bluuebunny/crossref_metadata_2025 huggingface dataset:
PARAHEMOPHILIA (OWREN'S DISEASE)
Authors: REDNER BERNARD , SCALETTAR HOWARD , WEINER MURRAY
Published: December 2021

A case of parahemophilia in a five year old child has been presented. This case follows the pattern first described by Owren, namely, a congenital hemorrhagic disease with deficient prothrombin activity by the one-stage method correctable by the addition of prothrombin-free plasma. The positive laboratory findings consisted of a prolonged prothrombin time and a slightly prolonged clotting time. Ac globulin deficiency was confirmed both by Dr. Seegers and by Dr. Stefanini. There was no abnormal fibrinolytic activity or fibrinogen deficiency. Serum prothrombin activity indicated that a deficiency of Factor V was accompanied by decreased prothrombin consumption. There was no response to prolonged vitamin K therapy. Blood and plasma transfusions temporarily controlled bleeding, although at no time was a normal one-stage plasma prothrombin time obtained.
THE GASTROINTESTINAL ABSORPTION OF UNALTERED PROTEIN IN NORMAL INFANTS AND IN INFANTS RECOVERING FROM DIARRHEA
Authors: Gruskay Frank L. , Cooke Robert E.
Published: December 2021

The serum concentration of egg albumin after the oral administration of 1 gm./kg. of purified egg albumin was determined by means of a quantitative immunochemical technique in 21 infants recovering from diarrhea and in 19 control subjects of the same age. In the patients with diarrhea the concentrations were significantly greater than in the controls. The use of hypoallergenic food in the recovery phase of diarrhea is recommended.
FAMILIAL DYSAUTONOMIA
Authors: Harris Jerome R. , Gall Henry , Wasser Sidi
Published: December 2021

The case of an infant with familial dysautonomia, complicated by an aspiration (lipoid) pneumonia, is presented. The additional manifestation of tongue-biting was attributed to underlying psychiatric disorder.
REVIEW ARTICLE
Authors: Iversen Torben
Published: December 2021

This paper gives a survey of the picture of electrolyte disturbance and virilization due to congenital adrenocortical hyperplasia, for which the term "dysadrenocorticism" has been coined.

The series comprises 135 patients, 57 boys and 78 girls.

The incidence of dysadrenocorticism in siblings was 24 per cent. The disorder manifested itself without any relation to birth order.

The clinical manifestations referable to the electrolyte disturbance began during the first week in half the patients and in all of them before the age of 7 weeks. Apathy, hypotonicity and refusal of feedings were commonly described. Vomiting was present in 126 cases (93 per cent) and was described as projectile in 37 of these cases. Diarrhea was observed in 45 cases (33 per cent). Crises with episodes of circulatory collapse were described in 88 cases (65 per cent). Loss of weight during the first few months after birth occurred in at least 109 cases (81 per cent). Dehydration and/or emaciation were observed at the time of admission in 123 cases (91 per cent). Pigmentation of the skin was found in 13 cases (10 per cent).

In male infants the external genitals were usually of normal appearance at birth. In 6 males, however, hypospadias was described. Enlargement of the penis was observed during the first 2 months of life in 7 patients, and in all boys more than 2 years of age. All the female infants except 3 presented pseudohermaphroditism with hypertrophy of the clitoris and common urogenital orifice.

The laboratory investigations showed electrolyte disturbance as in adrenocortical insufficiency. The serum concentration of sodium was below 135 mEq./l. in 34 of 37 cases, and the concentration of potassium above 5.8 mEq./l. in 31 of 36 cases. Hypoglycemia was observed in only 1 of 24 cases. The urinary excretion of 17-ketosteroids in 30 infants ranged from 1.8 to 16 mg. daily. The excretion of 11-oxycorticoids in the urine was normal or increased. Eighty-one of the patients (36 boys and 45 girls) received no specific treatment and all cases terminated fatally. Twenty-one patients died during the first month of life, and 32 within the second month. All non-treated patients except 1 died during the first 13 months of life.

Fifty-four patients (21 boys and 33 girls) were given specific treatment with sodium chloride combined with desoxycorticosterone and/or adrenocortical extract. Several of these patients were also treated with cortisone. Thirty-five patients (14 boys and 21 girls) were alive at the time when the reports were published. Twenty-five patients reported before 1953 were followed up in 1954. At the follow-up examination a total of 19 patients were alive; 5 boys and 5 girls were 5 years of age or older. In 12 patients, of whom 5 were 5 years of age or older, specific treatment of the electrolyte disorder was still required.

The adrenals showed diffuse bilateral hyperplasia in 98 of 100 cases. The total weight of the adrenals ranged from 11 to 34 gm. in 64 patients who died before the age of 12 months. The histologic picture was variable.
Clinical Biochemistry
Authors: BULL HENRY B.
Published: December 2021

This is the latest edition of a well-known textbook on clinical biochemistry designed essentially for use by advanced medical students and by practicing physicians.

