bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective, Randomized Study of Testosterone Treatment of Constitutional Delay of Growth and Development in Male Adolescents
Authors: Rosenfeld Ron G. , Northcraft Gregory B. , Hintz Raymond L.
Published: December 2021

The physiologic and psychological responses to androgen treatment of constitutional delay of growth and development were prospectively evaluated in 16 male adolescents, aged 14 to 17 years. Subjects were randomly assigned to a course of testosterone enanthate, 200 mg administered intramuscularly four times at three-week intervals or to observation. At one-year follow-up all subjects in the testosterone group exhibited excellent growth: 7.2 to 11.6 cm/yr (mean 9.2 cm/yr). Growth in control subjects was highly variable: 2.6 to 10.6 cm/yr (mean 6.0 cm/yr), significantly lower than that of the testosterone group (P < .02). The mean annual increment in bone age was 1.1 years for both groups. The Δ height age/Δ bone age ratio was slightly higher in the testosterone group (1.3 vs 1.1), and the treated subjects had a 1.7-cm increase in predicted adult height. Both groups showed improved self-image, and treated subjects also exhibited dramatic increases in both school-related and extraschool social activity. A brief course of testosterone enanthate appears to be an effective, safe means of promoting growth in select male adolescents.
Arachidonic Acid Metabolism in the Neonatal Platelet
Authors: Stuart Marie J. , Allen Judith B.
Published: December 2021

An assessment of arachidonic acid metabolism in the platelet of the neonate was performed. The uptake of [14C]arachidonic acid into platelets of both the neonate and the adult were similar. Neonatal platelets, however, released a significantly greater amount (P < .001) of prelabeled arachidonic acid (24.7% ± 2.8%) in response to the physiologic agent thrombin when compared with platelets from adult control subjects (14.6% ± 0.8%). When the activities of the lipoxygenase (12-L-hydroxy-5,8,10,14-eicosatetraenoic acid) and cyclooxygenase pathways (12-L-hydroxy-5,8,10-heptadecatrienoic acid and thromboxane B2) were evaluated following incubation of platelets with [14C]arachidonic acid, significant differences were observed between adult and neonatal platelets. Platelets from the neonate produced less (P < .01) thromboxane B2 (11.1% ± 1.7%) when compared with platelets from adult control subjects (19% ± 1.7%). In contrast, the lipoxygenase product 12-L-hydroxy-5,8,l0,14-eicostatetraenoic acid was increased (P < .005) in the platelet from the neonate (41.5% ± 2%), when compared with the adult (31.2% ± 2.1%). The observation that the availability of substrate arachidonic acid is increased in the platelet of the neonate may have general implications in neonatal pathophysiologic processes.
Anthropometric Determinants of Creatinine Excretion in Preterm Infants
Authors: Sutphen James L.
Published: December 2021

Creatinine output per unit of body weight increases throughout childhood. This reflects the increase in percent muscle mass observed during growth. Standard values for creatinine excretion are not available for the preterm infant. Accordingly, urinary creatinine output was measured in timed 24-hour specimens obtained in the second week of life of 15 preterm infants (gestational age 26 to 33 weeks). Three highly significant regression equations were derived that relate creatinine excretion to birth weight, length, and gestational age. Creatinine output correlated best with birth weight. Stepwise regression yielded no linear combination of these variables that improved the estimate based on weight alone. In a similar manner, consideration of other variables, including weight and length for age (expressed as percent of 50th percentile), did not improve the estimate based on weight alone. These data demonstrate that creatinine output in milligrams per kilogram of body weight increases by 16% between birth weight of 0.7 and 1.5 kg. This increase parallels that in body protein content per kilogram obtained from published fetal body composition data in infants of similar age. Creatinine output in preterm infants, therefore, can serve as a measure of growth.
A HIGHER DUTY
Authors: McCarthy John T.
Published: December 2021

We are but transient passengers on this planet Earth. It does not belong to us. We are not free to doom generations yet unborn. We are not at liberty to erase humanity's past or dim its future. Social systems do not endure for an eternity. Only life can lay claim to uninterrupted continuity. This continuity is sacred. We physicians, who shepherd human life from birth to death, are aware of the resiliency, courage, and creativeness that human beings possess. We have an abiding faith in the concept that humanity can control what humanity creates. This perception provides optimistic purpose in reversing the direction of humankind's potential tragic destiny.
Abnormal Cerebral Hemodynamics in Preterm Infants with Patent Ductus Arteriosus
Authors: Lipman Brian , Serwer Gerald A. , Brazy Jane E.
Published: December 2021

Blood flow patterns in the anterior cerebral arteries were studied in eight preterm infants with patent ductus arteriosus and left-to-right shunts. A noninvasive Doppler technique was used to obtain the blood flow patterns and to calculate a pulsatility index. Advancing diastolic blood flow was decreased in all eight infants, and two demonstrated retrograde anterior cerebral artery flow during diastole. Following ductal closure, the diastolic flow in the anterior cerebral arteries increased significantly, reaching levels seen in normal infants. These observations demonstrate that infants with patent ductus arteriosus and left-to-right shunts may have abnormal cerebral hemodynamics which return to normal following ductal closure.
Development of Sleep-Wake Patterns and Non-rapid Eye Movement Sleep Stages during the First Six Months of Life in Normal Infants
Authors: Coons Susan , Guilleminault Christian
Published: December 2021

