bluuebunny/crossref_metadata_2025 huggingface dataset:
Letter to the Editor
Authors: Jakobsson Iréne
Published: December 2021

Our study was performed in 66 infants and mothers. The mothers of 23 infants with cow's milk-related colic were asked to participate in the double-blind crossover trial, and 16 accepted. The results of the trial were expressed according to the rules of sequential analysis, a statistical method considered to be useful in a study like ours (references to the method were given in our paper). According to these rules the study should be completed as soon as any line of the sequential chart had been passed.
Psychosocial Health Issues in Pediatric Practices: Parents' Knowledge and Concerns
Authors: McCune Yolanda D. , Richardson Miriam M. , Powell Judith A.
Published: December 2021

Parents' general knowledge of child development and the demographic factors associated with that knowledge were studied. A questionnaire was completed by 230 parents of patients from three quite different pediatric practices in the south-central United States. χ2 analysis was used as the major statistical technique. Results indicated that age, educational level, and income were associated with level of child development knowledge. Parents reported the sources and educational techniques that were most helpful to them in the past and present. The majority (81%) of the questions that parents wished to direct to pediatricians, given sufficient time, were concerned with psychosocial issues. It appears that the pediatric practice is a logical means of providing information to parents about their children's health concerns, both behavioral and physical. These results emphasize the importance of training pediatricians in behavioral issues and in improving their communication skills. The results are presented to help pediatricians select the anticipatory guidance and educational techniques that might be provided to parents through the pediatric practice.
Unilateral Hearing Impairment in Children
Authors: Bess Fred H. , Tharpe Anne Marie
Published: December 2021

An overview and update are offered on difficulties experienced by children with monaural sensorineural deafness. It is the general consensus that children with unilateral hearing loss experience few, if any, communication and/or educational problems. The medical and educational status of a group (N = 60) of children with unilateral, hearing impairment are described. In addition, the auditory, linguistic, and behavioral manifestations of unilateral hearing impairment were studied in considerable detail for a subsample of these 60 children. The results revealed that approximately one third of the children with unilateral hearing loss had failed at least one grade. Nearly 50% of the group had either failed a grade and/or needed resource assistance in the schools. The small subsample of children with unilateral hearing loss performed much poorer than a matched group of children with normal hearing on both a localization and a syllable recognition task. Finally, the data on behavioral and linguistic manifestations of monaural hearing loss indicate that children with unilateral hearing impairment are experiencing more problems than previously supposed.
Direct Fluorescent Monoclonal Antibody Stain for Rapid Detection of Infant Chlamydia trachomatis Infections
Authors: Bell Thomas A. , Kuo Cho-chou , Stamm Walter E. , Tam Milton R. , Stephens Richard S. , Holmes King K. , Grayston J. Thomas
Published: December 2021

A method of direct fluorescent antibody staining for rapid diagnosis of Chlamydia trachomatis infections in infants is described. This method utilized a fluorescein-conjugated species-specific monoclonal antibody to C trachomatis for detecting chlamydial elementary bodies in smears of the conjunctiva, nasopharynx, oropharynx, anus, and vagina. The sensitivity of direct fluorescent antibody staining was compared with isolation of the organisms in McCoy cells. Thirty-nine infants with purulent conjunctivitis were studied. Diagnosis of C trachomatis conjunctivitis was correctly made by smear in all 16 infants when inflamed eyes were sampled. Positive smears were obtained from 12/14 culture-positive and 4/16 culture-negative nasopharyngeal specimens from infants with chlamydial conjunctivitis. All nasopharyngeal cultures and smears from infants with nonchlamydial conjunctivitis were negative. These results indicate that the direct smear test is a sensitive and specific test for diagnosing C trachomatis infection of the eye and nasopharynx in infants, and this test can be completed within one hour of specimen collection.
Continuous-Cycling Peritoneal Dialysis for Children: An Alternative to Hemodialysis Treatment
Authors: Brem Andrew S. , Toscano Alice M.
Published: December 2021

Treatment of end-stage renal failure in children is invasive and prolonged. Although kidney transplantation is often the desired therapy, children usually require some form of life-sustaining dialysis until a suitable donor is found. Home continuous-cycling peritoneal dialysis (CCPD) is a useful alternative to in-center hemodialysis for these children. Adequate biochemical control of the uremic state can be achieved with continuous-cycling peritoneal dialysis. Peritonitis remains the major complication of this form of dialysis, averaging approximately one episode per 12 patient-months. Growth rates of children maintained on continuous-cycling peritoneal dialysis appear to be equivalent to growth rates of children treated with hemodialysis. The advantage of continuous-cycling peritoneal dialysis lies in the fact that exchanges occur during the evening hours and parental intervention is minimized.
Otitis Media with Effusion During the First Three Years of Life and Development of Speech and Language
Authors: Teele David W. , Klein Jerome O. , Rosner Bernard A. ,   The Greater Boston Otitis Media Study Group
Published: December 2021

