bluuebunny/crossref_metadata_2025 huggingface dataset:
Enuresis: A Contrast of Attitudes of Parents and Physicians
Authors: Shelov Steven P. , Gundy John , Weiss Jeffrey C. , Mclntire Matilda S. , Olness Karen , Staub Henry P. , Jones Dorothy J. , Haque Malika , Ellerstein Norman S. , Heagarty Margaret C. , Starfield Barbara
Published: December 2021

Questionnaires were used to survey 1,435 parents and 446 physicians in order to determine and compare attitudes and beliefs about enuresis. Although both groups thought that bed-wetting is a maturational problem, the parent group thought emotional causes were important and were less likely to accept small bladder size as an etiology. Parents thought that children should be dry at a much younger age than did the physicians (2.75 vs 5.13 years, respectively). Only 63% of parents thought that medical intervention is a good way to deal with a child's bed-wetting, yet 87% of the physicians suggested medical evaluation. A comparison of the various methods used to stop bed-wetting indicated that parents use waking the child, reassurance and talking with the child, restricting fluids, and punishment significantly more often than physicians. Although many physicians prescribe medication, only 6.6% of the parents thought that medicines are a "very good way" to treat enuresis. When developing a treatment plan for a child with enuresis, the physician should recognize the wide differences between parental and physician attitudes toward this common problem of childhood.
Gastric Teratoma: Unusual Cause for Bleeding of the Upper Gastrointestinal Tract in the Newborn
Authors: Cairo Mitchell S. , Grosfeld Jay L. , Weetman Robert M.
Published: December 2021

Bleeding of the upper gastrointestinal tract in the full-term newborn is a relatively benign and rare occurrence. This report describes a female infant with a gastric teratoma who experienced recurrent bleeding of the upper gastrointestinal tract as a neonate and infant secondary to gastric outlet obstruction. Anteroposterior and lateral abdominal radiographs revealed a large calcified abdominal mass with the pathognomonic features of a teratoma with a mandible and teeth. Gastric teratomas have not been previously reported as an etiologic or predisposing condition of gastrointestinal hemorrhage in two large reviews concerning this topic in the newborn and infant. This patient represents the 51st case and only the second female described in the literature. The frequency and unusual features of this treatable lesion, as well as the diagnostic approach to bleeding of the upper gastrointestinal tract in the newborn, are reviewed.
Laryngotracheoesophageal Cleft and Unilateral Pulmonary Hypoplasia in Twins
Authors: Novak Robert W.
Published: December 2021

Laryngotracheoesophageal cleft1 and unilateral hypoplasia of the lung2 are rare congenital anomalies which heretofore have not been considered related. We report a unique pair of monozygous twins with mirror-image unilateral pulmonary hypoplasia associated in one twin with an extensive laryngotracheoesophageal cleft. A review of previous reports and embryologic considerations suggest that this association is not unlikely.

CASE REPORT

Twin girls were delivered by cesarean section after a 35-week gestation of a gravida 10, 39-year-old woman. The pregnancy had been uneventful until the onset of premature labor. Six previous pregnancies had produced normal healthy children and three had ended in first trimester abortions. Examination of the twin placenta showed that it was diamnionic-monochorionic, implying that the twins were monozygotic.
Are Pediatricians Qualified to Judge Suicide Gestures?
Authors: Cunningham Daniel G.
Published: December 2021

The statements of the Committee on Adolescence of the American Academy of Pediatrics regarding teenage suicide (Pediatrics 66:144, 1980) are, in my opinion, quite controversial as far as the recommendations of patient evaluation are concerned. Specifically, the statement that some patients who make suicide gestures may be evaluated and followed by a pediatrician, is unsound. Pediatricians are not trained to evaluate and treat psychotic patients and are not adequately trained to evaluate the psychiatric problems of the adolescent who makes a suicide gesture.
Letters to the Editors
Authors: Felice Marianne E.
Published: December 2021

We agree with Dr Cunningham that most pediatricians are not trained " to evaluate and treat psychotic patients However, to suggest that all adolescents who make a suicide gesture are psychotic is a gross error. We also agree that patients who are actively suicidal should be referred to a psychiatrist and, in fact, in the recommendations we suggest admission to a psychiatric facility. However, suicide gestures are not equated with being actively suicidal, a differentiation that has been well outlined previously.1
Neonatal Mortality Risk for the Eighties: The Importance of Birth Weight/Gestational Age Groups
Authors: Philip Alistair G. S. , Little George A. , Polivy Denise R. , Lucey Jerold F.
Published: December 2021

Since 1976 a computerized data base has been used to store information on babies admitted to two intensive care nurseries serving the Vermont/New Hampshire region. The data base now allows reporting "neonatal" mortality by birth weight/gestational age (BW/GA) groupings for 1976-1979. For all BW/GA groups, except the most immature infants, there has been marked improvement compared to data gathered in the sixties (ie, mortality has decreased). These data are probably applicable to most other centers providing neonatal intensive care. The use of BW/GA categories provides the most reliable way of objectively comparing statistics from one center to another. Differences between two centers were observed when birth weight specific rates were used, but were largely abolished by using BW/GA groups. Data gathered in this way will be increasingly important for comparisons between centers and across years and when evaluating the effectiveness of new therapeutic interventions.
Gastroesophageal Reflux
Authors: Winter Harland S. , Grand Richard J.
Published: December 2021

