bluuebunny/crossref_metadata_2025 huggingface dataset:
Follow-up of Families Who Experience a Perinatal Death
Authors: Rowe Jane , Clyman Ronald , Green Charlotte , Mikkelsen Cynthia , Haight Jeannette , Ataide Linda
Published: December 2021

We conducted a retrospective study by telephone interview (10 to 22 months later) of 26 families who had experienced a perinatal death. Six of 26 mothers had a prolonged grief reaction (12 to 20 months). Those mothers with a surviving twin or subsequent pregnancy less than five months following the death were at higher risk for a prolonged grieving period than were those without subsequent pregnancy or one more than six months later. Half of the families obtained information about the cause of death and risk of recurrence only during hospitalization; subsequent contact, weeks to months later, provided additional information for the other half. Twenty-two of 26 mothers met predetermined criteria for having an adequate understanding of cause of death and risk of recurrence; four of 26 knew neither. Sixty percent of the mothers who had adequate understanding and who had no prolonged grief response felt totally dissatisfied or only partially satisfied with the information they received and the way they received it. Follow-tip contact by phone or in person increased understanding significantly; mothers who had had in-person follow-up were more likely to be satisfied with the information they received.
THERAPEUTICS
Authors: VOLTAIRE
Published: December 2021

Therapeutics is the pouring of drugs of which one knows nothing into a patient of whom one knows less.
Postneonatal Infant Mortality in Infants Admitted to a Neonatal Intensive Care Unit
Authors: Kulkarni Prakash , Hall Robert T. , Rhodes Philip G. , Sheehan Michael B.
Published: December 2021

The postneonatal infant mortality (PNIM) of 2,205 infants admitted to a neonatal intensive care unit from January 1971 to December 1974 was 44 in 1,000 infants who survived to age 28 days. This rate is approximately ten times that of the general population. Congenital malformations (59%), infections (12%), sudden infant death syndrome (10%), and asphyxial brain damage (10%) were the most common causes of death.

One third (26) of the infants remained in the hospital whereas two thirds (52) had been dismissed prior to death. All who remained in the hospital plus 36 who had been dismissed died of severe illnesses that were incompatible with prolonged survival. The remaining PNIM was 10 in 1,000 neonatal survivors. This rate is still twice that of the general population. These deaths occurred in infants who were apparently well at the time of dismissal and subsequent examinations. Sudden infant death syndrome and infections constituted the largest portion of this mortality. Factors contributing to mortality in this group were poor socioeconomic status and low birth weight. Maternal age, race, marital status, and neonatal illnesses including apnea were not significantly related.

Factors that appear to be important in the birth of high-risk infants continued to be operative in the postneonatal period, and contribute to a high mortality in apparently normal infants dismissed from the neonatal intensive care unit.
Postvaricella Acute Transverse Myelitis: A Case Presentation and Review of the Literature
Authors: McCarthy John T. , Amer Jules
Published: December 2021

Although the complications and sequelae of varicella are rare, they can cause significant mortality and morbidity in both the normal and compromised patient. Eight cases of "pure" acute transverse myelitis (ATM) following varicella have previously been reported in the literature. We report the ninth case of postvaricella ATM in a 9-year-old girl. Her course was characterized by paraplegia, sensory Loss, hvperesthesia, and incontinence of urine and feces. All patients, except ours, recovered fully from ATM.
Experimental Design Deck for Clinical Research: A New Learning Resource in Aid of Scientific Thinking
Authors: Sinclair John C.
Published: December 2021

The Experimental Design Deck for Clinical Research is a simulation of a problem in experimental design in a card deck format. It is intended to stimulate the development of skills in scientific thinking by allowing the student, in a self-directed fashion, to design a clinical trial to test either a given hypothesis (specific deck) or a hypothesis that the player provides (general deck). In addition to its use as an educational tool, the Experimental Design Deck can be used as a guide to the application of scientific thinking in a variety of biomedical activities. It can easily be modified for application to problems in nonmedical research and evaluation.
WHICH WAY TO GO
Authors: Carroll Lewis , Gardner Martin
Published: December 2021

‘"Would you tell me, please, which way I ought to go from here?" "That depends a good deal on where you want to get to," said the cat. "I don't much care where—" said Alice. "Then it doesn't matter which way you go," said the cat.’

John Kemeny places Alices question, and the cat's famous answer, at the head of his chapter on science and values in A Philosopher Looks at Science, 1959. . . . The cat's answer expresses very precisely the eternal cleavage between science and ethics. As Kemeny makes the clear, science cannot tell us where to go, but after this decision is made on other grounds, it can tell us the best way to get there.
Choledochal Cyst: Delayed Diagnosis in a Jaundiced Infant
Authors: Harris Vivian J. , Kahler John
Published: December 2021

Obstructive jaundice in young infants represents a clinical situation whose diagnostic evaluation has changed dramatically over the past few years.1-3 Biliary atresia and some forms of neonatal hepatitis are the most common diseases to be differentiated. Emphasis has shifted in recent years toward early surgical exploration for the possibility of performing some form of portoenterostomy.

