bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to the Editor
Authors: Schreiner Richard L.
Published: December 2021

We concur with Babson and Reynolds that the volume of feeding in the first few weeks of life in very low birth weight infants is probably an important factor in the etiology of lactobezoar formation. We would certainly agree with their policy of increasing the volume of enteral feeding very gradually, but we doubt that limiting the total volume to 150 to 160 ml/kg/day until nipple feedings are established will prevent lactobezoar formation since 13 of our 17 cases of infants with lactobezoars in the past three years were receiving less than 160 ml/kg/day.
Annual Summary of Vital Statistics—1978
Authors: Wegman Myron E.
Published: December 2021

Continued decrease in infant mortality and relative stability in the other major indices highlight 1978 vital data (Table 1)2. The provisional infant mortality rate of 13.6 deaths in the first year of life per 1,000 live births set a new record, 3.5% below the final rate of 14.1 in 1977. Births in 1978 were slightly higher in number but, with the natural increase in the population, the birth rate was slightly lower than in 1977. The crude death rate, marriage rate, and divorce rate were all up slightly.

BIRTHS

Estimated live births in 1978 totaled 3,329,000,2 fractionally higher than the final figure for 1977.
Rapid Detection of Neonatal Intracranial Hemorrhage by Transillumination
Authors: Donn Steven M. , Sharp Marcia J. , Kuhns Lawrence R. , Uy Joaquin O. , Knake James E. , Duchinsky Brian J.
Published: December 2021

Using transillumination and a sensitive cadmium sulfide light meter, 145 newborns were screened for the presence of intracranial hemorrhage. Intracranial hemorrhage (ICH) was suspected when the light meter could not detect any light passing through the anterior fontanel when the light beam was directed through the frontal eminence. ICH was confirmed by cranial computed tomography or postmortem examination in all 17 infants not transmitting light. Spectrophotometry was performed on samples of cerebrospinal fluid (CSF) to demonstrate the mechanism through which blood in the CSF blocks light transmission.
Food Coloring and Allergy
Authors: Lewis Priscilla W.
Published: December 2021

Adverse reactions to food colorings in pediatric medications can complicate treatment. I write to describe a recent experience with this problem. A 4-year-old girl with asthma and documented allergies to trees, danders, dust, and molds reacted to ampicillin, erythromycin, and Keflex with wheezing, urticaria, and fever. When she developed similar signs after eating a "red velvet" cake, her mother and I wondered whether the red dye in the antibiotics had been responsible for her reactions.
Letters to the Editor
Authors: Weinshank Annette B.
Published: December 2021

A child may have the right not to be taught to read in the conventional manner, but Dr Snyder (The Right Not To Read, Pediatrics, May 1979) does not have the right to be so uninformed on an issue that impacts so many of the patients whom pediatricians treat.

1. Dr Snyder makes the error of misusing standardized reading tests whose function is to rank large groups of children, with diagnostic reading tests whose function is to provide specific information to individual teachers about the strengths and weaknesses of individual children.
Letters to the Editor
Authors: Snyder Russell D.
Published: December 2021

The following letter from a parent is in response to the article in Pediatrics (63:791, 1979). The letter expresses extremely well the dilemma faced when a child is identified as a poor reader and illustrates why our educational attitudes toward reading are in need of modification.

I had a personal interest for reading your report because my son was left-handed, slow to walk and slightly awkward when he did. That and other small differences distinguished him from his brothers and sisters.
It's Been Done Before
Authors: Hunter Stewart
Published: December 2021

I read with interest the article by Dr Nickerson and his colleagues from Arizona. In the discussion the writers quote Dr Rudolph as suggesting the theoretical possibility of catheterizing the pulmonary venous trunk via the portal vein. The authors say that Dr Rudolph indicated that catheterization of the pulmonary venous trunk had not been reported. They then go on to rightly make the point that the saturation of umbilical venous blood can make the diagnosis in this complex and difficult situation.
Corrective Shoes for Children: A Survey of Current Practice
Authors: Staheli Lynn T. , Giffin Laura
Published: December 2021

A survey of shoe-prescribing practices for children was taken among pediatricians, orthopaedists, pediatric orthopaedists, and podiatrists. Opinions differed significantly regarding the usefulness of shoe modifications for common pediatric lower limb and foot problems. Parents' attitudes toward children's shoes were also surveyed. Pediatricians and pediatric orthopaedists tended to prescribe corrective shoes less often than did orthopaedists and podiatrists. High topped shoes are not necessary to promote normal foot development, in the opinion of 85% of those surveyed; however, high topped shoes were often recommended for infants because they slip off less easily. Preferences for Thomas heels, scaphoid pads, reverse lasts, straight lasts, wedges, torque heels, and shoe lifts for problems including flexible flat feet, metatarsus adductus, intoeing, bow legs, knock knees, and leg length inequalities were delineated among the four groups treating children's feet. The authors conclude that whereas studies show that shoe modifications are of questionable value in the problems discussed, corrective shoes are often prescribed when regular shoes would be more appropriate and economical.
Understanding Children's Advocacy in the Health Sector
Authors: Tompkins Richard F.
Published: December 2021

