98 Discussion 



tends to delay the development of serious dehydration during the neo- 

 natal period. This process coupled with other attributes might enable 

 some newborn infants to survive total thirsting as long as an adult. 



Heller: I seem to remember that what Gans and Thompson showed 

 was that there was a decrease of body water in the infant which was corre- 

 lated with the excretion of maternal oestrogens, but this does not 

 establish a causal relationship. 



Swyer : I think the point they were trying to make was that there was 

 this parallel fall in oestrogen and in body water with no change in adrenal 

 steroid output. They put two and two together and thought one was due 

 to the other. 



Wallace: Dr. Swyer, what about the situation of a diabetic woman and 

 her baby? In a great number of instances there is a very intense water 

 retention. 



Swyer : I can counter that by saying what about the baby of a pre- 

 diabetic mother? It shows just the same changes before the mother has 

 diabetes. I do not think we know why the prediabetic mother has a 

 large baby — there have been suggestions that it is due to excess growth 

 hormone secretion by the mother, but there is no very convincing 

 evidence. 



Wallace : This kind of baby generally seems to have a great deal of 

 water in him — more water than in equivalent weight normal babies. 



Swyer : That is very true. The baby is large but it is not postmature — 

 indeed, it behaves more like a premature. 



Wallace: Is that an oestrogen effect? 



Swyer : I do not think we know. 



Wallace: Very often during these discussions the words "inefficient" 

 and "immature" have been used to describe the newborn infant. Mr. 

 Peter Rickham in his book, "The Metabolic Response to Neonatal 

 Surgery" (1957. Harvard University Press), develops the point of view 

 that the newborn infant is tolerant of adverse experiences such as 

 fasting, thirsting and surgical trauma. Despite the fact that the new- 

 born has an extra load of water in his body and a low metabolic rate he 

 does seem to have a certain toughness that at a later date is not so 

 evident. "Immaturity" and "inefficiency" may not be synonymous. 



Bull: I should like to support that observation. We see enough burnt 

 children and adults to be able to assess their comparative mortality in 

 given degrees of burning. Although it is widely stated that children react 

 badly to burning — and burning largely involves the problems of fluid 

 and salt management that we are talking about today — we failed to 

 find any evidence that the small children react any worse than their 

 elder brothers and sisters (Bull, J. P. and Fisher, A. J. (1954). Ann. Surg., 

 139, 269), The prognosis falls steadily from about 30 years to old age. 

 We do not frequently see babies during their first 14 days, but at least 

 in the first year there is no evidence that they react worse than older 

 children and adults. 