Among surgically correctible lesions, the choledochal cyst, although a rare cause of obstructive jaundice during the newborn period, should be considered and actively pursued since irreversible cirrhosis is a major sequela in untreated cases.4

We describe a patient who was considered to have biliary atresia but on whom a choledochal cyst was discovered at 5½ months of age.
Excessive Masturbation of Childhood: A Symptom of Tactile Deprivation?
Authors: McCray Glen M.
Published: December 2021

Five cases of excessive masturbation are presented. All cases represent adequate parent-child relationships altered by parental change of behavior toward the child. Upon reinstitution of affectionate tactile contact by the parents, the excessive masturbation ceased. Theoretical considerations are discussed.
Periorbital Cellulitis in Children
Authors: Barkin Roger M. , Todd James K. , Amer Jules
Published: December 2021

Inflammation of periorbital tissues is common in pediatric patients, but little information regarding guidelines for treatment is available. The patient with periorbital cellulitis has erythema and swelling of the soft tissues of the eye. The condition is distinguished from more severe orbital involvement by the absence of ophthalmoplegia, proptosis, or impaired vision (Table I).1 This review was initiated to develop bacteriologic data for the treatment of periorbital cellulitis.

PATIENT POPULATION

Patients hospitalized at the Children's Hospital of Denver between December 1972 and June 1976 with the diagnosis of orbital or periorbital cellulitis were reviewed. Patients with periorbital cellulitis (lid swelling and erythema without ophthalmoplegia, proptosis, or impaired vision) were analyzed; clinical, bacteriologic, and roentgenographic data were obtained. A positive blood or cellulitis aspirate culture was required to prove a bacteriologic cause. Roentgenograms were interpreted by two pediatric radiologists.

FINDINGS

Seventy-one cases of periorbital cellulitis without orbital involvement were identified during the study period. Children ranged in age from 10 days to 18 years; 41 (58%) were 4 years of age or younger. The right periorbital tissues were involved in 39 patients (55%) and the left in 28 (39%); bilateral involvement was noted in four.

A temperature greater than 37.8 C (100 F) was documented on the day of admission in 52 (73%) children; 34 (48%) had temperatures greater than 38.3 C (101 F). Although not a presenting complaint, 19 (27%) exhibited mild conjunctival hyperemia without purulent discharge. Clinical sinusitis manifested by a history of drainage, pain, or local tenderness was noted in ten (14%) patients.
Breath Tests in Pediatric Gastrointestinal Disorders: New Diagnostic Opportunities
Authors: Barr Ronald G. , Perman Jay A. , Schoeller Dale A. , Watkins John B.
Published: December 2021

Among physiological materials available for sampling by the pediatrician, breath has received the least attention. Important questions concerning breath collection methods and the sensitivity and specificity of breath tests remain to be answered. Nevertheless, the validation and the use of nonradioactive labels and simpler collection methods have established the safety, noninvasiveness, and simplicity of breath tests for use in the pediatric population. Because samples can be collected in the field, office, or hospital and are easily stored, the use of central laboratory facilities will permit pooling of resources and decreased cost. In the case of hydrogen excretion following carbohydrate loads, accurate measurements within the diagnostic range of 2 to 10 ppm are possible by gas chromatographs equipped with thermal conductivity detectors, and should be available in most hospital laboratories. For the application of stable isotopically labeled substrates, the development of regional mass spectrometry centers will permit easier accessibility to and reduced cost of the requisite technology for isotope measurement. Thus, breath tests hold considerable promise for extending our capacity to study and evaluate in vivo metabolic processes both in the clinic and in the laboratory.
On doing research in office practice
Authors: Carey William B.
Published: December 2021

In 1975 The Memorial and Endowment Fund for Children of the American Academy of Pediatrics very kindly made me one of its first grant recipients for a research project performed in an office practice setting. Dr. Gerald Hughes of the Academy invited several of us so favored to present the results of our sudies at the annual meeting in New York in November 1977. Since my report1 had just been published in Pediatrics, I summarized it rather briefly and then moved on to discuss the larger subject of doing clinical research in office practice. It seemed possible that those remarks, slightly expanded, might be of interest to some who were not present at that meeting. There has been very little written on this matter.
Pediatrics and child psychiatry: A new joint venture
Authors: H. R. J.
Published: December 2021

In this issue of Pediatrics, readers will note that abstracts from the Journal of the American Academy of Child Psychiatry have been used as fillers. The Journal, in turn, is publishing abstracts from Pediatrics. To ensure early publication, the editor of the Journal, Dr. Melvin Lewis, sends us prepublication abstracts of articles to appear in his journal, and we do the same for him with our abstracts. We each select those that appear to us to have the most interest for our readers, and then publish them as fillers as close as possible to the date of publication in the parent journal.
CONCERNING THE ORIGINS OF CULTURES
Authors: Harris Marvin
Published: December 2021

