Care and observation of a germ-free neonate.

Within the spectrum of childhood diseases that present with recurrent and persistent infections, the 'combined immunity deficiency syndrome' (Soothill, 1967) or 'Swiss' type of a-y-globulinaemia (Hitzig, Barandun, and Cottier, 1968) has recently been well defined. This familial disease is considered to result from a recessive genetic inheritance (Hitzig and Willi, 1961). Treatment has been invariably unsuccessful and every recorded case, like the previous child in this family(Thompson 1967), has died in early life. When this mother became pregnant again it was decided to deliver and maintain the infant in the germ-free state until it was established whether it was affected. In the event of the 'combined immunity deficiency syndrome' being present, it was proposed to treat the infant in the germ-free unit with a fetal tissue graft. In this environment it was postulated that the infant's immunological state would be relatively immature in the absence of foreign antigenic stimulation from the normal bacterial flora. The infant was delivered by elective caesarean section into a flexible plastic sterile surgical isolator, and passed directly into a connected transfer isolator for resuscitation. This sterile transfer isolator was then moved into the vicinity of the larger sterile maintenance isolator, assembled in a conventional hospital ward. The infant was introduced into this isolator aseptically (Barnes et al., 1968b), and the medical and nursing care of the infant during the period of investigation is described here.