There are 12 chapters beginning with the metabolism of carbohydrates, lipids, proteins and nucleic acids and continuing through the metabolism of iron, sulfur, iodine, etc. There are chapters on electrolytes, water and acid-base balance and on oxygen and carbon dioxide transport. There is a lengthy and impressive section on endocrine function followed by a short summary of the vitamins.
HYPERTONIC DEHYDRATION IN INFANCY
Authors: Weil William B. , Wallace William M.
Published: December 2021

Dehydration, biochemically characterized by increased concentrations of sodium and chloride in the extracellular fluid, is a frequent result of diarrhea in infants. The genesis of the hypernatremia and hyperchloremia lies in the relatively greater expenditure of water than electrolyte via skin, lungs, stool and urine. The significance of these events in terms of distribution of body water and cation are discussed. The water deficit in these infants is primarily intracellular. Cation deficits are minimal.

The majority of infants with this type of dehydration present certain clinical signs that should serve to make the clinician aware of the abnormality of concentration. These infants show varying degrees of depression of central nervous system varying from lethargy to coma. Convulsions are frequently observed during the course of the disturbance. While dehydration, as measured by water retention during recovery, is invariably present, the traditional signs of water deficit are deceptively absent.

Dilute solutions of electrolyte are indicated in repair. Rapid adjustment, however, of the concentration abnormality appears to accentuate the central nervous system disturbance. Repair is best carried out in a leisurely manner over a 2- to 3-day period.
GASTROENTERITIS IN INFANTS ASSOCIATED WITH SPECIFIC SEROTYPES OF ESCHERICHIA COLI
Authors: Stock Aaron H. , Shuman Mary E.
Published: December 2021

Except in the face of an epidemic the incidence of isolation of E. coli 0111:B4 and 055:B5 in the Pittsburgh area, as reflected by bacteriologic studies carried out on all patients with gastroenteritis admitted to a children's hospital, was low in a 3-year period. The incidence of salmonella infections was relatively higher. No shigella infections were found.

It may be seen from the tables that in approximately 80 per cent of the patients with diarrheal disease no enteric bacteria known to be pathogenic could be isolated.
GASTROENTERITIS IN INFANTS ASSOCIATED WITH SPECIFIC SEROTYPES OF ESCHERICHIA COLI
Authors: Stock Aaron H. , Shuman Mary E.
Published: December 2021

The history of outbreaks of infantile gastroenteritis associated with a specific bacteriologic serotype, Escherichia coli 0111:B4, has been presented.

The data presented in this paper add weight to the thesis that E. coli 0111:B4 is a pathogenic agent, especially in newborn infants. The reports of other investigators on other phases has also been corroborated, namely, the high contagiousness of the organism and the preponderance of the specific serotype in the aerobic fecal flora in the initial stages of infection.
STUDIES ON RESPIRATORY RATE IN THE NEWBORN
Authors: Haddad Heskel M. , Hsia David Yi-Yung , Gellis Sydney S.
Published: December 2021

Data has been presented to show that the respiratory rates of infants of diabetic mothers are significantly higher than those of normal full-term infants. [SEE TABLE VI IN SOURCE PDF].

Although the respiratory rates of premature infants and normal infants delivered by cesarean section are slightly higher than those of normal full-term infants, they are insufficient to account for the marked increase of respiratory rates in infants of diabetic mothers. The high incidence of pulmonary hyaline membranes in these infants appears to be the most likely explanation for the elevated respiratory rates.

Cortisone does not appear to materially affect the respiratory distress nor the respiratory rates in infants of diabetic mothers.

Although the results obtained in the present study do not directly clarify either the etiology nor the mechanism for formation of hyaline membranes in infants of diabetic mothers, the simple measurement of respiratory rates does provide an objective means for evaluating therapy in controlled trials.
CORTICOIDS IN SERUM OF CHILDREN WITH TREATED DIABETES MELLITUS
Authors: Klein R. , Weigand F. A. , lunes M. , Greenman L.
Published: December 2021

Free serum corticoids in children with treated diabetes mellitus were found to be significantly higher than those in normal children. The level of serum corticoids was directly related to the amount of reducing substances found in the urine and was inversely related to the carbon dioxide content of the sera.
THE RISK OF POLIOMYELITIS INFECTION AMONG EXPOSED HOSPITAL PERSONNEL
Authors: Wehrle Paul F.
Published: December 2021

Hospital personnel caring for acute poliomyelitis patients were studied for serologic evidence of infection by the 3 types of poliomyelitis virus during 1 poliomyelitis season.

Although nearly one-third of the personnel were presumably susceptible to the types of poliomyelitis virus present in the cases and an additional and slightly smaller proportion had antibody in low titer, there was no evidence of transfer of infection under these circumstances, as measured by increases in neutralizing antibody titer.

The striking difference between the rate of infection among members of households where a case has occurred and among hospital personnel is believed to be due chiefly to a decrease in the infectiousness of cases at the time of hospitalization.

The usual hospital isolation techniques appear adequate to prevent transmission of virus from the patient to susceptible personnel under the conditions of hospital exposure.
CEREBELLAR ASTROCYTOMA IN CHILDHOOD
Authors: Matson Donald D.
Published: December 2021

Thirty-four children with cerebellar astrocytoma have been treated at Children's Medical Center in Boston during the last 7 years. There was no operative mortality. The case mortality to date is 5.8 per cent.