No doubt my story [concerning the origins of cultures] would be more inspirational if I could set aside [a] cost/benefit approach to cannibalism and return to the old theory of moral progress. Most of us would prefer to believe that the Aztecs remained cannibals simply because their morals were mined in primitive impulses while the Old World states tabooed human flesh because their morals had risen in the great onwards-and-upwards movement of civilization. But I'm afraid this preference arises from provincial if not hypocritical misconceptions. Neither the prohibition of cannibalism nor the decline of human sacrifice in the Old World had the slightest effect on the rate at which the Old World states and empires killed each other's citizens. As everyone knows, the scale of warfare has increased steadily from prehistoric times to the present, and record numbers of casualties due to armed conflict have been produced precisely by those states in which Christianity has been the major religion. Heaps of corpses left to rot on the battlefield are no less dead than corpses dismembered for a feast. Today, hovering on the brink of a third world war, we are scarcely in a position to look down on the Aztecs. In our nuclear age the world survives only because each side is convinced that the moral standards of the other are low enough to sanction the annihilation of hundreds of millions of people in retaliation for a first strike. Thanks to radioactivity the survivors will not even be able to bury the dead, let alone eat them.
BENEVOLENCE
Authors: Glasser I.
Published: December 2021

. . .Although it is normal for parents to love their children, it is not normal for society to love the socially helpless. Who loves the aged, the mentally ill, or the troubled children of the poor? Who loves welfare recipients or the residents of public housing? Abstractly, perhaps, society adopts a superficially charitable attitude toward these groups. But if one looks at what society does, and not at what it says, there is little love reflected. The record of public charity is an unloving record of punishment, degradation, humiliation, intrusion, and incarceration. If parents treated their children the way society treats the helpless, they would be cited for neglect and child abuse. The power of "lovability," which normally saves the child from disaster, has no precise social analogue.

The varieties of social dependence, described in Dickens' novels and intrinsic to the modern American welfare state, have therefore resulted in profound violations of individual liberty. These violations were not explicitly anticipated by those who wrote our Constitution and its Bill of Rights. Dependence upon the institutions of caring establishes-for millions of people-a condition of fragility against encroachments of power, and benevolence is the mask that hides it. It is not that benevolence is itself mischievous or cynically to he regarded with mistrust. It is not benevolence we should abandon, but rather the naive faith that benevolence can mitigate the mischievousness of power so feared by those who wrote our Bill of Rights. We have traditionally been seduced into supposing that because they represented charity, service professionals could speak for the best interests of their clients.
Breast-Feeding
Authors:   A Commentary in Celebration of the International Year of the Child, 1979
Published: December 2021

1. Full-term newborn infants should be breastfed, except if there are specific contraindications or when breast-feeding is unsuccessful.

2. Education about breast-feeding should be provided in schools for all children, and better education about breast-feeding and infant nutrition should be provided in the curriculum of physicians and nurses. Information about breast-feeding should also be presented in public communications media.

3. Prenatal instruction should include both theoretical and practical information about breast-feeding.

4. Attitudes and practices in prenatal clinics and in maternity wards should encourage a climate which favors breast-feeding. The staff should include nurses and other personnel who are not only favorably disposed toward breast-feeding but also knowledgeable and skilled in the art.

5. Consultation between maternity services and agencies committed to breast-feeding should be strengthened.

6. Studies should be conducted on the feasibility of breast-feeding infants at day nurseries adjacent to places of work subsequent to an appropriate leave of absence following the birth of an infant.
Letter To The Editor
Authors: Kupst Mary Jo
Published: December 2021

This is a synthesis of the responses of Drs. Paul and Schulman and Ms. Blatterbauer, as well as my own. We are in agreement with Dr. Sissman that physicians should be able to deal with the psychosocial aspects of illness, and we know of many who do so. However, we are also aware that this becomes difficult in a large specialty clinic where time is short and many patients must be seen. This experimental study was done because the cardiologists believed that even under the best of circumstances, a small percentage of parents have the opportunity to assimilate the medical information and to think about its implications.
Impact of the Apnea Monitor on Family Life
Authors: Black Lois , Hersher Leonard , Steinschneider Alfred
Published: December 2021

The use of an apnea monitor in the home to limit the duration of prolonged apneic spells and thus, possibly, to prevent sudden infant death syndrome (SIDS) has raised a number of questions about the effect of such devices on the infant, family, and parent-child interaction. Through interviews and questionnaires, descriptive data were obtained from 31 families who recently or currently had an infant on a monitor. The infants treated were either those who had one or more severe cyanotic episodes, siblings of infants with SIDS or severely cyanotic infants, or normal newborn infants in a research study. On the basis of laboratory sleep studies, all were believed to be prone to prolonged apneic spells.

Most families believed that using the apnea monitor had a significant but temporary impact on their personal and social lives. Many patterns of daily living and child-care routines were altered to accommodate monitor use. Technical limitations of the machine severely aggravated parents' problems. Despite these observations, most parents believed the monitor was an anxiety reducer and, in retrospect, well worth the trouble. Generally it was not seen as a deterrent to normal parent-child relations.