Thirty-one normal infants were selected for 24-hour polygraphic monitoring at different ages during the first six months of life. The development of sleep-wake distribution patterns during day and night was observed. Qualitative changes in non-rapid eye movement (NREM) sleep as it becomes differentiated in stages 1, 2, and 3-4 were measured. Sustained periods of wake are present by 6 weeks of age. After 3 months of age, wake is predictably distributed in late afternoon and early evening. REM sleep is disproportionately distributed within sleep in 24 hours, presenting a higher percent of total sleep during the night. At 4.5 and 6 months of age, stages 2 and 3-4 NREM are coincident during the nocturnal hours and 3-4 NREM sleep peaks in the early period of the night. The decreasing proportion of REM sleep, particularly in its daytime distribution, suggests a reciprocal relationship to the development of wakefulness.
Response to Letters on Infant Botulism
Authors: Arnon Stephen S.
Published: December 2021

Few would disagree with the concern expressed by Shaw1 and echoed by Thompson2 that ". . . if unsupported hypotheses are repeated often enough, they may become accepted as fact." But what of hypotheses that appear unsupported because evidence on which they rest has been overlooked?

Except for work by Thompson and colleagues,3 the literature cited by both correspondents does not go beyond 1977, by which time infant botulism was recognized as an infectious disease in which ingested spores of Clostridium botulinum multiply in the gut and produce botulinal toxin in vivo.4,5
Imipramine and Enuresis: Never Forget Its Dangers
Authors: Bennett Howard J.
Published: December 2021

On Dec 31, 1981, a brief story about a 7-year-old boy who died in a coma one month after ingesting 40 Tofranil tablets, appeared in The Washington Post (p A3). The youngster had wet his pants at school on December 1, and it is presumed that he inadvertently overdosed himself in the hopes of curing his enuresis. The potential lethal effects of imipramine are well known,1 and accidental ingestions have occurred in children less than 5 years of age more frequently than in children in other age groups.2
Skinfold Thickness
Authors: Swyer P. R. , Heim T. , Reichman B.
Published: December 2021

The paper by Heimler et al1 concerning thermal environmental effects on growth and increase in skinfold thickness in premature infants was of interest to us in relation to our own work on macronutrient and energy accretion in the very low-birth-weight preterm infant. We are having some difficulty in reconciling the increase in skinfold thickness measurement reported by Heimler et al with our own measurements as well as with those reported in the literature. For example, the figure given by Heimler et al for preterm infants (their group A) reared in incubators was 0.21-mm skinfold thickness increase per day (average of four sites).
ELECTRIC BUNTING TO MAINTAIN BODY TEMPERATURE DURING EXCHANGE TRANSFUSION IN THE NEWBORN INFANT
Authors: VOGEL P. , ROSENFIELD R. E. , STEINBERG M.
Published: December 2021

THE maintenance of proper body temperature has been a serious problem in the performance of exchange transfusions on newborn infants suffering from hemolytic disease. Many of these infants are in such poor condition that extreme care in their handling is required, including incubation, oxygen and tracheal aspiration. The many procedures necessary create the hazard of prolonged exposure to room temperature, and a number of deaths may have resulted directly or indirectly from hypothermia. In the Children's Hospital in Boston, the entire exchange transfusion is carried out with the infant lying in a Hess bed; this is an ideal situation which undoubtedly is not readily available in most institutions where an exchange transfusion must be performed. The maintenance of body temperature with electric heating pads and/or hot water bottles has proved cumbersome and unsatisfactory, and has resulted in a number of burns, particularly about the buttocks.

A washable electric blanket bunting has been designed (see Figs. and 2) to maintain the temperature of newborn infants throughout the procedure of an exchange transfusion, as well as for a period following the procedure, if a heated crib is not available. This bunting was constructed by the General Electric Company using water-proof washable material and employing the principles of the commercial electric blanket. The bunting can be regulated to any desired temperature although the maximum temperature obtainable is 42°C., which avoids the possibility of skin burns. The design of the bunting is simple: it is a bag with a zipper along one side to allow for easy insertion and removal of the baby, and a "U" shaped zippered flap which can be opened to provide a window at the approximate position of the umbilical cord.
ACUTE PURULENT ARTHRITIS (B. PYOCYANEUS) IN A PREMATURE INFANT
Authors: COLEMAN JAMES M. , LOWRY FREDERICK C.
Published: December 2021

A pyogenic arthritis, acute in character, in which B. pyocyaneus was the infecting organism, occurred in a premature white female infant confined to an incubator from birth. The infection cleared rapidly with the administration of dihydrostreptomycin intramuscularly. Its use in irrigating the joint at the time of aspiration may have aided in therapy. On the patient's discharge from the hospital, she seemed normal in every respect.
Neonatal Seizures I. Correlation of Prenatal and Perinatal Events with Outcomes
Authors: Holden Kenton R. , Mellits E. David , Freeman John M.
Published: December 2021