Thirty-two of the thirty-four children are alive and free of increased intracranial pressure. Six have moderate and 2 have severe [See FIG. 8. in Source Pdf] neurological disturbance in the form of residual ataxia and cranial nerve disturbances. The other 24 patients are leading normal lives, and show no abnormality on neurological examination.

The importance and desirability of early recognition and complete one-stage surgical removal of cerebellar astrocytomas, which represent 20 per cent of all intracranial tumors of childhood, is emphasized by the high rate of cure which can be achieved.

It is estimated that the rate of cure for this intracranial tumor should be about 90 per cent. Significant neurological disturbance should probably not persist in more than 15 to 20 per cent of these patients.
DEVELOPMENT OF ANTIBODIES TO ENTERIC PATHOGENS: PLACENTAL TRANSFER OF ANTIBODIES AND DEVELOPMENT OF IMMUNITY IN CHILDHOOD
Authors: Yeivin Rina , Salzberger M. , Olitzki A. L.
Published: December 2021

Sera of newborns show a much lower content of antibodies against E. coli, serotypes 055 and 0111, than the corresponding maternal sera.

The bactericidal test yielded a higher percentage of positive results than the hemagglutination test with sensitized erythrocytes, and the titration of inactivated sera in the presence of a constant amount of guinea pig complement gave higher titers than the titration of active human sera without added complement.

The hemagglutination titer for erythrocytes sensitized with extracts of pathogenic E. coli or Shigellae rises from the third month until the peak of the average titer for all enteric pathogens tested is reached in the fourth year of life.

The highest percentage of positive reactors is reached for most of the strains at the age of 15 years, indicating that after the age of 5 years further contacts with these pathogenic microorganisms still take place.
SULFONAMIDE ADMINISTRATION IN NEWBORN AND PREMATURE INFANTS
Authors: Fichter Elaine G. , Curtis John A.
Published: December 2021

All newborn infants, both full-term and premature, who received, on the first day of life, a single subcutaneous injection of sulfadiazine, 100 mg./kg. body weight, maintained a satisfactory concentration of sulfonamide in the blood for 48 hours thereafter. This therapeutic concentration was subsequently maintained by single 24-hour doses of 50 mg./kg. body weight given subcutaneously, or by single 12-hour doses of 50 mg./kg. body weight given orally. A therapeutic concentration in the blood is generally considered to be a minimum of 5 mg./100 ml.

Based on these data the authors recommend the following sulfonamide dosage schedules:

A. Infants under 24 hours of age, full-term and premature: 1) subcutaneous sodium sulfadiazine, initial dose 100 mg./ kg. body weight, followed in 48 hours by 50 mg./kg. body weight as a single dose, and repeated each 24-hour period thereafter, or 2) subcutaneous sodium sulfadiazine, initial dose 100 mg./kg. body weight, followed in 48 hours by an oral preparation in the amount of 50 mg./kg. as a single oral dose, each 12-hour period thereafter. (This was evaluated only in full-term infants.)

B. Premature infants over 48 hours of age. (This dosage schedule is comparable to that generally accepted for older infants and children): 1) subcutaneous sodium sulfadiazine, initial dose 100 mg./kg. body weight, followed in 12 hours by 50 mg./kg. body weight as a single dose, each 12-hour period thereafter, or 2) oral sulfonamide preparation, initial dose 100 mg./kg. body weight, followed in 12 hours by 50 mg./kg. body weight as a single dose, each 12-hour period thereafter.
CONVULSIVE REACTION IN A TWO-YEAR-OLD CHILD FOLLOWING THE ACCIDENTAL INGESTION OF AN OVERDOSAGE OF ISONIAZID
Authors: Livingston Samuel , Petersen Don , Peck John L.
Published: December 2021

S. K., a 26-month-old white male, was admitted to the hospital because of several generalized convulsions in the preceding hour. The mother had tuberculous pleurisy with effusion in 1938. The father had pulmonary tuberculosis with cavitation in 1933 for which pneumothorax was induced from 1934 to 1939 and a lobectomy performed in 1940. Since 1942 neither parent showed signs of active tuberculosis.

The patient was one of twins born 3 weeks prematurely by breech presentation. Birth weight was 1,955 gm. He breathed and cried spontaneously. The neonatal period was eventful, development was entirely normal and there were no serious illnesses or convulsions.

Because of the family history of tuberculosis, the patient and 3 siblings were vaccinated on June 18, 1954 with 1/16 ml. of Rosenthal's B.C.G. vaccine (dry freeze), intradermally. Tuberculin tests preceding vaccination were negative and became positive by September 11, 1954. Because the patient had a continuously draining ulcer at the site of vaccination and a large, tender, fluctuant axillary lymph node, treatment was started with streptomycin sulfate 250 mg. twice weekly and 50 mg. of isoniazid t.i.d. on August 4. On September 11, the streptomycin sulfate was reduced to 125 mg. twice weekly, but the isoniazid was continued at the original dosage. This regimen of therapy was maintained until admission to the hospital on November 1.