In this issue of Pediatrics (p 29), Berquist and colleagues present a detailed study of the association between chronic pulmonary disease and gastroesophageal reflux. Of 283 children referred for possible gastroesophageal reflux, 82 patients had chronic asthma, or recurrent pneumonia, or both. These patients were divided into subgroups based on their presenting symptoms. Group 1 consisted of patients with recurrent pneumonia, and group 2 consisted of patients with chronic asthma. The patients in group 1 were further subdivided into those with only pulmonary symptoms and those with both pulmonary symptoms and symptoms of gastroesophageal reflux. The patients in group 2 were similarly subdivided: those with asthma only; those with asthma and pneumonia; those with asthma and symptoms of acid reflux; and those with all three symptoms.
Letters to the Editor
Authors: Ahmann Peter A. , Lazzara Anthony , Dykes Francine , Silverboard Gerald
Published: December 2021

We appreciate the interest that Dr Volpe has shown in our articles1,2 comparing lumbar puncture (LP) to computed tomography (CT) scan as an indicator of intracerebral hemorrhage. We find ourselves in disagreement with some of his conclusions and implications.

First, in regard to Volpe's comment concerning false-positive LPs. We have now performed more than 400 CT scans on high-risk preterm infants and have found CT evidence of isolated subarachnoid hemorrhage in very few. Also evidence of hemorrhage other than subependymal/intraventricular hemorrhage (SE/IVH) is very rare on CT scan.
Ataxia and Deafness in Children Due to Bacterial Meningitis
Authors: Kaplan Sheldon L. , Goddard Janette , Kleeck Marilyn Van , Catlin Francis I. , Feigin Ralph D.
Published: December 2021

Eight children with postmeningitis ataxia had detailed neurologic, audiologic, and neurovestibular evaluations. Prolonged fever, prolonged hyponatremia, or septic arthritis occurred in six during hospitalization. Severe to profound sensorineural hearing losses were present in seven of the children. Electronystagmography was abnormal in three of seven children. In seven children, the ataxia has persisted, but steady improvement has been observed during the course of repeated examinations. Hearing should be evaluated routinely in any child who develops meningitis.
Thermal Environment Change in Growing Premature Infants: Effect on General Somatic Growth and Subcutaneous Fat Accumulation
Authors: Heimler Ruth , Sumners James E. , Grausz John P. , Kien Craig L. , Glaspey John C.
Published: December 2021

Fourteen growing, healthy premature infants were moved from heated incubators to cribs at different points in their growth. Group A (six babies) was moved when babies reached a weight of 1,600 to 1,700 gm; group B (eight babies) when babies reached a weight of 1,800 to 1,900 gm. All other conditions of rearing were kept the same. The effect on their growth and thermal stability was measured during the week before and after the temperature change. All infants tolerated the change well. There was no drop in abdominal temperature in an environment cooler by 5 C. The rate of weight gain correlated with gross energy intake only and did not differ within or between the two groups. The rate of growth of the skinfolds increased dramatically after the infants were moved from the incubator. A cooler environment in a growing premature infant (weight >1,600 gm) may promote faster deposition of subcutaneous fat. This might be an important factor in efficient gain in cold resistance.
OVERDOSING WITH OPIUM, A SERIOUS PEDIATRIC PROBLEM IN ENGLAND A CENTURY AND A HALF AGO
Authors: C. T. E.
Published: December 2021

Early nineteenth-century physicians commonly believed Sydenham's panegyric about opium—that it was a donum Dei and that the "art of physic would be defective and imperfect without it."1 Opium preparations, such as Godfrey's Cordial, a nineteenth century English proprietary preparation, contained 1¼ grain of opium in each ounce of liquid. It was readily available without prescription in England and America, and was given to infants for a variety of complaints.

The severity of the problem caused by misuse of opium given to children in Nottingham, England, in 1840 is evident in the following quotation.2

The very great number of deaths amongst children, resulting from overdoses of opium, or its preparations, and from doses thereof given in mistake for other medicines, cannot fail to excite attention ....

Most of the children poisoned in this way, lost their lives owing to the ignorance, carelessness, or presumption of their mothers. It cannot be too generally known, that narcotic, and anodyne drugs, powerful though they be in the adult, act with infinitely greater energy upon the more sensitive nervous system of the infant: so that even experienced medical men never administer remedies of this class to the very young, without exerting the utmost caution, and making the most accurate calculation.