These generalizations are explored in detail and are presented as a stimulus to further investigation and improved management.
Chest Physiotherapy in the Newborn: Effect on Secretions Removed
Authors: Etches P. C. , Scott Bridget
Published: December 2021

The amount of upper airway secretions removed by suction alone was compared to that removed after chest physiotherapy in six neonates with a clinically suspected problem of increased respiratory tract secretions. More secretions were removed after physiotherapy.
Manometric Diagnosis of Lower Esophageal Sphincter Incompetence in Infants: Use of a Small, Single-Lumen Perfused Catheter
Authors: Vanderhoof Jon A. , Rapoport Peggy J. , Paxson Charles L.
Published: December 2021

Lower esophageal sphincter (LES) pressure is frequently measured to diagnose LES incompetence in adults. The multilumen perfused catheters with large diameters that are used for this purpose are not suitable for small infants. We measured LES pressure in ten normal newborns with a small, single-lumen perfused catheter and compared our values with those obtained with the standard adult apparatus. Higher pressures were recorded with the singlelumen catheter. Chloral hydrate sedation had no effect on LES pressure. Two-day-old infants had LES pressures comparable to those of adults and older children. The technique was applied to the diagnosis of LES incompetence in 23 infants. Infants with LES incompetence (chalasia) were correctly separated from infants with chronic vomiting secondary to all other causes. Single-lumen manometric studies provide a simple, reliable, and safe method of assessing LES incompetence in small infants.
PDAs, Prostaglandins, and RLF
Authors: Schrager Gloria O.
Published: December 2021

With the survival of an increasing number of premature infants, an increased incidence of retrolental fibroplasia (RLF) has been documented in neonatal centers despite the careful monitoring of both FIO2 and PaO2 levels. Johnson et al. report an incidence of 19% among infants weighing less than 2,500 gm, with 32% in the 1,000- to 1,500-gm weight group and 75% among the six survivors in the less than 1,000-gm weight category, at Pennsylvania Hospital from 1968 to 1972.
Treatment of Isoimmune Thrombocytopenia of the Newborn With Transfusion of Maternal Platelets
Authors: Vain Nestor E. , Bedros Antranik A.
Published: December 2021

Isoimmune neonatal thrombocytopenia is a rare condition with potentially serious complications and mortality of 10%. There are several ways of diagnosing and treating this potential neonatal emergency, but the most simple and effective method we have found is that of transfusing maternal platelets. Two cases are reported in which this type of management was successful.
Liver Disease in Infants Receiving Total Parenteral Nutrition
Authors: Postuma Ray , Trevenen Cynthia L.
Published: December 2021

Progressive cholestasis and abnormal elevations of liver enzymes occurred in one third of 92, mostly preterm, newborn infants who received total parenteral nutrition (TPN) with Protein hydrolysates, synthetic L-amino acids, and intravenous fat emulsion. The synthetic amino acid plus intravenous fat emulsion was not superior to the protein hydrolysate in preventing liver disease. The liver function returned to normal after discontinuation of TPN, which suggests a causal relationship. Hepatic microscopy was abnormal in 12 of 14 infants examined. The main features were progressive cholestasis and portal tract fibrosis and infiltration, which led to liver failure and death in two infants. In our experience, liver disease is the major matabolic complication of TPN in infants.
Ultrastructural Abnormalities of the Carotid Body in Sudden Infant Death Syndrome
Authors: Cole Solon , Lindenberg Leslie B. , Galioto Frank M. , Howe Peter E. , DeGraff Arthur C. , Davis Jonathan M. , Lubka Rhonda , Gross Elliot M.
Published: December 2021

The carotid bodies of four infants who died of sudden infant death syndrome (SIDS) were compared, using electron microscopic techniques, with the carotid bodies of various control subjects. In the SIDS patients, there was a marked reduction or absence of the dense cytoplasmic granules of the carotid chemoreceptor cells, as well as a reduction in cell number and size. These ultrastructural abnormalities may be pathophysiologically related to SIDS. A defect in this respiratory control organ could block normal stimulation of respiration during the periods of hypoxia that occur during episodes of sleep apnea in infancy. Further studies by electron microscopy are required to confirm degranulation of the carotid body as a pathognomonic sign of SIDS. Screening of high-risk infants should be directed at studying the carotid body and its mediated responses to hypoxia.
Severe Immobilization Hypercalcemia, Renal Insufficiency, and Calcification
Authors: Conley Susan B. , Shackelford Gary D. , Robson Alan M.
Published: December 2021

Severe hypercalcemia with decreased renal function, hypertension, and renal catcifications developed in a 14-year-old boy who required prolonged immobilization for multiple fractures. Parathyroid hormone was not detectable in the serum. Urinary calcium excretion was high. Initially, mobilization was impossible and the patient was treated with a high fluid intake, low calcium intake, acidification of the urine, furosemide, and a passive exercise program. Renal function improved and renal calcifications resolved but hypercalcemia did not resolve. After mobilization the serum calcium concentration became normal rapidly. This treatment regimen is suggested for use in patients with immobilization hypercalcemia when mobilization is impossible.
Some Kind of a Social Doctor: Martha May Eliot, 1891-1978
Authors: Schmidt William M.
Published: December 2021

Martha May Eliot was one of the most influential pediatricians to hold positions of public authority in the United States during a long and distinguished career. Her name is linked with that of Edwards A. Park in the history of the control of rickets. With Grace Abbott and Katharine Lenroot she brought provisions for children into the Social Security Act, a big step beyond the original plan.

within the councils of the American Pediatric Society, she encouraged proposals leading to the landmark study Child Health and Pediatric Education (1949) conducted by the Academy of Pediatrics.