About 1 hour before admission, the patient vomited several times while riding in the car with his mother. Shortly after this, the mother noted that ho seemed less alert and responsive than usual. He then had 3 generalized clonic convulsions in rapid succession, following which he became unconscious. He was brought immediately to the hospital.
A PLAN FOR MEDICAL CARE FOR ADOLESCENTS
Authors: Roth Arthur , Weissman Arthur , Linden Corinne
Published: December 2021

IN 1953 a teen-age clinic was established at the Kaiser Foundation Hospital Medical Center in Oakland, California. This report gives the reasons for establishing this medical service for adolescents; describes its setting, organization and method of operation of the service, and presents a brief review of the experience in the clinic.

Doctors differ in their approach to the dilemma of the adolescent's medical problems. Some find it an interesting and challenging experience to provide care to this in-between group; others find it unpleasant and at times forbidding. The striving of the adolescent for both independence and social acceptance, for recognition as an individual who is no longer a child and, at the same time, for the continuance of the security enjoyed as a child, may present special problems to the physician who assumes responsibility for the medical care of the adolescent.

In the medical care environment, as in other social environments, the adolescent resents being considered as a child, yet may not have the necessary understanding and background to accept being considered as an adult. The teenager is urged by parents and teachers to have periodic physical examinations and to obtain medical care for specific illnesses or injuries. His reaction to the attitudes and behavior of the receptionist, the nurse and particularly the physician can establish antagonisms to routine medical care which carry over into adulthood. In contrast, favorable reactions at this age can assist in developing a significant appreciation of the advantages of periodic examinations, disease prevention, and early detection of disease. If he learns to seek and to apply medical advice during a period of his life in which there is a low incidence of diseases that are difficult to treat, he probably will continue to do so in later years.
PROGERIA
Authors: Rosenthal Ira M. , Bronstein I. Pat , Dallenbach Frederick D. , Pruzansky Samuel , Rosenwald Alan K.
Published: December 2021

A typical case of progeria (Hutchinson-Gilford syndrome) is reported including the findings of the necropsy. Death occurred at the age of 11 years as the result of an accident. Analysis of cephalometric roentgenograms of this patient revealed that the characteristic facies of progeria results from marked retardation of facial growth in the presence of relatively normal growth of the neurocranium, and is therefore not the result of premature aging. Atherosclerosis was found in this child at necropsy. Concentrations of lipoproteins in the serum determined by analytical ultracentrifugation during life were found to be abnormally high, suggesting a metabolic error rather than premature aging of the arteries as the cause of the atherosclerosis. Psychologic studies showed the patient to be of normal intelligence with no evidence of senilism. Analysis of these data leads to the conclusion that premature aging does not occur in progeria.
SALICYLATE INTOXICATION
Authors: Riley Harris D. , Worley Lee
Published: December 2021

Forty-two cases of salicylate intoxication in infants and children observed over a 10-year-period are reviewed. The majority of the 13 cases of poisoning due to accidental ingestion occurred in the 2- to 4-year age range whereas the 29 intoxications resulting from therapeutic administration of salicylates occurred chiefly in infants. Accumulative therapy intoxication is more likely to occur in infants rather than older children not only because of an unawareness of the dangers and of the proper dose of acetylsalicylic acid, but also because of the decreased renal excretion of salicylates due to renal immaturity, and pre-renal azotemia due to dehydration resulting from the disease for which the drug is given. The marked variability in time response of an individual to salicylates is emphasized. Even in poisoning resulting from accidental ingestion, where the effects of an underlying disease do not have to be considered, the plasma concentration of salicylate, clinical response, degree of toxicity at a given concentration of salicylate, and time required for renal excretion varied greatly for children of time same age and size who ingested comparable amounts of salicylate. Severe intoxication at how concentrations of salicylate in the plasma was observed. Hyperventilation and vomiting are the most common clinical manifestations of salicylism but a hemorrhagic diathesis due to hypoprothrombinemia, hyperpyrexia, delirium or coma, circulatory collapse, and respiratory failure may be observed. The unique effect of salicylates on acid-base balance with an initial respiratory alkalosis progressing to a metabolic acidosis is discussed. A treatment program based on physiologic principles is outlined. The important role of drug ingestion, especially acetylsalicylic acid, as a cause of death is re-emphasized and a plea is made for better education and attention to the potential dangers of salicylates.
CLINICAL CONFERENCE
Authors: Wright F. Howell , Kenwood John F.
Published: December 2021

Dr. Wright: I shall describe a boy with ulcerative colitis whom we have been following for the last 15 years. His father is of Swedish extraction, American born. He is a very placid, long-suffering gentleman who enters very little into the picture which follows. His education extended slightly beyond the high school level as he went to college for 2 years at a technical school.