Two drops of laudanum have been known to kill an infant. Nay we have heard of a case in which one drop stole away the life of a newborn babe. It is evident that mothers and nurses should never dare to administer medicines of the narcotic kind, except under the immediate direction of the medical attendant.
Pulmonary Function and Bronchial Hyperreactivity in Long-term Survivors of Bronchopulmonary Dysplasia
Authors: Smyth John A. , Tabachnik Elvan , Duncan Walter J. , Reilly Bernard J. , Levison Henry
Published: December 2021

Nine children with bronchopulmonary dysplasia were studied at a mean age of 8.4 years. Persistent respiratory symptoms were common. Pulmonary function tests demonstrated airway obstruction and abnormal blood gas levels in most. In six of eight children results of methacholine challenge tests were positive, indicating bronchial hyperreactivity. Abnormal chest radiographs persisted in eight children. The bronchial hyperreactivity is a likely consequence of airway damage in infancy and is the probable reason for episodic wheezing in the early years of life. Improvement in expiratory flow rates following bronchodilator inhalation suggests that such therapy may improve function in these children.
Endoscopic Retrograde Cholangiopancreatography in Pancreatitis in Children and Adolescents
Authors: Blustein Philip K. , Gaskin Kevin , Filler Robert , Ho Chai-Sing , Connon Joseph
Published: December 2021

Five cases of relapsing pancreatitis in children and adolescents are reviewed. Endoscopic retrograde cholangiopancreatography was performed in all cases and was valuable in defining the ductal anatomy. The importance of always considering the presence of an underlying structural abnormality amenable to surgical correction is stressed. Endoscopic retrograde cholangiopancreatography should always be considered when recurrent pancreatitis is investigated as it allows the clinician to plan more accurately medical or surgical management based on the x-ray findings.
Availability of Zinc: Loading Tests with Human Milk, Cow's Milk, and Infant Formulas
Authors: Casey Clare E. , Walravens Philip A. , Hambidge K. Michael
Published: December 2021

Uptake of zinc with human milk, cow's milk, and four infant formulas was investigated using a standard zinc loading test. Female subjects consumed 25 mg of zinc with the milk or formula, the amount of which was calculated to provide 5 gm of protein, after an eight-hour fast. Blood samples were taken prior to (base line) and at 30-minute intervals for three hours after consumption of zinc. Plasma zinc response was calculated as the area under the curve of change in plasma zinc from the base line value, plotted against time over three hours. The plasma response with human milk was significantly greater (P < .005) than with cow's milk and all the formulas. The response with cow's milk and a cow's milk-based formula was one third that with human milk; responses with a soy-based and two casein hydrolysate-based formulas were lower. These results are compatible with the concept, strongly suggested by indirect evidence, that the bioavailability of zinc with human milk is better than with cow's milk or infant formulas.
Copper Deficiency with Cow's Milk Diet
Authors: Naveh Yehezkel , Hazani Anna , Berant Moshe
Published: December 2021

A 6-month-old full-term infant had severe anemia and neutropenia. The patient was being fed cow's milk and a diet of corn flour. Thorough investigation revealed low serum iron concentration, severe hypocupremia, low ceruloplasmin, retardation of bone age, and metaphysial irregularities and spurring. Bone marrow aspirate revealed cytoplasmic vacuolization in precursors of the erythroid and myeloid series and ringed sideroblasts. Therapy with oral iron, folic acid, and vitamin C was futile. Administration of copper sulfate resulted in brisk increase in neutrophils and reticulocytes. The child maintained normal levels of hemoglobin, neutrophils, serum copper and ceruloplasmin, and serum iron one year after copper therapy was discontinued. The probable role of unrecognized copper deficiency in causing anemia in infants more than 6 months of age is discussed, and the importance of serum copper examination in refractory iron deficiency anemia and neutropenia is stressed. To the best of our knowledge, no such case has previously been described in the literature.
Carrier Detection of Urea Cycle Disorders
Authors: Ng W. G. , Oizumi J. , Koch R. , Shaw K. N. F. , McLaren J. , Donnel G. N. , Carter M.
Published: December 2021

Published reports100,102,108 indicate that the degree of success attained in the treatment of infants with urea cycle disorders has not been completely satisfactory. Some new approaches in dietary management, using a combination of arginine, benzoate, and phenylacetate may be useful,67,72,76 but more studies are required. In many instances, clinical problems reflect delays in biochemical diagnosis. Families at risk need to be identified and the genotype of the fetus should be established as soon as feasible after conception, so that appropriate management can be provided during pregnancy and after delivery. Availability of effective methods for carrier detection is a critical component of this process.

With any metabolic disorder, a number of factors should be considered for carrier detection. These include: (1) frequency of occurrence of affected patients in the available population, (2) mode of inheritance, (3) cost-benefit ratio, (4) soundness of the methodology used, and (5) feasibility of prenatal diagnosis. Interestingly, the Tay-Sachs prevention program with the major objective of carrier identification is the only accepted program that has been widely discussed and evaluated.109 The frequency of occurrence of each of the five urea cycle enzyme disorders is uncertain, but ornithine transcarbamylase (OTC) deficiency, the only sex-linked disorder, is considered to be the most common. Not only the hemizygotes, but also many of the heterozygotes of OTC deficiency are clinically affected. The frequency of argininosuccinic aciduria has been estimated to be 1 in 60,000, based on results of a newborn screening program carried out in Massachusetts.110 Carrier identification of urea cycle disorders in the general population is not practical because of cost considerations, but it should be applied to members of affected families.
Doubts Relationship of Salicylate and Reye's Syndrome
Authors: Young William M.
Published: December 2021

I wish to comment on the article by Starko et al regarding salicylate use as a causative factor in Reye's syndrome (Pediatrics 66:859, 1980). If this study proves more than the fact that the sicker the child is the more salicylates his parents give him, it is certainly well hidden. In this era of therapeutic nihilism, are we not to be left with aspirin?