A review of 277 newborns with neonatal seizures enrolled in the Collaborative Perinatal Project revealed a mortality of 34.8%. Of the 181 survivors, most followed up to age 7 years, 70% were normal. Thus, despite the fact that seizures are a major indicator of perinatal asphyxia and a predictor of subsequent neurologic deficit, most infants with neonatal seizures who survived did well. Thirteen percent had cerebral palsy, 19% had an IQ <70, and 20% had epilepsy. Thirteen percent of survivors had a combination of mental retardation, cerebral palsy, or epilepsy. A low Apgar score, the need for resuscitation after 5 minutes of age, low birth weight, and the early onset of seizures or prolonged seizures correlated with adverse outcome.
Neurologic, Psychiatric, and Cardiovascular Complications in Children Struck by Lightning
Authors: Kotagal Suresh , Rawlings C. A. , Chen Su-chiung , Burris Garrett , Nouri Soraya
Published: December 2021

The neurologic changes following lightning injury include coma with cerebral edema, inappropriate secretion of antidiuretic hormone (ADH), seizures, cerebellar ataxia, and painful sensory disturbances. Deteriorating neurologic status may warrant the use of intracranial pressure monitoring devices. Myocardial injury and transient hypertension are generally evident at the onset. Monitoring of the cardiac rhythm may be needed for as long as a week for late onset arrythmia. Abnormalities of memory, mood, and affect noted on recovery of consciousness may persist for months, necessitating close psychiatric and neurologic follow-up.
SCIENTIFIC REVOLUTIONS
Authors:   Student
Published: December 2021

. . . Revolutions born in the laboratory are to be sharply distinguished from revolutions born in society. Social revolutions are usually born in the minds of millions, and are led up to by what the Declaration of Independence calls "a long train of abuses," visible to all; indeed, they usually cannot occur unless they are widely understood by and supported by the public. By contrast, scientific revolutions usually take shape quietly in the minds of a few men, under cover of the impenetrability to most laymen of scientific theory, and thus catch the world by surprise. . . .

But more important by far than the world's unpreparedness for scientific revolutions are their universality and their permanence once they have occurred. Social revolutions are restricted to a particular time and place; they arise out of particular circumstances, last for a while, and then pass into history. Scientific revolutions, on the other hand, belong to all places and all times. . . .

Works of thought and many works of art have a . . . chance of surviving, since new copies of a book or a symphony can be transcribed from old ones, and so can be preserved indefinitely; yet these works, too, can and do go out of existence, for if every copy is lost, then the work is also lost. The subject matter of these works is man, and they seem to be touched with his mortality. The results of scientific work, on the other hand, are largely immune to decay and disappearance.
Osteosarcoma in Early Childhood
Authors: Levy Moise L. , Jaffe Norman
Published: December 2021

Osteosarcoma is most commonly encountered in the teenage individual.1 The recent referral of a 20-month-old boy with this tumor to the M. D. Anderson Hospital and Tumor Institute prompted a comparison of characteristics of the disease reported in early childhood with those of older patients.

CASE REPORT

A 20-month-old Filipino boy was admitted with a provisional diagnosis of osteosarcoma involving the left femur. He had been in good health until a few months prior to admission when he began limping. Radiographs obtained at his local hospital revealed a lytic-blastic lesion at the distal left femur and a needle biopsy suggested a diagnosis of osteoblastoma.
Immunohemolytic Anemia and Hodgkin Disease
Authors: Carpentieri Ugo , Daeschner C. W. , Haggard Mary Ellen
Published: December 2021

The proteiform presentation of Hodgkin disease is well known. Also recognized are the immune disorders such as immunohemolytic anemia and immunothrombocytopenia which may be associated with, and sometimes precede, the disease.1(pp1025-1030)

A diagnosis of warm agglutinin Coombs positive hemolytic anemia of unknown etiology was made in an 8-year-old black boy after the most common causes, such as chemical agents, viral syndromes, malignancies, infectious diseases, collagen diseases, gastrointestinal diseases, and thyroid problems were apparently excluded. The patient was treated with erythrocyte transfusion and steroids.
Letter to the Editor
Authors: Bartoshesky Louis E. , Pashayan Hermine
Published: December 2021

We would agree with both writers that there were certain features of the child described in our report that were not typical of the so-called fetal hydantoin syndrome, particularly the birth weight. It is certainly true that single case reports do nothing more than suggest possible associations between malformations and in utero exposure, but much information has been accumulated associating clefts and congenital heart malformations with phenytoin.

The baby described had a normal male karyotype. Attempts were made to do karyotyping on tissue obtained at autopsy but were unsuccessful.
Cost Effectiveness of Home Management of Bronchopulmonary Dysplasia
Authors: Donn Steven
Published: December 2021

Improved technology and care have resulted in an increased number of survivors of neonatal respiratory distress syndrome. Although the incidence of bronchopulmonary dysplasia has remained fairly stable,1 the absolute number of infants requiring prolonged hospitalization for oxygen therapy has increased in our nursery. Several reports2-4 have documented the feasibility and efficacy of home management of infants with chronic lung disease. Our own experience with such a program began in August 1978. It is the purpose of this communication to document the cost effectiveness of our home management program.
Appendicitis
Authors: Ravitch Mark M.
Published: December 2021

The mortality from acute appendicitis has been reduced, but the sharp difference in the morbidity and complications associated with perforation demands a policy that will minimize the possibility of delay in operation or failure to diagnose acute appendicitis. The decrease in mortality is largely due to the quality of care within the hospital, and possibly to the less frequent use of cathartics, but not to a decreased incidence of perforation. The suggestion is made that the failure to decrease the incidence of perforation of the appendix may be related to the nature of pediatric practice.
Vitamin E and Retrolental Fibroplasia in 1982
Authors: Phelps Dale L.
Published: December 2021

