bluuebunny/crossref_metadata_2025 huggingface dataset:
Household Spread of Infection Due to Haemophilus influenzae Type b
Authors: Campbell L. Rebecca , Zedd Arnold J. , Michaels Richard H.
Published: December 2021

Instances of spread of infection due to Haemophilus influenzae type b in families and in day care centers have demonstrated the potential communicability of this organism among young children in close contact.1 There have been several recent studies to determine the risk of secondary illness in households of patients with H influenzae type b meningitis,2-5 including a large national survey.3 The first of these reports found an attack rate of 4.9% for children 2 years of age or younger.2 Our study was initiated soon after this study to find out whether a survey of a different population would yield similar results. The unique feature of our study was the inclusion of families of children with epiglottitis.
A Restraint and Transillumination Device for Neonatal Arterial/Venipuncture: Efficacy and Thermal Safety
Authors: Curran John S. , Ruge Walter
Published: December 2021

A different method of restraint together with technical details for construction demonstrating the use of reflected high intensity fiberoptic light is presented. Thermal data are presented demonstrating safety within recognized biologic skin temperature safety which permits utilization of a high intensity

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light source for arterial or venous cannulation for prolonged periods of time extending to 20 minutes. This device presents a method to demonstrate visualization of blood vessels in the infant's extremity without risk of thermal burn associated with an adequate flexible restraint quick-release mechanism. Disposable polyurethane 5-mm pads (cut from sheets) were utilized to minimize pressure on bony prominences or nerves of the extremity. Neither thermal burns nor pressure alterations have been noted. Although not specifically evaluated, the use of a heat filter and CS-2-73 orange filter might further reduce heat buildup while using this device.
Value of the Neonatal Neurologic Examination?
Authors: Knight Philip
Published: December 2021

The recent commentary on the "Value of the Neonatal Neurologic Examination" made two points: the logic examination of the newborn can evaluate cortical areas of the brain, and abnormal neurologic

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examination of the newborn can evaluate cortical areas of the brain, and abnormal neurologic findings in the newborn can be good indicators of subsequent neurologic abnormalities.1 The data used to substantiate the latter contention came from the Collaborative Study for Cerebral Palsy carried out on 54,000 pregnant women between 1959 and 1966.2
Parents' Perceptions of the Psychological and Social Impact of Home Monitoring
Authors: Cain Lillian Pike , Kelly Dorothy H. , Shannon Daniel C.
Published: December 2021

Self-assessments of 133 parents' (74 families) feelings, perceptions, reactions to stresses, and satisfactions during a period of electronic home monitoring are reported. Data were collected during structured interviews by students in a graduate social work program. Although extreme anxiety was prevalent initially, only 27.4% of the parents felt they were very anxious beyond the first month. Social life was restricted in 55.7% but job attendance was seldom affected. Only four parents felt very irritated by the increased demands of the monitored baby. The majority (72.9%) said that the monitor made them feel more comfortable with their baby. Only 14.2% felt that their marriage relationship worsened during the period of monitoring; two couples separated. Most supportive to parents were their spouses, least supportive were friends and relatives. With availability of a psychosocial support system, electronic home monitoring of infants can be conducted by parents without constant and extreme anxiety and, in their judgment, can even be a satisfying experience.
Interobserver Variability in the Radiographic Diagnosis of Necrotizing Enterocolitis
Authors: Mata Antonio G. , Rosengart Ronald M.
Published: December 2021

A total of 17 radiographs from seven babies with clinical evidence of necrotizing enterocolitis were examined by six pediatric radiologits and four neonatologists from the Southern California area. The participants were asked to interpret each radiograph as to the presence or absence of necrotizing enterocolitis and to indicate whether pneumoperitoneum was present. A substantial degree of interobserver variability was observed, with only one of the 17 films yielding universal agreement. We propose that this interobserver variability in interpreting abdominal films of neonates with clinically suspected necrotizing enterocolitis may in fact contribute to the reported difference in incidence of this disease among centers.
Unsuspected Nutritional Rickets
Authors: Rudolf Mary , Arulanantham Karunyan , Greenstein Robert M.
Published: December 2021

Based on the presentation and clinical features of four cases of nutritional rickets, it is suggested that particular groups of children, namely vegetarians, children breast-fed for an unusually long time, and black children, are at risk to develop the nutritional deficiencies of vitamin D and calcium that lead to clinical rickets. The diagnoses in these cases were made by fortuitous radiologic examination, even though the children had been receiving regular pediatric supervision, indicating a lack of awareness of the condition. This report is intended to emphasize the reemergence of nutritional rickets and to illustrate the different modes of its clinical presentation.
The Miller-Dieker Syndrome
Authors: Jones Kenneth Lyons , Gilbert Enid F. , Kaveggia Elizabeth G. , Opitz John M.
Published: December 2021

Four unrelated children with the Miller-Dieker syndrome, previously referred to as the lissencephaly syndrome, have been evaluated, bringing to ten the number of patients reported with that disorder. We wish to emphasize that lissencephaly is etiologically non-specific and represents only one feature in this malformation syndrome. Other features, such as the craniofacial, neurologic, and growth abnormalities, are more helpful in diagnosing this autosomal recessive disorder.
Scorpion Envenomation
Authors: Rimsza Mary Ellen , Zimmerman Dale R. , Bergeson Paul S.
Published: December 2021