On the other hand, it seems knowledgeable people are rapidly returning to the use of Chloromycetin without much concern.
Fetal Alcohol Syndrome Revisited
Authors: Iosub Silvia , Fuchs Magdalena , Bingol Nesrin , Gromisch Donald S.
Published: December 2021

The findings in 63 patients (aged 1 day to 23 years) with fetal alcohol syndrome are analyzed and compared with a survey of the literature. A younger age at onset of alcoholism was noted in the mother, and there was a high incidence of speech problems in the offspring, an abnormality not previously reported in the fetal alcohol syndrome.
Occipital Encephalocele and Early Gestational Hyperthermia
Authors: Fisher Nancy L. , Smith David W.
Published: December 2021

Hyperthermia as a human teratogen has been implicated as one cause for neurulation defects. To determine whether there is an association between early maternal hyperthermia (20 to 28 days' gestation) and isolated occipital encephalocele, record reviews were conducted for the period 1969 through 1979 in three major medical centers in the Pacific Northwest. Control patients consisted of children with Down's syndrome matched for year of birth, sex, and race. Of the 17 patients ascertained with an isolated posterior encephalocele, four (24%) of the mothers gave a history of hyperthermia, due to prolonged fever of at least 1.5 C above normal thermal levels early in gestation. In the control patients and siblings of affected children, no history of maternal hyperthermia was elicited. These data are compatible with the concept that early maternal hyperthermia is one cause in the genesis of isolated occipital encephalocele.
Composition of Breast Milk from Mothers of Preterm Infants
Authors: Gross Steven J. , Geller Jane , Tomarelli R. M.
Published: December 2021

The influence of daily mechanical expression of breast milk on nutritional composition was examined by comparing expressed milk from 12 mothers who delivered preterm with milk from two groups of mothers delivering at term: nine mothers who mechanically expressed all milk and five mothers who nursed their infants at the breast. Collections were obtained at four-hour intervals over a period of 24 hours so that variability of constituents in milk of different mothers, as well as variability in the same mother over a 24-hour period, could be assessed. Preterm milk contained significantly higher concentrations of protein, sodium, and chloride, and lower concentrations of lactose than the milk from either group of mothers delivering at term. The mean concentrations of protein, sodium, chloride, and potassium in early preterm milk were adequate to meet the estimated requirements for the preterm infant. However, there was large variability in nutritional composition of milk among mothers and among samples from the same mother.
Vasopressin and Pneumothorax in the Neonate
Authors: Stern Paul , Larochelle Frederick T. , Little George A.
Published: December 2021

The release of vasopressin (AVP) was assessed by measuring urinary excretion of the hormone in ten neonates who had an acute and symptomatic pneumothorax in the first three days after birth. AVP excretion rose significantly (paired t analysis) after the pneumothorax occurred. When apparent re-expansion of the lungs occurred after treatment, excretion of AVP returned to prepneumothorax levels within eight to 16 hours. If the pneumothorax persisted or worsened, AVP excretion remained elevated. Urine osmolality rose significantly (paired t analysis) after pneumothorax, presumably in response to the increased AVP levels. Two of the ten infants had hyponatremia in the period studied, while in a state of positive sodium balance. It was concluded that AVP release is increased after a pneumothorax occurs. This increase is apparently not due to osmoregulatory requirements. Fluid intake in these infants may need adjustment to prevent an inappropriate positive water balance.
Letters to the Editor
Authors: Black Robert E. , Merson Michael , Sack David
Published: December 2021

Dr Hughes-Davies may feel justified to treat diarrhea with "starvation and water" on the basis of reason and tradition, but we do not feel that such treatment can be supported by a review of the available evidence.

Rotaviruses, which were present in the stools of all children in our study, appear to cause diarrhea by infecting epithelial cells in the small intestine. In animals, infection is segmental and progresses from proximal to distal. Thus, only a portion of the mucosa is involved at one time.1
WILLIAM CARLOS WILLIAMS RIDS THE PEDIATRIC WARDS OF THE NEW YORK NURSERY AND CHILD'S HOSPITAL OF BEDBUGS
Authors: C. T. E.
Published: December 2021

William Carlos Williams (1883-1963), one of the most significant American poets of this century, practiced pediatrics for more than 40 years in his birthplace, Rutherford, New Jersey.

As an intern in 1908-1909 at the New York Nursery and Child's Hospital, he discovered that the persistent screaming of several of his patients, especially at night, was caused by bedbug bites.

In his Autobiography Williams described his tactics as an exterminator.

