Features of transient hypogammaglobulinaemia in infants screened for immunological abnormalities

The incidence of transient hypogammaglobulinaemia of infancy (THI) detected in a major paediatric centre over a 10 year period was examined. A total of 2468 subjects less than 2 years of age had an IgG measurement taken between July 1979 and March 1990. Subjects with known immunodeficiencies were excluded. Fifteen patients were classified as having THI with an initial IgG level less than the fifth centile followed by a second measurement within the normal range. A further 24 patients were identified as having possible THI with a single low IgG concentration. There were 60,174 live births each year in Victoria in the years 1979-88. This gives an incidence of proved THI of 23 per 10(6) births, and including proved and probable THI an incidence of 61 per 10(6) live births. Of those patients with proved THI 12/15 had symptoms of either atopic disease or food allergy/intolerance and three had gastrointestinal symptoms without any evidence of atopic disease. At presentation 12/15 (80%) were IgA deficient and 9/15 had IgM concentrations less than the 20th centile for age. It is suggested that in view of the preponderance of atopic and food intolerant patients that subclinical protein loss from the bowel due to allergic inflammation may be a contributing factor to the development of THI in some patients.     

Lithium, pregnancy and breast feeding

Due to its teratogenic potential and its passage in the maternal milk, the administration of lithium during pregnancy and post-partum, if breast-feeding is contemplated, raises specific issues. The kinetics of lithium during pregnancy is reviewed, as well as its influence on the foetus during this period and during breast-feeding. Its teratogenicity affects particularly the cardiovascular system, the Ebstein's anomaly being the most typical and frequent malformation. As a general rule, the administration of lithium should be avoided during pregnancy, at least during the first trimester. However, pregnancy and breast-feeding do not represent an absolute contraindication for the continuation of lithium therapy if it is deemed necessary, in spite of the risks that can be incurred and of which the patient should be informed.