A potentially lethal neurotoxin-producing scorpion, Centruroides sculpturatus, exists in the southwestern United States. The most common symptoms of envenomation of 24 patients included local pain, restlessness, and roving eye movements. In this series 80% of cases were in children less than 10 years of age. Pain at the site of the sting was a predominant symptom in the patient more than 10 years of age; however, extreme and perpetual restlessness was the most common symptom in the younger patient. The diagnosis in children is usually made by clinical presentation alone since the site of the sting cannot be identified and children may not communicate the history of the sting. The most commonly used chemotherapeutic agent is phenobarbital. There is no evidence, however, that this drug decreases morbidity or mortality, and massive doses of phenobarbital were associated with two respiratory arrests in this series. The nature of scorpions and their venoms is discussed. Research is needed regarding the use of sympathetic blocking agents in scorpion envenomation.
Mouthwash: A Source of Acute Ethanol Intoxication
Authors: Weller-Fahy Edward R. , Berger Lawrence R. , Troutman William G.
Published: December 2021

Treatment of a 33-month-old girl who sustained severe ethanol intoxication resulting from mouthwash ingestion prompted us to review the ingestions, compositions, and sales of these common household products. Mouthwashes contain up to 26.9% ethanol (53.8 proof), and each of the leading brands markets single containers that can supply a lethal ethanol dose to a toddler. Mouthwashes are particularly hazardous because they are thought to be innocuous, and they are widely available, attractive, and kept within easy reach of children. Parent education, and restrictions on packaging and ethanol concentration are recommended.
Congenital Adrenal Hyperplasia Presenting with Posterior Labial Fusion Without Clitoromegaly
Authors: Marshall William N. , Lightner Elmer S.
Published: December 2021

In females with congenital adrenal hyperplasia, 21-hydroxylase deficiency without salt loss is usually recognized in the neonate because of ambiguous genitalia (ie, clitoromegaly with or without labial fusion), or at a later age because of progressive virilization and/or accelerated linear growth. We are reporting the second case of posterior labial fusion without clitoromegaly as the presenting sign of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Here, as in the prior case of Wolff et al,1 the absence of clitoromegaly postponed recognition of the patient's problem.

CASE REPORT

C.V. was born at term to a 25-year old, gravida 2, para 1, Mexican-American woman after a normal pregnancy; only vitamins were taken during the pregnancy.
The Natural History of Herpes Simplex Virus Infection of Mother and Newborn
Authors: Whitley Richard J. , Nahmias André J. , Visintine Arolyn M. , Fleming Charles L. , Alford Charles A. , Yeager Anne , Arvin Ann , Haynes Ralph , Hilty Milo , Luby James
Published: December 2021

The controlled evaluation of vidarabine as therapy of neonatal herpes simplex virus (HSV) infection provided an opportunity to collect data to further assess the natural history of maternal and newborn infections. Women delivering infected babies were young, nulliparous, and infrequent aborters. Nearly 50% of the gestations ended in premature labor. Maternal infection was asymptomatic in 39 of 56 (70%) of the mothers, at the time of delivery. However, risk factors included a past history of genital herpes at any time and exposure to a sexual partner with presumed HSV lesions. Associated diseases in children born to these women were common. Premature infants had an incidence of respiratory distress of 52% (14 of 27). Eight of 29 (28%) term newborns had a bacterial infection, antedating the onset of neonatal HSV infection. Virologic studies on infected newborns confirmed that skin lesions were the most frequent site for virus retrieval. Progression of disease from isolated skin lesions was common, occurring in 70% of babies whose presenting sign was skin vesicles. CSF was virus-positive from 14 babies and more frequently in those with localized CNS disease. Importantly, brain biopsy was necessary for diagnosis in four cases. Finally, neither the presence or absence of antibodies to HSV was useful in predicting either presentation or outcome of infection. These studies further emphasize the complex nature of HSV infections of the newborn and need for tertiary care.
Lack of Identifiable Risk Factors for Kernicterus
Authors: Turkel Susan Beckwitt , Guttenberg Marta E. , Moynes Diane Radovich , Hodgman Joan E.
Published: December 2021

In recent years kernicterus at autopsy has been observed in sick premature infants in the absence of markedly elevated levels of serum bilirubin. Potentiating factors have been suggested to explain kernicterus in such a setting. In order to establish which factors are associated with increased risk for kernicterus in these small babies, this retrospective matched control study was undertaken. Thirty-two infants with kernicterus at autopsy were matched for gestational age, birth weight, length of survival, and year of birth to 32 control infants without kernicterus. Multiple historical, clinical, and laboratory factors were compared, including therapy, sepsis, hypothermia, asphyxia as reflected by Apgar score, hematocrit, acidosis, hypercarbia, hypoxia, hypoglycemia, and hyperbilirubinemia. No statistically significant differences between the kernicteric and nonkernicteric infants were demonstrated for any of these factors, including peak total serum bilirubin levels. Multivariant analysis also failed to determine a group of factors associated with increased risk for kernicterus. It was not possible to separate those infants with and without kernicterus at autopsy on the basis of the clinical factors evaluated.
Diet and Hyperactivity: Is There a Relationship?
Authors: Stare Fredrick J. , Whelan Elizabeth M. , Sheridan Margaret
Published: December 2021