Next day I got permission to buy half a barrel of bar-sulfur, big pieces round as my wrist.
Pharmacologic Compliance with Antibiotic Therapy for Acute Otitis Media: Influence on Subsequent Middle Ear Effusion
Authors: Schwartz Richard H. , Rodriquez William J. , Grundfast Kenneth M.
Published: December 2021

The frequency of otitis media with effusion (serous otitis media, secretory otitis media) detected after conventional antibiotic treatment of acute otitis media is approximately 50%. The relationship between pharmacologic compliance and the frequency of otitis media with effusion was studied. A Micrococcus lutea bioinhibition test was used to detect the presence of substances in the urine that inhibited the growth of this antibiotic-sensitive organism. On the fourth, seventh, and tenth days of antibiotic treatment for acute otitis media urine specimens were collected. Otitis media with effusion was detected in 53% of 66 children who had positive results for M lutea bioinhibition compliance tests for all three urine specimens. Electro-acoustic impedance measurements (tympanograms) confirmed the presence of effusion in all children in the effusion group tested by this method. The M lutea bioinhibition assay is a practical, in-office method to validate periodically, during treatment, pharmacologic compliance with antibiotics used for treatment of acute otitis media.
Normal Pressure Hydrocephalus in the Newborn
Authors: Hill Alan , Volpe Joseph J.
Published: December 2021

The entity of normal pressure hydrocephalus (NPH) following intraventricular hemorrhage in the newborn has been characterized. Of 87 infants with intraventricular hemorrhage, 20 had early and rapidly progressive hydrocephalus with intracranial hypertension and/or death. In 47 cases there was no increase in ventricular size and in 20 cases there was progressive increase in ventricular size with normal intracranial pressure, ie, NPH. Of these infants with NPH, nine had spontaneous arrest with or without resolution of ventriculomegaly, beginning within 31 days of onset. In 11 cases, after a stable period of NPH lasting 12 to 84 days, there was progressive increase in ventricular size accompanied ultimately by raised intracranial pressure. A relationship between the degree of ventriculomegaly and severity of intraventricular hemorrhage was demonstrated. The data thus define a state of NPH after intraventricular hemorrhage and indicate that approximately half of such cases will not develop progressive hydrocephalus with increased intracranial pressure. If arrest or onset of resolution of ventriculomegaly is not apparent within approximately one month, continued progression and necessity for intervention are to be expected. Serial measurements of intracranial pressure and ventricular size in newborns with posthemorrhagic ventricular dilation allow the diagnosis of NPH and permit early recognition of rapidly progressive ventricular dilation with intracranial hypertension which may follow a stable period of NPH. Such early recognition of this potentially harmful state allows prompt ventricular drainage, thereby preventing brain compression.
Suppurative Thrombophlebitis in Childhood
Authors: Sears Nicholas , Grosfeld Jay L. , Weber Thomas R. , Kleiman Martin B.
Published: December 2021

Thrombophlebitis in children is almost always related to intravenous therapy. In most cases the inflammatory reaction is self-limited and resolves when the intravenous catheter or needle is removed. In some cases contamination may result in suppurative thrombophlebitis, a potentially life-threatening complication of intravenous therapy. This report describes two 6-year-old children with suppurative thrombophlebitis that was successfully treated by drainage of periphlebitic abscess and excision of the infected vein. Early recognition and prompt surgical management should reduce morbidity and prevent mortality in these cases.
Effect of Antenatal Administration of Betamethasone on Hospital Costs and Survival of Premature Infants
Authors: Johnson Dana E. , Munson David P. , Thompson Theodore R.
Published: December 2021

Prenatal administration of glucocorticoids has been shown to decrease the incidence and severity of respiratory distress syndrome in premature infants, but little is known regarding the immediate economic impact of this reduction in respiratory morbidity. This study retrospectively examined 342 infants born during 1978 and 1979 and hospitalized in the University of Minnesota Hospitals. Comparison of survival and the hospital charges for infants whose mothers had or had not received prenatal glucocorticoid therapy showed that administration of glucocorticoids had a significant effect in lowering mortality in infants with birth weights between 750 and 1,249 gm (27 to 29 weeks' gestation). Glucocorticoid therapy was also effective in decreasing morbidity as reflected by hospital charges of surviving infants with birth weights between 1,250 and 1,749 gm (30 to 32 weeks' gestation). In both steroid-treated and nontreated mothers, prolongation of gestation decreases hospital charges in a linear fashion. The noted decrease in hospital costs should not justify prenatal glucocorticoid administration but should stimulate examination of long-term effects of the drug on surviving infants.
Utilization of School and Primary Health Care Resources for Common Health Problems of Schoolchildren
Authors: Brink Susan Gilman , Nader Philip R.
Published: December 2021

The episode of care is used as a concept to assess potential areas for interaction between private and public health care facilities in the community and the school health service in child health care. Health care utilization (both patient-initiated and provider-initiated) of a random sample of elementary school-aged children in three ethnic groups was observed for two years. The analysis suggests areas of child health care in which a school health service can be used more effectively with community health care providers: care for chronic childhood diseases, follow-up for acute infections and some trauma, and health maintenance.
In Praise of Useful Articles
Authors: Schnitzker William F.
Published: December 2021

Many thanks to Apollo, Aesculapius, Hygeia, Panacea, and all the gods and goddesses of health for the May 1981 issue of Pediatrics. In "Fever and Convulsions..." Jaffe et al concluded "that the only routine investigation indicatd, even in the absence of clinical suspicion, is a lumbar puncture. In ideal situations even this procedure may be omitted. Other investigations should be performed only if the clinical features of the case warrant them." I would amend the "ideal situation" to: if and when a clinician with the usual qualification to practice is available, the lumbar puncture should be omitted.
Alterations in Cerebral Blood Flow in Preterm Infants with Intraventricular Hemorrhage
Authors: Ment Laura R. , Ehrenkranz Richard A. , Lange Robert C. , Rothstein Peter T. , Duncan Charles C.
Published: December 2021

