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There is a growing understanding of the role and place of men in maternity care generally and for fathers of babies in neonatal care in particular. This review offers a systematic narrative review on issues affecting fathers, whose babies are admitted to neonatal units. Twenty-seven papers in the review highlighted four key themes: stress & anxiety; information; gender roles and emotions.

Background Light exposure of TPN generates peroxides which induce vasoconstriction. Mesenteric vasoconstriction may affect feeding tolerance. Since photo-protection of TPN decreases peroxide generation, we hypothesized that shielding TPN from light may improve the establishment of minimal enteral nutrition in preterm infants. Methods Infants were randomized to TPN being light exposed (LE) or protected (LP) from birth. Feeding volumes were monitored through 7 days of life in those initiated on minimal enteral nutrition (MEN). Comparisons between LP and LE were performed by ANOVA. Results Daily increments and cumulative volumes of enteral feeds (mL/kg birth weight/d) during the first week of life were significantly higher in LP (n = 18) than LE (n = 19). Conclusion Photo-protection of parenteral nutrition enhances advancement of MEN in preterm infants. Further research is needed to substantiate these findings and determine whether this confers long-term nutritional advantages.

A neonate presented with hyperphenylalaninemia (HPA), with a persistently elevated phenylalanine/tyrosine ratio. The HPA was responsive to tetrahydrobiopterin (BH4). His clinical course was dominated by liver failure, associated with perinatal hemochromatosis. He also developed renal tubulopathy. HPA has not previously been reported in association with any of these features. We investigated the etiology of his condition, and discuss the possibility that this represents a novel single-gene disorder.

1808 www.thelancet.com Vol 366 November 19, 2005 A baby boy at 32 weeks’ gestation was born by spontaneous onset of preterm labour. He weighed 2265 g and had Apgar scores of 7 at 1 min and 9 at 5 min. He was clinically stable for 3 days and was started on enteral feeds. On the fourth day, we noted that he had temperature instability and abdominal distension with sanguineous gastric aspirates. He had poor perfusion, lactic acidaemia, and hyperglycaemia, and needed intubation and fluid resuscitation. Abdominal radiographs showed gastric and intestinal pneumatosis without any evidence of free intraperitoneal or portal venous air (figure). Leucopenia, neutropenia, and thrombocytopenia were also present, and we started the boy on antibiotics after blood culture. Because no organism was isolated, we did not do a laparotomy. He improved over the next month but became intolerant to the enteral feeds. We did a contrast study, which showed small bowel obstruction. At laparotomy we found several old small bowel perforations with associated strictures, and resected two small ileal segments. His stomach and duodenum did not show any abnormality. Histopathology was consistent with necrotising enterocolitis with perforation, and a rectal biopsy showed submucosal ganglia with normal cholinesterase pattern. Although necrotising enterocolitis is common in babies in neonatal intensive care, gastric pneumatosis is rare and usually follows cardiac surgery, pyloric or duodenal stenosis, or intramural misplacement of a feeding catheter. Gastric pneumatosis in a preterm infant