For more than 50 years Martha May Eliot took a leading part in the development of health services for mothers and children. She was concerned for children of all countries of the world and worked for them in the great international organizations: the League of Nations, the United Nations Relief and Rehabilitation Administration (UNRRA), the United Nations Children's Fund (UNICEF), and the world Health Organization. In the United States, her own country, she used her Vision and vigor in the US Children's Bureau, at Yale Medical School, Harvard School of Public Health, and the Massachusetts Committee for Children and Youth, as well as in many other governmental and nongovernmental agencies and committees.

Her entire career was a fulfillment of a decision and comniitment made early in her life. At Radcliffe she had a great interest in the classics, and her deep appreciation of her cultural heritage enriched her work and her life. While still a Radcliffe student, she determined to study medicine.
Recommendations for Feeding Normal Infants
Authors: Fomon Samuel J. , Filer Lloyd J. , Anderson Thomas A. , Ziegler Ekhard E.
Published: December 2021

Our current recommendations for infant feeding are based on relatively few facts and many opinions. In a number of areas of infant feeding, the crucial experiments have not yet been carried out and in some areas our experimental methods are too crude to permit design of appropriate studies. Changes in recommendations are to be anticipated as new evidence becomes available. Meanwhile, we make the following recommendations.
Dihydropteridine Reductase Deficiency Associated With Severe Neurologic Disease and Mild Hyperphenylalaninemia
Authors: Brewster Thomas G. , Moskowitz Michael A. , Kaufman Seymour , Breslow Jan L. , Milstien Sheldon , Abroms Israel F.
Published: December 2021

A deficiency of hepatic dihydropteridine reductase (DHPR) activity was found in a neurologically impaired infant with mild hyperphenylalaninemia and normal levels of hepatic phenylalanine hydroxylase. DHPR is required for the regeneration of tetrahydrobiopterin, an essential cofactor in aromatic amino acid hydroxylation, a necessary step in the biosynthesis of the neurotransmitters, dopamine and serotonin. Evidence for decreased synthesis of these transmitters in this patient was provided by the finding of reduced levels of homovanillic acid and 5-hydroxyindole acetic acid, metabolites of dopamine and serotonin, respectively, in the cerebrospinal fluid and urine. Treatment with dopamine and serotonin precursors, l-3,4 dihydroxyphenylalanine and 5-hydroxytryptophan, respectively, was associated with improvement in temperament and motor tone and less frequent seizures. However, there was no improvement in gross motor function or language development.
Kawasaki Disease: Effect of Treatment on Coronary Artery Involvement
Authors: Kato Hirohisa , Koike Sigeyuki , Yokoyama Takashi
Published: December 2021

Ninety-two patients with Kawasaki disease were treated with five different types of drug therapy: a steroid preparation (prednisolone), aspirin, an antibiotic, a combination of steroid plus aspirin, and a combination of steroid plus warfarin. One to two months after the onset of the disease, coronary angiography demonstrated coronary aneurysms in 20% of cases treated with an antibiotic alone, 64.7% of cases in the steroid-treated group, and 11% of those in the aspirin-treated group.

These findings suggest that the steroid might act adversely to cause a progression of coronary lesions of the disease. The aspirin-treated group did not have a significantly lower incidence of coronary lesions compared with the group treated with an antibiotic alone. But in view of the fact that the direct cause of sudden death of the disease is thrombotic occlusion of a coronary artery, aspirin might act as the effective means for prevention of sudden death due to Kawasaki disease.
Maternal Oral Herpes: Isolation Policy
Authors: Schreiner Richard L. , Kleiman Martin B. , Gresham Edwin L.
Published: December 2021

Current official recommendations are that parents and personnel with oral herpes lesions be isolated from newborn infants. A survey of 110 neonatal centers, 50% of them replying, showed that most centers do not isolate mothers with oral herpes from their newborn infants. A review of the literature suggests that exposure of infants to personnel or family with oral herpes lesions might occasionally result in disseminated neonatal herpes simplex virus disease. Since the separation of a mother from her newborn infant Up to 1 week of age is a decision that should not be taken lightly, more information is urgently needed to decide whether or not to isolate mothers and hospital personnel with oral herpes lesions from newborn infants. Recommendations to obtain more information concerning these infants are provided.
Delayed Elevation of Serum Phenylalanine Level in a Breast-Fed Child
Authors: Binder John , Johnson Charles F. , Saboe Beverly , Krug-Wispe Susan
Published: December 2021

Phenylketonuria (PKU) is an autosomal recessive disorder that causes mental retardation if not treated. Treatment consists of a low phenylalanine diet. If the diet is instituted prior to 3 to 4 weeks of age, the child can be expected to develop within the normal range.1 Early detection of PKU is therefore necessary to institute dietary therapy before harmful effects begin. In Iowa, state public policy specifies that a blood test for phenylalanine must be done on an infant prior to discharge from the hospital and again at 4 weeks of age.2

To diagnose PKU, the National Collaborative Study of Children Treated for Phenylketonuria requires that two serum phenylalanine levels of greater than 20 mg/dl be obtained.
Fussy Baby: A New Cause
Authors: Rogers W. B.
Published: December 2021