Xenon-133 inhalation hemispheric cerebral blood flow (HCBF) determinations at one to two days and four to six days postnatally and at 37 weeks postconceptual age have been correlated with computed tomography (CT) scan and autopsy findings in 15 preterm infants weighing less than 1,250 gm at birth. Ten of these infants had germinal matrix hemorrhages (GMH) or intraventricular hemorrhages (IVH). Although HCBF obtained at one to two days showed no mean difference between the GMH/IVH group and the nonhemorrhage infants, hemispheric flow ratios showed significant discrepancies in the GMH/IVH group. In addition, in four of five patients in whom the hemorrhage appeared asymmetric on CT scan, the side of higher flow correlated with the hemorrhage. At four to six days HCBF showed a lower mean value in the GMH/IVH patients than in the nonhemorrhage patients and differences in the interhemispheric ratios in the GMH/IVH group persisted. There were no differences in the mean HCBF values or hemispheric ratios between the two groups of infants at 37 weeks postconceptual age.
THE PERNICIOUS PRACTICE OF FEEDING DISTILLERY SLOP TO DAIRY COWS
Authors: C. T. E.
Published: December 2021

Robert M. Hartley (1796-1881) was one of the founders and for many years secretary of the New York Association for Improving the Condition of the Poor. In his long-forgotten Essay on Milk,1 he vividly described the appalling dairy practices in New York City in the 1840s.

He wrote:

The manner of producing milk to supply the inhabitants of cities and other populous places, is so contrary to our knowledge of the laws which govern the animal economy, that from a bare statement of the facts, any intelligent mind might confidently anticipate the evils which actually result from it. The natural and healthy condition of the cows, appears, for the most part, to be utterly disregarded. They are literally crowded together in large numbers in filthy pens, which at once deprives them of aequate exercise and pure air, both of which are indispensably essential to their health.... The dairies have been formed around the distilleries, for the purpose of consuming on the spot the slop refuse.... The cow-pens are rude, unsightly wooden buildings, varying from fifty to two hundred feet in length, and about thirty feet in breadth. They are very irregularly arranged, so as to cover the entire ground, excepting narrow avenues between; and appear to have been temporarily constructed, as the arrival of new dairies required enlargements for their accommodation.... Let the visitor go into the midst of the pens, when crowded with cattle... and inhale but one breath of the polluted air, and an inexpressible impression of heart-sickening disgust will be produced, which time will never efface....
Once-Daily Dosing with Phenobarbital in Children with Seizure Disorders
Authors: Davis Anne G. , Mutchie Kelly D. , Thompson Joel A. , Myers Garth G.
Published: December 2021

In nine pediatric patients with seizure disorders, aged 8 months to 16½ years, a single daily dose of phenobarbital was as effective in maintaining therapeutic serum concentrations as twice-daily dosing. There were no adverse reactions to the once-daily regimen, and no seizure activity occurred during the study as a result of the change in dosing pattern.
Outcome of Early and Long-Term Management of Classical Maple Syrup Urine Disease
Authors: Clow Carol L. , Reade Theresa M. , Scriver Charles R.
Published: December 2021

The outcome of 8,400 treatment days in the lives of four patients with classical maple syrup urine disease (MSUD) (present ages: 13½, 57½, 71½, and 811½ years) are described. Each diagnosis was made by clinical signs rather than by newborn screening. Acute-phase treatment beginning on the 11th day of life comprised peritoneal dialysis, intravenous lipid, and early intestinal alimentation. Mean age at discharge from hospital was 29 days. There were 16 readmissions to the hospital for the group (89 days, 1.05% treatment days) without any serious neurologic symptoms. The mean level of plasma leucine for the group (for levels below 1 mM) during treatment was 0.42 mM (normal for age range, 0.077 ± 0.021 mM [mean ± SD]). Plasma leucine exceeded 1 mM during 1.02% of treatment days (representing 8.6% of 1,042 measurements. Mean levels of plasma valine and isoleucine were 60% and 70% of the plasma leucine value for the group. Tolerance for dietary leucine did not exceed 620 mg/day in any patient. Somatic growth was normal and the mean current IQ/development quotient (DQ) score is 101 (range 89 to 117); the three oldest patients attend regular schools. A characteristic EEG pattern resembling the teeth of a comb was observed in three patients during the acute phase in the newborn period but not during long-term treatment. These results were obtained in an ambulatory program with home visiting.
Management of Asthma
Authors: Easton James , Hilman Bettina , Shapiro Gail , Weinberger Miles , Anderson John , Buckley Jerome , Eggleston Peyton , Bierman C. W.
Published: December 2021

