittery, restless or irritable". Only four had convulsions. Most infants' withdrawal presented within 72 hours (median 24 hours) and lasted for less than six days. Infants exposed to methadone had symptoms for longer but required less treatment than infants exposed to heroin. Forty infants needed treatment with phenobarbitone for a median of four days. Only six infants needed other drugs. Median age of discharge was 11 days and 49 out of 53 went home with their mothers.

CONCLUSIONS

The Glaswegian polydrug pattern would make morphine/methadone unsuitable treatment. If these infants are not showing signs of withdrawal at 72 hours it is, in our opinion, reasonable to discharge them. Infants should not be discharged with outstanding problems, as follow-up is usually unsuccessful.

New bicyclam-AZT conjugates: design, synthesis, anti-HIV evaluation, and their interaction with CXCR-4 coreceptor

We report the synthesis of mono- and bis-tetraazamacrocycle-AZT conjugates. All new compounds were screened for their ability to inhibit HIV-1 replication in MT4 cell line and were compared to AZT alone. It appears that N-protected covalent prodrugs are equipotent to AZT as inhibitor of HIV replication, while N-deprotected analogues exhibit both higher activity and selectivity against HIV-infected cells. The most active antiviral compounds 27, 28, 34, and 35 were then tested for their binding capability to CXCR-4 receptor. N-Boc analogues 27 and 34 were only weakly effective; in contrast, N-deprotected conjugates 28 and 35 were antagonists to 12G5 mAb binding until 0.05 and 5 microg/mL, respectively. The stability of compound 28 in human plasma was evaluated, and half-life was found to be approximately 8 h in the described conditions. All these results seem to demonstrate the confidence of our prodrug approach, with analogue 28 emerging as the best candidate as lead compound in HIV-1 polytherapy perspective.

Role of Kaposi's sarcoma cells in recruitment of circulating leukocytes: implications in pathogenesis

OBJECTIVE

We sought to identify and characterize mechanisms of interaction between Kaposi's sarcoma cells and circulating leukocytes leading to leukocyte migration into the lesion.

STUDY DESIGN/METHODS

By using static and dynamic adhesion models, we measured the ability of late-stage KSY1 cells to support adhesion and transmigration of peripheral blood lymphocytes (PBL).

RESULTS

We showed that resting as well as TNF-alpha- or PMA-activated KSY1 cells supported adhesion and transmigration of PBL with a higher efficiency compared with normal endothelial cells. The LFA1/ICAM1 pathway was totally involved in PBL adhesion to resting or TNF-alpha-activated KSY1 cells and partially responsible for adhesion to PMA-activated KSY1 cells. No inhibition of adhesion was observed by blockage of the VLA4 pathway. Under flow conditions, PBL/KSY1 cell interaction was totally dependent on L-selectin.

CONCLUSION

Our data indicate that KS cells mimic an endothelium-like structure by regulating extravasation of lymphocytes into lesions.

Dominantly inherited cerebral dysplasia: arachnoid cyst associated with mild mental handicap in a mother and her son

We report a mother and son who each presented in infancy with hypotonia and global developmental delay. Subsequently, in both subjects, mild mental handicap was diagnosed in association with temporal lobe arachnoid cysts. Mendelian inheritance of this phenotype seems likely and macroscopic cerebral dysplasia in general may be underdiagnosed in people with familial, mild mental handicap.

Circulating cell adhesion molecules in HIV1-infected patients as indicator markers for AIDS progression

Cell adhesion molecules play an important role during immune responses. Circulating (c) forms of these molecules have been used as monitors of disease progression. In this study, we have investigated serum levels of ICAM1, ICAM2, ICAM3 and VCAM1 in HIV-infected patients. Our results showed that levels of cICAMs and cVCAM1 are increased during HIV infection. Among an HIV-infected population, the cICAM2 level was higher in the asymptomatic group compared to the AIDS group. In contrast, the cICAM1 level was higher in the AIDS group compared to the asymptomatic group. No difference between the two groups was observed in cICAM3 and cVCAM1 levels. A significant correlation was found between cICAM1, cICAM2 and cVCAM1 in both populations. We also showed that the cICAM1/cICAM2 ratio was correlated with the increase in the c beta 2 microglobulin level and the decrease in CD4 T-cell counts in the AIDS group. These results indicate that serum cCAM1 and cICAM2 in HIV infection could be additional markers to discriminate between asymptomatic and progressor patients.

