bluuebunny/crossref_metadata_2025 huggingface dataset:
Pitfalls in Interpretation of Oral Glucose Tolerance Tests in the Newborn
Authors: Pildes Rosita S. , Hart Robert J. , Warrner Richard , Cornblath Marvin
Published: December 2021

In the course of study of metabolic responses to oral glucose in eleven newborn infants of gestational diabetic mothers (IGDM), three infants had significantly higher blood glucose and plasma insulin values than those of the other eight. The only difference between the two groups was that, in the former, blood was obtained from an umbilical vein catheter and, in the latter, from a peripheral vein. In order to determine if the differences observed in insulin and glucose values were due to sampling sites, standard oral glucose tolerance tests were done with simultaneous sampling from both sources.

Material and Methods

Two-hour oral glucose tolerance tests (2 gm per kilogram) were done in five IGDM.
WHAT PARENTS OF RHEUMATIC FEVER PATIENTS DON'T UNDERSTAND ABOUT THE DISEASE AND ITS PROPHYLACTIC MANAGEMENT
Authors: Kennell John H. , Soroker Eleanor , Thomas Paula , Wasman Marvin
Published: December 2021

Interviews with 60 parents of children attending a rheumatic fever clinic showed confusion and many unrealistic beliefs about the disease and its long-term effects, about recurrences, and about the rationale for the prophylactic program. The parents' all-pervading anxiety about heart disease and death led them to impose or continue restrictions contrary to medical advice, even on children with normal hearts.

The mothers' lack of understanding correlated with their level of education and a number of social and environmental factors. One group of families with a clearly defined pattern of social characteristics-almost entirely Negro, on public assistance, with a low educational level, a very low income, and a high degree of family disorganization-stood out because of its lack of understanding about the disease and about its prophylactic treatment.

The responses of Negro mothers on public assistance as well as those with higher educational and income levels were similar in several respects and differed from those of Caucasian mothers. On the basis of what the mothers reported, communication about the disease was remarkably poor between physician and parent, parent and child, and physician and patient.
PHYSICIANS' RECOGNITION OF COMPLAINTS MADE BY PARENTS ABOUT THEIR CHILDREN'S HEALTH
Authors: Starfield Barbara , Borkowf Shirley
Published: December 2021

In the course of a routine screening program for indigent school-age children carried out in an ambulatory hospital clinic, 40% of the mothers spontaneously recorded a concern about a child's health. Physicians were much more likely to record their awareness of the complaint if it related to a body system or function, as compared with complaints made about behavior and mental problems.
STUDIES IN THE EPIDEMIOLOGY AND PREVENTABILITY OF RHEUMATIC FEVER. IV. A QUANTITATIVE DETERMINATION OF COMPLIANCE IN CHILDREN ON ORAL PENICILLIN PROPHYLAXIS
Authors: Gordis Leon , Markowitz Milton , Lilienfeld Abraham M.
Published: December 2021

Reliability of rheumatic fever patients in maintaining regular oral daily penicillin prophylaxis was studied in 136 children and adolescents by testing their urine specimens for penicillin. Random weekly urine specimens were obtained from each child by school nurses and specimens were also obtained at the time of clinic visits. The children did not know the reasons for the tests. The development of a simple test using filter paper strips dipped in the urine permitted the school specimens to be mailed into the laboratory. In this way over 1,800 specimens were obtained over a 5-month period from children in 71 schools. On the basis of specimens obtained at school, 36% of the patients attending rheumatic fever prevention clinics took their penicillin one fourth of the time or less. Compliance determined from school specimens compared closely with that determined from specimens obtained at clinic visits. An initial sequence of three negative tests identified most non-compliers in this population.

The methods described are a practical means for identifying non-compliers and are applicable to the follow-up of patients in rheumatic fever prevention programs which use penicillin prophylaxis. The finding of a high rate of non-compliance demonstrates the need for such a test in rheumatic fever patients. Furthermore, the test also provides the opportunity of studying the relationship of noncompliance to medical, social, cognitive, and attitudinal factors so that the most appropriate types of health care can be provided for chronically ill children.
DISSEMINATED INTRAVASCULAR COAGULATION IN THE NEWBORN
Authors: Hathaway William E. , Mull Marilyn M. , Pechet Giselle S.
Published: December 2021

Eleven of 19 sick newborn infants were shown to have either laboratory and/or pathologic evidence of disseminated intravascular coagulation (DIC) during an observation period of 8 months. Three of the affected infants had severe viral diseases (rubella, cytomegalic inclusion virus, and herpes simplex). Seven of the infants had severe idiopathic respiratory distress syndrome (IRDS), and one infant (the product of a severely toxemic mother) had transient respiratory distress. The remainder of the sick infants had mild IRDS without evidence of DIC. Diagnosis of DIC in the newborn is best made by reliance upon specific clotting factor assays (platelets, fibrinogen, and factors V and VIII) rather than nonspecific screening tests or presence of fibrin degradation products. DIC may be a more common complication of severely ill newborn infants than is generally realized.
EFFECT OF MEASLES VACCINE ON IMMUNOLOGIC RESPONSIVENESS
Authors: Fireman Philip , Friday Gilbert , Kumate Jesus
Published: December 2021