To determine the association between time spent with middle ear effusion and development of speech and language, 205 three-year-old children were studied. Each child had been followed prospectively from birth to record the number of episodes of middle ear disease and to document time spent with middle ear effusion. Standardized tests of speech and language were administered at age 3 years to children who had spent much time with middle ear effusion and to children who had spent little or no time with middle ear effusion. Children who had spent prolonged periods of time with middle ear effusion had significantly lower scores when compared with those who had spent little time with middle ear disease. The correlation was strongest in children from higher socio-economic strata. Time spent with middle ear effusion in the first 6 to 12 months of life was most strongly associated with poor scores.
Assessment of Thumb Placement
Authors: MERLOB PAUL , MIMOUNI FRANCIS , ROSEN ORNA , REISNER SALOMON H.
Published: December 2021

Normal thumb placement has not been defined topographically, and distally or proximally placed thumbs are defined subjectively. We wish to report an objective method of assessment of the normal range of thumb placement.

MATERIALS AND METHODS

One hundred fifteen infants between the gestational age of 34 to 42 weeks were examined within the first 24 hours of life. All were appropriate for gestational age, without any congenital anomalies. Gestational age was calculated from the first day of the last menstrual period, and it was verified by the Dubowitz scoring system.1 Whenever a difference of 2 weeks on more was found in calculation of gestational age, the infant was excluded.
Guidelines for Infant Bioethics Committees
Authors:   Infant Bioethics Task Force and Consultants
Published: December 2021

BACKGROUND

In recent years a widespread public debate has developed on issues surrounding the care and treatment of critically ill infants. One aspect of this debate concerns the procedures that should be available to ensure that difficult treatment decisions regarding such infants are always made in the most effective manner possible. The American Academy of Pediatrics believes that hospital-based "infant bioethics committees," consisting of both physicians and nonphysicians, can provide consultation and review, ensuring sensitive treatment decisions made in a reasoned, informed, and caring manner. Infant bioethics committees can provide education, develop and recommend institutional policies, and offer consultation to providers and families facing a range of ethical problems or questions about medical treatment of infants. The Academy urges all hospitals to establish such committees either on their own or in conjunction with other hospitals. This document is intended to assist those individuals and institutions who elect to engage in this process.

The American Academy of Pediatrics has been involved in discussion of ethical issues surrounding the care and treatment of critically ill infants since 1982. In 1983, the US Department of Health and Human Services published regulations on this issue, establishing federal law enforcement activities which were intrusive into patient care. The Academy successfully challenged that rule in court. Subsequently, the Department of Health and Human Services issued regulations in the Federal Register (effective Feb 13, 1984, but currently in litigation) that, among other things, endorse the concept of infant review committees as suggested in comments that had been submitted by the American Academy of Pediatrics.
Sports and the Child with Epilepsy
Authors: BERMAN WULFRED
Published: December 2021

To the Editor.—

The Committee on Children with Handicaps and the Committee on Sports Medicine of the American Academy of Pediatrics are to be congratulated for their concise statement on Sports and the Child with Epilepsy.1 There is little doubt that the child whose epilepsy is under reasonable control and who desires to participate in sports, whether involving body contact or not, should be allowed to do so. Although it is logical to assume that repetitive head trauma—as might possibly occur in contact or collision sports—could not help but have a deleterious effect on the frequency of seizures in the epileptic child, fortunately, no clinical or statistical proof that this is true has ever been published.
W.A.S.T.E
Authors: VITANZA ALFRED T. , MOFENSON HOWARD C.
Published: December 2021

To the Editor.—

The American Academy of Pediatrics' policy statement announcing "The Injury Prevention Program" of the Committee on Accident and Poison Prevention has elevated injury prevention to a status where it will be considered an important and appropriate part of pediatric practice and not a minimum standard of pediatric care.