The retrolental fibroplasia (RLF) blind are an increasingly tragic shadow in the otherwise brightening picture for extremely premature infants1,2; thus, it is natural to feel eager anticipation at the report of vitamin E as an effective prophylactic.3 However, in seeking a solution to this frustrating disease, we must remain cautious about the price to be paid for prevention. I believe the time is ripe to ask "Where do we stand in our current knowledge of RLF; what is the history of vitamin E in this disorder; what is the strength of the evidence for its efficacy and safety; and finally is the risk/benefit ratio tipped in favor of treating the estimated 37,000 susceptible infants born annually in the United States, or must we await further evidence?"

RLF OR RETINOPATHY OF PREMATURITY

Through the combination of meticulous clinical observations4-7 and innovative studies in animal models,8,9 we have come to understand that acute, proliferative RLF occurs when the retina becomes ischemic following oxygen-related vaso-obliteration of immature, developing retinal arterioles. In the most immature infants (weight < 1 kg) this occurs as frequently as 75% of the time.7 There, however, our understanding of RLF ends inasmuch as cicatricial RLF (or retinopathy of prematurity with idiopathic fibrosis10), the scarred, occasional sequelae of acute RLF, is the output from a classic "black box." Prematurity, illness, and acute retinopathy go into one side, but we have no idea what determines healing vs cicatrix, the outputs on the far side. Animal models offer no help in this regard as none progress from acute vasculopathy to cicatricial sequelae (with perhaps one promising11).
Incidence of Mitral Valve Prolapse in Adolescent Scoliosis and Thoracic Hypokyphosis
Authors: Hirschfeld Stephen S. , Rudner Charles , Nash Clyde L. , Nussbaum Eliezer , Brower Eleanor M.
Published: December 2021

Seventy-four patients with adolescent scoliosis underwent cardiac examination and M-mode echocardiography to detect the presence of mitral valve prolapse (MVP). Twenty-one (28%) had echocardiographic evidence of MVP, whereas 18 had auscultatory findings of a nonejection click or late systolic murmur. A subset of 41 patients had a family history of scoliosis and 37% had MVP. The incidence of MVP increased to 41% when a first degree relative, such as a sibling, parent, or offspring, had scoliosis. Thirty-six patients with scoliosis had additional thoracic hypokyphosis (straight back) and 13 (36%) had MVP. The incidence of MVP was 48% when the scoliosis and hypokyphosis were hereditary and increased to 53% when a familial history of skeletal abnormality was present. This study indicates a high incidence of MVP in patients with scoliosis and hypokyphosis, especially when the skeletal abnormality is familial. It suggests that the cardiac and skeletal systems may be affected by a generalized soft-tissue defect.
Transcutaneous Bilirubin Measurements in Full-Term Infants
Authors: Maisels M. Jeffrey , Conrad Sarah
Published: December 2021

A total of 292 transcutaneous bilirubin (TcB) measurements were performed in 157 white full-term infants: 157 were obtained from the forehead and 135 from the midsternum. TcB measurements correlated well with serum bilirubin determinations (r = .93, P < .0001). The sensitivity of the test was 100% and the specificity 97%. It was possible to establish guidelines for the TcB measurement which identified all infants whose serum bilirubin concentrations exceeded 12.9 mg/100 ml (221 µmoles/liter) with no false-negative and only five false-positive determinations (3%). The positive predictive value for the TcB measurements was 58%. This implies that, in our population, an infant with a TcB index ≥24 has a 58% chance of having a serum bilirubin concentration >12.9 mg/100 ml. The negative predictive value was 100%. Thus, a negative test will correctly predict the absence of hyperbilirubinemia in all cases. As these measurements were obtained prospectively in a well-baby population with a prevalence of hyperbilirubinemia (>12.9 mg/100 ml) of 4.5%, the positive predictive value should be applicable to other similar populations and will, in fact, increase in populations with a higher prevalence of hyperbilirubinemia. TcB measurements can be recommended for the identification of significant neonatal jaundice in full-term infants. It is important to recognize, however, that because of potential variations in TcB meters as well as serum bilirubin measurements in different laboratories, each institution should establish its own criteria for the use of this instrument.
Massive Digoxin Poisoning Treated with Fab Fragments of Digoxin-Specific Antibodies
Authors: Murphy Daniel J. , Bremner W. Fraser , Haber Edgar , Butler Vincent P. , Smith Thomas W. , Gaum Winston E.
Published: December 2021

Acute digoxin poisoning is an uncommon but potentially lethal event in childhood. A case of massive digoxin ingestion and its successful treatment with Fab fragments of digoxin-specific antibodies is described.
Theophylline Dosage
Authors: Kirshenbaum Arnold S. , Frick Oscar L.
Published: December 2021