Immunologic responses, both humoral and cellular, following vaccination with live attenuated measles vaccine were studied in 11 children and compared to the immunologic responses observed following vaccination with killed attenuated measles virus and placebo. The attenuated measles virus temporarily suppressed the cutaneous delayed hypersensitivity reaction to purified protein derivative for 1 to 4 weeks; in addition, the delayed hypersensitivity reactions to candida, vaccinia, diphtheria toxoid, poison ivy, and 2,4-dinitrochlorobenzene antigens were also temporarily suppressed for 1 to 4 weeks. A modest depression of total leucocyte counts, including small lymphocytes, was noted for 1 to 3 weeks; at the same time, the capacity of lymphocytes from patients who received live measles vaccine to respond in vitro to stimulation with purified protein derivative, candida, and ragweed antigens was suppressed without decrease in their in vitro response to phytohemagglutinin. Administration of live measles vaccine did not decrease pre-existing humoral antibody titers to diphtheria toxoid or poliovirus, serum γG-, γA- and γM-globulin concentrations or immediate wheal and flare hypersensitivity skin reactions. The mechanism of the suppression of delayed hypersensitivity by live measles vaccine appears dependent on a viable virus since killed measles vaccine had no demonstrable effect on pre-existing cutaneous delayed hypersensitivity or on the in vitro lymphocyte responses. This study demonstrates that live attenuated measles virus interferes with the capacity of the recipient to express cutaneous delayed hypersensitivity without suppression of humoral antibody.
Hypertensive Encephalopathy with Overdosage of Deoxycorticosterone
Authors: Monteleone James A.
Published: December 2021

Deoxycorticosterone acetate (DOCA), a potent salt-retaining mineral corticoid, is widely used in the management of adrenal insufficiency, particularly in the adrenogenital syndrome. For convenience in long-term management, subcutaneous implantation of DOCA pellets is often employed. We report here a case of hypertensive encephalopathy following overdosage of DOCA pellets.

This white male infant, the product of a normal pregnancy and delivery, was first diagnosed by his private physician as having the adrenogenital syndrome at 3 weeks of age when he presented with weight loss and shock. His initial serum potassium was 8.0 mEq per liter, his sodium was 135 mEq per liter, and his blood urea nitrogen was 69.2 mg per 100 ml.
Unilateral Proptosis in Cystic Fibrosis
Authors: Strauss Ronald G. , West Paul J. , Silverman Frederic N.
Published: December 2021

A child with unilateral proptosis and erosion of bone of the ethmoid sinus was found to have cystic fibrosis. Reports of four children with cystic fibrosis and progressive unilateral proptosis were found in the literature. In two of these five children the diagnosis of cystic fibrosis was not considered before the onset of the proptosis. Dilated ducts filled with inspissated secretions-findings very suggestive of cystic fibrosis-were found on biopsy of the paraorbital mass in our patient. Progressive unilateral proptosis may be an early sign of cystic fibrosis, and the histopathology of the mass may contribute to establishing the diagnosis of this disease and eliminating the possibility of neoplasm.
INFANT FEEDING PRACTICE IN BOSTON IN 1876
Authors: C. T. E.
Published: December 2021

The Department of Health of the City of Boston in 1876 distributed a small manual to mothers with newborn infants outlining for their information what was at that time considered enlightened rules for the proper rearing of infants and children. The younger pediatricians in practice today may find the advice about infant feeding in this manual of interest because it is so different from contemporary practice.1

As a rule, until the child has its eight centre teeth, it should receive no food but milk.... Until the child is six weeks old feed it every two hours during the day, and every three hours during the night. After this gradually lengthen the intervals between the meals, so that, by the time the baby is four months old, it shall be fed every four hours during the day, and if necessary once during the night....

As soon as the centre teeth have come, weaning may be attempted....
THE RESPONSE OF INFANTS OF DIABETIC WOMEN TO TOLBUTAMIDE AND LEUCINE AT BIRTH, AND TO GLUCOSE AND TOLBUTAMIDE AT 2 YEARS OF AGE
Authors: Velasco Mutya S. A. , Paulsen Elsa P.
Published: December 2021

Twelve newborn infants, 2 to 8 days old, of gestational (IGDM) and insulin-requiring (IDM) diabetic mothers responded to intravenous tolbutamide (20 mg/kg) with abnormally large decreases in plasma glucose and marked rises in plasma insulin (the latter was measured only in IGDM). Only 3 of 13 IGDM tested with leucine had significant decreases in plasma glucose. Newborn infants of normal mothers showed no changes in glucose or insulin in response to intravenous tolbutamide, and one of five had a small decrease in glucose levels after leucine. The results suggest the presence of large stores of pancreatic insulin in newborn infants of diabetic mothers which are more readily released by stimulation with tolbutamide than with leucine.