I read Dr. Mortimer's letter to the editor in which he reported a hyperirritable infant who was receiving breast milk (Pediatrics 60:780, November 1977). I had a similar case in 1974. The patient was an 8-month-old baby whom I had cared for since birth. The infant, who had always been breast-fed, suddenly began having prolonged fussy spells, episodes of crying, and trouble sleeping, especially in the evening. I did no studies, but I could find nothing wrong after a thorough physical examination.
THE RISE OF PROFESSIONALISM
Authors: Larson M. L.
Published: December 2021

The particular relation that professionalism bears to individualism and to the subjective illusion deserves to be noted. Their special competence empowers professionals and experts to act in situations where laymen feel incompetent or baffled. In fact, the assumption by the public that the expert is competent creates a sort of pragmatic compulsion for the expert: to certify his worth in the eyes of the laity, he must act. Deferentially requested to intervene by his clients, the expert practitioner is compelled to do something; from this point of view, anything is better than nothing. As Freidson remarks: "Indeed, so impressed is he by the perplexity of his clients and by his apparent capacity to deal with those perplexities, that the practitioner comes to consider himself an expert not only in the problems he is trained to deal with but in all human problems." Most particularly in the personal professions, the behavior of the expert asserts, ideologically, that a variety of ills—and, in particular, those that can most affect the person—have individual remedies. This reinforces the optimistic illusion of ideological individualism: personal problems of all kinds are purely private and admit, as such, individual and ad hoc solutions. In the predominant ideological way of addressing social issues and social relations experienced by individuals, therefore, structural causes, as well as collective action upon those causes, are relegated to a vaguely utopian realm. At the same time, the practitioner's "compulsion to act" reiterates to the layman that education confers superior powers upon the individual and superior mastery over physical and social environments.
Thyroid Hormone and Thyrotropin Responses to Parturition in Premature Infants With and Without the Respiratory Distress Syndrome
Authors: Klein Alan H. , Foley Barbara , Kenny Frederic M. , Fisher Delbert A.
Published: December 2021

Serum thyroxine (T4), triiodothyronine (T3), reverse triiodothyronine (rT3), thyrotropin (TSH), and thyroxine-binding globulin (TBG) concentrations were measured in well full-term infants (group 1), well premature infants (group 2), and premature infants with the respiratory distress syndrome (group 3). Samples were collected at birth and at 2, 12, and 24 hours after delivery. Significant increases in mean serum TSH concentrations occurred in all three groups two hours after delivery, but the two-hour levels measured in groups 2 and 3 were less than those in group 1 infants. Serum T4 concentrations increased significantly after delivery in groups 1 and 2 but not in group 3 newborns; mean TBG concentrations did not vary significantly in any of the groups. Serum T4, concentrations increased significantly at two hours in all three groups but were significantly depressed at 12 and 24 hours in group 3 infants. Mean serum rT3, concentrations decreased after birth in group 2 and 3 in contrast to group 1 newborns; the mean value increased significantly between 2 and 24 hours in group 3 infants. The pattern of decreasing senrum T3 and increasing rT3 concentrations in group 3 infants between 2 and 24 hours resembles the pattern of change in triiodothyronines in ill adult patients, which suggests that these variations are due primarily to illness and not to prematurity.
Growth Increments With Low Dose Intermittent Growth Hormone and Fluoxymesterone in First Year of Therapy in Hypopituitarism
Authors: Kirkland Rebecca T. , Clayton George W.
Published: December 2021

The availability of a commercial preparation of human growth hormone (hGH) prompted a study in children with hypopituitarism to determine the efficacy of a lower dose of hGH. Thirteen children, ages 4 years 3 months to 13 years 7 months, were given hGH concomitant with fluoxymesterone in an intermittent regimen. The hGH was given intramuscularly, 1 IU daily for 12 to 36 days in each course. There were four courses per year. The fluoxymesterone was given orally, 1 to 2 mg. The total amount of hGH administered was between 48 and 112 IU per year, as compared with the regimen of 312 IU per year, 2 units three times a week. The growth velocity in all 13 children improved, and the mean growth velocity was 6.4 cm ± 1.13 SD. The mean bone age increment was 0.57 years ± 0.14 SEM in one chronological year of therapy. The low dose regimen permits a significant reduction in cost of hGH without causing undue advance in bone age.
Digitalis Toxicity and Serum Levels
Authors: Berman William
Published: December 2021

The article by Halkin et al (Pediatrics 61: 184, February 1978) alerts pediatricians to the prevalence of toxicity to dligoxin in infants and children. However, I am concerned that casual reading of the article will lead some to conclude that tolerance to digoxin does not vary with age and that a serum level of digoxin of 2 ng/ml is a "magic number." Neither of these conclusions is substantiated by the data in the manuscript.