The article by Shapiro et al1 wherein a nomogram relating daily theophylline dose requirements to single serum levels appears to us either misleading or in error. According to our calculations, the upper and lower limits depending on K = 0.07 to 0.5 hr-1 would give a value with no units: dose (mg/kg/day) = K x V x 24 hr x 10 µg/ml = 0.07 liter/hr x 0.45 liter/kg x 24 hr x 10 µg/ml = 0.07 liter/hr x 450 ml/1,000,000 µg x 24 hr x 10 µg/ml = 0.00756 = 0.5 liter/hr x 450 ml/1,000,000 µg x 24 hr x 10 µg/ml = 0.054.
Does Carbon Dioxide Play a Role in Retrolental Fibroplasia?
Authors: Wolbarsht M. L. , George Gregory S. , Kylstra Jan , Landers M. B.
Published: December 2021

Gordon et al1 were the first to note the association of retrolental fibroplasia (RLF) with the administration of high concentrations of oxygen to premature infants. Since that time, clinical research has demonostrated that RLF can develop in a variety of circumstances. Typically, this retinopathy arises after the cessation of supplemental oxygen therapy to neonates. Currently, the most widely accepted paradigm proposes that the neovascularization of RLF is the immature vascular system's response to a retina that has become hypoxic after the withdrawal of supplemental oxygen.
Letter to the Editor
Authors: Voora S. , Srinivasan S. , Lilien L. D. , Yeh T. F. , Pildes R. S.
Published: December 2021

Huston's concern about the validity and predictive value of fever in detecting bacterial disease in full-term newborns is based on his questioning our methods of proving which of the nonfebrile infants had bacterial disease. Our method was not given in detail in the materials and methods of our paper. As is obvious, it is impossible, as well as unethical, to subject all newborns to septic work-up. During the study, as was routine in our nursery, we did, however, work-up all afebrile infants with symptoms possibly related to sepsis (contrary to what Huston said with respect to irritability and diarrhea).
Theophylline Toxicity and Viral Infections
Authors: Walker Susannah B. , Middelkamp J. Neal
Published: December 2021

We were most interested in the article by Kraemer et al1 concerning altered theophylline clearance in asthmatic patients during an influenza B outbreak. We have studied two compliant asthmatic patients who had sudden changes in theophylline clearance at the time of symptomatic viral infections.

The first patient was a steroid-dependent asthmatic child who was maintained on 10.54 mg/kg/dose of Theo-Dur for six months with theophylline levels in the therapeutic range of 10 to 20 µg/ ml.
Letter to the Editor
Authors: Kraemer Michael J. , Furukawa Clifton T. , Koup Jeffrey , Shapiro Gail G. , Pierson William E. , Bierman C. Warren
Published: December 2021

We thank Walker and Middelkamp for sharing their experiences. We also would like to emphasize Weinberger's point that when nausea, vomiting, or headache are present in nonwheezing children, additional theophylline administration should always be withheld until a serum theophylline level is measured.

Theophylline continues to be very effective in the treatment of chronic asthma, and its use is to be encouraged. However, for optimal benefits with minimal risks, serum theophylline determinations must be rapidly obtainable.
Ultrasonic Demonstration of Ectopic Ureterocele
Authors: Athey Patricia Ann , Carpenter Robert J. , Hadlock Frank P. , Hedrick Thomas D.
Published: December 2021

The gray scale ultrasound findings in two children with ectopic ureterocele are presented and correlated with traditional radiographic findings. In one case, the diagnosis was made in utero, utilizing ultrasound. The examination is noninvasive and performed quickly, and it may be able to replace the intravenous pyelogram in the initial evaluation of patients suspected of having such congenital anomalies. Retrograde cystography will still be necessary to detect vesicoureteral reflux.
Anti-inhibitor Coagulant Complex (Autoplex) in Hemophilia Inhibitor Patients Undergoing Synovectomy
Authors: Hutchinson Raymond J. , Penner John A. , Hensinger Robert N.
Published: December 2021

Surgical synovectomy employed in the management of hemophilic arthropathy has been contraindicated in patients with inhibitors because of potential difficulties in achieving hemostasis. However, the development of activated prothrombin-complex concentrates has improved the management of hemophiliacs with inhibitors, particularly those with high levels of inhibitor for whom other treatment modalities are of minimal benefit. With the use of one of these activated products, Autoplex, surgical procedures have been successfully accomplished in hemophiliacs with inhibitors. Two inhibitor patients who each had severe arthropathy of one knee underwent elective surgical synovectomy while being treated with Autoplex. Hemostasis was achieved during the perioperative period in both patients. Neither patient exhibited clinical signs suggestive of consumptive coagulopathy or thrombosis, side effects potentially associated with the use of activated prothrombin-complex concentrates.
Adoption: An Option for the Imperfect Child
Authors: HILL REBA MICHELS , CALDWELL Jo ANN
Published: December 2021

To the Editor.—

With the angry outcry by the public regarding the ethics of withholding of nutrients from infants with handicaps to promote early death, or death by neglect, I would like to propose an alternate method for handling cases of malformed or damaged infants who are unacceptable to biologic parents. Susie Q was born November 1975, after 28 weeks' gestation. She weighed 1,000 g and had virilization of her external genitalia due to a maternal ovarian tumor.
Percutaneous Insertion of Central Venous Catheters
Authors: EVANS JACQUELYN R. , ALLEN ALEXANDER C. , STINSON DORA A.
Published: December 2021

