By using proton nuclear magnetic resonance to measure urinary lactate: creatinine (L:C) ratio, it may be possible to make an early diagnosis of hypoxic–ischaemic encephalopathy and start neuroprotective treatment. Ninety eight babies were studied in Taiwan (New England Journal of Medicine1999;341:328–35) and the mean L:C ratio on urine collected within 6 hours of birth was 0.09 in 58 normal babies, 0.19 in 24 asphyxiated babies who did not develop clinical hypoxic–ischaemic encephalopathy, and 17.0 in 16 babies who did. An L:C ratio of 0.64 or greater was 94% sensitive and 100% specific for hypoxic–ischaemic encephalopathy.

Children with laryngeal symptoms often have gastro-oesophageal reflux (Journal of Pediatric Surgery1999;34:1053–6). In Montreal, Canada around 60% of young children with a diagnosis of stridor, laryngomalacia, or laryngitis had significant reflux on pH monitoring, and the symptoms resolved with medical treatment of the reflux in over 80% of them. Reflux was not common in children with recurrent otitis media.

Evidence of a neuronal basis to dyslexia continues to accumulate. A necropsy study in Boston, Massachusetts, USA (Annals of Neurology 1999;46:189–96) has shown that, whereas normal brains have larger neurons in the left primary visual cortex than in the right, dyslexic brains show no such asymmetry.

A study in Brussels (Journal of Pediatrics1999;135:34–8) has added to the evidence that smoking in pregnancy affects infant behaviour. Newborn babies and 3 month old …