CHILD ADVOCACY

Children cannot always articulate their own interests or make their own decisions; even though their abilities increase substantially and predictably throughout childhood, society is forced to find ways to make decisions for children. Children's advocacy is an attempt to improve the lives of children through attention to the decisions that affect children. Advocacy is "intervention on behalf of children in relation to those services and institutions that impinge on their lives."1

During the late 1960s and early 1970s, different enterprises have been conducted under the rubric of children's advocacy. They have been initiated or funded by both public and private sources at all levels: national, state, and local. Surveys of children's advocacy activities, most notably a national base line survey conducted by Kahn et al,1 have attempted to define children's advocacy activities. After extensive field work, Kahn and colleagues summarized the diversity of children's advocacy activities:

...affirming new concepts of legal entitlements; offering needed services in areas where none existed; persisting in the provision of services when other more conventional programs dropped cases; assuring access to entitlements and help; mediating between children or families and institutions such as schools, health facilities, and courts; and facilitating self-organization among deprived community groups, adolescents, or parents of handicapped children.1(p9)

Health care is an area where society has a considerable interest in good decision-making on behalf of children. On humanitarian grounds, society has a caretaker interest and responsibility. On economic grounds, society benefits from the healthy development of its children, who represent a resource pool.
Noise Pollution
Authors: Hursey Francis X. , Powers William E.
Published: December 2021

The potentially dangerous results of infant exposure to high intensity and/or high frequency sound have been well documented.1-3 The Occupational Safety and Health Act of 1970 (OSHA) is the only federal standard establishing noise level limits. OSHA allows 90 decibels on the "A" scale (90 dB(A)) exposure for eight hours for a working adult. The American Academy of Pediatrics Committee on Fetus and Newborns has recommended 75 dB(a) as the maximum sound level permitted in the nursery and inside incubators.
Vitamins and Low Birth Weight Infants
Authors: Houck Peter W.
Published: December 2021

The most recent recommendation by the AAP Committee on Nutrition (Pediatrics 60:519, 1977) as to vitamin administration in the low birth weight (LBW) infant is confusing. One can appreciate that at present there is a paucity of information and much controversy as to the actual vitamin requirements of the growing LBW infant at different stages. It is amazing that the same recommended daily allowance of vitamins is suggested for both the 1-kg premie and the 10-kg older infant.
Birth Weight of Children with Phenylketonuria
Authors: Saugstad Letten Fegersten
Published: December 2021

In their investigation of the birth weight of siblings with phenylketonuria, Rothman and Puesehel (Pediatrics 58:842, 1976) found a difference of 90 gm between affected and unaffected sibs, a finding " compatible with the assumption that the intrauterine growth of children with classical PKU is not adversely affected." In my own investigation,1,2 the discrepancy was 356 gm. This reduced fetal growth in homozygotes with PKU was associated with increased perinatal morbidity and with limited intellectual achievement.
The Conservative Management of Vesicoureteric Reflux: A Review of 121 Children
Authors: Aladjem Mordechay , Boichis Hayim , Hertz Marjorie , Herzfeld Shmuel , Raviv Uzi
Published: December 2021

A group of 121 children with vesicoureteric reflux (VUR) grades 1 to 3 managed conservatively were followed-up for a period of six to ten years. In the majority of patients VUR grades 1 and 2 disappeared spontaneously. Prognosis was less favorable in those who were seen initially with grade 3 VUR. A statistically significant higher incidence of reflux disappearance was observed in children who were seen before 4 years of age. In the majority of patients with paraureteric-vesicle diverticulum, reflux persisted. Reflux was more likely to disappear in children with lower incidence of urinary tract infection than in those with multiple infections.
West Syndrome and Lennox-Gastaut Syndrome: A Survey of Natural History
Authors: Kurokawa Toru , Goya Nagahide , Fukuyama Yukio , Suzuki Masaki , Seki Toru , Ohtahara Shunsuke
Published: December 2021

The West syndrome and the Lennox-Gas-taut syndrome are characterized by their onset in infancy and early childhood, intractable seizures occurring almost daily, severe psychomotor retardation, and poor prognisis. Among handicapped children, they offer the most serious problems in daily care at home or in institutions because of frequent attacks and marked retardation. A nationwide survey in Japan was performed to elucidate the natural history of these two syndromes.
Early Intervention for Infants with Down Syndrome: A Controlled Trial
Authors: Piper Martha C. , Pless I. B.
Published: December 2021

The mental development of 37 infants with Down syndrome, allocated either to an experimental or control group, was assessed over a six-month period by an independent evaluator. The experimental group participated in biweekly therapy sessions designed to stimulate normal development while the control group received no intervention. The Griffiths Mental Developmental Scales were used to assess changes in the developmental status in the two groups, which were shown to be equal initially on a variety of variables. No statistically significant differences in mental development between the experimental and control groups were found. The early intervention regimen investigated in this study was not efficacious in altering the pattern of mental development in those Down syndrome infants participating in the program.
Anomalies of Heart, Spleen, Kidneys, Gut, and Limbs May Result from an Overdistended Neural Tube: A Hypothesis
Authors: Gardner W. James , Breuer Anthony C.
Published: December 2021

