bluuebunny/crossref_metadata_2025 huggingface dataset:
Athletic Activities for Children Who Are Mentally Retarded
Authors: Thornton Melvin L. , Diamond Eugene F. , Garvin John P. , Heffelfinger John C. , Kennell John H. , Poncher John R. , Schell Norman B. , Shackleford E. C. , Shaffer Thomas E.
Published: December 2021

Recreation and athletic activity are important for all children, regardless of their mental capacity. A physician's recommendation about athletic activity for mentally retarded children, as is true with other children, must take into account differences in size, coordination, degree of physical fitness, and physical health. The stage of maturation, the level of mental development, and the emotional stability of the child are all important considerations when organizing activities for children who are mentally retarded. Children with average mental development usually have multiple opportunities for athletic activities and recreation without special planning. In contrast, there is a tendency for parents and children in most communities to exclude the mentally retarded child so he completely lacks the type of exercise and personal experiences he needs. Children who are mentally retarded frequently are not physically fit, have poor coordination, and are obese. These conditions become progressively more severe as the retarded child grows older, partly as a result of limited opportunity for athletic activity. The majority of mentally retarded children can and should participate safely and productively in athletic activities when appropriate supervision is provided.

Parents of children who are mentally retarded are often confused and uncertain about what to expect from their child. Some tend to restrict their youngsters from physical activities, and others may push their children at too rapid a pace. However, most parents are anxious for guidance to help determine what is best for their child. The pediatrician is in a unique position to advise these parents because he is likely to know the family and to know the emotional and personal needs of the child and his physical capabilities.
Interspersed Advertising
Authors: Hervada Arturo R.
Published: December 2021

I have carefully read Dr. Frazier's statement1 in the December issue regarding the publication of Pediatrics. I have also read Dr. Wineberg's letter on the same matter.2

I personally agree with Dr. Wineberg. A very important question on this whole issue, unfortunately unanswered by Dr. Frazier in his commentary, is why, on what grounds, the decision to intersperse pharmaceutical advertising was made? Because, if the real reason—as I can sense between the lines—was the pharmaceutical industry's threat to withdraw their advertisements unless you publish them all over the Journal, then I object to such a decision.
Need for Medication in Minimal Brain Dysfunction
Authors: Levitis Karen A.
Published: December 2021

The article by Safer and Allen in the April 1973 issue of Pediatrics sent me to the records (at Montgomery County, Maryland, Health Department) of about 30 patients with minimal brain dysfunction on behavior-modifying medication whom I had been following. Was I missing long-term effects on their growth? Twelve had been on medication for two years or more (mostly dextroamphetamine or methylphendiate, with diphenylhydantoin and thioridazine each added in one case). Growth curves, some plotted from birth (unlike the single premedication measurements used by the authors) showed no cause for worry.
T.I.M.E. (Techniques to Improve Management Efficiency). Bloomfield, New Jersey: Health Management Systems Inc., 1973
Authors: Hoekelman Robert A.
Published: December 2021

One of the criticisms often leveled at undergraduate and graduate medical educational programs is their failure to prepare physicians in practice management. The neophyte physician beginning practice finds himself faced with a myriad of decisions which will affect the organization, efficiency and economics of that practice immediately and over time. Without direction, many of these decisions are likely to be poor ones which will be costly in terms of time, money and satisfaction to the physician and his patients.
Lets Talk About Adoption, by Susan and Elton Klibanoff. Boston: Little, Brown & Co., 1973, 263 pp., $7.95
Authors: Sissman Norman J.
Published: December 2021

Often pediatricians and family physicians are among the first to be consulted about problems connected with adoption, either by prospective adoptive parents with questions about how the procedure can best be arranged or by a variety of individuals and organizations concerned with the health of a child during or after actual placement has occurred. In more instances than not, unfortunately, the consultant may have no more expertise in the area than limited anecdotal experience has given him.
CESAREAN SECTION PERFORMED WITH SUCCESS BY AN ILLITERATE IRISH MIDWIFE IN 1738
Authors: C. T. E.
Published: December 2021

To read about major surgical operations being performed by untrained laymen before the discovery of anesthesia and the beginning of modern medical practice fills one with profound sympathy for the patient's harrowing ordeal.

Imagine the suffering of poor Alice O'Neal on whom a cesarean section was performed in January 1738 by an illiterate midwife as described below by Mr. Duncan Stewart, Surgeon in Dungannon in the County of Tyrone, Ireland.

(I believe this is the first reported cesarean section performed in the United Kingdom from which the mother recovered.)