The boy's mother, by contrast, was born in Italy. Her family migrated to this country when she was only 9 months. They settled in Chicago and set up a closely knit family unit which spoke Italian most of the time. His mother grew up under circumstances which made her feel considerably inferior to persons around her. She had a younger sister of whom she was very jealous during the early part of her life. She also had many feelings of resentment toward her mother from whom she apparently received little or no affection. During her early childhood she had clubbed feet which were corrected by her mother by the application of an apparatus which was painful and which caused her to cry a good ideal without receiving much solace from her mother. Her education extended only through grammar school, with the addition of 2 years of secretarial training. After this, she never held a job for any length of time. She worked sporadically as a waitress. She lived at home with her family and became closely attached to them. In spite of her feeling toward her mother, she was quite dependent upon her.
BRAIN TUMORS IN CHILDREN
Authors: Odom Guy L. , Davis H. , Woodhall Barnes
Published: December 2021

IN 1889 Starr published the first comprehensive review of the problem of brain tumors in children. This report was followed by those of Read, Tooth and Critchley, representing the total experience, chiefly neuropathologic, gained from 564 patients. A high incidence of tuberculoma was noted, probably due to the prevalence of bovine tuberculosis in Europe and the inclusion in these statistics of minute tuberculomas found in cases of tuberculous meningitis. The modern treatment of this subject may be said to have commenced with successive analyses of the Cushing tumor material by Van Wagenen and by Cushing. Their findings may be summarized in the simple statement that 75% of the neoplasms of the pre-adolescent brain are malignant gliomas; numerous references are made by these authors to the almost complete absence of such common adult tumors as meningiomas, acoustic neuromas and pituitary adenomas. It is the purpose of this paper to report our experience, covering a 12-year period, with 164 cases of brain tumor in patients 16 years of age or younger, with the hope that this record may aid in formulating what appears to be an historic end-point in the consideration of these difficult problems.

INCIDENCE

Between January, 1939, and January, 1951, these 164 cases of brain tumor appeared among 28,385 children less than 16 years of age admitted to Duke Hospital, an incidence of 0.42%. Rand and Van Wagenen found 38 cases of brain tumor in children among total admissions of 11,340, an incidence of 0.33%. From a similar hospital population, Bailey, Buchanan and Bucy found 38 cases in 40,443 admissions, an incidence of 0.09%. In the general population of the Duke Hospital during the 10-year period, these 164 cases were recorded among an inpatient census of 135,066 cases, an incidence of 0.09%.
SPECTROGRAPHIC COMPARISON OF RANGES OF VIBRATION FREQUENCY AMONG SOME INNOCENT CARDIAC MURMURS IN CHILDHOOD AND SOME MURMURS OF VALVULAR INSUFFICIENCY
Authors: Harris T. N. , Saltzman Herbert A. , Needleman Herbert L. , Lisker Leigh
Published: December 2021

Tape recordings have been made of some cardiac murmurs in children, including examples both of organic murmurs, aortic and mitral insufficiency and some congenital malformations, and the two major groups of presumably innocent murmurs, the precordial vibratory "twanging-string murmur" of Still and pulmonic systolic murmurs. Relative values of the upper limit of frequencies of vibration of these murmurs were determined by the use of a sound spectrograph. These data have significance as relative measurements, within conditions of sensitivity of the spectrography, which were kept constant within the present study.

In the case of the precordial vibratory murmur the upper limit of frequencies was in most cases less than 170 cy/sec, with a range extending to 240 cy/sec. Of the pulmonic systolic murmurs examined there was a broader distribution of maximum frequencies, the range of these extending to 370 cy/sec. The groups of organic murmurs tested were all found to have maximum frequencies ranging from 800 to 1300 cy/sec.
NEONATAL AND MATERNAL THROMBOCYTOPENIC PURPURA DUE TO QUININE
Authors: Mauer Alvin M. , DeVaux William , Lahey M. E.
Published: December 2021

A case of quinine induced thrombocytopenic purpura in a mother and her newborn born infant is presented. In-vitro confirmation of the presence of quinine-platelet "antibodies" in the plasma of both mother and infant was obtained just after delivery. Five months later the "antibody" was still demonstrable in the mother, though backing in the infant. It is suggested that the neonatal thrombocytopenic purpura in this infant resulted from transplacental passage of antibody and quinine from the mother.

A careful search for possible drug sensitization seems warranted in other cases of neonatal thrombocytopenia not explained by other means.
FACIAL PARALYSIS IN CHILDREN
Authors: Paine Richmond S.
Published: December 2021

The anatomy of the facial nerve and the various etiologic factors in both congenital and acquired facial paralysis in children have been reviewed. Differential diagnosis among the more important of these has been discussed and an evaluation of the possible methods of treatment attempted. This evaluation is difficult because of the high recovery rate without treatment, which may approach 90% in children. If careful study of a case of facial paralysis indicates its idiopathic nature, prompt treatment with oral cortisone is considered indicated. While it is difficult to establish that cortisone greatly improved an already high recovery rate, it seems more clear that the average recovery time is favorably influenced, at least in adults and probably also in children. Cortisone seems the treatment of choice at the present time and during the past 2 years at one hospital, all of 10 patients so treated recovered. This has eliminated the need for consideration of surgical decompression of the facial canal. Whether this will remain true with larger numbers of cases remains to be seen.
PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK
Authors: Robinson Pinchas
Published: December 2021

When this column presented the paper by Dr. Lowe on "Observations on the Care of Children in Afghanistan," there was considerable interest in the rather unusual conditions presented. The way children live and are cared for in other countries of the world interests pediatricians, both because of their catholic interest in child health and the possible lessons to be learned from such a study which can be applied in one's own situation.