A hypothesis is advanced that many congenital anomalies of non-neural organs may be produced by damage to their mesodermal or entodermal anlagen caused by overdistention of the embryonic neural tube. Evidence to support the hypothesis derives from: (1) seldom appreciated but unequivocal embryologic facts about prechoroid plexus neural tube morphogenesis; (2) an understanding of the role of neural tube overdistention in the production of various dysraphic conditions; (3) the frequency of association of non-neural anomalies with dysraphic conditions; and 4) an analysis of the anatomic features of the organ anomalies associated with dysraphism. The practical utility of the hypothesis is that (1) it helps explain a seemingly widely divergent subset of phenomenology and (2) it is testable. At present, treatment of children with congenital anomalies is largely palliative. Prevention of these distressing defects in the future will only be realizable if the mechanisms of their genesis are more clearly understood.
HEROIC DRUG THERAPY OF PNEUMONIA IN CHILDHOOD RECOMMENDED BY JACOBI IN 1917
Authors: C. T. E.
Published: December 2021

Abraham Jacobi (1830-1919), the first professor of pediatrics in America, and the first president of the American Pediatric Society, did more than any other physician to place pediatrics in America on a firm and lasting basis. Nonetheless, his treatment of pneumonia in childhood, even as late as 1917, was as heroic, and as unscientific, as that practiced by physicians in the mid 1800s. He wrote:

I rarely treated a child pneumonia without digitalis. American practitioners have gradually ceased to be cowardly. If faint-heartedly you wait for changes or chances to turn up, you lose your patient. Pneumonias have no stomach for waiting. In treating pneumonia some American doctors have learned to know that hearts lose strength by the hour, unless they are stimulated at once and persistently. Small doses are insufficient; big ones are demanded, and they must be reliable drugs. Digitalis alone may not be sufficient. Spartein sulphate should accompany it in good doses. The modern American pharmacopeia is no guide for you or your patients. Ignorance of apothecaries has been presiding over it. I read in it that ⅙ grain of spartein sulphate is proclaimed to be the dose for an adult. But very rarely ⅙ or ¼ is sufficient as a baby's dose, provided you want it to be efficient; and you want it repeated frequently. Caffein is one of the efficient drugs, that means 4 or 6 or more grains a day for a baby. Camphor has been neglected by us. A year old baby may require 2 or 4 or 8 or 10 grains a day.
Childhood Primary Aldosteronism Due to an Adrenal Adenoma: Preoperative Localization by Adrenal Vein Catheterization
Authors: Ganguly Arunabha , Bergstein Jerry , Grim Clarence E. , Yum Moo Nahm , Weinberger Myron H.
Published: December 2021

Primary aldosteronism resulting from an adrenal adenoma is rare in children. An 8½-year-old girl was found to have hypertension and spontaneous hypokalemia, both detected as incidental findings. Subsequent investigations revealed inappropriately elevated levels of plasma and urinary aldosterone with suppressed plasma renin activity. Adrenal vein blood sampling and venography suggested the presence of left adrenal adenoma which was confirmed at surgical exploration and pathologic examination. All the clinical and biochemical abnormalities were corrected by the adrenalectomy. The differential diagnoses of various types of hyperaldosteronism and/or hypokalemia in such a clinical setting are discussed.
Communication
Authors: Kendig Edwin L.
Published: December 2021

As far as can be determined, the first medical organization was founded in the year 1518, when Dr Thomas Linacre, physician to Henry VII and Henry VIII, proposed and arranged the establishment of the College of Physicians (now the Royal College of Physicians). There is no recording as to differences of opinion among the membership, but it seems more than likely that complete accord and harmony did not always exist. According to the old adage, "That's what makes horseracing."

Good communication (the exchange of information) can bridge most disagreements or differences of opinion. The most frequently discussed and the most important question faced by the Executive Board of the American Academy of Pediatrics has concerned the best means by which to develop and utilize communication. Examples indude the President's letter to the membership (December 1978) listing 32 AAP accomplishments and activities over the past five years; and still another is the Academy program for the International Year of the Child, "The AAP Speaks Up for Children."

Communication, then, is the way to begin to solve most problems and that leads us to the theme of this discussion today: communication between practicing pediatricians and those engaged in academic pediatrics, and communication between those groups and both the Federal government and the public sector. Pediatric practitioners could not exist without pediatric teaching programs and research; conversely, the latter would be pragmatically useless without the practicing pediatricians. Both groups must recognize that they exist interdependently and that their mutual growth and development is equally interdependent.
Reye Syndrome in Children Less than 1 Year Old: Some Epidemiologic Observations
Authors: Sullivan-Bolyai John Z. , Nelson David B. , Morens David M. , Schonberger Lawrence B. , Marks James S. , Johnson Deane , Holtzhauer Frank , Bright Frank , Kramer Taylor , Halpin Thomas J.
Published: December 2021

Much of the epidemiology of Reye syndrome is still not well understood, particularly in the age group <1 year of age. Huttenlocher and Trauner1 recently reported the clinical findings in a series of patients <6 months of age. They noted that a disproportionate number of infants came from lower socioeconomic areas.