In 1973 Dr Ben Feingold, a California allergist, proposed that salicylates, artificial flavors, and artificial food colors are a cause of hyperactivity. Dr Feingold recommended a diet free of these substances as both treatment and prevention of the condition. He has published two popular books on the subject, Why Your Child Is Hyperactive (1974) and The Feingold Cookbook for Hyperactive Children (1979). Many parents have adopted the diet for their hyperactive children, and some have reported a noticeable improvement in their child's behavior when the diet was followed. In recent years a number of experiments have been carried out to evaluate the relationship between hyperactivity, salicylates, artificial food colors, and artificial flavors. The data indicate that the symptoms of the vast majority of cases of children labeled "hyperactive" are not related to additives in their diet.
Evaluation of a Rural Perinatal Care System
Authors: Hein Herman A.
Published: December 2021

A voluntary system of regionalized perinatal health care was developed in Iowa to provide accessible services for a rural population. Larger community hospitals were upgraded to serve as level II regional centers and small obstetric units continued to provide maternity services for low risk patients. Consolidation of services was encouraged only when accessibility was not compromised. Education rather than legislative fiat was the stimulus for change. Evaluation by review of birth and mortality data suggests that a stratified system of care exists in Iowa. Judged by mortality statistics, perinatal outcome has improved since the inception of the program in 1973. The concept of a mortality risk ratio (neonatal deaths/<1,500 gm live births) is suggested as a method of reviewing mortality data from the perspective of risks inherent in the population served.
Complications of Sinusitis in Children
Authors: Brook Itzhak , Friedman Ellen M. , Rodriguez William J. , Controni Guido
Published: December 2021

Eight patients (6 to 15 years of age) who had periorbital cellulitis and other complications of sinusitis were studied. Both ethmoid and maxillary sinusitis were present in four patients, frontal sinusitis in two, and ethmoid sinusitis and pansinusitis in one patient each. Subdural empyema occurred in four patients, in one case accompanied by cerebritis and brain abscess and in another by meningitis. Periorbital abscess was present in two children who had ethmoiditis. Alveolar abscess in the upper incisors was present in two children whose infection had spread to the maxillary and ethmoid sinuses. Anaerobic bacteria were isolated from the infected sinuses in all the patients. These were seven isolates of Bacteroides sp, four Fusobacterium sp, three microaerophilic streptococci, three Gram-positive anaerobic cocci, and two Veillonella sp. There was only one aerobic isolate recovered, a group F β-hemolytic Streptococcus. Surgical drainage and appropriate antimicrobial therapy resulted in complete eradication of the infection in all patients. The role of anaerobic bacteria in sinus infection and its subsequent complication is discussed. Given the possible serious complications of this disease, the early recognition of sinusitis in children and the institution of appropriate antimicrobial and surgical therapy are of great clinical importance.
Urine Mercury Levels in Kawasaki Disease
Authors: Orlowski James P. , Mercer Robert D.
Published: December 2021

Six patients with diagnostic criteria for Kawasaki disease had abnormally high urinary excretions of mercury. They were compared by age, sex, and geographic location with matched controls. Improvement of one patient was temporally related to chelation of mercury with penicillamine. There are numerous clinical similarities between acrodynia and Kawasaki disease and the appearance of the mucocutaneous lymph node syndrome (Kawasaki disease) has been related temporally and geographically to environmental pollution with mercury. The mucocutaneous lymph node syndrome (Kawasaki disease) may represent a disease caused by environmental pollution with mercury, or clinical symptoms compatible with Kawasaki disease may indicate environmental exposure to mercury.
More Contraindications to the Pill
Authors: Realini Janet P.
Published: December 2021

I read with interest the excellent review by Drs Greydanus and McAnarney.1 Several of their points concerning combined oral contraceptives deserve discussion, however.

The relative potencies of the progestins and estrogens contained in oral contraceptives are controversial. Progestin potency is difficult to measure reliably, and comparisons among progestins can be misleading.2 While animal studies have suggested that mestranol is a weaker estrogen than ethinyl estradiol, a study of human ovulation inhibition suggested that ethinyl estradiol may be weaker than mestranol.3
Age of Onset of Lactose Malabsorption
Authors: Simoons Frederick J.
Published: December 2021

The Committee on Nutrition, American Academy of Pediatrics, understandably focuses on American ethnic groups in the section of their article1 dealing with studies on lactose intolerance. Their conclusions bear out the earlier one by Bayless et al2 that although precise data are lacking on age of onset of lactose malabsorption (LM) among children in the United States, there appear to be notable differences among American ethnic groups in that regard. Bayless et al, relying on four studies of normal, healthy children,3-6 observed that substantial percentages of blacks and Mexican Americans become lactose malabsorbers at 1 to 4 years of age, whereas those white Americans who develop LM do so at age 5 or later.
Varicella Arthritis
Authors: Borgenicht Louis
Published: December 2021

Varicella arthritis is a rare and usually self-resolving complication of chickenpox. The reports in the literature are few and far between.13 I have had the opportunity to observe a case of what I believe to have been varicella arthritis in my practice.

