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Treatment choice in acute rheumatic carditis.

Dr Davies and Mr Leivers comment that they have not found it necessary to make frequent adjustments to their parenteral nutrition regimens and that they therefore usually use one of three standard formulas. I have in the past worked in a major referral unit which used a similar system. I agree that apparently satisfactory parenteral nutrition is indeed possible with such a system when the infant is metabolically stable. There is an inevitable tendency, however, with such a system to either postpone the initiation of parenteral nutrition in the metabolically unstable infant or to tolerate minor electrolyte disturbances rather than alter a standard solution. In my experience allocating the problem to a senior staff member does not protect against mistakes. In the increasingly complex environment of a modern neonatal intensive care unit errors of all sorts are all too common. I believe that computers should be used whenever possible to help alleviate this problem. The clinical importance of minor electrolyte disturbances is certainly debatable. In the context of the availability of inexpensive microcomputers I do, however, submit that it is manifestly absurd that arithmetical complexity alone should act as a constraint on optimal clinical management.