A 1973 to 1977 epidemiologic study of Reye syndrome in Ohio by the Ohio State Department of Health and the Center for Disease Control (CDC) has shown different age-specific attack rates for black children and for white children.2 Although the overall attack rates of Reye syndrome for black and for white children were not significantly different, among children <1 year old, black children had a rate of Reye syndrome approximately eight times the rate for whites.
Intravesical Chemical Cauterization and Methemoglobinemia
Authors: Lebowitz Robert L.
Published: December 2021

This case is another tragic reminder that remedies that have been used successfully in older children or adults may be inappropriate or even hazardous in an infant or a small child. Great care must be exercised whenever a potentially noxious substance is instilled into the bladder of an infant.
Alkalosis in Infancy and Commercial Formulas
Authors: Holliday Malcolm A.
Published: December 2021

The recent occurrence of alkalosis in infants fed Neo-Mullsoy has raised a number of points concerning infant nutrition. Two products, Neo-Mullsoy and CHO-free had levels of sodium and chloride below standards recommended by the Committee on Nutrition of the American Academy of Pediatrics.1 Regulations of the Food and Drug Administration (FDA) concerning infant formulas do not cover sodium chloride content.2 The company intended its products to meet the recommendations made by the Committee on Nutrition,1 but a number of changes in manufacturing practices led to the products containing less sodium and, learned after the fact, very little chloride. The sodium content of most batches while below recommended levels1 probably met minimum needs for virtually all infants.
School Nurse Practitioner
Authors: Cook Donald E. , Andringa Conrad L. , Hess Karl W. , Kishner Leonard L. , Leavitt Samuel R. , Novak Stanley F. , Rogers Kenneth D. , Stackpole J. Ward , Wiggins Casper , Kolb Weldon G. , Newton Jerome , Carlyon William , Sanders Joe M.
Published: December 2021

These issues and others are being addressed by projects conducted over the next five years in four states, with the financial support of the Robert Wood Johnson Foundation. Through these projects, the role and effectiveness of the SNP in different geographic and socioeconomic settings in the United States will be better defined and determined. The Committee applauds these efforts and eagerly awaits their conclusions.

Because of the increased scope of health care and evaluation practiced by SNPs, which includes some areas of primary health care, the Committee presently endorses SNP participation in school health programs only when they function under the direct supervision of a physician.
Letters to the Editor
Authors: Faraj Bahjat A. , Newman Stephen L.
Published: December 2021

We read with great interest the letter by Mitchell and Arcinue concerning our finding of hypertyraminemia in Reye's syndrome patients. Since the acceptance of our manuscript we have confirmed this finding in an additional 16 patients with biopsy-proven Reye's syndrome. The discovery of depressed hepatic monoamine oxidase activity described by the authors confirms our preliminary findings in four patients whose hepatic monoamine oxidase levels were measured in our laboratories. We feel that the work of Mitchell and Arcinue supports our hypothesis that derangement in biogenic amine metabolism may contribute to the encephalopathy of Reye's syndrome.
Letters to the Editor
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: December 2021

Drs Livingston, Pauli, and Pruce question our categorization of spontaneous seizure disorders following febrile seizures. We used two terms, afebrile seizure and epilepsy. The former term was nonrestrictive, and included all children who had one or more afebrile seizures, whatever the time of occurrence. We reserved the term epilepsy to identify that subset of children with afebrile seizures whose afebrile seizures were recurrent and relatively active, that is, children whose afebrile seizures constituted a clinical problem.
Letters to the Editor
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: December 2021

Dr Wallace is concerned that unreported treatment might have decreased the frequency of adverse outcomes observed in the NCPP after febrile seizures. The outcomes examined were death, motor deficit, epilepsy, intellectual impairment, poor early scholastic achievement, and recurrences of febrile seizures. To the best of our knowledge, there is no evidence that treatment of febrile seizures can alter the frequency of any of these outcomes except recurrences. Furthermore, in studies performed without monitoring of blood levels of anticonvulsants, compliance was apparently so poor that there was no effect of treatment even on recurrence rate.1,2
Letters to the Editor
Authors: Liebman William M.
Published: December 2021

I concur with Christensen that an insufficient rise in blood glucose after the oral lactose load may not be absolute for diagnosis of lactose intolerance, instead representing other factors, such as delayed gastric emptying. I further concur that some children may develop a stomachache associated with the examination procedure itself and not the lactose consumption. However, the number in my experience has been small. Furthermore, all children in my study with abnormal tests and/or symptomatology underwent a four-week trial of a lactosefree diet in order to further substantiate a causative role for lactose intolerance.
Differential Diagnosis of Variant Forms of Hyperphenylalaninemia
Authors: Kaufman Seymour
Published: December 2021

In 1975, a form of hyperphenylalaninemia was described in which neurologic deterioration occurs despite dietary control of the elevated blood phenylalanine levels.1 Subsequently, it was demonstrated that this condition can be caused by defects in the phenylalanine hydroxylase system other than in phenylalanine hydroxylase itself, ie, by a tissue deficiency of dihydropteridine reductase (DHPR)2,3 or of biopterin.4 Since then, research in the field of these newer, unresponsive variants of phenylketonuria (PKU) has moved ahead swiftly.