During a discussion on injury prevention at morning report with our interested house staff, a resident introduced a mnemonic in regard to what the committee recommends that physicians caring for children should advise parents to acquire for their children's safety.
A Survey of Pediatric Resident Training Programs 5 Years After the Task Force Report
Authors: Weinberger Howard L. , Oski Frank A.
Published: December 2021

Twenty-nine pediatric residency training programs responded to a survey with detailed descriptions of the scheduled rotations before and after the Report of the Task Force on Pediatric Education. This survey documented some changes in the overall structure of residency programming in that all programs demand 3 years of general pediatric training. Little if any changes were noted in the traditional emphasis on inpatient and neonatal training. Some changes in content area have been noted, namely a modest increase in the experiences in adolescent medicine. The survey failed to demonstrate any trend indicating increased emphasis on training experiences in the "new morbidity."
`Failure to Thrive' or the Failure to Define
Authors: STICKLER GUNNAR B.
Published: December 2021

Smith and Berenberg wrote a commentary, "The Concept of Failure to Thrive," in these pages in 1970.1 After recounting the history of the term, they added: "We hope that as a label it will not become indistinct or obscured by uncertainty as to its past, current, or future diagnostic implications." Their warning was appropriate, but numerous authors have failed to accept their concern.

Failure to thrive is assigned as a diagnosis to many children. To some physicians, it means that a child fails to gain weight; others intend it to include failure to grow. It is widely assumed that a failure to gain entails inevitably a failure to grow.
Preface
Authors: FOEGE WILLIAM H.
Published: December 2021

In November 1981, Dr Edward N. Brandt, Assistant Secretary of Health, Department of Health and Human Services, commissioned the Task Force to examine the scientific evidence regarding infant feeding and infant health in both the United States and developing countries. In addition, the report was to include recent information on trends, infant-feeding practices, and factors associated with infant-feeding decisions. The purpose of the Task Force was to determine those areas that were reasonably well studied and well proven and also to indicate where important deficiencies in knowledge existed. Because of the enormous volume of scientific literature dealing with infant feeding, the Task Force elected to concentrate on the most recent studies.

In addition, studies of health effects were reviewed if they primarily addressed clinical outcomes in infants or children as end points. This approach necessarily excluded many of the laboratory studies that provide the theoretical framework under which breast-feeding would be expected to have important positive health effects relative to other forms of infant feeding.

The Task Force also realized that because of the nature of clinical and epidemiologic research in this area, few of their conclusions could be based on the gold standard of causal research, namely, the randomized clinical trial. Nevertheless, to avoid arriving at conclusions and to say merely that more research was needed, would not live up to responsibility the Task Force was given.

Accordingly, the authors of this report have tried to indicate which observational studies were of sufficient quality and consistency that reasonably firm conclusions could be reached, while indicating methodologic difficulties as they were found.
Infant Feeding and Infant Growth
Authors: Seward Jane F. , Serdula Mary K.
Published: December 2021

Growth in infancy is a complex process affected directly or indirectly by numerous interrelated factors. The predominant factors include diet, the nutritional status and health of the mother, and the occurrence of infections. In addition, social factors (family structure and cohesiveness), economic status, cultural practices, and biologic factors—such as the sex of the infant, birth weight, birth order, birth interval, and genetics—may also play a significant role in growth.

Nutritional factors may affect growth in infancy both before and after birth. Maternal and infant nutrition are intimately related. For breast-fed infants, nutrition of the mother and that of her young are interrelated from conception until weaning; therefore, dietary intake of pregnant and lactating women is very important.67 Underweight mothers with poor weight gain in the last trimester of pregnancy bear infants with lower mean birth weights.111 Although there are ethnic differences in low birth weight in the United States, the incidence is relatively low.45 In contrast, in developing countries, low birth weight (≤2,500 g), mainly caused by the high proportion of growth-retarded newborns, is a major public health problem.126,138 Infants who have suffered from intrauterine growth retardation remain smaller, on average, than normal babies throughout infancy and early childhood.30,39,44

In developing countries, many nondietary factors also play an important role in determining growth. Infections, particularly gastroenteritis, are among the most important of these factors.91,124 Case-control studies examining factors that differ between malnourished (weight-for-age less than Harvard third or tenth percentile) and adequately nourished children in the second 6 months of life have found significant associations between the following nondietary factors and growth failure: high birth order (greater than six or seven), lower mean maternal age, low maternal weight, children from families in which one or more siblings had died, greater mean number of children less than 5 years old in the home, birth weight less than 2.4 kg, twinning, infections (measles, whooping cough, severe or repeated diarrhea), death of either parent, or a broken marniage.4,96
Hereditary Transcobalamin II Deficiency with Subnormal Serum Cobalamin Levels
Authors: Meyers Paul A. , Carmel Ralph
Published: December 2021