Alice O'Neal, aged about 33 years, Wife to a poor Farmer near Charlemont, and Mother of several Children, in January 1738 took her Labour-Pains; but could not be delivered of her Child by several Women who attempted it. She remained in this Condition twelve Days; the Child was judged to be dead after the third Day. Mary Donally, an illiterate Woman, but eminent among the common People for extracting dead Births, being then called, tried also to deliver her in the common Way: And her Attempts not succeeding, performed the Caesarian Operation, by cutting with a Razor first the containing Parts of the Abdomen and then the Uterus; at the Aperature (sic) of which she took Out the Child and Secundines. The Part of the Incision was an Inch higher, and to a Side of the Navel, and was continued about six Inches downwards in the Middle betwixt the right Os Ilium and the Linea alba. She held the Lips of the Wound together with her Hand, till one went a Mile and returned with Silk and the common Needles which Taylors (sic) used: with these she joined the Lips in the manner of the Stitch employed ordinarily for the Hare-lip, and dressed the Wound with whites of Eggs, as she told me some days after, when led by Curiosity I visited the poor Woman who had undergone the Operation.
Unilateral Partial Adactyly in Down's Syndrome
Authors: Pueschel Siegfried M. , O'Donnell Patricia
Published: December 2021

During a six-month period three children with Down's syndrome presented with a unique unilateral hand dysplasia. Epidemiological investigations did not uncover a special etiological agent responsible for the formation of the partial adactyly.
Ultrasonography in Children
Authors: Grossman Herman , Felman Alvin , Kirkpatrick John A. , Shopfner Charles H. , Swischuk Leonard E. , Taber Paddy , Tefft Melvin , Goldberg Barry B.
Published: December 2021

Ultrasound is the manifestation of a high frequency mechanical vibration. The sound waves produced are beyond the range of human hearing, i.e., 1 to 10 mHz. The sound waves travel through liquids and solids but cannot pass through air or vacuum. Ultrasonic energy is produced by a transducer, the power to which is supplied by a high-voltage pulsing circuit in an amplifier (ultrasonoscope). Ultrasonography has been used successfully in the examination of pediatric patients. One of the most common uses has been to measure shifts of the midline structures of the brain. By utilizing the standard echoencephalographic approach established for adults, and positioning the transducer above the ears in the temporoparietal regions, echoes are recorded from the midline structures. Ultrasonography is used as a preliminary study prior to more definitive procedures such as pneumoencephalography or arteriography, particularly in the presence of localizing signs. It has also been used to detect hydrocephalus and to follow changes in ventricular size which occur after ventricular shunting procedures. In fact, this is the easiest way to serially monitor the response to decompression.

In many hospitals, ultrasonagraphy is considered to be the primary diagnostic study for the detection of pericardial effusion. Ultrasonic examination of the heart of pediatric patients with suspected congenital or acquired heart disease appears to be a promising new diagnostic technique. It has been successfully used to evaluate a number of abnormalities: great vessel transposition, cardiac chamber size and position, valve motion, and ventricular wall thickness. Extensive research is in progress to establish both normal values and patterns for differentiating various congenital abnormalities.
Remarks on Receiving the C. Anderson Aldrich Award
Authors: Dybwad Gunnar
Published: December 2021

Twenty years ago, Grover Powers, in accepting from the American Pediatric Society the John Howland Award, surprised and challenged his audience by an address on the then so universally neglected subject of mental retardation. "The Retarded Child and his Family—a Challenge to Pediatric Practice, Research and Education"1 is still worth reading today. As a matter of fact, when my wife and I were charged in 1965 with putting together a special mental retardation issue of the International Child Welfare Review, we felt that Dr. Powers' statement was still as strong as anything we had heard from other pediatricians and with the Academy's permission we reprinted it for a wide international audience. That I am honored today by your Committee is undoubtedly a direct outgrowth of Dr. Powers' influence on me. When I became Executive Director of the National Association for Retarded Children, the Association had had for four years the benefit of Dr. Powers' counsel. As founder and guiding spirit of NARC's Scientific Research Advisory Committee, he was a hard taskmaster and contributed materially to the Association's high standard of performance. In a very real sense he was my teacher, and I cherish the memories of the afternoons I spent at his home in New Haven. With this background I am, of course, particularly appreciative and moved by the fact that I am privileged to receive today the C. Anderson Aldrich Award from one of Grover Powers' most gifted and, to his final days, most faithful students, Harry Gordon, whose service on NARC's Research Board enhanced its contributions in no small measure.
TRANSPLACENTAL CARCINOGENESIS
Authors: Miller Robert W.
Published: December 2021

An overview of experimental studies concerning transplacental chemical carcinogenesis and their possible implications for man has been published by J. M. Rice (Teratology, 8:113, 1973).

Ulfelder (Amer. J. Obstet. Gynec., 17:794, 1973) believes that there may have been 10,000 to 16,000 persons exposed in utero to diethylstilbestrol, 1960 to 1970. He estimates the probability of developing adenosis or other minor morphologic anomalies in girls at not less than 30%, and guesses the risk of adenocarcinoma of the cervix or vagina to be about one in 1,000. A more precise estimate from a prospective study at the Mayo Clinic is less than seven per 1,000 by age 13 and less than 13 per 1,000 by age 22 (Lanier, A. P., et al., Mayo Chin. Proc., 48:793, 1973).
Letter to the Eitor
Authors: Henderson Arvin T. , Dahlin Irmeli , Partridge Cloyd R. , Engelsing Elizabeth Lyman
Published: December 2021

We agree with Dr. Oettinger that considerations of etiology are highly important. We regard the etiology of hyperactivity as a "chain of events" with at least primary and secondary sources of the symptom behavior.