Dr. Robinson has been serving as Consultant in Maternal and Child Health in the Regional Office for South East Asia of the World Health Organization, one of the most populous regions in the world. India itself, as Dr. Robinson indicates in the cold figures of his opening paragraph, has a population larger than that of the 21 American republics, that is of North and South America combined. It is clear that variations within the region must be great and that generalizations must be made with great care.
THE MAINTENANCE NEED FOR WATER IN PARENTERAL FLUID THERAPY
Authors: Holliday Malcolm A. , Segar William E.
Published: December 2021

It is generally agreed that the maintenance requirements for water of individuals is determined by their caloric expenditure. By means of the following formulae, the caloric expenditure of hospitalized patients can be determined from weight alone. For weights ranging from 0 to 10 kg, the caloric expenditure is 100 cal/kg/day; from 10 to 20 kg the caloric expenditure is 1000 cal plus 50 cal/kg for each kilogram of body weight more than 10; over 20 kg the caloric expenditure is 1500 cal plus 20 cal/kg for each kilogram more than 20.

Maintenance requirements for water depend upon insensible loss of water and renal loss. An allowance of 50 ml/100 cal/day will replace insensible loss of water, and 66.7 ml/100 cal/day will replace the average renal loss so that the total requirement is 116.7 ml/100 cal/day. As water of oxidation will supply approximately 16.7 ml/100 cal/day, the remaining 100 ml/100 cal/day must be supplied to meet the remaining water losses of patients on parenteral fluid therapy. Possible exceptions to this figure are discussed.

Maintenance requirements of sodium, chloride and potassium are 3.0, 2.0 and 2.0 mEq/100 cal/day, respectively.
EFFECTS OF CUP, BOTTLE AND BREAST FEEDING ON ORAL ACTIVITIES OF NEWBORN INFANTS
Authors: DAVIS HERBERT V. , SEARS ROBERT R. , MILLER HERBERT C. , BRODBECK ARTHUR J.
Published: December 2021

Sixty babies were divided into three groups of 20 each, one group being fed by cup, one by bottle and one by breast during the first 10 days of life. The breast fed infants developed a stronger sucking reflex than either of the other two groups, which did not differ from one another. There were no statistically significant differences between the groups with respect to amount of spontaneous oral activity or amount of crying. The breast fed group showed slightly higher general body activity in the last five days and slightly poorer appetite on the first three days.
URINARY RETENTION DUE TO HEMATOCOLPOMETRA
Authors: BLOXSOM ALLAN , POWELL NORBORNE
Published: December 2021

Two additional cases of acute urinary retention due to hematocolpometra have been added to the seven cases already reported.

In three of the nine cases reported there has been a partial, congenital, intrinsic obstruction of the urethra which together with the extrinsic hematocolpometra resulted in the complete bladder obstruction.

Spontaneous rupture of the overstretched hymen can occur; and, when it does, it leads to relief and recovery.
IMMUNOLOGIC AND BIOCHEMICAL STUDIES IN INFANTS AND CHILDREN WITH SPECIAL REFERENCE TO RHEUMATIC FEVER
Authors: LUBSCHEZ ROSE
Published: December 2021

Electrophoretic analyses of blood plasma or serum of 30 children in apparent health between the ages of two and 11 years revealed that the relative concentration of the various components was in close agreement with adult values, although the individual variation was several times greater.

For 27 children in apparent health, but who had experienced various types of infection during a one to four month interval prior to the time the specimen was taken, elevation of the gamma component occurred in about 40% of the determinations. Illness within the month produced the greatest number of abnormalities, although abnormalities were noted in specimens of children who had been free of infection two to three months. A few abnormalities were noted in all components except beta globulin.

At younger ages (two to four years) children showed a slightly higher albumen level and a slightly lower gamma globulin level.

Normal children susceptible to rheumatic fever on a genetic basis exhibited no specific differences in the electrophoretic pattern.
IMMUNOLOGIC AND BIOCHEMICAL STUDIES IN INFANTS AND CHILDREN WITH SPECIAL REFERENCE TO RHEUMATIC FEVER
Authors: WILSON MAY G. , LUBSCHEZ ROSE
Published: December 2021

Electrophoretic analyses are presented for 79 specimens of blood plasma or serum from 42 rheumatic subjects during apparent health, following respiratory illness, and during rheumatic fever.

Electrophoretic studies revealed a prolonged elevation in the gamma component for a period varying from weeks to months following an antecedent respiratory illness with or without the development of rheumatic fever.