The offspring of the diabetic women were restudied at 2 years of age for their response to intravenous tolbutamide and oral glucose. Seven of nine children had normal glucose and insulin levels after intravenous tolbutamide, and two had abnormally low glucose levels with high insulin levels. Three of the nine had normal glucose tolerance with normal insulin levels. The other six had abnormally elevated glucose levels which varied in duration from one-half to 2 hours. Four of the six had an accompanying hyperinsulinemia; two, who had diabetic glucose tolerance, had poor insulin responses. The findings in the 2-year-old children support a concept that the fetal environment provided by a diabetic woman has effects on carbohydrate tolerance which extend beyond the newborn period.
HOW YOUNG GIRLS IN THE 1840' S SHOULD BEHAVE WHEN SICK ACCORDING TO MRS. SIGOURNEY
Authors: C. T. E.
Published: December 2021

Mrs. Sigourney, of Hartford, Connecticut, was a prolific writer of school and childrne's books during the first half of the nineteenth century. All of her writings seem terribly "preachy" today, but in her time she was noted for her progressive attitudes toward the rearing of children. A good example of her style of writing and advice to young children is the following.

When you are seriously sick, give yourself up entirely to those who have the care of you. Take without objection whatever they bring you, however unpleasant to the taste. Sickness is not a time to gratify the palate, but to learn patience. Thank those who perform any service for you, however small. Do not add to their fatigue any more than you can help.

If you have watchers, urge them to take refreshment in the course of the night, and, if possible, to get some repose. These attentions are pleasant to those who nurse you and help to turn your thoughts from self, for selfishness is too prone to introduce into the chamber of sickness. Consider your physician as your friend. Tell him frankly all he asks, and submit to his remedies without opposition.

Open your mind to cheering thoughts, and keep your heart full of hope, for they promote recovery. Spread your case before the great physician, and ask his blessing on every remedy. When you are well again, remember that you are under a renewed weight of gratitude to him, and to those who have watched over you, and shown you kindness, and from your own sufferings learn to pity others who suffer.1
Seasonal Neonatal Hyperbilirubinemia
Authors: Milby Thomas H. , Mitchell James E. , Freeman Thomas S.
Published: December 2021

A seasonal variation in the incidence of neonatal nonhemolytic, unconjugated hyperbilirubinemia has been observed in a small, predominantly agricultural community. A total of 3,096 records, representing all newborns delivered during a 4-year period (1963-1966) in one local hospital and during an overlapping 3-year period (1964-1966) in another, were reviewed. A case was defined as an infant whose highest recorded unconjugated bilirubin level reached 10 mg/100 ml during the first days of life. Infants with clear-cut hemolytic disease of the newborn were excluded from consideration. One hundred seventy cases were identifled. In one hospital, an excess of cases occurred during the fourth quarter of each of the 4 years reviewed. A similar trend was apparent in the second hospital during 2 of the 3 years reviewed.

The cause of this systematic fluctuation is unclear. Insofar as possible, factors commonly associated with neonatal hyperbilirubinemia were excluded. During the peak incidence penods, a surplus of cases among infants fed with tap water-containing formula was noted.
Open Heart Surgery and Active Rheumatic Carditis: Report of a Case
Authors: Kloth Howard H. , Reed George E. , Spagnuolo Mario
Published: December 2021

A 15-year-old boy with intractable, active rheumatic carditis underwent open heart sungery to repair severe aortic and mital insufficiency. His dramatic recovery suggests that this unorthodox approach should be considered in the management of such patients when the usual medical regime of digitalis diuretics, aspirin, and steroids have failed.
Treatment of Myelomeningocele: I
Authors: Bluestone Seymour S.
Published: December 2021

In his Commentary, "Surgical Treatment of Myelomeningocele" (Pediatrics, 42:225, 1968),Dr. Donald D. Matson recommends only custodial care for children with no neurologic function "below the upper lumbar levels," whether or not there is signifiant hydnocephalus." He acknowledges a divergence of opinion, implying that those who would operate upon such patients are misguided in their disregard of moral and social issues. The weight of evidence, however, seems to support the contrary opinion.

Understandably, but unfortunately, Dr. Matson could not detail in a brief Commentary the numbers, management, and duration of ohservation of the cases upon which his conclusion is based.
Further on Footprinting
Authors: Shepard Kenneth S.
Published: December 2021

In "Letters to the Editor" in your December 1968 journal (Pediatrics, 42:1012), there appeared a letter from a Doris Gleason, RRL, Director, Medical Record Research Bureau, Hollister, Inc., 211 E. Chicago Avenue, Chicago, Illinois 60611. This letter indicated that the general use of routine footprinting of infants in the delivery room is a valid and necessary procedure.

It is still our opinion, after consulting with many hospitals and many university hospitals and viewing footprinting techniques, that over 80% of the footprints taken are completely unrecognizable.
The Surfactant System of the Lung, by Emile Scarpelli, M.D., Ph.D. Philadelphia: Lea and Febiger, 1968, 296 pp., $14.60
Authors: Brumley George W.
Published: December 2021

This monograph, with a foreword by Mary Ellen Avery, correlates current information pertinent to surface tension as a potent dynamic force in pulmonary physiology and pathology. The author's expertise as pediatrician and physiologist is evident in the smooth organization of the text, beginning with the defense of surface tension as an important mechanical retractive force in the alveolus to the consideration of the effects of nebulization, pollutants, and pneumogalactan on the alveolar lining layer. The material presented is well referenced and, in general, presented without bias.
A SHORT ESSAY ON CONTENTMENT READ BY AMERICAN CHILDREN IN THE 1780'S
Authors: C. T. E.
Published: December 2021

Early children's schoolbooks in this country leaned heavily On the belief that Divine Law foreordained a man's station in life. Not to accept this tenet led to discontentment and-even worse-pride and arrogance. The "contentment" that comes from accepting one's place in the social order is clearly described in a passage from one of the first children's readers written just after the American Revolution.