As primary factors we include characteristics of normal individual genetic differences in reactivity and arousability, plus intra-uterine, birth and postbirth introduced pathology.

However, we think these basic characteristics constitute only a partial explanation for the hyperactive child's typical or atypical development.
Letter to the Editor
Authors: Dweck Harry S. , Cassady George
Published: December 2021

Dr. Klein is correct in suggesting that stress may be one of the causes of hyperglycemia in this birth weight group. His data are supportive of the possible role of stress or sepsis, as alluded to in our discussion.1 It is difficult, however, to describe these babies as nonstressed. In our series, the mortality rate of the group reported was 78% and of the 40 babies with recorded Apgar scores, all but nine (five from group 3) had one-minute Apgars of 6 or less.
Another Unusual Complication of Amniocentesis
Authors: Jones James F. , Woodall John B. , Selter Phyllis R. , Neal Gary L. , Carter Samuel C.
Published: December 2021

In the March 1974 issue of Pediatrics, Drs. Cook et al. describe an infant with a pneumothorax secondary to a diagnostic amniocentesis.1 We have recently treated a similar case, but with an additional, unusual finding.

A 25-year-old black woman (gravida 4, para 2, abortus 1) with sickle cell trait, previous cesarean section due to cephalopelvic disproportion, left renal calculi, and recurrent urinary tract infection, was admitted December 24, 1973 with pyelonephritis and intrauterine pregnancy. She was treated with gentamycin and progressed satisfactorily.
Nurse Practitioners for Children—Past and Future
Authors: McAtee Patricia A. , Silver Henry K.
Published: December 2021

During the past decade there has been a significant expansion in the role of the nurse in providing patient care. Studies have shown that nurse practitioners can, by themselves, care for approximately three fourths of all those who come to ambulatory settings, and that nurse practitioners are well accepted, highly competent in assessing health status, and provide improved as well as increased health care.

It is recommended that there be more meaningful and extensive incorporation of the teaching of nurse practitioner concepts, training, and goals into undergraduate curricula of schools of nursing; that nursing students should have an opportunity to apply nurse practitioner concepts and practices in a supervised orientation and practical experience (a nursing "internship"); that less well-trained health workers (licensed practical nurses, nurse's aides, etc.) should be trained as "assistant nurse practitioners" to meet many basic health assessment and management needs; and that the scope of nursing needs to be expanded further so that its practitioners can give even more comprehensive, direct, and responsible health care to the public.
Screening in Child Health Care: Where Are We Now and Where Are We Going?
Authors: North A. Frederick
Published: December 2021

The preceding papers1-7 in this symposium discuss criteria for evaluating screening tests and screening programs and demonstrate how these criteria can be applied to several screening techniques of particular current interest. This paper will briefly review how a number of procedures measure up to the suggested criteria for screening tests and suggest some future directions which must be pursued if screening is to be based on science rather than on polemic.

WHERE ARE WE NOW?

Table I lists a number of diseases, functions and tests which have been considered to be of use in screening. For each of these it also gives my own estimate of how well each disease meets the criteria listed by Frankenburg2 and how well the available tests meet his criteria for effectiveness, direct costs, costs of false positives, and costs of false negatives. In the following paragraphs some of the considerations which led to these judgments are discussed.

Phenyketonuria

Despite its low frequency, the cost effectiveness of screening for PKU is well demonstrated, tests are adequately sensitive and specific, and with expert management the potentially high costs of false-positive tests can largely be eliminated.3

Galactosemia

Though even rarer than PKU, current methods make routine neonatal screening both feasible and cost effective, provided that the test is combined with routine PKU screening.8

Other Inborn Metabolic Errors

With the kind of regionalized facilities and planning discussed by Scriver,3 testing for these diseases can be added to routine neonatal screening at very little additional cost. Some of them lend themselves to effective early treatment; with others, genetic counsulling is the only currently available useful intervention.
More on Indian Health
Authors: Turbeville David F.
Published: December 2021

Dr. Mortimer's commentary on Indian health care (Pediatrics, 51:1065, 1973) deserves discussion. Dr. Mortimer may have overstated his point when implying that life or death situations may be influenced by financial considerations, but other critical decisions are influenced by finances and Dr. Mortimer is correct in condemning Indian medical health care because of inadequate funds. For example, if a child needs minor surgery because of chronic otitis media, his care may have to wait until the end of the fiscal year to see what funds are left; and if funds are not available, the patient's surgery will have to wait until later.
Further Analysis of Minor's Consent Bill
Authors: Ris Hania W.
Published: December 2021

Two model bills for minors' consent for health services have been published in Pediatrics in 1973, one espoused by the Youth Committee of AAP, the other by the Society of Adolescent Medicine.1-2

In my endeavor to promote the concept of the bills among pediatricians, I became aware that an important discrepancy regarding birth control in the AAP bill is not clearly evident to the reader. One should be cognizant of it before initiating legislation.