On June 26, 1978 a 5-year-old boy was seen with chickenpox. Four days earlier he had broken out with a typical varicella exanthem. One day earlier he had tripped, striking his left knee, but sustaining no major injury at the time. Over the next 24 hours the patient started to complain of progressive pain in his knee and on the morning he was seen, he was unable to bear weight on it.
Letters to the Editor
Authors: Mandell Frederick
Published: December 2021

We report two cases of coagulopathy following bites by snakes normally considered "nonvenomous." Our purpose in doing this was not to be unpleasant to snakes or to create needless fear. However, these cases did cause significant medical concern on the part of the patients and the practitioner. For this reason we thought it was important for physicians caring for snake bite victims with coagulopathy to be aware of our experience.
Intrauterine Detection of Cystic Fibrosis
Authors: Nadler Henry L. , Walsh M. M.J.
Published: December 2021

Thirteen pregnancies of obligate heterozygotes of cystic fibrosis have been prospectively monitored utilizing quantitative and qualitative measurements of methylumbelliferylguanidinobenzoate (MUGB) reactive proteases in amniotic fluid. In each case the diagnosis was accurately ascertained in midtrimester and confirmed after delivery. The measurement of MUGB reactivity in midtrimester amniotic fluid by three different procedures, quantitative analysis, polyacrylamide isoelectric focusing, and column filtration appears to provide a practical and reliable approach for the intrauterine detection of cystic fibrosis.
Extent and Duration of Small Intestinal Mucosal Injury in Intractable Diarrhea of Infancy
Authors: Rossi Thomas M. , Lebenthal Emanuel , Nord Kenneth S. , Fazili Rafiqua R.
Published: December 2021

Thirty infants with intractable diarrhea of infancy (IDI) underwent small bowel biopsies in order to determine the extent and duration of small intestinal mucosal injury. The onset of the persistent diarrhea occurred prior to 3 months of age and continued for an average of 48 days prior to investigation. In 18 cases, no associated entities were found. Mucosal injury was invariably found in all 30 infants: grade IV injury in 11, grade III in eight, grade II in nine, and grade I atrophy in one. Disaccharidase activities were diminished and corresponded to the degree of atrophy. Lactase activity was diminished to a greater extent than sucrase and maltase. Significant, persistent mucosal injury existed for an average of six months in 16 of the 23 (70%) repeat biopsies. All infants were given an elemental diet (ED). Twelve of the 30 infants required parenteral nutrition (PN). These infants were gradually advanced to an oral elemental diet and maintained on this diet until histologic findings and disaccharidase levels were normal. Eighteen infants were fed and maintained on an elemental diet by mouth from time of admission until normal histologic findings and disaccharidases were found. No mortality occurred during management and follow-up. Twenty-two of the 28 infants in whom follow-up growth data were available excelled in weight and height velocity. The data suggest that prolonged injury to the small intestinal mucosa is a common finding in many cases of intractable diarrhea of infancy. Elemental diets should be started early in the course of protracted diarrhea in young infants, and may need to be continued for several months since histologic and enzymatic changes of the small intestine may persist for extended periods.
Cooperative Study Comparing Three Methods of Performing Sweat Tests to Diagnose Cystic Fibrosis
Authors: Denning Carolyn R. , Huang Nancy N. , Cuasay L. R. , Shwachman Harry , Tocci Paul , Warwick Warren J. , Gibson Lewis E.
Published: December 2021

Directors of cystic fibrosis centers in the United States have noted an increasing number of patients with histories of either false-positive or false-negative sweat tests. These inaccuracies were attributed to the use of rapid test methods which avoided actually weighing the sweat collected. These rapid tests have inherent difficulties which, theoretically at least, could lead to mistaken diagnoses. To evaluate methods of performing the sweat test, the National Cystic Fibrosis Foundation organized a combined study comparing the older Quantitative pilocarpine iontophoretic test (QPIT) method of performing the test with two newer and more rapid methods, the Orion skin electrode, and the Medtherm conductivity apparatus. Five cystic fibrosis centers participated in the study. Although two centers obtained considerably more accurate results with the Orion and the Medtherm than did the other three centers, the combined results of the study indicate that these procedures can be considered to be little more than screening tests.
ROBERT BURTON ON MATERNAL IMPRESSIONS (1621)
Authors: C. T. E.
Published: December 2021

Robert Burton (1577-1640), author of the Anatomy of Melancholy (1621), one of the two books favored above all others by Sir William Osler, has ironically become one of the great entertainments among English writings. The irony, however, is accidental, because Burton, a joyful pessimist, wrote what has been called "undeniably one of the oddest, wittiest, and most learned books in English literature."1