Contentment

Forget not that thy station on earth is appointed by the wisdom of the eternal; who knoweth thy heart, who seeth the vanity of all thy wishes, and who in mercy often denieth thy request; yet for all reasonable desires, for all honest endeavors, his benevolence hath appointed, in the nature of things, a probability of success. The uneasiness thou feelest, the misfortunes thou bewailest, behold the root from whence they spring, even thine own folly, thine own pride, thine own distempered fancy; murmur not therefore at the dispensations of God, but correct thine own heart; neither say within thyself, if I had wealth or power, or leisure, I should be happy; for know, they all of them bring to their several possessors their peculiar inconveniences.

The poor man seeth not the vexations and anxieties of the rich; he feeleth not the difficulties and perplexities of power, neither the wearisomeness of leisure, and therefore it is that he repineth at his own lot.

But envy not the appearance of happiness in any man, for thou knowest not his griefs. To be satisfied with a little, is the greatest wisdom; and he that encreaseth his riches, encreaseth his cares; but a contented mind is a hidden treasure, and trouble findeth it not.
A STUDY OF THE NEED FOR ALTERNATIVE TYPES OF HEALTH CARE FOR CHILDREN IN HOSPITALS
Authors: Robinson Geoffrey C. , Shah Chandrakant P. , Argue Corinne , Kinnis Claire , Israels Sydney
Published: December 2021

A study at the Health Centre for Children of the Vancouver General Hospital was undertaken to determine the need for alternative care facilities for a population of children in hospitals. The alternative facilities were a day-care medical unit, a short-stay surgical unit, an extended custodial unit, and a longer-stay rehabilitation unit. Predetermined criteria for the utilization of alternative facilities were prepared in advance.

Two thirds of the children in the hospital were found to require conventional hospital care. Nearly one quarter of the children required facilities for short-stay surgery, with admission and discharge the day of surgery. Day-care medical facilities were also required, but to a lesser extent (7%). A small number of children (3%) required the longstay facilities, and they occupied a disproportionately large number of conventional hospital days (20%). It was estimated that the availability of alternative facilities could result in a saving of approximately 27% of hospital days. The number of patients and days in the various alternative care patterns for the medical and surgical subspecialties were also studied.
CHILDREN IN THE 1860'S WERE ADVISED TO SLEEP ON THEIR RIGHT SIDE: BY E. SMALL, M.D
Authors: C. T. E.
Published: December 2021

Anatomy and physiology were taught in just a few of the common (public) schools and academies (independent schools mostly for boys) prior to our Civil War. One of the most widely read textbooks on these subjects, at least in Boston, was written by Dr. E. Small, a general practitioner. His book was commonly known a century ago by the title The Laws of Health Made Plain.

Dr. Small let his young readers know that the position in which they slept was important. He wrote as follows:

The position for sleeping is of consequence. The recumbent is preferable, but not indispensable,-I mean for a healthy person. Some sleep on the back, but this is objectionable, as it is liable to produce nightmare, in consequence of the pressure of the organs of the chest upon the aorta and other vessels. The sick can often lie and sleep on the back better than in any other position. For the healthy, sleeping on the right side is the most favorable. There are physiological causes for its being so. . . .

The most favorable position for sleeping is that in which the blood and other fluids circulate the most freely and with the least obstruction. When lying on the back, as I have said, the organs of the thorax press upon the aorta and thoracie [sic] duct, obstructing the passage of blood and chyle. Lying on the left side obstructs the free flow of the blood through the lung, by the pressure of the heart upon it, the heart being situated to the left of medial line of the chest.
SPLENECTOMY IN CHILDHOOD AND THE HAZARD OF OVERWHELMING INFECTION
Authors: Diamond Louis K.
Published: December 2021

Splenectomy is a necessary remedial operation in a number of conditions in childhood; in others it is of questionable value. In traumatic rupture of the spleen, the necessity for removal of the organ is absolute and immediate; in aplastic anemia there is little need for haste and the possible benefit of the operation is doubtful. Between these extremes, there are several gradations (Table I).

In the last 12 years, attention has been called to the greater frequency of sudden overwhelming infection in the splenectomized infants or children as compared to those with intact spleens. There are conflicting opinions about this danger. Some see no greater risk after splenectomy than after appendectomy; many others believe that the hazard is so specific as to contraindicate splenectomy in childhood, even when it might relieve acute or chronic hemolysis.

The syndrome of overwhelming postsplenectomy infection (OPSI) is unlike most fulminating bacteremias and septicemias in ordinary (spleen-containing) individuals. Very few patients with bacteremia progress from good health to death in less than 24 hours, whereas the OPSI syndrome constitutes a distinct entity which often lasts only 12 to 18 hours. It may begin abruptly with slight sore throat, fever, and "feeling or looking sick," proceed to headache, vomiting, and hyperpyrexia; and be followed within a few hours by convulsions or coma and death. In the uncomplaining infant, the prodromata of spreading infection may be absent or missed.