An unusual hernia: congenital pericardial effusion associated with liver herniation into the pericardial sac

To our knowledge there have been only two previous cases of diaphragmatic hernia into the pericardium diagnosed antenatally. We describe our pre- and post-natal radiological findings in such a case, although the final diagnosis eluded us until after delivery.

Familial aplasia cutis congenita

Two siblings with extensive aplasia cutis congenita of the extremities are described. These lesions healed spontaneously and in the older sibling at four years follow-up there was minimal scar tissue at the affected sites.

Phenotypic characterization of CD4+ T cells that exhibit a transendothelial migratory capacity

The phenotype of CD4+ T cells capable of transendothelial migration was determined using an in vitro model system, in which cells migrate through a monolayer of endothelial cells (EC) on collagen gels. A specific subset of resting CD4+ memory T cells was found to migrate. T cells within this subset can be defined by the bright expression of CD11a, CD26, CD44, and CD49d. Additionally, the migratory CD4+ T cell population is largely CD58bright, CD31-, CD62L-, and is also enriched in cells that brightly express CD49c, CD49e, and CD49f. Only a minority of the cells are activated, as indicated by expression of CD69. The EC were found to play a central role in facilitating migration of this subset because selective enrichment of CD11abright, CD26bright, CD44bright, CD4+ T cells was not observed when cells migrated in the absence of EC. Activation of the T cells induced a modest degree of migration of an additional subset of CD45RA+, CD31+ naive T cells. In contrast, TNF-alpha activation of the EC increased the transendothelial migration of an additional subset of activated memory T cells that expressed CD69 and CD62L. Neither activation of the T cells, stimulation of the EC, nor the presence of macrophage inflammatory protein-1 alpha (MIP-1 alpha) or RANTES, however, altered the phenotype of the majority of the migratory CD4+ T cell population, which is characteristic of a particular stage of memory cell differentiation. These results suggest that CD4+ T cells acquire the capacity for transendothelial migration at a specific phase of maturation that is only minimally altered by the activation of either the T cell or the EC, or by the presence of specific chemokines in the subendothelial matrix.

Phenotypic characterization of CD4+ T cells that exhibit a transendothelial migratory capacity

The phenotype of CD4+ T cells capable of transendothelial migration was determined using an in vitro model system, in which cells migrate through a monolayer of endothelial cells (EC) on collagen gels. A specific subset of resting CD4+ memory T cells was found to migrate. T cells within this subset can be defined by the bright expression of CD11a, CD26, CD44, and CD49d. Additionally, the migratory CD4+ T cell population is largely CD58bright, CD31-, CD62L-, and is also enriched in cells that brightly express CD49c, CD49e, and CD49f. Only a minority of the cells are activated, as indicated by expression of CD69. The EC were found to play a central role in facilitating migration of this subset because selective enrichment of CD11abright, CD26bright, CD44bright, CD4+ T cells was not observed when cells migrated in the absence of EC. Activation of the T cells induced a modest degree of migration of an additional subset of CD45RA+, CD31+ naive T cells. In contrast, TNF-alpha activation of the EC increased the transendothelial migration of an additional subset of activated memory T cells that expressed CD69 and CD62L. Neither activation of the T cells, stimulation of the EC, nor the presence of macrophage inflammatory protein-1 alpha (MIP-1 alpha) or RANTES, however, altered the phenotype of the majority of the migratory CD4+ T cell population, which is characteristic of a particular stage of memory cell differentiation. These results suggest that CD4+ T cells acquire the capacity for transendothelial migration at a specific phase of maturation that is only minimally altered by the activation of either the T cell or the EC, or by the presence of specific chemokines in the subendothelial matrix.