Osler described the Anatomy as "the greatest medical treatise written by a layman."2 An example of Burton's views on the importance of maternal impressions, which would have been thoroughly approved of by the learned physicians of his day, follows:3

If she be over-dull, heavy, angry, peevish, discontented and melancholy, not only at the time of conception, but even all the while she carries the child in her womb, her son will be so likewise affected, and worse, as Lemnius adds, if she grieve over much, be disquieted, or by any casualty be affrighted and terrified by some fearful object heard or seen, she endangers her child, and spoils the temperature [temperament] of it; for the strange imagination of a woman works effectually upon her infant, that...she leaves a mark upon it, which is most especially seen in such as prodigiously long for such and such meats; the child will love those meats... and be addicted to like humours. If a great-bellied woman see a hare, her child will often have an hare-lip, as we call it. Garcaeus hath a memorable example of one Thomas Nichell, born in the city of Brandenburg, 1551, "that went reeling and staggering all the days of his life, as if he would fall to the ground, because his mother being great with child saw a drunken man reeling in the street."
Clitoris Tourniquet Syndrome
Authors: Press Shirley , Schachner Lawrence , Paul Philip
Published: December 2021

Reports have appeared in the literature describing strangulation of an appendage.1-8 The appendages described have included the finger,1 the toes,1-4 the penis,1,5-7 and in one previous report, the clitoris.8 This is a report of a patient with clitoral strangulation who was seen recently in a pediatric emergency room.

CASE REPORT

An 8-year-old girl was seen at the Pediatric Walk-in Clinic of Jackson Memorial Hospital (University of Miami, School of Medicine) with the chief complaint of severe pain in the genital area. She was afebrile, well nourished, and in good general health. Both the patient and her mother denied trauma to the genital area.
Acrodermatitis Enteropathica: Zinc Levels and Cell-Mediated Immunity
Authors: Chandra R. K.
Published: December 2021

Acrodermatitis enteropathica (AE) is a rare vesicobullous skin disorder.1 Genealogic data suggest an autosomal recessive mode of inheritance. The onset of symptoms is generally insidious. In breastfed infants, the disorder may be precipitated on weaning to cow's milk. The frequent occurrence of secondary infections, particularly with opportunistic fungi and bacteria, led to the suspicion that AE is associated with immunodeficiency. "Dysgammaglobulinemia" has been reported in one infant2 and defective chemotaxis in another three patients.3 Limited autopsy observations showed atrophic thymus, tonsils, germinal centers, and Peyer patches.2,4 We report variable impairment of cell-mediated immunity in ten patients with AE of whom eight had low plasma zinc levels.
Surfactant for Hyaline Membrane Disease
Authors: Fujiwara Tetsuro , Adams Forrest H.
Published: December 2021

Since it has been demonstrated that hyaline membrane disease (HMD) is due to a relative deficiency of lung surfactant,1,2 one possible approach to the treatment or prevention of HMD in premature infants might be the introduction of surfactant into the lungs. Thus far, attempts at aerosolization of either synthetic surfactant (dipalmitoyl lecithin [DPL]) or natural surfactant into the lungs of patients or animals have failed to produce convincing benefits.3-5 On the other hand, direct instillation of a solution of natural surfactant into the trachea seems to produce striking results.

Enhörning et al6 were the first to show that tracheal deposition of natural surfactant into premature rabbit fetuses before the first breath enhanced air intake and improved the pressure-volume relationships of the lungs; it also increased their survival time.7
Level II Neonatal Units
Authors: Brann Alfred W. , Hall Robert T. , Harper Rita G. , Maisels M. Jeffrey , Poland Ronald L. , Rhodes Philip G. , Sunshine Philip , Whittinghill John A. , Allen James R. , Alper Milton H. , Cassady George , Cefalo Robert C. , Hasselmeyer Eileen , Heerens Robert E. , Hey Dennis
Published: December 2021

The concept of a regionalized system encompassing three broadly defined levels of neonatal care is now well recognized and increasingly practiced in the United States. The American Academy of Pediatrics has described, in some detail, a system of classifying nurseries as Levels I, II, or III, based on the type of care they are capable of providing for the newborn infant.1

There has been little question about the composition of care in Level I or Level III units, but the committee recognizes that there is considerable diversity of opinion about the definition of Level II units and the functions these units should perform. The concept of the Level II neonatal unit has, in general, been supported by most pediatricians and neonatologists; however, there is little factual information available about Level II units, how they function, and how they contribute to perinatal outcome.

The committee sent 300 questionnaires to the directors of all neonatal training programs, to the Chairmen of all Academy Chapters, and to 70 other practicing pediatricians. Responses were received from 114 Level III centers, 46 Level II centers, and 7 Level I hospitals. The responses came from 45 states and five Canadian provinces.

According to the responses and the thoughtful comments received, the functions of Level II units are of considerable interest and concern to many pediatricians; but, obviously, it is impossible to suggest universal solutions for all regions which will cover all possible occurrences.