The pneumococcus is usually the invading organism. The meningococcus or influenza bacillus have also been blamed, but these infections last several days and are less fulminant.
Mumps Virus Vaccine
Authors: Bock Lewis L.
Published: December 2021

For several years a number of pediatricians have been on an advisory committee on immunizations to the Montana State Board of Health. At the last meeting I was commissioned to write the Committee on Control of Infectious Diseases regarding the mumps virus vaccine and the recommendations which at that time had not been revised, but which subsequently have been. I am taking the liberty of also sending a copy of this letter to the editor of Pediatrics.
INTERMITTENT CEREBELLAR ATAXIA ASSOCIATED WITH HYPERPYRUVIC ACIDEMIA, HYPERALANINEMIA, AND HYPERALANINURIA
Authors: Lonsdale Derrick , Faulkner Willard R. , Price J. Waide , Smeby Robert R.
Published: December 2021

This report describes the case of a child with optic atrophy and intermittent episodes of ataxia recurring after infection or injury. During one such 8-day episode the child remained under continuous observation until spontaneous regression occurred. The illness was shown to be associated with increased serum levels of pyruvate, lactate, and alanine, together with a tremendous increase in the excretion of these compounds in the urine.

Ataxia and mental confusion increased throughout the day, being most severe in the evening. There was a synchronous increase in pyruvicuria and alaninuria during the day; their concentrations decreased in the urine at night. These observations suggested the possibility of a partial block in the oxidative decarboxylation of pyruvic acid and that the encephalopathy was similar to that described by Wernicke in which pyruvate levels are increased in the serum because of deprivation of thiamine. Pharmacologic doses of vitamin B complex had no effect on the concentration of pyruvate on alanine in the urine when the child was considered to be well, but massive doses of thiamine did cause decreases in these concentrations. It is considered possible that this may be the first example of vitamin B1 dependency.
EFFECTIVE PATIENT CARE IN THE PEDIATRIC AMBULATORY SETTING: A STUDY OF THE ACUTE CARE CLINIC
Authors: Fink D. , Malloy M. J. , Cohen M. , Greycloud M. A. , Martin F.
Published: December 2021

Our study used family compliance and understanding as indices of effectiveness. In a control population of 142 cases, effectiveness averaged 52% of the desired level but only 8% achieved desired levels of effectiveness in all measured categories. Scores were highest in appointment keeping, lowest in understanding of the child's condition, and intermediate for medication taking and procedure performance. The services of family health management specialists were added to the regular clinic services and resulted in significant improvement in all measured categories. These specialists were trained public health nurses and directed their efforts to an understanding of total family health situation and the capacity and resources of the family for completing recommended care. They undertook full responsibility for medical follow-up in a significant number of cases. Through them the average percentage of effectiveness was raised to an average of 82% of the desired level, although only 31% of the cases were judged to be at an adequate level in all of the categories.

Questions still unanswered are which aspects of the services of the family health mnanagemcnt specialist were responsible for the improvement in effectiveness, whether non-professionals can achieve the same improvements, and whether such services can he applied to other clinic and private practice settings.
SUDDEN, UNEXPECTED, AND UNEXPLAINED DEATH IN INFANTS
Authors: Fitzgibbons John P. , Nobrega Fred T. , Ludwig Jurgen , Kurland Leonard T. , Harris Lloyd E.
Published: December 2021

Among 210 deaths in infants aged 2 weeks to 2 years in Olmsted County, Minnesota, during the 20-year period 1946 through 1965, review of the clinical and pathologic reports disclosed 37 instances of sudden, unexpected, unexplained death (SUUD). The incidence rate was 1.2/1,000 live births. The death occurred between midnight and noon in 90% of cases, and all but one of the children were found dead in bed. Some seasonal variation was noted.

Autopsy was done in 75% of the 210 instances, including 86% (32) of the SUUD cases. More than two thirds of the cases of SUUD coming to autopsy had some evidence of an infectious disease, but these findings were minimal and in no case sufficient in themselves to cause death. Therefore, it was concluded that a second factor is necessary to initiate the sequence of events that leads to death, although the specific trigger mechanisms are unknown and may be quite variable.
GROWTH AND GROWTH HORMONE. IV. LIMITATIONS OF THE GROWTH HORMONE RESPONSE TO INSULIN AND ARGININE AND OF THE IMMUNOREACTIVE INSULIN RESPONSE TO ARGININE IN THE ASSESSMENT OF GROWTH HORMONE DEFICIENCY IN CHILDREN
Authors: Youlton R. , Kaplan S. L. , Grumbach M. M.
Published: December 2021

The growth hormone (GH) response to insulin-induced hypoglycemia and to arginine infusion has been evaluated in 60 children with growth retardation. These children have been classified into three groups:

Group 1-9 children had peak serum growth hormone values of 7 mµg/ml or greater to both stimuli, a normal growth hormone response.

Group 2-18 children had peak GH values of ≤ 3 mµg/ml to both stimuli, an abnormal response indicating growth hormone deficiency.