The treatment for these forms of hyperphenyl-alaninemia, which have been estimated to account for about 10% of the total, is different from that used for classic PKU.
Why Not Use Oxygen to Close PDAs
Authors: Yamanouchi Itsuro , Igarashi Ikuko
Published: December 2021

Patent ductus arteriosus (PDA) has become very common in modern nurseries in recent years. The favorite methods of managing it are either doing nothing, giving indomethacin, or surgical closure. The initial enthusiasm for the use of indomethacin to induce closure is now being tempered as a result of experience. Early surgical ligation of PDA, especially that complicating respiratory distress syndrome, is considered too aggressive for extremely small preterm infants, and for the management of infants having congestive heart failure.
Pulmonary Function Abnormalities in Thalassemia Patients on a Hypertransfusion Program
Authors: Keens Thomas G. , O'Neal Margaret H. , Ortega Jorge A. , Hyman Carol B. , Platzker Arnold C.G.
Published: December 2021

Pulmonary function tests were performed in 12 thalassemia patients on a hypertransfusion program (age 18.4 ± 2.6 SEM years) to determine the presence of any abnormalities of lung function. These included spirometry, expiratory flow rates, body plethysmography, single-breath nitrogen washout, single breath carbon monoxide diffusing capacity, and arterial blood gases. Only one patient had normal pulmonary function. Arterial hypoxemia was present in ten of 12 patients at rest. The total lung capacity (TLC) was normal. The residual volume was abnormally increased in five of 12 patients. The slope of phase III of single breath nitrogen washout curve was abnormal in five of 12 patients, but the closing volume was normal. The maximal expiratory flow rate at 60% total lung capacity was decreased in four of 12 patients, suggesting the presence of small airway disease. The single breath carbon monoxide diffusing capacity was normal in all patients. These pulmonary function abnormalities did not correlate with age or the cumulative amount of iron via blood transfused. The small airway obstruction, hyperinflation; and hypoxemia observed in thalassemia patients on a hypertransfusion program may result from the basic disease, iron deposition in the lungs, or other factors.
Letters to the Editor
Authors: Kelly Dorothy , Shannon Daniel C.
Published: December 2021

We have now supervised 230 families who have monitored an infant at home and have gradually developed our hospital and home monitoring program in response to our families' needs. The hospital program begins once a medical decision has been reached that the infant requires continuous surveillance. It consists of: (1) Evaluation of the family's strengths and weaknesses by the pediatrician and social worker. (2) Determination of family and community resources available to support weaknesses and to provide relief services.
Intracranial Bleeding—Follow-up Needed
Authors: Miller Gary M.
Published: December 2021

The recently published study by Krishnamoorthy et al1 provides some interesting information regarding the sequelae of intraventricular hemorrhage. However, the methodology of the study limits its usefulness in determining an approach to the management of these infants. Almost half of the original study population died, and whether the degree of hemorrhage influenced their course and management is not described. There were no controls for gestational age, hence the influence of prematurity on the developmental outcome cannot be determined.
Letters to the Editor
Authors: Miller John F.
Published: December 2021

I want to thank the Committee on Adolescence for sharing with me your personal, individual, and deeprooted attitudes in "Pregnancy and Abortion Counseling" (63:920, 1979). Following the reading of your article, I am more committed than ever to touch my adolescent patients with all the love, all the compassion and all the wisdom that flows from our Judeo-Christian heritage.

First, I will tell my kids that God loves them, that they are basically good, and that they have a lot going for themselves.
Letters to the Editor
Authors: Roche Alex F. , Lipman Ronald S. , Overall John E. , Hung Wellington
Published: December 2021

We were pleased to read the letter written by Dr Greenhill and colleagues. The area we reviewed is a very active one; this is indicated by the fact that four of their 12 references are to papers that had not been published at the time we wrote the review. After considering the total literature available to us, particularly in regard to the apparent quality of the various studies, we are reluctant to make any statement regarding the relative merits of these drugs in regard to their effects on growth.
Protest of a Misquote
Authors: Kirkman Henry N.
Published: December 2021

In their report on ABO hemolytic disease of the newborn (ABO HDN), Peevy and Wiseman1 confirm that the frequency of the disorder is higher in black than in white neonates. Coupled with earlier reports,2-8 their observations are valuable in showing that the difference is not just a local phenomenon. The cumulative evidence for a racial difference in frequency of ABO HDN is now overwhelming.

Peevy and Wiseman1 state, however, ". . . we show no evidence for increased severity, unlike Kirkman,8 who found an increase in severity of ABO HDN in black infants."
Spurious Conclusions
Authors: Coplan James
Published: December 2021

I read with interest the article by Littman and Parmelee (Pediatrics 61:470, 1978), which looked at the correlation between prenatal and postnatal medical events and subsequent developmental outcome. To this end, the authors have devised four scales, looking at medical status during the prenatal, and postnatal periods, as well as at 4 months and 9 months of age, respectively. The authors point out that all items received equal weighting and that the scales were scored in an arithmetic summary fashion.
Letters to the Editor
Authors: Littman Bruce
Published: December 2021

The letter from Dr Coplan was read with great interest and this opportunity to reply to his inquiry is much appreciated. The questions posed by him are pertinent ones and I shall try to provide some answers.