Although "contraceptive advice and devices" are included in the definition of "Health Services" in the AAP bill, section three dealing specifically with minors' consent limits it to "any minor who professes or is found to be pregnant."
Idiopathic Hyperbilirubinemia and Phototherapy—Evidence Suggesting a Decreased Incidence of Kernicterus
Authors: Petrich C. , Göbel U.
Published: December 2021

The recent article by Lewak1 dealing with hyperbilirubinemia and phototheraphy prompted us to try to answer the following three questions:

1. Does phototherapy reduce the incidence of kernicterus? Although Lewak's article concerns full-term healthy infants, we believe our experience with premature infants is important. From 1965 to 1967 only those premature infants whose serum bilirubin level rose higher than 18 mg/100 ml received exchange transfusions. As Table I indicates, pathologists found kernicterus in two to four children every year.
Indications for Naloxone in Lomotil Poisoning
Authors: Lovejoy Frederick H.
Published: December 2021

Rumack and Temple in their thoughtful analysis of Lomotil poisoning1 note that narcotic antagonists should be used "as soon as adequate indications exist." From our experience with Lomotil toxicity in the last three years at Children's Hospital Medical Center and with other drugs producing narcotic like effects,2.3 we would like briefly to comment on the indications for the use of the narcotic antagonist, naloxone (Narcan) hydrochloride. Four prominent signs of naloxone efficacy exist: (1) dilatation of constricted pupils; (2) increase in depth and rate of respiratory effort; (3) reversal of hypotension; and (4) correction of an obtunded or comatose state.4
Plasma Corticoids in the Respiratory Distress Syndrome and in Normal Infants
Authors: Bacon George E. , George Rachel , Koeff Steve T. , Howatt William F.
Published: December 2021

Serial plasma samples for corticoid determination were obtained during the neonatal period in 16 infants with RDS (eight of whom died) and 44 healthy babies. The median corticoid level in the eight infants with fatal RDS was considerably higher than that of patients with RDS who survived, or the normal babies. The median corticoid level in the surviving RDS infants was statistically greater than that of the normal controls, but the actual difference was only 1.9 µg/100 ml. Simultaneous pH, Pco2, Po2,, HCO3 and corticoid measurements were obtained serially in five patients with fatal RDS. However, the correlation between plasma corticoids and the acid-base determination was poor in all but one infant. It is concluded that infants are able to respond to severe physical stress in the neonatal period with an appropriate rise in plasma corticoid concentration, but lesser degrees of illness may cause only minimal changes in corticoid levels.
Effects of Therapeutic Irradiation Delivered in Early Childhood Upon Subsequent Lung Function
Authors: Wohl Mary Ellen B. , Griscom N. Thorne , Traggis Demetrius G. , Jaffe Norman
Published: December 2021

To determine the long-term effects of therapeutic pulmonary irradiation and treatment with actinomycin D during a period of lung growth, 12 patients treated for Wilms' tumor metastatic to the lung and 8 patients treated for Wilms' tumor with no evidence of pulmonary metastases were studied 7 to 14 years after their initial tumor therapy. All patients had received irradiation to the tumor bed and treatment with actinomycin D. Group I had received a single course of bilateral pulmonary irradiation; group 2 had received additional pulmonary irradiation and/or thoracic surgery; group 3 had received no therapeutic irradiation directed primarily to the chest. Total lung capacity (TLC) averaged 71% of predicted value in group 1,58% in group 2, and 94% in group 3. Diffusing capacity in groups 1 and 2 was reduced to the same extent as lung volume. Quasi-static pressure-volume relationships, studied in three of six patients in group 1, were within the normal range when lung volume was expressed as percentage of observed TLC. Airway resistance, evaluated by spirometry, maximum expiratory flow-volume curves, and resistance of the total respiratory system, was normal or reduced. The data support the hypothesis that therapeutic irradiation during a period of lung growth primarily affects the lung parenchyma and produces a decrease in subsequent size of both the lung and chest wall. No effect of actinomycin D alone upon the lung could be demonstrated.
Stinging-Insect Hypersensitivity: A 20-Year Study of Immunologic Treatment
Authors: Mueller Harry Louis , Schmid William H. , Rubinsztain Rosalinda
Published: December 2021

It is evident that the degree of severity of the sting reactions and the degree of protectiveness from immunotherapy are dose-related. Immunologic treatment for three years seems to provide a high degree of protection6 but 5% of the patients did not have complete protection during treatment and an additional 5% of patients had a decrease in protection after treatment was stopped. Until a method is developed for determining whether clinical protection is present and persisting after three years of injection treatment, all patients should probably have some plan of continuing immunological treatment. As indicated in previous publications, one author's (H.L.M.) experience with patients relying on sting avoidance and emergency self-treatment for protection has proven to be disastrous in three cases and fatal in one instance. Some stinging insect reactions are probably not immunologic.6 Increasingly severe local reactions to successive stings may be reason for considering immunologic treatment, depending on the circumstances in each case.
DR. MARY WOOD-ALLEN ON PROPER BEHAVIOR FOR AMERICAN GIRLS AT PUBERTY—A 1905 VIEW
Authors: C. T. E.
Published: December 2021

Mary Wood-Allen, M.D., World Superintendent of the Purity Department, Woman's Christian Temperance Union, was the author of a widelyacclaimed book entitled What A Young Girl Ought to Know. This book first appeared in 1897 and received high praise from many contemporary physician reviewers.