Randomised trial of continuous nasogastric, bolus nasogastric, and transpyloric feeding in infants of birth weight under 1400 g

Forty three infants under 1400 g were fed by a bolus nasogastric, continuous nasogastric, or transpyloric route. There were more complications with transpyloric feeding and no identifiable benefits in the growth rate, oral energy input, or chosen biochemical indices of nutrition. Bolus or continuous nasogastric feeds rather than transpyloric are better routine methods in infants of low birth weight.

Neonatal listeriosis in Scotland

Thirty-one cases of neonatal listeriosis occurred in Scotland between 1 January 1987 and 31 August 1989. In each of these, Listeria monocytogenes was cultured from blood, cerebrospinal fluid or both. No case of neonatal listeriosis occurred between 1 September 1989 and 31 July 1990, a statistically significant difference in incidence (p less than 0.001). A possible explanation may be that pregnant women adjusted their diet in accordance with the advice given by the Chief Medical Officer in his letter to General Practitioners of February 1989 entitled 'Food and Listeriosis'. Full clinical features and outcome of nineteen of the thirty-one cases were obtained from the paediatricians responsible for their care. Of these, sixteen were early onset and three late onset cases. There were eight deaths, all early onset cases. Two severely asphyxiated infants could not be resuscitated and of the five infants who required assisted ventilation from birth, four died. Four early onset and three late onset cases presented with pyogenic meningitis and all seven recovered without sequelae. It is concluded that when neonatal listeriosis presents as an asphyxiated infant who, after resuscitation, requires assisted ventilation, a fatal outcome is probable. When neonatal listeriosis presents as pyogenic meningitis, recovery without sequelae is the usual outcome.

Normal growth and development in a child with Baller-Gerold syndrome (craniosynostosis and radial aplasia)

The cardinal features of the Baller-Gerold syndrome (MIM *21860) are craniosynostosis and radial aplasia. Only 12 cases have been published and these are roughly divisible into two groups: cases without any additional abnormalities and cases with a broad range of additional features. We describe a boy with craniosynostosis and radial aplasia alone and highlight genetic counselling difficulties presented by a sporadic case of this rare syndrome.

Visceral leishmaniasis in a Scottish child

A Scottish girl acquired visceral leishmaniasis (kala-azar) while on holiday in Majorca. She presented with the infection, six months later, in Scotland. Because of inexperience with the disease and a degree of scepticism unnecessary investigations were carried out resulting in a delay in treatment.

Comparison of maximum aerobic power, maximum anaerobic power, and skinfold thickness of elite and nonelite junior wrestlers

The purpose of this investigation was to identify physiologic differences between elite high school-age wrestlers and nonelite wrestlers of comparable age, weight, and training experience. Two groups of junior wrestler, elite (n = 18) and nonelite (n = 18) were measured for maximum aerobic power (treadmill run), maximum anaerobic power of the arms and legs (Wingate test), and skinfold thickness. On the average (+/- SE) elite juniors had a VO2max of 52.6 +/- 2.0 ml/kg.min-1, 376 +/- 20 W for arm power, and 540 +/- 25 W for leg power. The nonelite group had a VO2max of 51.5 +/- 1.4 ml/kg.min-1 and 331 +/- 22 W and 467 +/- 29 W for arm and leg power, respectively. Ttests were computed to identify differences between the groups. The results revealed significant differences in four skinfold thicknesses, absolute anaerobic leg power, and relative anaerobic power of arms and legs. It was concluded that relative maximum anaerobic power is distinctly greater in elite high school wrestlers than less successful peers. In light of the results, it may be of benefit for wrestlers of lower caliber to decrease body fat, increase fat-free weight, and increase total body power through training.