Group 3-6 children had a blunted GH response (> 3 < 7 mµg/ml) to both stimuli; 8 showed a normal rise in serum GH following arginine infusion (> 7 mµg/ml) but exhibited no rise, or a minimal one, following insulin administration; 9 children had minimal increase in serum GH concentration following arginine infusion but showed a normal GH response to insulin administration (> 7mµg/ml).

Children included in Group 3 represent a heterogenous population. In some patients with a blunted response to both stimuli, evidence of partial or less severe form of GH deficiency was found, whereas in 17 of 18 children exhibiting a disparate response the impaired growth was not attributable to growth hormone deficiency.

The blood glucose at all sampling periods was significantly lower following insulin administration in patients in Group 2 than that observed for children in Group 1 and 3. The blood glucose was significantly lower at 90 and 120 minutes following arginine infusion in Group 2 compared to values for patients in Group 1 and 3.

Changes in serum insulin in response to the infusion of arginine did not provide a useful index of discrimination among these groups.

Administration of diethylstilbestrol, 10 mg/day times 2 days, prior to testing can modify the GH response to both hypoglycemia and arginine; it is a useful ancillary procedure in children with blunted or disparate responses.

These studies suggest that two types of stimulation tests are necessary to establish the diagnosis of isolated GH deficiency with a high degree of probability.
THE CAUSES FOR LOW SPINAL FLUID SUGAR IN BACTERIAL MENINGITIS: ANOTHER LOOK
Authors: Menkes John H.
Published: December 2021

One of the most characteristic abnormalities of cerebrospinal fluid (CSF) in patients with bacterial and tuberculous meningitis is a decrease in its glucose content. This finding, first observed by Lichtheim, was initially attributed to utilization of glucose by the bacteria growing in the fluid This explanation, as many subsequent ones, has been abandoned in the light of conflicting experimental evidence, and at present the mechanisms inducing a low CSF sugar are enigmatic. Recent publications bearing on this problem prompt a review of the factors involved in lowering cerebrospinal fluid sugar.

Goldring and Harford found that the utilization of glucose by concentrations of pneumococci equal to or higher than those usually seen in meningitis was too small to be measured and could, therefore, not affect the spinal fluid sugar in the face of a normal mechanism for its replenishment.
Long Survival in a Male with 18-Trisomy Syndrome and Wilms' Tumor
Authors: Geiser C. F. , Schindler A. M.
Published: December 2021

At 11½ years of age, this patient is the oldest known surviving male with the 18-trisomy syndrome verified by autoradiographic studies of peripheral leucocytes. He presents, in addition, the unusual finding of a Wilms' tumor, which was removed at the age of 2 years.
THE UNIVERSALITY OF OTITIS MEDIA IN 50 INFANTS WITH CLEFT PALATE
Authors: Paradise Jack L. , Bluestone Charles D. , Felder Herman
Published: December 2021

Bilateral secretory (serous) or suppurative otitis media was found without exception in 50 infants with cleft palate who were 20 months of age or younger. Middle ear disease probably develops in all cleft palate infants during the first few months of life, and appears to be best managed by myringotomy with insertion of plastic tubes. Unless drainage and aeration of the middle ear are accomplished, irreparable damage to middle ear structures may develop in some patients; and, in all of them, hearing impairment will probably persist throughout infancy or longer, with adverse effects on well-being and function and with serious implications for intellectual, speech, and emotional development. Further studies are required to assess the long-range effectiveness of surgical management.
CHRONIC RESPIRATORY DISTRESS IN THE PREMATURE INFANT
Authors: Hodgman Joan E. , Mikity Victor G. , Tatter Dorothy , Cleland Robert S.
Published: December 2021

Thirty-four premature infants with Wilson-Mikity syndrome were seen during a 7-year period. Insidious onset of mild respiratory symptoms usually began after the first week of life. These symptoms became increasingly severe and reached maximum intensity from 4 to 8 weeks later. One quarter of the infants died during this stage. In survivors, the respiratory symptoms cleared slowly over the next months and completely disappeared in all but one infant by 2 years of age.

The chest radiograph was consistent and distinctive. Diffuse, streaky infiltrate with small cystic areas appeared during the first stage and progressed as the clinical symptoms increased. The second stage was characterized by basilar hyperaeration with residual strands in the upper lobes. These changes slowly cleared as the clinical symptoms disappeared.

Eleven lung biopsies were performed, and all 12 infants who died were autopsied. The pathologic picture progressed from an early, immature pattern through areas of hyperinflation and collapse in the first stage, to diffuse overinflation during the second stage. Two infants had pulmonary fibrosis.

We consider the most likely pathogenesis of the syndrome to be an abnormal air distribution with a disturbance in ventilation/perfusion ratios secondary to characteristics of the immature lung.
Comprehensive Care of an 8-year-old Boy Following Traumatic Amputation of the Glans Penis
Authors: Vincent H. Bartlett , Rothenberg Michael B.
Published: December 2021

We have presented a case of a child severely traumatized, both physically and emotionally. We feel that this and similarly difficult cases are well within the field of competent, comprehensive care that the pediatrician can provide. By means both of his proximity to the problems and in most cases by his familiarity with the psychological makeup of the patient, he is in the best position not only to initiate but to carry through prophylactic psychiatric care. The goals of minimizing both the trauma of hospitalization and long-term psychiatric sequelae can best be met by the pediatrician who can, in a non-threatening and in a non-pressuring manner, first listen to and then talk with the child and outline the thoughts and feelings that might occur in children similarly incapacitated.