An example of Dr. Wood-Allen's advice to pubescent girls is as follows:

It is far better for the young girl at puberty to be gently active in household duties than to be lying around reading love stories. These exciting stories do her great harm, physical as well as mental. They are like forcing houses that hurry the buds into blossoms. Many little girls are being hurried into the physical developement of womanhood through novel-reading. I want you to be my little girl as long as you can, and, therefore, I ask you not to read lovestories and silly books of romance. Let me choose your story books for you for a few years longer. There are so many beautiful books nowadays for young people that you can find plenty of healthful reading. And nature is the roost delightful book of all. Read the lives of plants and flowers as they grow in the garden, read the experiences of the living birds in the trees. Learn to know their songs, so that you recognize them whenever you hear them. I know a young girl who keeps an opera glass always at hand and I have often seen her jump up from the dinner table, catch up the glass and rush out to examine some bird whose song was new to her.
Objection to Commercialism
Authors: Bolton John C.
Published: December 2021

As part of its continuing trend toward commercialization I noticed that the Academy now prints and distributes the Red Book with the co-sponsorship of Mead Johnson Laboratories.

I was informed by the sales representative of the latter organization that the only way I could receive a copy was to accept it by hand from him, otherwise I would have to send a check to the Academy for this. I do not agree with this technique of distributing necessary medical information to members of the Academy.
The Need To Ban Competitive Sports Involving Preadolescent Children
Authors: Sayre Blaine M.
Published: December 2021

After attending the 20th World Congress in Sports Medicine this spring in Melbourne, the most important point that remained in my mind was the possibly deleterious effects of competitive sports on the preadolescent child. This question should be of concern to all pediatric practioners, since the question concerns not only the physical and psychological well-being of the adolescent, but may well be a very influential factor in determining his adult health.

First of all, it is generally accepted that the onset of puberty has a normal span of at least four to five years.
Leukemia in Twins
Authors: Feehan Edward B.
Published: December 2021

The article by Falletta et al. on leukemia in twins1 touches on a subject of long-standing interest to me. Some points could stand further discussion. The possibility of non-nuclear inheritance has not been mentioned by the authors. Carter2 states, "It is theoretically probable, though this has not been demonstrated, that there may be differences in cytoplasmic division in the splitting, leading to non-genetic inequalities of development." This possibility might explain some of the less than complete concordance noted in the first sentence of the abstract.
Additional Comments on Tc Po2, by Dr. Rooth
Authors: Rooth Gosta
Published: December 2021

Since the publication of my article1, further data on tc Po2 have become available.

There is some risk that a too low tc Po2 value may be recorded in seriously sick infants unless the temperature of the electrode is kept at 43 C. Even at this temperature the Huchs have seen no blisters at the site of measurements in the 500 cases they studied. In one premature infant with hemorrhagic tendency after exchange transfusion we saw a blister on the day after a four-hour recording had been performed.
The Challenge Is There
Authors: Wessel Morris A.
Published: December 2021

The discussions of Patricia McAfee, Henry Silver, and Abraham Bergman in the November issue suggest that some individuals believe that clinical pediatrics as a practitioner's primary role is about to disappear and be replaced by subspecialty colleagues serving hospitalized patients and pediatric nurse practitioners caring for most of the children currently being seen by doctors in private offices, university clinics, and health maintenance organizations. The primary care pediatrician working with or without a pediatric nurse practitioner has many advantages when compared to his counterpart a few decades ago.
More About Dr. Nathan
Authors: Muirhead Donald M.
Published: December 2021

There is little doubt that the recent saga of Dr. David Nathan and especially the subsequent rebuttles in Pediatrics will do much for the souls of practicing pediatricians, and consequently for the patients and children who benefit from their guidance and care. Perhaps the fact that Dr. Shiller's letter1 appeared recently as a "lead editorial" (Commentary) says something about a beginning trend (hopefully) in pediatrics today. There was an era when patient care was honorable work.
ILLITERACY IN PHYSICIANS
Authors: Simpson M. A.
Published: December 2021

The psychological, social, and political illiteracy of so many doctors has helped to make them constitute part of the health care problem, rather than part of its solution. Over the last few centuries, we have progressively focused on understanding man, his functions and malfunctions at ever smaller levels—the system, the organ, the cell, and the molecule. Now while retaining the great advantages these perspectives have gained, we must move conceptually in the opposite direction, and see the problems in the wider prespective—the dyad, the family, the community and beyond. While doctors have become more and more specialized, their patients are perversely becoming less so.
VIRAL CAUSES OF HYDROCEPHALUS IN ANIMALS
Authors: H. R. J.
Published: December 2021

Previous reports have demonstrated that hydrocephalus can be produced in animals by intracranial innoculation of mumps, influenza, and parainfluenza virus. A mutant measles virus produced by treatment with proflavine when injected intracranially in newborn hamsters also produced hydrocephalus due to aqueductal stenosis in 76%.1 Other mutant strains of measles virus did not produce hydrocephalus. The authors point out that "virus mutants should be considered potentially more hazardous than the parental strain."
CARING
Authors: Erikson E.
Published: December 2021

In youth you find out what you care to do and who you care to be, even in changing roles. In young adulthood you learn whom you care to be with—at work, and in private life. In adulthood, however, you learn to know what and whom to take care of.
The Pediatric Pneumogram: A New Method for Detecting and Quantitating Apnea in Infants
Authors: Stein Israel M. , Shannon Daniel C.
Published: December 2021

Schwartz, D. L., White, J. J., Saulsbury, F., and Haller, J. A., Jr.: Gastrin response to calcium infusion: An aid to the improved diagnosis of Zollinger-Ellison syndrome in children. Pediatrics, 54:599, 1974.