The findings of the series are clouded somewhat by the broad criteria used for diagnosing toxicity, the time at which serum specimens were obtained (eight hours after the preceding maintenance dose), and the lack of information about drug clearance as it relates to drug dose and the serum levels achieved.
Effect of Posture on the Pattern of Stomach Emptying in the Newborn
Authors: Blumenthal Ivan , Ebel Anna , Pildes Rosita S.
Published: December 2021

To determine the effect of posture on the pattern of neonatal stomach emptying, 56 test meals of a 10% dextrose were given to 14 healthy infants over a period of two or three consecutive days. The infants, whose postnatal age ranged between 5 and 27 days, were studied in each of four positions. The emptying pattern was determined by the double-sampling dye-dilution technique. The results indicate that there are no significant postural differences in the pattern of stomach emptying. They also indicate that neonatal and adult patterns are similar.
Resting Oxygen Consumption of Premature Infants Covered with a Plastic Thermal Blanket
Authors: Darnall Robert A. , Ariagno Ronald L.
Published: December 2021

Premature infants in single-wall incubators covered with "thermal blankets" made of plastic packing material have large reductions in insensible water loss (IWL) conipared with naked infants. We postulated that such reductions in evaporative heat loss would not result in decreases in caloric expenditure if body temperature were maintained by a servocontrolled heat source. Using an open-circuit technique, we measured oxygen consumption (Vo2), carbon dioxide production (Vco2), heart rate (HR), respiratory rate (RR), and abdominal skin ( Tabd), cheek, thigh, rectal, incubator air, wall, and room air temperatures in ten infants less than 37 weeks gestational age and from 2 to 24 days of age both naked and covered with a plastic thermal blanket. Tabd temperature was maintained between 36.2 and 36.8 C and rectal temperature between 36.8 and 37.2 C in each environment by manual or automatic servocontrol. A "resting state" was defined by using a combination of subjective and objective criteria. The mean values of Vo2 during the "resting state" were 7.31 and 7.59 cc/kg of body weight per minute for naked and covered infants, respectively. There were no significant differences between mean values of VCO2, respiratory quotient, HR, RR, abdominal, cheek, thigh, or rectal temperatures in the two environments. Operant temperatures averaged 0.5 C lower when the infants were covered. These data support the hypothesis that decreases in insensible water loss do not necessarily imply reductions in caloric requirements in infants where Tabd is niaintained by servocontrol.
Psychological Management of Acute Paraplegia in Adolescence
Authors: Geller Barbara , Greydanus Donald E.
Published: December 2021

Important management principles regarding emotional needs of the teenager with acute paraplegia during early hospitalization are discussed. One illustrative case is presented. Mourning reaction of the patient and family to this severe loss of bodily function is reviewed. Reaction of medical caretakers to this catastrophe is also discussed. It is emphasized that these concepts be applied by pediatricians in managing adolescent paraplegics.
Physiologic Determinants of Serum Urate Levels in Adolescence
Authors: Harlan William R. , Cornoni-Huntley Joan , Leaverton Paul E.
Published: December 2021

During adolescence, serum urate increases and adult levels are achieved. Physiologic factors related to serum urate were investigated in a nationally representative population of 6,768 youths aged 12 to 17 years (the US Health Examination Survey). Serum urate concentration increases markedly from ages 12 to 14 years in males, and levels were related to sexual and skeletal maturation. Although similar relationships were observed in females, the association is less striking, probably because of earlier pubescence, which was not captured in this study, and a pronounced androgenic response. In the later stages of adolescence ( ages 15 to 17 years for males and 13 to 17 years for females), body composition (body mass index and skinfold thickness), blood pressure, and hematocrit have stronger relationships than sexual and somatic maturation. These latter relationships are similar to those in adults. This survey affords a portrayal of physiologic interrelationships with serum uric acid during adolescence.
Transmission of Hepatitis B Virus Infection by Asymptomatic Chronic HBsAg Carrier Mothers
Authors: Papaevangelou George , Hoofnagle Jay H.
Published: December 2021

The courses of 18 children born to 13 chronic hepatitis B surface antigen (HBsAg) carrier mothers were followed prospectively for serological and biochemical evidence of type B hepatitis. Three children developed transient HBsAg positivity accotupanied by the appearance of antibody to the hepatitis B core antigen. Two others had no detectable HBsAg but developed antibody to HBs Ag. These serological manifestations of hepatitis B virus infection occurred late—6 to 24 months after birth. None of the children had clinical evidence of hepatitis and none became chrotiic HBsAg carriers. The infrequency of transmission of infection, the mild course of disease, and the lack of persistence of HBsAg in these children probably reflected the low level of infectivity of the chronic carrier mothers and perhaps the healthy immunologic status of the children.
Purulent Ocular Discharge in Neonates: Significance of Chlamydia trachomatis
Authors: Rowe D. Stewart , Aicardi Eileen Z. , Dawson Chandler R. , Schachter Julius
Published: December 2021

We obtained cultures for bactend chlamydiae om 100 infants with conjunctivitis that began during the first month of life. Sixty-nine infants were evaluated during well-child visits (group A); 31 were seen specifically for the ocular discharge (group B). Potentially pathogenic bacteria, predominantly Staphylococcus aureus, were cultured from one third of the infants in each group. Chtamydia trachoinatis was recovered from three infants (4%) in group A and from ten (32%) in group B. Three infants with chiamydial conjunctivitis (two in group A, one in group B) had only mild inflammation. Initial treatment with topical antibiotics was unsuccessful in eliminating the organism from seven of 11 infants.
THE INFANTICIDAL MOTHER
Authors: Piers Maria W.
Published: December 2021