In regard to his first concern it should be stated that historically there has always been interest to relate perinatal life events and medical complications to later outcome. In fact methods used in earlier research attempted to correlate such occurrences on a single one-to-one basis to subsequent developmental performance.
Colorless Babies Mature Late
Authors: Harris Howard B.
Published: December 2021

The apparent earlier fetal pulmonary maturation of infants from a black African population demonstrated in a recent article by Olowe and Akinkugbe1 had been previously shown in a black American population in a review of lecithin/sphingomyelin (L/S) ratios from complicated pregnancies by Dyson et al.2

Both these studies provide biochemical evidence to substantiate the clinical observations of a lower incidence of hyaline membrane disease in the black population.3,4 The reason for this acceleration of lung maturity in blacks is unclear, but it may well be racial, as suggested by Olowe and Akinkugbe.
Pneumocystis carinii Pneumonitis in Young Immunocompetent Infants
Authors: Stagno Sergio , Pifer Linda L. , Hughes Walter T. , Brasfield Dana M. , Tiller Ralph E.
Published: December 2021

Of 67 infants enrolled in a prospective study of infant pneumonia ten (14%) had evidence of Pneumocystis carinii infection. Diagnosis was achieved by demonstrating circulating P carinii antigens by counterimmunoelectrophoresis in all ten cases and by histopathology in the only infant who underwent an open lung biopsy. Antigenemia did not occur in 64 control infants (P = .003), nor in 57 patients of similar age who were hospitalized with pneumonitis due to Chlamydia trachomatis, respiratory syncytial virus, cytomegalovirus, adenovirus, and influenza A and influenza B viruses. None of the ten infants with P carinii pneumonitis had evidence of a primary immunodeficiency nor had any received immunosuppressive medication. These patients were hospitalized at a mean age of 6 weeks (range 2 to 12) and their illness was characterized by its afebrile course, presentation in crisis with severe respiratory distress, apnea, tachypnea, cough, increased IgM, and bilateral pulmonary infiltrates with hyperaeration. The clinical features of P carinii pneumonitis were indistinguishable from those of C trachomatis and cytomegalovirus pneumonia. Treatment with trimethoprim-sulfamethoxazole was associated with rapid disappearance of circulating antigens; however, the small number of patients studied did not permit an analysis of its clinical efficacy. These results indicate that P carinii singly or in combination with other infectious agents may be an important cause of pneumonitis in young, immunocompetent infants with no underlying illnesses.
Haemophilus influenzae Type b Meningitis: Occurrence in Three Siblings Over a Two-Year Period
Authors: Chad Zave H. , Pearson E. Lee , Reece Elena R. , Powell Keith R.
Published: December 2021

Haemophilus influenzae type b meningitis occurred in all three siblings in one family over a 24-month period. Investigations of the organisms involved and immunologic studies of the family revealed low percentages of E-rosette-forming cells (T-cells) in both surviving children and in the father. This report suggests that host susceptibility to H influenzae is genetically controlled and that T-cell functions, as yet undetermined, may be involved.
THE APPEARANCE OF AMERICAN GIRLS, AS VIEWED BY MOREAU DE SAINT-MÉRY ABOUT 1795
Authors: C. T. E.
Published: December 2021

The French jurist, Méderic Louis Élie Moreau de Saint-Méry (1750-1819), was driven into exile during the French Revolution by Robespierre's accession to power.

From 1794 to 1798 Moreau lived in the United States. In the journal he kept during these years, he described American young girls as follows:

American girls are pretty, and their eyes are alive with expression; but their complexions are wan, bad teeth spoil the appearance of their mouths, and there is also something disagreeable about the length of their legs. In general, however, they are of good height, are graceful, and, in enumerating their charms, one must not forget the shapeliness of their breasts.

Philadelphia has thousands of beauties between fourteen and eighteen. To offer but a single proof: on the north side of Market Street, between Third and Fifth Street, on a single winter's day I saw four hundred young maidens promenading, each one of whom would surely have been followed in Paris, a seductive tribute that could be offered by perhaps no other city in the world.

But these girls soon became pale, and an indisposition which is reckoned among the most unfavorable for the maintenance of the freshness of youth is very common among them. They have thin hair and bad teeth, and are given to nervous illnesses. The elements which embellish beauty, or rather which compose and order it, are not often bestowed by the graces. Finally, they are charming, adorable at fifteen, dried up at twenty-three, old at thirty-five, decrepit at forty or fifty.
Sudden Infant Death Syndrome: Sleep Apnea and Respiration in Subsequent Siblings
Authors: Hoppenbrouwers Toke , Hodgman Joan E. , McGinty Dennis , Harper R. M. , Sterman M. B.
Published: December 2021

Subsequent siblings of infants who died of the Sudden Infant Death Syndrome are at a four- to six-times increased risk to die of this syndrome. This study compares the respiratory development during sleep state of this epidemiologic high risk group with that of normal infants during the first six months of life. Subsequent siblings exhibited higher respiratory rates in all states at 3 months of age. Quiet sleep and indeterminate respiratory rates were elevated at 1 week of age compared to control infants. Indeterminate respiratory rates remained higher at 6 months of age. These differences were accompanied by a reduced incidence of total breathing pauses of two to five seconds and six to nine seconds duration in siblings. Study groups could not be differentiated on the basis of either breathing pauses of more than ten seconds or central apnea of six seconds or more. Obstructive and mixed apnea (6 seconds or more) were infrequently observed in these study groups. A high degree of intersubject variability characterized all data on breathing pauses.
Juvenile Detention: Another Boundary Issue for Physicians
Authors: Hein Karen , Cohen Michael I. , Litt Iris F. , Schonberg S. Kenneth , Meyer Monica R. , Marks Andrea , Sheehy Audrey-Jean
Published: December 2021