The committee has considered all the opinions expressed and the information available regarding the functioning of Level II units and makes the following recommendations:
Mitomycin C Test for Diagnostic Differentiation of Idiopathic Aplastic Anemia and Fanconi Anemia
Authors: Cervenka Jaroslav , Arthur Diane , Yasis Carmen
Published: December 2021

A cytogenetic test was developed to enable the diagnostic differentiation between Fanconi anemia and the group of disorders classified as "idiopathic" aplastic anemia. The method is based on the effect of the bifunctional alkylating agent mitomycin C (MMC) on chromosomes of peripheral lymphocytes in culture 92 to 96 hours. At the highest concentration of 80 ng/ml of MMC, about a 50-fold increase of chromosomal breaks and a 200-fold increase of radial figures was observed in Fanconi anemia lymphocytes in comparison with the average values for aplastic anemia cells or cells of healthy control subjects. In addition, sister chromatid exchange analysis of cells treated with MMC demonstrated a marked inhibition of mitotic activity of lymphocytes of patients with increased sensitivity to MMC. It is advocated that the MMC-stress test should be used in each case of pancytopenia, as part of the therapy planning. The cytoreduction regimens used prior to bone marrow transplantation may produce lethal complications in patients with high clastogenic response to MMC.
Prepubertal Gonorrhea: A Multidisciplinary Approach
Authors: Farrell Michael K. , Billmire M. Elaine , Shamroy Jerilyn A. , Hammond Jeanne G.
Published: December 2021

Forty-six children less than 12 years of age with gonorrhea were studied over a 4½-year period. The investigation was conducted by a multidisciplinary team including physicians, social workers, and health department representatives. Extensive interviewing and routine culturing of contacts eventually identified the source of gonorrhea in 38/46 (83%) children. Males, both adult and preadolescent, were implicated as the source of gonorrhea almost twice as often as the child's mother. Nineteen children were victims of sexual assault, but only four of them had a hymenal orifice larger than one fingerbreadth. Compliance, both in pursuing the history and obtaining cultures of contacts, was significantly increased by admission to the hospital. A Gram stain and culture for gonorrhea should be done in all children presenting with vaginal discharge regardless of history. Hospitalization of children with suspected gonorrhea greatly facilitates the contact identification.
Progress in the Delivery of Health Care in Mexico
Authors: Frazier Robert G.
Published: December 2021

The Joint Pediatric Congress of the National Confederation of Pediatrics in Mexico and of the Mexican Association of Pediatrics, held April 28 through May 4, 1980, provided an unusual opportunity to review the dramatic changes that have been implemented in the past few years in the health care system of Mexico. A social security system, embodying health and welfare services and retirement benefits, became law in Mexico in 1943. In addition to supporting community welfare services, it has struggled to develop a format and resources for delivery of health care to the masses of Mexicans, including the poor or those too isolated from urban centers to have any effective access to the benefits of modern health technology.
Letters to the Editor
Authors: Piper Martha C. , Pless I. B.
Published: December 2021

We certainly appreciate the comments of Drs Holm, Robinson, and Sells about our paper. As they themselves note we are well aware of some of the limitations of our study and indeed discussed these in considerable detail in the report. What needs to be emphasized before commenting on their specific points is that our study must be viewed in the context of previously published reports and reflects the necessary compromise between what we acknowledge would be desirable and what is presently feasible.
Massachusetts Metabolic Disorders Screening Program. II. Methylmalonic Aciduria
Authors: Coulombe J. Thomas , Shih Vivian E. , Levy Harvey L.
Published: December 2021

Screening neonates for methylmalonic aciduria is part of routine screening for metabolic disorders in Massachusetts. The process of urine collection by the parent and transmittal to the central screening laboratory was described in a previous publication (Pediatrics 49:825, 1972). The primary objective of screening for methylmalonic aciduria is to detect methylmalonic acidemia, an inherited organic acid disorder. During the most recent 5½-year period when the sensitive fast blue B stain was used in the analysis, four infants with methylmalonic acidemia were detected among 293,535 screened. Additional infants and children who came to attention because of clinical illness or family study also could be readily detected. Prior to this period, 325,634 neonates had been screened with the aniline-xylose method, which proved to be not sensitive enough for the identification of methylmalonic aciduria. Some affected infants have responded well to therapy and are clinically normal while two have shown poor biochemical response and are developmentally delayed. Four children in two families appear to have a benign variant of methylmalonic acidemia. Based on these studies the observed incidence of methylmalonic acidemia in Massachusetts is 1:48,000. Screening for methylmalonic aciduria may be an appropriate addition to newborn screening programs.
Current Status of Infant Stimulation or Enrichment Programs for Children with Developmental Disabilities
Authors: Denhoff Eric
Published: December 2021

Infant stimulation programs are organized programs of enrichment designed to provide developmentally appropriate activities to babies and toddlers who have or who are at risk for a variety of conditions that may interfere with their ability ultimately to have a full and productive life. Among these conditions are the sequelae of poverty, nutritional, sensory, and emotional deprivation, family instability, and developmental disability, any of which may interfere significantly with social and interpersonal relationships as well as cognitive, language, and motor performance.1-3 There are now a number of well-documented follow-up studies to show that early preschool stimulation programs for the baby from a low socioeconomic environment have both short-term and long-term benefits, providing that support systems are maintained during the school years.4,5 Further, there are studies which demonstrate short-term cognitive and long-term social improvement in babies genetically handicapped with Down syndrome,4 although contrary results have been reported recently.6

The Committee on Children with Handicaps of the American Academy of Pediatrics has requested this review of the historical background of infant stimulation programs and has sought to confirm that they accomplish their purpose of improving the overall outlook for children with developmental disabilities and those considered at high risk for them.