During acute rheumatic fever, the gamma globulin component was normal in the absence of antecedent illness. Elevation of the gamma globulin component in rheumatic fever is not a function of the rheumatic process. The alpha globulin components were usually elevated during febrile periods.

No evidence was obtained in these studies that the immune response of rheumatic subjects to infections presumably streptococcal in origin differed from that of nonrheumatic individuals.
Teaching Psychotherapeutic Medicine
Authors: MERCER MARY E.
Published: December 2021

This book is a striking account of how 25 general practitioners, under the skilled direction of a small group of psychiatrists, came to see, understand and handle some of the basic emotional problems that belong to all human beings sick or well. Few books follow so faithfully and honestly each step in the development of insight on the part of the physician.

It has unique value for the physician unable to take such a refresher course. It answers the questions he would ask. It translates into clear practical terms the often-times baffling problem of treating a patient as a "total human being."
HEREDITARY RENAL DISEASE ASSOCIATED WITH NERVE DEAFNESS AND OCULAR LESIONS
Authors: Goldbloom R. B. , Fraser F. C. , Waugh Douglas , Aronovitch M. , Wiglesworth F. W.
Published: December 2021

A family with an unusual hereditary syndrome characterized by renal disease, nerve deafness, and sometimes by lesions of the ocular lens, is reported. A total of 10 apparently unrelated families are known to us, either in the literature or in unpublished data, to have been affected by the syndrome.

The pattern of inheritance of the renal disease appears to be due to a dominant gene, which may be partially sex-linked, males being more severely affected than females. Evidence is presented which indicates that the auditory and ocular lesions are due to the presence of the same abnormal gene.

The histologic appearance of the terminal renal lesion is usually that of a chronic interstitial pyelonephritis. Suggestions regarding the possible etiology of the syndrome are advanced.
INTRACELLULAR COMPOSITION AND HOMEOSTATIC MECHANISMS IN SEVERE CHRONIC INFANTILE MALNUTRITION
Authors: Gordillo Gustavo , Soto Raphael A. , Metcoff Jack , Lopez Elizabeth , Antillon Luis Garcia
Published: December 2021

The present report deals with preliminary results on the study of renal function in advanced malnutrition. The glomerular filtration rate (clearance of inulin) and renal plasma flow (clearance of para-aminohippurate) were studied in 10 children with severe chronic malnutrition. Osmolar clearance were also measured in six of these children. In three, with marked hypotonicity despite acute dehydration, the effects of intravenous administration of a load of sodium chloride were studied.

A significant reduction in filtration rate and renal plasma flow was encountered, which was most evident during dehydration. A decrease in osmolar clearance and the presence of "free-water" clearance in both non-dehydrated and dehydrated malnourished children suggested suspension of the usual antidiuretic mechanisms for conservation of water; however, the rise in osmolar clearance and reabsorption of osmotically free water following administration of hypertonic saline, indicated that the capacity of the renal tubules to respond to an adequate stimulus was not lost.

Administration of an hypertonic solution of saline produced a marked expansion of the volume of extracellular fluid. More than half of this expanded volume resulted from redistribution of intracellular "endogenous" water. Expansion of volume limited rise of osmolality of extracellular fluid in two cases, but failed to do so in the third.

A relatively large proportion of the filtered water was excreted during hypotonic dehydration. Filtration rates apparently decreased as the proportion of filtered water excreted became increased.

The possibility that reduction in filtration rate constitutes a volume defense mechanism and that the apparent anomalies in renal function represent an adaptation to the cellular hypotonicity of the malnourished subject are discussed.
DISEASES OF THE RENAL TUBULES IN CHILDHOOD
Authors: Piel Carolyn F.
Published: December 2021

As indicated in the preceding sections of this review, it seems evident that renal diabetes insipidus, renal glycosuria, "cystinuria" and renal hyperchloremic acidosis are unquestionably renal tubular diseases. Vitamin D resistant rickets has tentatively been placed in the same category although it is recognized that the evidence for this classification is not yet thoroughly convincing. All of the findings of the Fanconi syndrome seem actually to represent a summation of the single tubular diseases, except "cystinosis." Known renal tubular dysfunction fails to explain the cystine-storage disease, cystinosis.
Presidential Badge, British Paediatrics Association
Authors: CRAIG JOHN
Published: December 2021

It occurs to me that I have seen no mention in Pediatrics of the badge of the British Paediatric Association which was acquired 4 years ago as part of a memorial to Sir Leonard Parsons.