To the Editor.—

We have also used the percutaneous technique for insertion of Silastic catheters in neonates as described by Dolcourt and Bose1 and have seen results similar to theirs. From July 1981 to July 1982 we used this technique successfully on 18 occasions in 14 infants with two failed attempts. All infants except one weighed <1,400 g at the time of insertion. Although the catheters were often removed because sepsis was suspected clinically, there were in fact two episodes of documented septicemia both due to Staphylococcus albus in infants receiving total parenteral nutrition.
Two Siblings with Recurrent Cardiorespiratory Arrest: Munchausen Syndrome by Proxy or Child Abuse?
Authors: Rosen Carol Lynn , Frost James D. , Bricker Tim , Tamow Jay D. , Gillette Paul C. , Dunlavy Susan
Published: December 2021

The terms "Munchausen syndrome by proxy" or "Polle syndrome" have been used to describe children who are victims of parentally induced or fabricated illness. This report gives case histories of two siblings (a 7-month-old girl and a 4-year-old boy) with recurrent episodes of cardiorespiratory arrest that were induced by a mother who skillfully resuscitated the children and who demonstrated model parental behavior. Polygraphic monitoring with hidden camera was used to determine that the episodes of cardiorespiratory arrest were parentally induced in the infant. The 4-year-old sibling had previously undergone multiple diagnostic and surgical procedures. After the diagnosis was made in the infant, and the mother was no longer permitted to be alone with the children, neither child had further episodes. A psychologic profile of the mother is presented, and special features of these two and other cases in the literature are reviewed. These cases represent a form of child abuse. A parentally induced illness should be considered in the differential diagnosis of unusual illnesses with bizarre features, even when the parent's behavior appears exemplary.
`Near-Miss' for Sudden Infant Death Syndrome Infants: A Clinical Problem
Authors: Ariagno Ronald L. , Guilleminault Christian , Korobkin Rowena , Owen-Boeddiker Margaret , Baldwin Roger
Published: December 2021

Three hundred six infants were referred for evaluation of "near-miss" sudden infant death syndrome (SIDS) from 1973 to 1980. Following the hospitalization and medical evaluation, there were 156 infants (115 term and 41 preterm) for whom there was no explanation for the presenting event and who were considered near-miss infants; 88% of these infants were seen during the first 3 months of life. A repeat near-miss event was reported in 63% (term) and 83% (preterm) infants. Twelve percent of term infants and 17% of the preterm infants had ten or more repeat events. A home apnea/cardiac monitor was prescribed for 88% of the infants for an average duration of 5.6 months in term infants and 3.5 months in preterm infants. Monitoring had been discontinued in 69% of the infants by 7 months of age. One full-term infant was later a SIDS victim. The risk of a repeat nearmiss event is concluded to be sufficiently great to demand immediate hospitalization, medical evaluation, home monitoring when there is no specific treatment, and close clinical follow-up. Follow-up studies are needed to determine whether there is any long-term morbidity for infants who have had near miss events.
Improved Method for Administration of Aerosol in Young Children
Authors: JOOS THAD H. , NICKLES PETER A. , PIERANTONI WAYNE N.
Published: December 2021

The child less than 3 years of age with bronchospastic lung disease often poses a challenge to the effective administration of β2-agonists as proposed in a review article by Tabachnik and Levison.1 A mask that fits properly over the nose and mouth is viewed by the patient as an unwanted therapeutic intervention.

Since Jan 1, 1982, we have employed an Ohio Face Tent type enclosure for the administration of aerosolized isoetharine to a group of 20 such children (Fig 1). Nebulization in the home or office was provided by a portable electrically powered unit, whereas in the hospital either central compressed air or oxygen was used.
Automobile Accidents: Potential Years of Life Lost
Authors: CHRISTOPHERSEN EDWARD R.
Published: December 2021

Regular readers of Pediatrics have been kept apprised of advancements in the prevention of childhood deaths and injuries from automobile accidents. The American Academy of Pediatrics initiated the "First Ride—A Safe Ride," which has endorsed programs ranging from prenatal education of parents to state legislation.

In March 1982, the Centers for Disease Control (CDC) in Atlanta revised its Morbidity and Mortality Weekly Report to include "Potential Years of Life Lost by Cause of Death" (March 12, 1982;31:110). This is derived for persons aged 1 to 65 years at the time of death by taking the number of deaths in each age category as reported by the National Center for Health Statistics, Monthly Vital Statistics Report, multiplied by the difference between 65 years and the age at the midpoint of each category.
Effect of Iron Therapy on Behavior Performance in Nonanemic, Iron-Deficient Infants
Authors: Oski Frank A. , Honig Alice S. , Helu Brenda , Howanitz Peter
Published: December 2021

In an effort to determine whether iron deficiency, in the absence of anemia (hemoglobin >11.0 g/dL), might produce alterations in behavioral development, four groups of nonanemic infants, 9 to 12 months of age, with varying degrees of iron deficiency were studied. Infants were classified as iron sufficient, iron depleted, or iron deficient based on measurements of serum ferritin concentration, erythrocyte protoporphyrin values, and the mean cell volume of erythrocytes. Subjects in each group were tested with the Bayley Mental Development Index, treated with parenteral iron, and retested seven days later. The administration of iron produced a significant increase in the Mental Development Index scores (+21.6 points) in the infants with iron deficiency but no significant change in the scores of infants with iron sufficiency (+6.2 points) or only iron depletion (+5.6 points). It is concluded that iron deficiency, even in the absence of anemia, results in biochemical alterations that impair behavior in infants.
Back Transport of Neonates: Improved Efficiency of Tertiary Nursery Bed Utilization
Authors: Jung August L. , Bose Carl L.
Published: December 2021