DEVELOPMENTAL DISABILITIES

The 1979 Developmental Disabilities Assistance and Bill of Rights Act defines the term "developmental disability" as any severe, chronic disability of a person attributable to a mental or physical impairment or combination thereof, that is manifested before the age of 22 years, is likely to continue indefinitely, and will result in substantial limitation of function in three or more of the following areas: (1) self-care, (2) receptive and expressive language, (3) learning, (4) mobility, (5) self-direction, (6) capacity for independent living, (7) economic self-sufficiency, and (8) need for combinations and sequences of special, interdisciplinary or generic care, treatment, or other services which are of lifelong or extended duration and are individually planned or coordinated.
Discordance of Congenital Bilateral Anorchia in Uniovular Twins: 17 Years of Observations on Growth and Development
Authors: Ruvalcaba R. H.A. , Gogué H. Paul , Kelley Vincent C.
Published: December 2021

We have reported observations of growth and development made over a 16-year period on a subject who suffered bilateral congenital anorchia and his uniovular twin brother. The anorchic individual was treated with oxandrolone for a period of 3.6 years prior to the testosterone replacement therapy. The oxandrolone therapy produced a significant increment in the height age without excessive gain in bone age. At the age of 20.9 years the anorchic twin is 5.4 cm taller than his normal twin. Other differences observed between the twins reported here include the following: the anorchic subject had longer extremities, greater biacromial and biiliac distances and a smaller penis than his normal sibling. Oxandrolone therapy does appear to modify the ultimate height in children.
When Should One Discourage Breast-feeding
Authors: Berger Lawrence R.
Published: December 2021

Breast-feeding has advantages in terms of psychosocial aspects, maternal considerations, and infant factors.1-3 Within these same broad areas, I want to address circumstances in which reservations about breast-feeding should be considered.

In terms of infant conditions, galactosemia is clearly an absolute contraindication to breast-feeding. Breast milk is a rich source of lactose, and the very survival of infants with galactosemia is dependent on their receiving a non-lactose-containing formula. Of course, galactosemia is a rare disorder, occurring in approximately 1:60,000 births.

Phenylketonuria is often mentioned as another contraindication to breast-feeding. Breast milk, however, has relatively low levels of phenylalanine; in fact, infants who are exclusively breast-fed may receive a phenylalanine intake near the amount recommended for treating phenylketonuria.4
Meconium Passage in Utero, Fetal Distress, and Gestational Age
Authors: Verma Ishawar C. , Parida Sailaja N. , Thomas Sosamma
Published: December 2021

The article by Drs Matthews and Warshaw (Pediatrics 64:30, 1979) prompted us to analyze our data from an ongoing study of meconium staining, fetal outcome, and neonatal listeriosis. Our observations are given in the Table.

We have excluded breech presentations from the fetal distress group as these are commonly associated with meconium passage even in the absence of fetal distress.1

Thus, contrary to their observations, 3.24% of babies <34 weeks gestational age passed meconium in utero.
Renin Levels in Normokalemic Hyperaldosteronism
Authors: Walson Philip D.
Published: December 2021

The recent report by Grim and Weinberger1 of three cases of normokalemic hyperaldosteronism makes some interesting points but made (I feel) an unwarranted conclusion about the routine measurement of renin levels. In addition, the report did not include some important information. The report states that "Renin levels should be determined in all hypertensive children and their hypertensive parents." This conclusion is debatable at best and certainly not justified by the presentation of this case. Also, with respect to this case, it is important to know what the authors meant by "rarely" when they state that, "It should be emphasized that we rarely found serum potassium levels less than 3.6 mEq/liter in either the father or the two children."
The Pediatrician and the Deaf Child: Perspectives of a Pediatrician-Parent
Authors: Fischer Thomas J.
Published: December 2021

As a pediatrician who is a parent of a profoundly deaf child, I have an unusual perspective of the problems of hearing-impaired children. From personal, nonprofessional contacts with parents of deaf children, it is unfortunately apparent that pediatricians are often unpopular with these parents. This dissatisfaction frequently results from unnecessary, prolonged delays in diagnosis, or from bad advice once the diagnosis of hearing impairment is made. Too often pediatricians have told these parents, "don't worry about your suspicions, I have never had a deaf child in my practice," or "Your child is too young to test, we will do it later."
Legionnaires' Disease in Children
Authors: Muldoon Robert L. , Jaecker Donna L. , Kiefer Harry K.
Published: December 2021