The child's ability to communicate can be facilitated by using a three-step process including the "third person technique" and the "option play" which have been outlined. Finally, it is our impression that the pediatrician often underestimates his ability to assume the role of primary physician, who is responsible for the total care of the child.
LUNG TAP IN CHILDHOOD
Authors: Hughes James R. , Sinha Dinesh P. , Cooper Mehroo R. , Shah Keerti V. , Bose Sisir K.
Published: December 2021

Eighteen acute lower respiratory tract infections in 16 young children in Calcutta, India, were investigated for bacteria, viruses, and mycoplasmas by methods which routinely included lung tap. Cultures of the nasopharynx, throat, and tracheal aspirate yielded moderately helpful but imprecise data, whereas the lung tap was quite specifically informative and was relatively safe. Seven lung taps were culturally positive for recognized pulmonary pathogens; six of these yielded Hemophilus influenzae alone or accompanied by other organisms. Poliovirus, type 1, was an unexpected lung tap isolate and was the only virus recovered from a bacteriologically sterile lung tap. A complex interaction of bacterial and nonbacterial agents was suggested by the evidence in all but 3 of the 18 instances of more than one potentially pathogenic organism. Since the population studied was definitely abnormal by North American standards of length, weight, and subcutaneous fat thickness, the authors suggest that the microbiologic data should be applied cautiously to well nourished populations.
CALORIE REQUIREMENTS FOR WEIGHT GAIN IN INFANTS WITH GROWTH FAILURE DUE TO MATERNAL DEPRIVATION, UNDERNUTRITION, AND CONGENITAL HEART DISEASE
Authors: Krieger Ingeborg , Chen You C.
Published: December 2021

The correlation between calorie intake and weight gain was analyzed in 31 patients with growth failure who were 5 to 36 months old. The BMR and that portion of the total daily calorie intake which is responsible for weight gain ("residual calories") was calculated, using a fixed estimate for muscular activity and calorie losses. The BMR per weight predicted from height was similar to normal controls. The correlations between residual calories and gram weight gain, and between total calories per predicted weight and weight gain per predicted weight were good (p < .01). Total calories per gram weight gain followed a log-log regression on weight gain (gram/day/kilogram predicted weight) when normal standard values were used (r = .999). This relationship was examined in the patients with growth failure (r = .971). The slopes and height of the slopes were similar.

It is concluded that calorie requirements were predictable, because the BMR and the calorie cost of weight gain were predictable. Calorie losses and muscular activity apparently did not vary significantly in this patient sample. Calorie requirements were roughly comparable to those of normal infants when predicted weight was used as reference standard, because the BMR predicted weight was normal and other expenditures apparently did not differ significantly from those to be expected of well children of the same age.
INCIDENCE OF HIGH BLOOD LEAD LEVELS IN CHICAGO CHILDREN
Authors: Blanksma Lorry A. , Sachs Henrietta K. , Murray Edward F. , O'Connell Morgn J.
Published: December 2021

The Chicago Board of Health in October 1986 began a mass-screening program using a blood lead test to detect lead poisoning in children. Atomic absorption spectroscopy made it possible to screen 5,000 specimens in 1 month, and to test a total of 68,744 children in 2 years.

The incidence of high blood lead values was variable and seasonal it was lowest in November through January and highest in June. Control children exhibited the same seasonal variation in lead levels as did the children at-risk for lead poisoning.

As a result of this program, 1,154 children were treated with chelates for lead poisoning in 1967 and 1968 at the Lead Poisoning Clinic, and the incidence of high blood lead levels among children living in the same areas declined from 8.5% in 1967 to 3.8% in 1968.
Vitamin K Deficiency After the Newborn Period
Authors: Goldman Herbert I. , Amadio Peter
Published: December 2021

Sixty infants, 1 to 18 months of age, with diarrhea, were treated with a skimmed milk diet and succinylfathiazole. Thirty received supplemental vitamin K1 and had oral vitamin K intakes, expressed as K1 activity, of 16.1 to 36.3 µg/kg/day. Hypoprothrombinemia was not observed. Thirty did not receive supplementation and had intakes, similarly expressed, of 9.2 to 29.5 µg/kg/day. A single episode of hypoprothrombinemia was recorded on an intake of 9.8 µg/kg/day.

In a group of 15 infants with clinical bleeding episodes due to vitamin K deficiency, the oral vitamin K intakes, expressed as K1 activity, were 0.0 to 8.4 µg/kg/day.

These data suggest that, in infants who have diarrhea and/or are receiving antimicrobials, there exists a risk of vitamin K deficiency if the dietary intake contains less than the approximate equivalent of 10 µg/kg/day of vitamin K1 activity.
REVIEW OF PURPOSE, SCOPE, AND FUNCTION
Authors: Fried Ralph I. , Baratz Merrill A. , Cermak Ethel G. , Feiertag Richard B. , Lewis Donald , Seidel Henry M. , Work Henry H. , Chenoweth Alice D.
Published: December 2021

At its meeting May 8-9, 1969, the Committee on Adoptions accepted the directive of the Executive Board which created the new Council on Child Health, consisting of the Committees on Adoptions, Infant and Preschool Child, Children with Handicaps, School Health, and Youth.