It is estimated that there are 500,000 youngsters in detention in the United States per year. Detention facilities offer a unique environment in which adolescents at high risk for medical problems can be identified and treated. A health care program within the secure juvenile detention facility for New York is described in order to demonstrate how an academic medical center can effect improvement in the health status of underserved, incarcerated youth while meeting professional educational objectives for health trainees. Results of medical services are given for the past 11 years. Medical problems were diagnosed in 46% of the 47,288 adolescents examined. The conditions were grouped into those related to the legal status of the youngsters, socioeconomic background, and/or the institutional setting. The interrelationship of medical conditions with legal, ethical, and youth advocacy issues were demonstrated. The setting affords an opportunity to train primary care physicians with special emphasis on issues such as the nature of the doctor-patient relationship, confidentiality, and patient advocacy, while providing a necessary service to medically disadvantaged adolescents.
Low Dose Single Weekly Injections of Growth Hormone: Response during First Year of Therapy of Hypopituitarism
Authors: Rosenbloom Arlan L. , Riley William J. , Silverstein Janet H. , Garnica Adolfo D. , Netzloff Michael L. , Weber F. Thomas
Published: December 2021

Initial year growth responses to single weekly injections of 2.5 units human growth hormone (hGH) in 29 patients with hypopituitarism (130 units/yr/patient) were compared to responses in a series using smaller doses in conjunction with androgen (48 to 112 units/yr); the US collaborative study experience with the standard dose (2 units 3 times/wk = 312 units/yr), and with two size-adjusted doses (0.06 units/kg 3 times/wk = 212 ± 94 SD units/yr, 0.03 units/kg 3 times/wk = 116 ± 33 units/yr); and to the British experience with much larger doses (1,040 units/yr). During the first year of hGH treatment our patients grew an average 13% faster than the androgen-supplemented and collaborative study-0.03 units/kg/dose groups. They had a similar pace to the collaborative study-312 units/yr and 0.06 units/kg/dose patients, but grew 15% more slowly than did the British patients. Growth response correlated positively with age and negatively with hGH dose per kilogram of body weight. Of 17 patients with isolated growth hormone deficiency ten developed hypothyroidism with hGH therapy, leading to a policy of routine adjunctive thyroxine replacement.
Aerobic and Anaerobic Bacteriology of Perirectal Abscess in Children
Authors: Brook Itzhak , Martin William J.
Published: December 2021

Aspirates of pus from perirectal abscesses in 28 children were studied for aerobic and anaerobic bacteria. A total of 87 isolates (64 anaerobic and 23 aerobic) were recovered from the patients, an average of 2.3 anaerobes and 0.8 aerobes per specimen. Anaerobic organisms alone were recovered from 15 specimens (54%), and in nine specimens (32%) they were mixed with aerobic organisms. Aerobic organisms were recovered in pure culture in only four patients (14%). The predominant anaerobic organisms were Bacteroides sp (32 isolates, including 14 B fragilis group and seven B melaninogenicus group), Gram-positive anaerobic cocci(15), Fusobacterium sp (six), and Clostridium sp (three). The predominant aerobic organisms were Escherichia coli and Staphylococcus aureus (six of each), group A β-hemolytic streptococci, Pseudomonas aeruginosa, and Proteus morganii (two of each). Five children had a serious underlying chronic disease; three of these had an accompanying bacteremia and two died. Incision and drainage were performed on all patients: some children also received parenteral, or oral antibiotic treatment, or both.
Vascular Malformation of Hypothalamus: A Cause of Isolated Growth Hormone Deficiency
Authors: Russell J. D. , Wise P. H. , Rischbieth H. G.
Published: December 2021

The etiology of pituitary dwarfism is varied.1 The majority of cases are idiopathic (with an observed increase in history of birth trauma), and approximately one third are associated with radiologic changes of craniopharyngioma or pituitary tumor. A number are associated with midline embryonal defects, histiocytosis, basilar meningitis, and sarcoidosis. An increasingly reported cause is craniospinal irradiation for oncologic disease. An unusual, and previously unreported, cause is described.