Advances in the knowledge of clinical pharmacology and pulmonary physiology have significantly improved the management of asthma in children and adolescents. Acute episodes of asthma can be treated with oral bronchodilators if the episodes are mild, but inhaled sympathomimetic drugs are more effective and may have fewer side effects. Effective therapy for status asthmaticus consists of intravenous aminophylline and corticosteroids and aerosolized sympathomimetic drugs. Theophylline, in a dose that maintains serum concentrations between 10 and 20 µg/ml, or cromolyn is the drug of choice for managing asthma when symptoms are continuous or recur frequently. Theophylline appears to be more convenient to use than inhaled cromolyn sodium, after the proper dose is established. However, cromolyn has no risk of overdosage and does not require the measurement of serum concentrations essential for theophylline efficacy and safety. β-Adrenergic agents are useful adjuncts or alternatives to therapy with theophylline or cromolyn. Treatment by short courses of corticosteroids may be needed at intervals for patients with chronic or labile asthma. Continuous use of corticosteroids will be required for the relatively few patients whose asthma cannot be controlled with other medications. Alternate-day prednisone or inhaled beclomethasone dipropionate offer two alternatives for continuous therapy with corticosteroids which are relatively free from adverse effects of chronic steroid administration. Immunotherapy for inhaled pollens, house dust, or molds may be useful in selected patients whose allergy is clearly exacerbating to their asthma.
Atypical Kawasaki Disease with Aortic Aneurysm
Authors: Canter Charles E. , Bower Richard J. , Strauss Arnold W.
Published: December 2021

Kawasaki disease (mucocutaneous lymph node syndrome), initially described in Japan, is now being seen with increasing frequency in the United States.1 The diagnosis is based on the typical constellation of signs and symptoms.1,2 Mortality is 1% to 2%, and significant morbidity results from aneurysmal formation in midsize arteries, especially the coronary arteries, which may result in rupture or myocardial infarction.

We report an unusual case of Kawasaki disease. The initial febrile illness was an atypical presentation.

A large abdominal aortic aneurysm developed, which subsequently was resected. Seven months after the febrile illness an asymptomatic myocardial infarction secondary to bilateral coronary arterial aneurysms was documented.
Influence of High Altitude on Sudden Infant Death Syndrome
Authors: Barkin Roger M. , Hartley Marlina R. , Brooks John G.
Published: December 2021

Approximately 8,000 infants die annually in the United States of sudden infant death syndrome (SIDS), but the pathophysiology of events leading to death remains unclear. A number of the postmortem findings in these children are consistent with chronic and/or recurrent hypoxemia prior to death. Hypoxia may initiate factors or be the result of mechanisms that ultimately lead to death.1 Baker and McGinty2 reported that, in kittens, chronic, intermittent hypoxia can produce cardiorespiratory irregularity and depression and decreased active sleep, the latter being the sleep state when ventilation is least vulnerable to hypoxia. Naeye3 documented the presence of increased muscle mass in the small pulmonary arteries of infants living at high altitudes and those dying of SIDS at sea level.
Letters to the Editor
Authors: Duff Raymond S.
Published: December 2021

Dr McLaughlin seems preoccupied with selected facts and rules of decision making, but he indicates little concern about the accuracy of some facts and the adequacy of the rules. Several examples illustrate this, He says, "all infants deserve supportive treatment," but he also recognizes this may result in "perverse" death. He reasons that "present-tense facts" primarily should guide decision making, but parents with good reasons often are much more concerned about the future of their child and family.
Treatment of Tricyclic Poisoning
Authors: Fujita Pamela
Published: December 2021

Magera et al1 reported successful seizure control with physostigmine after acute ingestion of hydroxyzine. We concur with the authors' recommendation for cautious use of physostigmine. The authors point out that physostigmine-induced seizures have been reported following rapid intravenous administration and recommended that it be "administered slowly." We would like to clarify further the rate of administration. It has been recommended that the dose of physostigmine be administered intravenously over a two- to five-minute period to minimize the possibility of seizures.2,3
New Issues in Newborn Screening for Phenylketonuria and Congenital Hypothyroidism
Authors: Scriver Charles R. , Holtzman Neil A. , Howell R. Rodney , Mamunes Peter , Nadler Henry L. , Manley Audrey F. , Oakley Godfrey , Simpson Joe Leigh
Published: December 2021

Screening for phenylketonuria (PKU) and congenital hypothyroidism (CH) is of concern to parents, physicians, and public health professionals. Parents have an abiding interest in a predictive activity that can prevent disease in their offspring. Physicians and their consultants must counsel parents and interpret a positive screening test. Public health personnel are concerned with the specificity and sensitivity, efficiency, and effectiveness of newborn screening.

The Committee on Genetics has previously published recommendations on newborn screening for PKU and CH.1 Further recommendations are required because PKU and CH screening are widely practiced joint procedures in the newborn and because most full-term newborn infants are now being discharged from North American nurseries within the first three days after birth. This new practice is likely to have an effect on the validity of newborn screening and on screening for PKU, in particular.

A recent statement from the Committee on Fetus and Newborn (Pediatrics 65:651, 1980) addressed the problem of so-called "in and out deliveries." However, the statement was ambiguous on the issue of whether such infants should be screened routinely on the initial discharge from the nursery. The Committee on Genetics believes that all infants, regardless of age, should be screened for PKU and CH at discharge from the nursery.

The Committee believes that screening is not the equivalent of diagnosis; some cases of PKU and CH will inevitably be missed by screening. Whereas an important reason for missed cases may be the biology of the target disorders, none should slip through the screening mesh because of flaws in the program and its components.
Food and Behavior Studies Needed
Authors: Crook William G.
Published: December 2021

I read with interest the letters of Rapp and Stare on "Diet and Hyperactivity" (Pediatrics 67:937, 1981) and I'm pleased that Pediatrics is continuing to air this problem.