Discrimination against the unwed mother runs like a red thread through the history of Western civilization. It became blatant in eighteenth-century France (and Germany and, undoubtedly, in other European countries). It did not matter how the infant had been conceived, i.e., by way of rape, excessive pressure, prostitution as a means to stay alive; the father was only interesting as a source of money. Whatever punishable acts were committeed, such as abandonment or killing of a baby, the guilt was fastened exclusively on the mother, and the penalty was usually a cruel death ... the condemned woman was faced with a variety of death penalties, of which decapitation was considered the most merciful. Other means were burial alive, impalement, and "sacking" (drowning), which was frequently the penalty of choice.... The infanticidal mother was stuffed into a black sack together with a dog, a cat, a rooster, or a viper. The sack had to remain under water for six hours and the choir boys sang "Aus tiefer Noth schrei ich zu Dir." Then the deceased was interred.
A New Complication of Nutritional Management of the Low-Birth-Weight Infant
Authors: Schreiner Richard L. , Lemons James A. , Gresham Edwin L.
Published: December 2021

The important article by Erenberg et al (p 642) demonstrates a dramatic increase in the incidence of lactobezoars in low-birth-weight (LBW) infants at their institution. We have experienced a similar rise in the number of infants with lactobezoars in our newborn intensive care unit. During the past two years there were 12 infants with this complication in contrast to the previous four-year period, when only one infant had this condition. The characteristic clinical findings in our patients were quite similar to those reported by Erenberg and colleagues. All the infants were prematurely born, and only three had birth weights greater than 1,500 gm.
Intellectual Development and Familial Dysautonomia
Authors: Welton Wooster , Clayson David , Axelrod Felicia Bliss , Levine David B.
Published: December 2021

The study examined adaptive trends in cognitive development among individuals with familial dysautonomia and sought to establish new base rates of intelligence for the dysautonomic population. Fifty-two subjects, aged 6 to 28 years, were administered the Wechsler scales of intelligence. The results indicate that there is less cognitive impairment than previous research would suggest, and that more dysautonomic children are capable of adjusting to standard school programs than was heretofore thought possible. Specific deficits seen in this population are discussed along with a rationale for deleting the termretarded where most of these individuals are concerned.
IMPOSITION vs GROWTH OF KNOWLEDGE
Authors: Perkinson H.
Published: December 2021

The trouble with the transmission conception of the educational process, which has reigned since Aristotle, is not simply that it is wrong, but that it results in an authoritarian construction of education.

Construing education as a process of transmission converts it into imposition. The teacher's task is to impose knowledge, or learning on the students. The knowledge transmitted is the acquired (justified? proven?) wisdom of society. Teachers who try to transmit usually employ many different tactics and strategems to pull this off in a benign way. They try to "motivate" students to want to learn what they are supposed to learn. They try to match the materials to be learned to the learner—to his "needs," "interests," "abilities," "aptitude," and "capabilities." But the process is still one of imposition.

The argument against imposition is that it prevents growth. Here is the argument....

In all cases the student learns through trial and error elimination. So when teachers and schools try to impose learning, they are simply coercing students to adopt their criteria for identifying errors. They are saying, in effect, "All knowledge that is contrary to this knowledge we present to you is false." This prevents growth.

Here is another argument. Suppose teachers completely succeeded in imposing knowledge on the young and completely succeeded in "proving" that this knowledge was true. It is patently clear that for those students so taught (indoctrinated?) that the advancement of that knowledge would cease. Because, you see, these students would "know" the truth. So we are led to conclude that the growth of knowledge has occurred and will continue to occur only because teachers failed to impose knowledge on the young.
Sustained Effect of Human Growth Hormone Therapy on Children With Intrauterine Growth Retardation
Authors: Lanes Roberto , Plotnick Leslie P. , Lee Peter A.
Published: December 2021

Previous studies have not clarified whether human growth hormone (HGH) therapy can significantly increase the height of patients with intrauterine growth retardation (IUGR). To determine whether the initial increase in growth rate is sustained through subsequent treatiment, 19 prepubertal patients who had IUGR were treated with HGH Ten of them received a second treatment course. Growth rates (in centimeters per year) were 4.8 ± 1.4 ( mean ± SD) for the pretreatment period, 7.6 ± 2.3 for the first treatment period, 4.2 ± 2.5 for the interval between treatments, 5.9 ± 1.4 for the second treatment period, and 4.3 ± 2.6 for the posttreatment period. Growth rates for the two treatment periods were significantly greater than for the periods before, interval between, and posttreatment. Height expressed as the number of standard deviations below the mean for age increased significantly between the onset of treatment and the most recent measurement. These data indicate that HGH has a sustained positive effect on increasing growth rates in children with IUGR, although the magnitude of the effect may decrease with further treatment. Furthermore, we suggest that it is worthwhile to treat patients who have IUGR with HGH for prolonged periods of time, if supplies exceed those necessary to treat children with growth hormone deficiency.