Neonatal back transport is defined as the return of previously critically ill neonates from Level III newborn intensive care units to Level II and Level I nurseries for intermediate and/or convalescing care. During 1980, 172 infants (65% of eligible infants) were back transported from a Level III nursery to both Level I and Level II community hospitals. Infants who were returned to Level II hospitals tended to be smaller at the time of transfer, were less frequently nipple fed, and more frequently required oxygen supplementation compared with infants returned to Level I hospitals. Back transport permitted physicians to defer 3,892 days of hospitalization for these infants to community hospitals, an equivalent savings of approximately ten hospital beds at full occupancy. This resulted in a 44% reduction in the need for services in the newborn intensive care unit. Back transport is an efficient means of dealing with overcrowding of Level III nurseries.
Temperature, Mitochondria, and Reye's Syndrome
Authors: DON BROWN R. , WILSON JOHN T.
Published: December 2021

In Reply.—

El-Mallakh raises hypothetical questions about an enhancing effect of fever on mitochondrial damage associated with Reye's syndrome. Our article on aspirin and Reye's syndrome1 emphasized the role of prodromal illness in use of aspirin. Fever was only one of several

[See table in the PDF]

prodormal illness events that were different in patients as compared with control subjects.

Results of our analysis of the epidemiologic data from the Ohio study reveal a statistically significant higher temperature in those children which Reye's syndrome as compared with unmatched control subjects (Table) as well as in patients and control subjects matched for record temperatures.1
Renal Tubular Acidosis in a Patient with Recurrent Metabolic Alkalosis
Authors: Hymes Leonard C. , Warshaw Barry L.
Published: December 2021

A 7-month-old infant with failure to thrive and recurrent episodes of vomiting and metabolic alkalosis was evaluated. Urine pH, serum bicarbonate, and urine Pco2-blood Pco2 studies were consistent with the diagnosis of distal renal tubular acidosis (RTA-type I). Analysis of serum potassium and chloride levels during periods of alkalosis and acidosis revealed that potassium depletion and hypochloremic volume contraction served to maintain the alkalotic state despite the presence of an underlying chronic acidosis. This case represents an unusual presentation for renal tubular acidosis and suggests that, under certain conditions, renal tubular acidosis may predispose to the maintenance of a metabolic alkalosis.
GEORGE ARMSTRONG ON THE TREATMENT OF INGUINAL HERNIAS IN MALE INFANTS (1783)
Authors: C. T. E.
Published: December 2021

George Armstrong (1719-1789), the founder, in 1769, of the first children's dispensary in Europe and author of one of the best pediatric works of the period, treated inguinal hernias in male infants as follows:

Hernia scroti ... in very young children, for the most part readily yields to the following treatment. If the child is of a costive habit, an emollient glyster[enema] is requisite, consisting of three or four ounces of thin water-gruel, a tablespoonful or two of salad-oil, and the same quantity of brown sugar, which must be repeated occasionally. At the same time, a gentle laxative should be given from day to day, just sufficient to open the body moderately, and thereby preventing the straining during the time of going to stool, which, from the child being costive, pushed down the intestine. On the other hand, if the child is of a lax habit of body, and especially if it is purged, the indication of cure is to remove the stimulus attending, or sometimes occasioning the looseness, and thereby prevent the straining in this case also ... I direct the groins and scrotum to be well dabbled with cold pump-water, or lime-water when it can conveniently be had night and morning, the rupture being first reduced, if it was down. By this simple method I have cured a great number of infants (many of whom were born with ruptures) in a few months, and some in a few weeks. But if the disease is stubborn, and the child a little grown up, for example a year or two old, or upwards, I recommend the elastic steel truss to be used, which if skilfully made, answers the purpose very well, without hurting, and should be worn until the cure is perfectly completed, and the part has gathered sufficient strength.1
Hypergonadotropism in Peripubertal Boys with Chronic Renal Failure
Authors: Marder Harold K. , Srivastava Laxmi S. , Burstein Stephen
Published: December 2021

Serum gonadotropin and testosterone concentrations were measured in ten peripubertal boys to assess the effects of uremia on pubertal maturation. Serum luteinizing hormone (LH) concentrations were elevated for stage of puberty in eight boys, whereas in most boys serum follicle-stimulating hormone and testosterone concentrations were normal. Serum LH concentrations correlated with the severity of uremia. LH levels declined when measured 1 year after the initial measurements in four boys who received renal allografts, but were further elevated in two boys who were treated conservatively. Elevated serum LH concentrations in the presence of normal serum testosterone concentrations imply limited testicular sensitivity to the effects of LH in these peripubertal boys, as has been documented for adult men with chronic renal failure. Alternatively, there may be accumulation of an immunoreactive LH molecule that lacks bioactivity. A testicular dysfunction may explain the pubertal delay experienced by some uremic adolescent boys.
Postnatal Development of Circadian Rhythm in Serum Cortisol Levels in Children
Authors: Onishi Shoju , Miyazawa Genji , Nishimura Yutaka , Sugiyama Satoru , Yamakawa Takeshi , Inagaki Hiroshi , Katoh Toshiyuki , Itoh Susumu , lsobe Kenichi
Published: December 2021