CASE REPORT

A male child, born Aug 8, 1961, was investigated at the Royal Adelaide Hospital for shortness of stature. He was the second of four siblings; gestation and delivery were normal with a birth weight of 2.6 kg.
Damn the Simplicities
Authors: Haggerty Robert J.
Published: December 2021

A major advance in our understanding of early mother-child interaction was made by Klaus and Kennell when they reported that early contact between a mother and her newborn infant promoted bonding and even led to improved development at 1 year of age. In spite of questions concerning their results, others are also reporting positive effects of home support by relatively untrained women. In this issue of Pediatrics, Siegel and colleagues1 summarize these studies and report on a carefully controlled study which was designed to test the power of continuing postpartum home visiting and early bonding. They show that at 4 months of age there were significant differences in mother-child interaction between those who had early and sustained hospital contact followed by home support compared to those who did not.
The Otoscope as a Transilluminator
Authors: Uga Naoki , Kondo Yoichi
Published: December 2021

We read with great interest the article by Dr Wall in the June 1977 issue reporting arterial blood sampling by transilluminator. However, sometimes it is very cumbersome to do arterial blood samplings or cannulation using the transilluminator in a limited space such as the neonatal incubator. We have found that the bright otoscope (Welch Allyn model no. 25000) without ear piece works out efficiently to locate radial, ulnar, dorsalis pedis, and posterior tibial arteries in premature babies in a dark room.
Clouds, Skin Color, and Rickets
Authors: O'Connor P. A.
Published: December 2021

The article by Bachrach et al,1 on vitamin D deficiency rickets (Pediatrics 64:871, 1979) presents interesting data expanding the number of reported recent cases of vitamin D deficiency rickets in breast-fed infants. Of particular interest are the large number of cases of varying degrees of severity in a community where concerned parents are committed to natural methods of feeding.

These cases are similar to two children I reported in 1977.2 These were two cases of vitamin D deficiency rickets in breast-fed infants who were not receiving vitamin D supplementation as had been advised.
Touché
Authors: Reader Hopeful
Published: December 2021

In October 1979, a meeting was convened in Geneva by WHO/UNICEF to consider the development of measures to improve infant and young child feeding practices.1 Among the recommendations concerning marketing and distribution of infant formula and weaning foods, the following statement was made: "Promotion to health personnel should be restricted to factual and ethical information."

How will this recommendation be implemented in the United States? Can we, for example, hope that (1) a single issue of Pediatrics will be published with no advertisements, and (2) a single annual meeting of the American Academy of Pediatrics will be held without the carnival atmosphere of advertising hoopla, industry-hosted cocktail parties...ete?
Pneumocystis carinii Pneumonitis in Young Immunocompetent Infants
Authors: Stagno Sergio , Pifer Linda L. , Hughes Walter T. , Brasfield Dana M. , Tiller Ralph E.
Published: December 2021

In the article "Pneumocystitis carinii Pneumonitis in Young Immunocompetent Infants" by Stagno et al (Pediatrics 66:56-62, 1980) the second author's name should read Linda L. Pifer, PhD, not Linda L. Pifer, MD.
CASE REPORTS OF TWO INFANTS ADMITTED TO THE BABIES HOSPITAL IN NEW YORK CITY IN THE FALL OF 1888
Authors: C. T. E.
Published: December 2021

The Babies Hospital in New York City opened to receive patients in a temporary home at 161 East 36th Street on June 16, 1888.

The following case reports of two infants, who were among the first patients admitted, will graphically show the modern pediatrician that acutely ill infants in 1888 could survive by virtue of the vis mediatrix naturae rather than by the drug therapy prescribed for them.1

Case 1—Cecilia, aged fifteen months; entered in November with pneumonia of lower lobe, left side, and pleurisy of both sides. The father had been carrying her around the city all day in a cold storm, trying to find a hospital which would admit her. The mother had been intemperate for several years, and was at the time suffering from a two weeks' debauch. The child was not yet weaned, and was presented with its clothing saturated and in collapse. Temperature, 104.8° F.; respiration, 60; pulse, 140. Tr. digitalis, gt. one, every four hours, and brandy, one-half drachm, every one-half hour, produced but little improvement in the pulse. Nutritive enemata, containing one drachm of brandy, every two hours were added. Four and one-half ounces of brandy were given each twenty-four hours, for three days, the pulse remaining 136 to 148, and compressible, while the temperature had fallen to 99° F. Musk and camphor were then added, but the pulse continued at 148 and intermittent. The child was seen in consultation with Dr A. H. Smith, who suggested the tincture of strophanthus, one-half drop every two hours.
Sudden Infant Death Syndrome: A Review of the Medical Literature 1974-1979
Authors: Valdeś-Dapena Marie A.
Published: December 2021

In the last five years there have been literally hundreds of articles in the world's medical literature regarding sudden infant death syndrome. This work has shed some light on various epidemiologic aspects of the problem, on pathologic anatomy, and on clinical issues such as the relative importance of spontaneous, protracted, idiopathic apnea and prolongation of the Q-T interval. This relatively comprehensive review treats only a limited number of these subjects and publications in an attempt to bring the reader more or less up-to-date on the major aspects of developments over the last five years.
The Role of Chlamydia trachomatis in Middle Ear Effusions in Children
Authors: Hammerschlag Margaret R. , Hammerschlag Paul E. , Alexander E. Russell
Published: December 2021

The finding that Chlamydia trachomatis is a significant respiratory pathogen in young infants has focused attention on its possible role in other respiratory diseases in children. There have been several reports of otitis media occurring in adults with experimental1 and natural inclusion conjunctivitis.2 Tripple et al3 suggest that secretory otitis media may be a common occurrence in infants with chlamydial pneumonia. C trachomatis was isolated from the middle ear fluids of three of 11 infants with chlamydial pneumonia who had serous otitis media. However, this study was limited to infants less than 6 months of age. Little is known about respiratory infection with C trachomatis in older children.