The Committee on Adoptions unanimously agreed that it is important it retain its autonomy and continue to function as a standing committee of the Academy. The Committee concurs that the following facts justify this conclusion:

1. Out-of-wedlock births are currently showing a relative and absolute increase. Since these births are a major source of babies for adoption and until this situation is reversed, adoption will remain a major pediatric consideration.

2. As the social structure of our nation undergoes evolutionary change, new questions arise in adoptions, such as the value of placement of interracial children in Caucasian homes. The Committee must help the Academy resolve these questions.

3. Adoption procedures are undergoing major changes and improvements, catalyzed by the work of the Committee in conjunction with adoption agencies.

4. Guides for the pediatric care of the adopted child will he established by the Committee.

5. Important areas of research in adoptions are not concluded, such as the etiology and incidence of severe emotional problems in adopted children.

6. Much of the work of the Committee is concerned with behavioral pediatrics-one of the most important areas in the future of pediatrics.

7. One function of the Committee should be the continuing revision of the manual on adoptions.

8. The Committee should address itself to the many issues that are involved in abortions, family life education, and contraception.
COMPETITIVE ATHLETICS FOR CHILDREN OF ELEMENTARY SCHOOL AGE
Authors:   American Academy of Pediatrics,   Committee on the Medical Aspects of Sports, American Medical Association,   The American Association for Health, Physical Education and Recreation,   The Society of State Directors of Health, Physical Education, and Recreation
Published: December 2021

Competitive sports organized by school or other community agencies are now played so universally in all parts of the country by children 13 years of age and younger that the above organizations wish to suggest positive and realistic guidelines to govern participation.

Children of this age are not miniature adults; they are boys and girls in the process of maturation into adults. They seek and can profit from suitable play opportunities, but the benefits are not automatic. High quality supervision and a broad range of physical education activities, including sports adapted to the needs and capacities of growing children, are required for full realization of benefits.

A variety of competitive sports, appropriately a part of a sound physical education program, has the advantage of directing funds, facilities, instruction, and leadership toward all children in the school system or community. Such a program avoids providing a narrow sports experience for children or one directed only to the physically gifted, the well developed, the skillful, or the precocious child.

The problems involved are sufficiently significant and variable to warrant each community's having a local committee representing education, recreational, and medical specialists. Decisions about all school or community athletic programs may then be made in terms of local interest and needs, adequate supervision, and assurance of proper safeguards. Such decisions about athletic programs for children of elementary school age should embody local consideration of the following:

1. Proper physical conditioning.

2. Conduct of the sport: (a) competent teaching and supervision with regard for the relative hazards of each particular sport; (b) modification of rules, game equipment and facilities to suit the maturity level of the participants; (c) qualified officials.
Admission to an Adolescent Ward
Authors: Schowalter John E. , Lord Ruth D.
Published: December 2021

Admission reactions of younger children to the hospital are ivell described, but little has been published about experiences on adolescent units.

METHOD In order to determine adolescents' reactions to hospitalization, 200 semi—structured interviews were conducted: 100 with patients on the Ward for Older Children and 100 with their parents. Age is the only criterion for a patient's admission to the ward. Niale as well as female, private as well as non—private, and surgical as well as medical patients are together On the same floor. The median length of stay is 5 days. The 100 patients studied were randomly selected and included 55 girls and 45 boys.
Complications of Umbilical Vessel Catheterization: Peritoneal Perforation
Authors: Van Leeuwen G. , Patney M.
Published: December 2021

Umbilical artery catheterization has been performed for approximately 6 years for diagnostic and investigative studies, and more recently for intravascular fluid therapy. We recently encountered a complication—perforation of the peritoneum—which illustrates another potential danger of this procedure.

CASE REPORT Baby Y., a 1,590 gm female infant, was delivered in a community hospital. She was delivered with membranes intact but aspirated amniotic fluid containing meconium when the membranes were removed.

At 20 minutes of age examination revealed marked intercostal retractions, a respiratory rate of 60 per minute, and cyanosis. Roentgenograms of the chest showed a fine reticular pattern. An umbilical vein catheter was inserted, but blood could not be aspirated.
Prognosis in Child Psychiatry, by Hilchen Somerschild Sundby, M.D., and Peter Christian Kreyberg, M.D. Oslow, Norway: Universitetsforlaget, 1969, 117 pp., $13.50. (The Williams and Wilkins Company, Baltimore, Maryland 21202, exclusive U.S. agents.)
Authors: Crowell William M.
Published: December 2021

This small, well written, and well arranged book printed in Norway is a statistical study of 285 Norwegian children admitted as in-patients to the then new Department of Child Psychiatry of the Rikshospitalet, Oslo, in the period 1950 to 1954; all were followed up in 1965. The authors have compared the original diagnoses of 1950—1954 with those of 1965, and the data thus obtained are considered in various statistical ways with conclusions being drawn therefrom.