In a retrospective survey of sera collected from 126 patients under the age of 10 years, seroreactivity was first detected at 1 year of age when the geometric mean titer rose from 12 to 24. This activity increased to a titer of 102 in the 4- to 6-year-old group and was maintained in the 7- to 9-year-old group. At the time of serum collection, at least 25% of those sampled had a titer of 256 or greater, a level currently thought to be presumptive evidence of infection at some undetermined time. No difference in the geometric mean titer could be ascertained when the population was divided by clinical diagnosis or by sex. No seasonal variation was observed. Of 35 paired sera from children under the age of 5 years, three fourfold rises were observed. One rise to a titer of 128 was detected in an 11-month-old girl with a clinical diagnosis of bronchiolitis. The second rise in a 5-year-old boy with pneumonia was an increase from 256 to 2,048. The third rise in a 6-month-old with pneumonia did not meet the currently accepted level necessary for confirmed diagnosis. These data suggest that infection with Legionella pneumophila, or a closely related agent, is common in this population, occurring before 9 years of age, and may be a cause of mild respiratory disease in infants and children.
Neurologic Sequelae of Rocky Mountain Spotted Fever
Authors: Gorman Richard J. , Saxon Samuel , Snead O. Carter
Published: December 2021

Forty-two children who had Rocky Mountain spotted fever were seen for neurologic and psychologic examination at follow-up. The presence of sequelae was more common in children with severely impaired states of consciousness. Behavioral disturbances and learning disabilities were the most common problems. Seizures, although a common occurrence during acute disease, did not occur as sequelae to Rocky Mountain spotted fever.
Comparative Measurements of Phototherapy: A Practical Guide
Authors: Hammerman Cathy , Eidelman Arthur I. , Lee Kwang-sun , Gartner Lawrence M.
Published: December 2021

Increasing the dose of administered phototherapy has been shown to increase the rate of bilirubin decrement up to a saturation point beyond which no further increases in bilirubin degradation are observed. This study provides irradiance measurements which can be used to interpret phototherapy dose-response and saturation data clinically and to determine an optimal phototherapy lamp combination for maximal bilirubin degradation.
Antibiotic-Associated Pseudomembranous Colitis in Children
Authors: Viscidi Raphael P. , Bartlett John C.
Published: December 2021

Ten cases of antibiotic-associated pseudomembranous colitis in children are reviewed. The ages ranged from 4 years to 17 years; the most frequently implicated antimicrobial agents were penicillins in six children and clindamycin in two. Stool assays showed specimens from all ten patients yielded a cytopathic toxin which was neutralized by Clostridium sordellii antitoxin with titers ranging from 1:40 to 1:40,000. Bacterial cultures of nine specimens uniformly yielded Clostridium difficile with a median concentration of 105,4 organisms per gram of wet weight. All nine isolates of C difficile showed in vitro production of a cytopathic toxin which was similar to or identical with that which was detected in the original stool specimen. All ten patients recovered. Six were treated with oral vancomycin and showed a good therapeutic response; one patient, however, suffered two relapses when treatment was discontinued, requiring a total of three courses of oral vancomycin. Two patients received cholestyramine and responded well. These observations provide supportive evidence that C difficile is responsible for antibiotic-associated pseudomembranous colitis in children and document efficacy of the newer therapeutic modalities in this patient population as well.
Abdominoscrotal Hydrocele—Cause of Abdominal Mass in Children
Authors: Black Richard E. , Cox Joseph A. , Han Bokyung , Babcock Diane S.
Published: December 2021

Abdominoscrotal hydrocele is relatively uncommon in adults and rare in children. The case presented typifies the classic features of the clinical presentation and the satisfactory response to conservative surgical therapy.
Sunkissed Urine
Authors: Roseman Byron D.
Published: December 2021

A 3-month-old infant had episodes of brightly pink-colored urine. She was delivered by cesarean section because of cephalopelvic disproportion. There were no perinatal difficulties until age 2 months when moderate torticollis became evident. By 3 months of age this had improved with stretching exercises. The mother indicated then that her exclusively breast-fed infant had been having transitory episodes, at least monthly, of decidedly pink urine.

The mother had an insight when she experienced difficulty in removing an orange-pink stain from a plastic glass from which she had drunk Sunkist orange soda.
Was the Intralipid Dose Too High?
Authors: Caplan Daniel B.
Published: December 2021

The article by Pereira et al, "Decreased Oxygenation and Hyperlipemia During Intravenous Fat Infusions in Premature Infants" (Pediatrics 66:26, 1980) again points up the importance of a full understanding of the efficacy and possible adverse effects of any medication or treatment approach when applied to the young and small premature infant. I did note, however, that the amount of Intralipid used was far in excess of the usual recommended limits for pediatrics of 4 gm/kg/24 hr.
Relationship of Head Circumference to Length in the First 400 Days of Life: A Mnemonic
Authors: Dine Mark S. , Gartside Peter S. , Glueck Charles J. , Rheins Larry , Greene Gail , Khoury Phillip
Published: December 2021

The relationship between length and head circumference can be expressed by the simplified formula: head circumference (centimeters) = 0.5 length + 9.5 ± 2.5; head circumference (inches) = 0.5 length + 3.75 ± 1. This formula is accurate for 95% of measurements in the first 400 days of life. The correlation coefficient of length to head circumference is .94 (P = .0001).