Tuberculous meningitis in children: a review of 15 cases

Tuberculosis meningitis (TBM) is the most serious form of infection with Mycobacterium tuberculosis. Between 1968 and 1986 15 children (five boys and 10 girls) were seen at the Royal Hospital for Sick Children, Glasgow, because of TBM. Fourteen children were Caucasian and one was Asian. The mean age at presentation was two years. None had been given BCG vaccination. In 12 children close contact with other cases of tuberculosis was reported. The signs and symptoms which helped in the diagnosis are discussed together with the initial CSF findings, results of mantoux testing and chest X-rays. Three children had unusual modes of presentation. All children were treated with chemotherapy though the drug combinations, route of administration and therapy varied from case to case. Steroids were used in nine children. Five children required neurosurgical intervention. Two children died and of the survivors six had serious sequelae. Five children made a complete recovery. The outcome of TBM depended on the duration of symptoms prior to the onset of therapy, on the neurological status reached at the time of diagnosis and the age of the child. The roles of chemotherapy, steroids and neurosurgery in the management of TBM are discussed. The need for routine BCG vaccination of all neonates is examined.

Maternal narcotic abuse and the newborn

In 50 infants born to women who continued to take heroin during all or part of their pregnancy the drug withdrawal symptoms were mild and were noted in 21 infants (42%). Only nine infants required treatment. Sudden infant death syndrome occurred in two infants at 4 and 6 months.

Toxic shock syndrome (TSS) in children

Toxic shock syndrome is uncommon in the prepubertal age group. Two children presented with pyrexia, macular erythroderma, vomiting, hypotension and rapid deterioration of consciousness. One child had severe neurological involvement. The diagnosis of toxic shock syndrome was established in both cases by the exclusion of other causes and by culturing staphylococcus aureus. We postulate that the neurological manifestations were caused by a direct neurotoxic action of the staphylococcal-produced toxin. Both children made a complete recovery.

Ocular complications in juvenile chronic arthritis (JCA)

Fifty-six children with JCA have attended the Rheumatology Clinic at the Royal Hospital for Sick Children, Glasgow, over the past five years. Eleven have monoarthritis, 21 pauciarthritis and 24 polyarthritis. Seven children with pauciarthritis and one with monoarthritis developed ocular complications. Of these six were girls. In six children the arthritis preceded the uveitis. In one child arthritis and uveitis presented at the same time and in another the uveitis preceded the arthritis by one year. All were treated with steroids (7 topically, 1 systemically) and topical mydriatic agents. After an initial response the uveitis persisted as a low-grade inflammation gradually leading to secondary complications and increasing loss of vision. Only two patients enjoy normal vision at present. The importance of routine slit-lamp microscopy in all children with JCA is stressed, especially in those with pauciarthritis and antinuclear antibodies.

Feto-fetal transfusion syndrome

Out of 42 pairs of liveborn monochorial twins there were 32 pairs with vascular anastomoses. Of these, 11 pairs had feto-fetal transfusion syndrome. There were another 8 pairs of stillborn twin fetuses with vascular communications and in these chronic feto-fetal transfusion syndrome might have resulted in intrauterine death.

Isoimmune neonatal thrombocytopenic purpura

Ten cases of isoimmune neonatal thrombocytopenic purpura (4 pairs of siblings and 2 singletons) are described. The condition was diagnosed by excluding other causes of thrombocytopenia , and in 8 cases it was confirmed by detecting antiplatelet antibodies in the mother. Perhaps steroids should be given to affected infants as soon as the condition is diagnosed in order to stabilise the capillary membrane. Exchange transfusion, using platelet antigen-negative blood if available, helps to remove antibodies and should be followed by the infusion of antigen-negative platelets, easily obtained from the mother by platelet-phoresis. The use of random donor platelets (as in 3 of these cases) was ineffective because 98% of the population are platelet antigen-positive. Nine of the infants recovered completely. The exception was an infant who developed hydrocephalus, possibly as a result of intracranial haemorrhage.