In column two, page 600, Kopel and Barbero were inadvertently misquoted. The sentence should read: "Kopel and Barbero19 have studied gastric secretion in infancy and childhood, and have shown a normal mean basal acid of 0.45 mEq/kg/hr for children 6 to 12 years of age. Our patient had a basal output of 41 mEq/hr or 17 mEq/10 kg/hr (38 times normal)."
Child Care in the People's Republic of China—1973: Part II
Authors: Wray Joe D.
Published: December 2021

NUTRITION OF CHILDREN

There is very little solid information concerning the nutrition of children in China in preliberation days. Given the severity and magnitude of the problem in most contemporary developing countries, and the anecdotal information about the situation in China then, it seems safe to assume that it was indeed a serious problem. Thus, the nutritional status of preschool children in China today is a matter of special interest.

Breast-Feeding

There is no satisfactory alternative to breastfeeding for the vast majority of mothers in the developing world. For such mothers, adequate artificial feeding is prohibitively expensive; it also requires careful education of the mother and then extreme care on her part to prepare feedings hygienically. The many significant advantages of breast-feeding for such mothers have been spelled out by the Jelliffes in a recently published symposium. They call attention there, and elsewhere, to the fact that human milk offers one of the best, but perhaps least appreciated, ways to close the "protein gap" in the developing world. Berg has discussed the economic aspects of breast-feeding in developing countries. He has calculated, for example, that if only 20% of urban mothers in such countries do not breast-feed, the cost of an adequate replacement diet for their infants would equal $365,000,000 per year. Berg believes that 20% is an underestimate of the proportion not breast-feeding and reckons that the total loss in cities throughout the developing world is in the billions of dollars each year. This sum is not actually spent, of course, and the vast majority of infants in the urban slums of developing countries receive a far less than adequate replacement.
Insensible Water Loss in Preterm Infants: Changes With Postnatal Development and Non-ionizing Radiant Energy
Authors: Wu Paul Y. K. , Hodgman Joan E.
Published: December 2021

Wu, P.Y.K., and Hodgman, J.E.: Insensible water loss in preterm infants: Changes with postnatal development and non-ionizing radiant energy. pediatrics, 54:704, 1974.

The sentence beginning on the last line of column one on page 708 should read: "In infants with birthweights under 1,500 gm, the values obtained were much higher than those reported in the earlier studies,11,13 but are comparable to those reported by Fanaroff et al."3
Treatment of Acrodermatitis Enteropathica With Zinc Sulfate
Authors: Kaloustian Vazken M. Der , Musallam Salim S.
Published: December 2021

Recently many articles have appeared in Pediatrics1-3 and in the literature4 relating the toxic effects of diiodohydroxyquin (Diodoquin) on the eye. In many instances the medication had been used for the treatment of acrodermatitis enteropathica.3-5

Following the report by Moynahan6 of successful treatment of this condition with the oral administration of zinc sulfate, we treated a 7-year-old boy suffering from acrodermatitis enteropathica with 50 mg of zinc sulfate by mouth, three times daily. The effect of this regimen was dramatic with complete clearing of all the skin lesions, regrowth of normal hair, and arrest of the diarrhea.
A New Treatment for Acrodermatitis Enteropathica
Authors: Sturtz George S.
Published: December 2021

The report of the Committee on Drugs dealing with the effects of diiodohydroxyquin-like drugs concluded that with the recommendation "these drugs not be used in children, with two possible exceptions . . . ."1 One of the exceptions was the treatment of acrodermatitis enteropathica.

E. J. Moynahan2 has suggested that acrodermatitis enteropathica is a lethal inherited human zinc-deficiency disorder. He has treated nine patients with zinc supplements alone (zinc sulfate, 150 to 200 mg daily).
Two points of view on herpesvirus vaccines
Authors: H. R. J.
Published: December 2021

The editors think it appropriate for readers to be presented with different points of view in areas where controversy exists. Although neither of the vaccines discussed below is currently licensed for use in the United States, both are under evaluation ion as experimental vaccines. They are brought to the attention of the readers as a means of informing them of developments in pediatrics and the potential problems that the new developments might bring.
The Pharmacological Assessment of Single Drugs and Drug Combinations in Exercise-induced Asthma
Authors: Blerman C. Warren , Pierson William E. , Shapiro Gall G.
Published: December 2021