We had plans for a medallion to be struck but eventually a medal of the Mother and Child by Louis Oscar Roty (done in 1897) was acquired. Dr. Bernard Schlesinger was largely responsible for its acquisition; and he put us further in his debt by presenting the Association with a fine leather-bound book which is written in copperplate handwriting and describes the life and work of Roty.
Innovations in Cardiorespiratory Monitoring to Improve Resuscitation With Helping Babies Breathe
Authors: Patterson Jackie K. , Girnary Sakina , North Krysten , Data Santorino , Ishoso Daniel , Eilevstjønn Joar , Bose Carl L.
Published: December 2021

Ninety percent of intrapartum-related neonatal deaths are attributable to respiratory depression, with the vast majority of these deaths occurring in low- and lower-middle–income countries. Neonatal resuscitation training with Helping Babies Breathe (HBB) decreases mortality from respiratory depression. Cardiorespiratory monitoring in conjunction with HBB can provide valuable resuscitation feedback for both training and bedside purposes. In this article, we discuss 3 innovations that couple cardiorespiratory monitoring with HBB: NeoNatalie Live, the Augmented Infant Resuscitator, and NeoBeat. NeoNatalie Live is a high-fidelity manikin that facilitates bag mask ventilation training through case scenarios of varying difficulty. The Augmented Infant Resuscitator is added in-line between a face mask and ventilation bag during bag mask ventilation training to provide users with real-time feedback on ventilation quality. NeoBeat is a battery-operated heart rate meter that digitally displays the newborn heart rate during bedside resuscitations. For each innovation, we review details of the device, implementation in the field, and areas for further research. Using early experience implementing these devices, we suggest building blocks for effective translation of training into improved care. We also highlight general challenges in implementation of devices in facilities in low- and lower-middle–income countries including considerations for training, adaptations to existing workflow, and integration into the ecosystem. Although the devices highlighted in this article hold promise, more data are needed to understand their impact on newborn outcomes.
Digital Health Innovations, Tools, and Resources to Support Helping Babies Survive Programs
Authors: Bucher Sherri L. , Cardellichio Peter , Muinga Naomi , Patterson Jackie K. , Thukral Anu , Deorari Ashok K. , Data Santorino , Umoren Rachel , Purkayastha Saptarshi
Published: December 2021

The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.
Achieving Country-Wide Scale for Helping Babies Breathe and Helping Babies Survive
Authors: Perlman Jeffrey M. , Velaphi Sithembiso , Massawe Augustine , Clarke Robert , Merali Hasan S. , Ersdal Hege
Published: December 2021

Helping Babies Breathe (HBB) was piloted in 2009 as a program targeted to reduce neonatal mortality (NM). The program has morphed into a suite of programs termed Helping Babies Survive that includes Essential Care for Every Baby. Since 2010, the HBB and Helping Babies Survive training programs have been taught to >850 000 providers in 80 countries. Initial HBB training is associated with a significant improvement in knowledge and skills. However, at refresher training, there is a knowledge-skill gap evident, with a falloff in skills. Accumulating evidence supports the role for frequent refresher resuscitation training in facilitating skills retention. Beyond skill acquisition, HBB has been associated with a significant reduction in early NM (<24 hours) and fresh stillbirth rates. To evaluate the large-scale impact of the growth of skilled birth attendants, we analyzed NM rates in sub-Saharan Africa (n = 11) and Nepal (as areas of growing HBB implementation). All have revealed a consistent reduction in NM at 28 days between 2009 and 2018; a mean reduction of 5.34%. The number of skilled birth attendants, an indirect measure of HBB sustained rollout, reveals significant correlation with NM, fresh stillbirth, and perinatal mortality rates, highlighting HBB’s success and the need for continued efforts to train frontline providers. A novel live newborn resuscitation trainer as well as a novel app (HBB Prompt) have been developed, increasing knowledge and skills while providing simulation-based repeated practice. Ongoing challenges in sustaining resources (financial and other) for newborn programming emphasize the need for innovative implementation strategies and training tools.
Lessons Learned From Helping Babies Survive in Humanitarian Settings
Authors: Amsalu Ribka , Schulte-Hillen Catrin , Garcia Daniel Martinez , Lafferty Nadia , Morris Catherine N. , Gee Stephanie , Akseer Nadia , Scudder Elaine , Sami Samira , Barasa Sammy O. , Had Hussein , Maalim Maimun Farah , Moluh Seidou , Berkelhamer Sara
Published: December 2021

Humanitarian crises, driven by disasters, conflict, and disease epidemics, have profound effects on society, including on people’s health and well-being. Occurrences of conflict by state and nonstate actors have increased in the last 2 decades: by the end of 2018, an estimated 41.3 million internally displaced persons and 20.4 million refugees were reported worldwide, representing a 70% increase from 2010. Although public health response for people affected by humanitarian crisis has improved in the last 2 decades, health actors have made insufficient progress in the use of evidence-based interventions to reduce neonatal mortality. Indeed, on average, conflict-affected countries report higher neonatal mortality rates and lower coverage of key maternal and newborn health interventions compared with non–conflict-affected countries. As of 2018, 55.6% of countries with the highest neonatal mortality rate (≥30 per 1000 live births) were affected by conflict and displacement. Systematic use of new evidence-based interventions requires the availability of a skilled health workforce and resources as well as commitment of health actors to implement interventions at scale. A review of the implementation of the Helping Babies Survive training program in 3 refugee responses and protracted conflict settings identify that this training is feasible, acceptable, and effective in improving health worker knowledge and competency and in changing newborn care practices at the primary care and hospital level. Ultimately, to improve neonatal survival, in addition to a trained health workforce, reliable supply and health information system, community engagement, financial support, and leadership with effective coordination, policy, and guidance are required.