Admittedly, the diet/hyperactivity controversy is complex—unbelievably complex. Yet, every single day in my own pediatric and allergy practice I receive anecdotal reports from parents who tell me that the hyperactive behavior in their children subsides...often dramatically ... following a seven-day elimination diet. Parents report sugar as the number one cause of hyperactivity.
Head Size and Intelligence
Authors: Knobloch Hilda , Malone Anthony
Published: December 2021

We would like to raise some of the more obvious questions about the procedures and conclusions in the article by Lipper et al (Pediatrics 67:502, 1980) relating head circumference at birth to neurobehavioral outcome.

One criterion stated for inclusion of an infant in the study was a birth weight less than the tenth percentile. How then can the authors proceed to divide their population into those who were below the tenth percentile (small for gestational age [SGA]) and those who were above the tenth percentile (appropriate for gestational age [AGA])?
Chronic Granulomatous Disease and Pneumocystis carinii Pneumonia
Authors: Adinoff Allen D. , Johnston Richard B. , Dolen Jale , South Mary Ann
Published: December 2021

Chronic granulomatous disease (CGD) is a syndrome characterized by recurrent purulent infections of the skin, lungs, and reticuloendothelial organs. The underlying defect is an inability of phagocytes to convert molecular oxygen into high-energy metabolites that contribute to microbial death. Infections are primarily due to staphylococci, enteric bacteria, fungi, and occasionally mycobacteria.1 An 11-year-old girl with CGD was reported to have pneumonia due to P carinii.2 We have found a second case of CGD with pneumonia due to P carinii.
Mortality and Morbidity in Infants Less Than 1,001 Grams Birth Weight
Authors: Driscoll John M. , Driscoll Yvonne T. , Steir Mary E. , Stark Raymond I. , Dangman Barbara C. , Perez Alicia , Wung Jen-Tien , Kritz Paula
Published: December 2021

A prospective study of 54 infants with birth weights of 1,000 gm or less was conducted over a period of two years. Of the 26 infants who survived, 24 weighed between 750 and 1,000 gm; two infants died after discharge and one was lost to follow-up, leaving 23 in whom serial observations were made over 18 months to 3 years of age. The incidence of neurologic deficit in these infants was 17% and of intellectual deficit, 13%. Of the four who were abnormal neurologically, two had spastic quadriparesis, one static encephalopathy, and one hydrocephalus secondary to intraventricular hemorrhage. The three with intellectual deficit had a developmental quotient <85. Of the perinatal factors examined, only birth asphyxia correlated significantly with both neonatal mortality and subsequent morbidity. Six (26%) of the surviving infants had mild, nonblinding retrolental fibroplasia; only one of them had a significant refractive error that required corrective lenses for vision. Sepsis was a significant contributor to neonatal mortality in ten of 28 infants who died, but was detected in only one survivor. Although the prognosis for the infant weighing 1,000 gm or less at delivery has improved significantly, there is promise for still further improvement by reducing perinatal asphyxia.
Failure of Hydrocortisone to Affect Outcome in Dengue Shock Syndrome
Authors: Sumarmo Dummy , Talogo Widodo , Asrin Arnis , Isnuhandojo Bachrudin , Sahudi Achmad
Published: December 2021

Despite the absence of a clear-cut rationale for their use, corticosteroids are widely employed in the treatment of dengue shock syndrome. Previous comparative therapeutic trials have yielded contradictory results. Resolution of this therapeutic controversy has been attempted with a double-blind evaluation of the clinical effect of steroid administration in dengue shock syndrome. Placebo or a single dose of hydrocortisone hemisuccinate, 50 mg/kg of body weight, was administered randomly to 97 physiologically treated patients with dengue shock syndrome. The severity of disease on admission to the hospital and the effectiveness of treatment were quantified by a World Health Organization scoring system. The response to therapy as measured by mortality, duration of shock, and amount of replacement fluids required was virtually identical in 47 children who were and 50 children who were not treated with steroids. The comparison groups were composed of children similar in age, sex, and severity of illness. It is concluded that hydrocortisone is of no value in the treatment of dengue shock syndrome. Reliance should be placed on appropriate supportive and physiologic therapy.
Lactic Acidemia in Reye's Syndrome
Authors: Tonsgard James H. , Huttenlocher Peter R. , Thisted Ronald A.
Published: December 2021

Plasma lactate level was measured in 21 patients with Reye's syndrome and was compared with neurologic state as rated on a simple coma scale. Significant elevations in plasma lactate, ranging from 2 to 15 mEq/liter, were noted in all patients. There was a close correspondence between stage of coma at the time the sample was drawn and lactate levels. The correlation of plasma lactate level with clinical stage could not be accounted for by differences in glucose, Po2, Pco2, pH, blood pressure, or serum osmolality. In contrast, blood ammonia level correlated with the severity of the encephlopathy early in the course only and often returned to normal in patients with persistent coma. Other measurements of hepatic dysfunction such as SGOT and SGPT levels failed to correlate with clinical state. All patients had a metabolic acidosis; in five patients it was uncompensated. Lactate accounted for nearly all (mean 81%) of the observed base deficit. The findings suggest that lactic acidemia is an important metabolic component of Reye's syndrome.