The relative effectiveness of ephedrine, theophylline, hydroxyzine, and their combinations in relieving cycloergometer exercise-induced asthma were studied in 16 children and adolescents. Ephedrine had no effect on post-exercise asthma, hydroxyzine had a weak effect on hastening recovery, while theophylline modified the post-exercise response significantly. The three drugs together produced an additive effect superior to that of theophylline alone.
Think of the Thymus
Authors: Simmons Vaughan P.
Published: December 2021

A great deal of progress has been made in the treatment of leukemia since the paper entitled "The Thymus and Leukemia" appeared in this journal 25 years ago.1 Nevertheless, there seems today to be no wide acceptance of the thesis presented at that time that leukemia is a thymic disease–that the thymus not only participates in the disease but is the source of the abnormal cells. Perhaps the resurgence of interest in the thymus in recent years might make the article worth reading again.
Questions on Theophylline
Authors: Rosenfeld Charles R.
Published: December 2021

The articles by Shannon et al.1 and Uauy et al.2 concerning the treatment of apnea in low-birthweight infants are of great interest, and, as noted in the commentary by Lucey,3 their topic should stimulate a great deal of research and controversy. The controversy began when Dr. Shannon presented his paper on the use of theophylline at the annual meeting of the APS-SPR (Denver, Colorado; April 1975). During the discussion, it was very clearly pointed out by a number of individuals that, by virtue of the data, theophylline cannot be considered an acceptable mode of treating apnea in preterm or low-birthweight infants at the present time.
Seasonal Variation in the Onset of Diabetes in Children
Authors: MacMillan Duncan R. , Kotoyan Marcos , Zeidner Daniel , Hafezi Bijan
Published: December 2021

A distinct seasonal incidence pattern in the onset of detection of diabetes mellitus among school-age children is apparent. However, the true picture of seasonal variation in the onset of symptoms and detection of juvenile diabetes mellitus in this country may have to await the establishment of regional or national diabetes registries similar to those in Great Britain and Eire. Such data when available must be interpreted with caution so that aggravating, precipitating, and true etiological factors underlying seasonal variation in the onset of juvenile diabetes mellitus are distinguished.
Questions About Hypertension
Authors: Bailie Michael D.
Published: December 2021

The commentary "The Pediatrician and Hypertension"1 emphasized a most important but still much ignored aspect of health maintenance of children. I feel that two points need to be emphasized further. First, physicians measuring blood pressure in children should be aware that the three sizes of cuff normally available for newborn, infants, and children may be inadequate and could potentially lead to an overestimation of the blood pressure. This situation arises because the bladder is frequently too short and not because it is too narrow.
Reconstruction of the Right Ventricular Outflow Tract With a Conduit in Congenital Heart Disease
Authors: Waldhausen John A. , Pierce William S. , Whitman Victor , Pennock John L.
Published: December 2021

A series of five patients with complex cyanotic congenital cardiac malformations underwent surgical reconstruction of the right ventricular outflow tract using a Dacron conduit with a porcine aortic valve. All patients survived and all have shown clinical improvement. At cardiac catheterization postoperatively, a pressure gradient of between 20 and 50 mm Hg across the conduit was found in all patients. This surgical approach to patients necessitating reconstruction of the right ventricular outflow tract is effective and appears to have the best long-term results.
Natural History of Neonatal Colonization With Group B Streptococci
Authors: Speck William T. , Driscoll John M. , Polin Richard A. , Rosenkranz Herbert S.
Published: December 2021

Thirteen percent of the newborns in our study group were colonized with group B streptococci on day 3. This colonization rate appeared constant during the first two weeks of life and then decreased to 5%. Of the babies colonized on day 3, 59% and 91% were culture-negative on days 14 and 42, respectively. Sixty-five percent of the babies carrying group B streptococci on day 14 acquired this microorganism following discharge (day 3). Babies colonized with staphylococci or Escherichia coli were found to have decreased probability of colonization with group B streptococci.
Asymptomatic Viral Hepatitis Types A and B in an Adolescent Population
Authors: Tabor Edward , Jones Richard , Gerety Robert J. , Drucker Jacques A. , Colon A. R.
Published: December 2021

Sera from 95 adolescents were examined for markers of hepatitis B virus (HBV) infection and hepatitis A virus (HAV) infection. HBV markers were found in eight adolescents (8%) and evidence of previous HAV infection was found in 18 adolescetits (19%); none had a history of clinically recognizable hepatitis. These findings support the growing evidence that HBV and HAV infections are diseases of the pediatric age group, amid that testing of HBV vaccines when they become available for patient use will have to include a pediatric population.
Liver Dysfunction in Children and Adolescents During Hemodialysis and After Renal Transplantation
Authors: Fennell Robert S. , Andres Joel M. , Pfaff William W. , Richard George A.
Published: December 2021