High-pressure liquid chromatography was used to study the development of blood adrenocortical circadian rhythm in a total of 64 children, ranging in age from 1 month to 15 years. Patients with endocrine diseases, congenital anomalies, and diseases of the central nervous system were excluded from this study. Determination of corticosteroid concentration was possible with 20 to 100 µL of serum. Twenty-four hour patterns were determined at six-hour intervals. A distinct circadian rhythm with an amplitude comparable to that of an adult emerged at approximately 6 months of age.
Breast or Bottle: A Personal Choice
Authors: FISHER PATRICIA J.
Published: December 2021

To the Editor.—

Many women throughout the country have chosen not to breast-feed or have been unable to do so. Their relationships with their husbands and/or children have suffered while they have tried unsuccessfully to satisfy the needs of the new baby. They have lost confidence in themselves as mothers, and lack of sleep and routine have brought about general chaos in their households. When they have considered bottle-feeding in the best interest of baby and family, they have been pressured by extremist groups into believing that breast-feeding is "vital" to the survival of their babies, and have been urged to continue by peers and medical professionals.
Optimism and Myths
Authors: KLEIN MICHAEL
Published: December 2021

To the Editor.—

This is a letter about optimism and myths. St. Geme1 commenting on the challenging article by Starfield2 writes an extremely positive and optimistic forecast for the future of pediatrics. He addresses the issue of the changing curricular content of the newer ambulatory pediatric programs and expresses confidence that they will produce the "Oslerian" "consultative generalists" or "generalists-specialists" of the future, especially in the area of the new morbidity.

It is important to be optimistic, but one also should be realistic and acknowledge the fact that few of the new ambulatory programs have such depth as to be able to compete successfully with traditionally subspecialist-dominated training programs.
Burn Injury Related to the Improper Use of a Microwave Oven
Authors: PUCZYNSKI MARK , RADEMAKER DENNIS , GATSON ROBERT L.
Published: December 2021

Microwave ovens are found in nearly one quarter of all households and are a potential source of accidents (Business Week, March 8, 1982, p 28). They pose a threat to individuals with pacemakers and misuse can cause burns and lacerations secondary to exploding containers. We wish to report a microwave-related burn injury to emphasize the danger that improper use of this appliance poses for children.

CASE REPORT

A 1-week-old male infant was admitted to our hospital with second degree scald burns over 6% of his body surface area. According to his mother, the burns resulted from overheated formula burning the child. The formula was poured into a commercial nurser, which consisted of a disposable plastic liner with a rubber nipple tightly stretched over the bottle top.
Theophylline Toxicity
Authors: KOSSOY ALLEN F. , WEIR MICHAEL R. , BRYANT MAX V.
Published: December 2021

To the Editor.—

The recent review of theophylline intoxication by Sahney et al,1 was of interest to us because of our experience with patients with high theophylline blood levels but without symptoms.

Five patients were seen; one patient [Figure, A(1), A(2)] had a second ingestion. Theophylline blood levels ranged from 55 µg/mL (14 hours after ingestion) to 140 µ/mL. We followed standard emergency procedures including the use of oral removal, absorption, and catharsis. We then placed the patients under close scrutiny to watch for further symptoms.
Circumcision
Authors: WALLERSTEIN EDWARD
Published: December 2021

To the Editor.—

The paper by Maisels et al1 circumcision calls for a response. The failure to achieve a significant reduction in the circumcision rate in a small sample (N = 23), solely in the dissemination of printed material to mothers, is not surprising. The researchers themselves suggest potential methodologic problems—whether the material was understandable, the lack of reinforcement (verbal or written), and the fact that additional information was given to the mothers from other health care sources (was it pro or con?). Such problems invalidate the study.
Misconceptions About Sleep
Authors: VAN SOMEREN V. , STOTHERS J. K.
Published: December 2021

In Reply.—

We were interested in the comments of Guilleminault et al and were pleased to see that they agree that efforts should be made to recognize obstructive events appropriately.

As indicated in our paper, when we began monitoring infants we had difficulty in distinguishing between movement and obstructive apnea. We turned to the "Methods" section of papers published by experienced investigators, including Guilleminault, for enlightenment. After careful reading, it was not clear to us that Guilleminault et al used endoesophageal pressure analysis, the presence of bradycardia, oxygen saturation, and behavioral observation to define obstructive apnea.
Chronic Protracted Diarrhea of Infancy: A Nutritional Disease
Authors: Lo Clifford W. , Walker W. Allan
Published: December 2021

Diarrhea is an extremely common cause of morbidity in infancy. Occasionally, it becomes protracted, leading to a vicious cycle of malabsorption, malnutrition, and failure to thrive. A number of causes of chronic diarrhea in infancy are discussed, including postinfectious enteritis, celiac sprue, cow's milk allergy, and parasitic infection. Although many mechanisms may contribute to diarrhea, a similar pathophysiologic syndrome of mucosal atrophy, inflammation, and malabsorption results. Attention should be paid to recognition of malnutrition as well as etiologic diagnosis. Therapeutic efforts should concentrate on nutritional rehabilitation, through appropriate oral elemental formulas or total parenteral nutrition. However, encouragement of breast-feeding is probably a more effective way of preventing this difficult problem.