Liver dysfunction is common in patients on hemodialysis or during the posttransplant period. Twelve children in the End-Stage Renal Disease Program at the University of Florida ranging in age from 4 to 18 years, developed persistent, elevated liver enzymes (SGOT or SGPT > 100 IU/liter) during hemodialysis in preparation for renal transplantation. Eleven of 12 developed enzyme elevations within six weeks of the initiation of hemodialysis. The other child exhibited enzyme elevations after one year on dialysis while awaiting a second transplant. Most of the children were anicteric and asymptomatic. Potential hepatotoxic drugs were discontinued when serum transaminase elevations were noted. Hepatitis B surface antigenemia was associated with enzyme elevations in one patient; cytomegalovirus seroconversion had occurred in eight patients, but only three had associated enzyme elevations. Liver biopsies were performed in all the patients before or at the time of renal transplantation. The histology was variable and ranged from normal in six patients, mildly abnormal with changes compatible with acute hepatitis in four patients, and granulomatous hepatitis in one patient, to severely abnormal with chronic hepatitis in the remaining patient. Seven of the 12 children underwent successful transplantation with return of enzyme levels to normal in five and persistent elevations in the others. These findings suggest that evaluation of liver histology provides the only accurate means of assessment of persistent liver dysfunction in children and adolescents on hemodialysis and after renal transplantation.
Plasma Concentrations of Isoniazid in Children with Tuberculous Infections
Authors: Olson William A. , Pruitt Albert W. , Dayton Peter G.
Published: December 2021

Six children with tuberculous infection were given their daily prescribed doses of isoniazid by the oral and the intramuscular route on different days. The plasma concentrations reached after both routes of administration were nearly equivalent. The plasma half-life of isoniazid ranged from 1.6 to 4.8 hours. The observed plasma concentrations in these children were higher than those reported in many adults. This difference is due to the larger doses of isoniazid prescribed for children.
Serious Analytical and Conceptual Errors in Bilirubin Binding Studies
Authors: Ahlfors Charles E.
Published: December 2021

The unexpectedly high and 1:1 correlation among fluorometric, Sephadex, and peroxidase determinations of total and reserve bilirubin binding capacities as reported by Cashore et al1 is quite remarkable considering the serious analytical and conceptual errors in the article, the previously observed lack of linear correlation between the fluorometer and 2-(4'-hydroxybenzene)azobenzoic acid (HABA),2 and the relatively low correlation coefficient (.92) observed when the peroxidase test is compared with itself on different instruments.3

The addition of sufficient bilirubin to near saturation of the first site should make the fluorometer a reasonably accurate method of assessing "true" total capacity (usually thought to be 1 mole of bilirubin bound per mole of albumin).
Haemophilus Flu on the Move
Authors: Macknin Michael L.
Published: December 2021

In the commentary, "Common Wisdom and New Findings in Sinusitis" (Pediatrics 66:638, 1980), Fulginiti suggests that it is not necessary to suspect and treat Haemophilus influenzae in acute sinusitis in children more than 4 years of age. However, several studies of both acute and chronic sinusitis in adults using cultures from direct puncture of the maxillary antrum show H influenzae is a common isolate.1-7 Therefore, it is probably necessary to include coverage for H influenzae when treating sinusitis in all age groups.
Exaggerated Natural Measles Following Attenuated Virus Immunization: A Retraction—Toxic Shock Syndrome
Authors: St Geme Joseph W. , Bush Bartholomew M. , George Barbara L.
Published: December 2021

In 1976, we reported a case of an adolescent girl who, in the absence of detectable measles virus antibody despite two inoculations of live attenuated vaccine, incurred an exaggerated atypical measles illness following exposure to wild virus prevalent in Los Angeles at that time (1972-1973).1 The editors of Pediatrics and we were puzzled that the measles virus hemagglutination inhibition anti-body response in this youngster was not as striking as the antibody responses reported for other children with untoward atypical wild virus infections following repetitive doses of inactivated measles vaccine.
Letters to the Editor
Authors: Stare Fredrick J.
Published: December 2021

"Sugar...food colors, additives, and flavors (especially red food color)...many children reacted to other common foods, including milk, corn, wheat, chocolate, eggs, and oranges." What is left to eat?

We completely agree with Dr Crook's statement that some of his patients "may have improved due to coincidental or concomitant factors including the placebo effect." It is well known that many individuals of all ages, from infancy to old age, with "nervous system symptoms" improve with a little personal attention, frequently referred to as TLC.
A Silk Purse from a Sow's Ear?
Authors: Todd James K.
Published: December 2021

In the 1970s it became axiomatic that a manuscript discussing the value of the white blood cell (WBC) count and differential would be an object lesson in flawed study design and inaccurate interpretation of prior literature. Somehow I always seem to get dragged into the argument with the mistaken impression that I feel, as misquoted by Dr Karniski, that a "CBC could accurately distinguish between any child with bacteremia and a child with a viral illness."
Entry of Bilirubin into the Brain Due to Opening of the Blood-Brain Barrier
Authors: Levine Rodney L. , Fredericks Wendy R. , Rapoport Stanley I.
Published: December 2021

A potential animal model of kernicterus has been developed. The blood-brain barrier was opened on one side of the brain, by brief infusion of a hypertonic solution into the carotid artery. Upon peripheral infusion of bilirubin, the animals developed unilateral yellow staining of the brain: the treated side was stained whereas the control side was not. This cerebral icterus resulted from the entry of albumin-bound bilirubin into the brain, and not from the passage of free bilirubin.