An infant with transcobalamin II deficiency had the unusual feature of a low serum cobalamin level. Moreover, the level did not rise greatly with cobalamin therapy. Clinically, the features of the infant's illness were unexceptional other than the somewhat delayed onset of symptoms at 3½ months of age. In addition, the patient's impaired antibody response to specific antigen challenge was not completely corrected following cobalamin therapy, and this result contrasts with the findings in the only previous examination of this feature of the disorder. As in previous cases, the transcobalamin II deficiency was accompanied by findings in the serum of complexing of the patient's R binder and the relative prominence of a cobalamin-binding peak eluting at a molecular weight of approximately 70,000 on Sephadex G-200 gel chromatography. In addition, the total serum R binder (free and complexed) level was low. This case demonstrates that transcobalamin II deficiency should be considered in any infant with a low serum cobalamin level in the first few months of life.
Fragile-X Syndrome Ascertained by the Presence of Macro-orchidism in a 5-Month-Old Infant
Authors: Carmi Rivka , Meryash David L. , Wood John , Gerald Park S.
Published: December 2021

The fragile-X syndrome, an X-linked form of mental retardation, is estimated to affect one in every 1,000 to 2,000 live-born male infants. Most commonly, fragile-X syndrome has been detected only after patients clearly demonstrate developmental delay, and frequently detection occurs only if the family history is consistent with X-linked mental retardation. Macro-orchidism is a finding commonly associated with the fragile-X syndrome. It has been suggested that the sparsity of reports of macro-orchidism among prepubertal boys with the fragile-X syndrome might be due to lack of careful measurement of the testes rather than to initiation of the enlargement at puberty. A 5-month-old infant with fragile-X syndrome, ascertained through testicular enlargement noted by actual measurement of testicular size as part of his physical examination, is reported.
Zinc and Low Birth Weight: Relationship Questioned
Authors: CARPENTIERI UGO , DAESCHNER C. W. , SMITH LEIGH R. , HAGGARD MARY ELLEN
Published: December 2021

To the Editor.—

Kumar and Anday1 recommended the addition of zinc deficiency to the list of causes of generalized edema in low-birth-weight infants.

In our opinion, none of the three patients they described support this conclusion, although the conclusion itself may be true. One patient, in fact, improved with protein supplementation alone, although over a longer period of time, and the other two patients improved with protein and zinc supplementation over a period of four to five days.
Marijuana in Urine
Authors: SILBER TOMAS
Published: December 2021

To the Editor.—

Congratulations on the moving and accurate report on marijuana that was published to "open some pediatric eyes to the need to drop the current all too prevalent laissez-faire attitude about this problem."1 I use this opportunity to call attention to an extremely useful tool that is available to the pediatrician working with patients and their families around the issue of drug use; namely, the cannabinoid urine assay for the detection of marijuana metabolites in the urine.2
Role of the Pediatrician in Patient Education
Authors: Fulginiti Vincent A.
Published: December 2021

Although most pediatricians agree on the importance of teaching parents and children about health care, they may not succeed in patient education because of a lack of the requisite communication skills, inadequate printed materials to augment personal involvement, a tendency to substitute such materials for personal involvement, and inadequate compensation. Physician recognition of an obligation to teach is a requisite for effective education. Adjustment of current practices is essential: use of educational materials must be systematically incorporated, educational efforts must make effective use of time and be cost-effective. Information should be readily understood, parents given an opportunity to ask questions, and effectiveness of the education evaluated. Pediatricians must have a constant source of supplementary material to use in patient education. Videotapes and interactive computer programs should be considered for more effective communication. Residency programs must teach future pediatricians how to educate parents and children.
Prevention of Childhood Injuries
Authors: Greensher Joseph
Published: December 2021

Accidents account for more deaths among children aged 1 to 14 years than the next five most common causes. Thinking about accidents as injuries that happen in a context comprising a host, an agent, and an environment may help prevent them. Until a profile of the family and child at risk of injuries is developed, causal factors must be identified and removed, and parents and children educated about injury prevention. Different problems occur at different stages of a child's development. nt. The agents most commonly associated with injuries are automobiles, bicycles, swimming, and animals The special vulnerability of infants was addressed by the American Academy of Pediatrics' "First Ride/A Safe Ride" program, which encouraged the use of safety seats. Design changes have reduced the number of bicycle injuries, but human factors continue to contribute significantly. Most drownings occur in fresh water, with many children within a few feet of safety; continuing education is essential. Inculcating respect for animals, learning safety rules for interaction, and advice on pet ownership help to reduce animal bite injuries.
Lipid Digestion and Absorption
Authors: Watkins John B.
Published: December 2021

The importance of nutrient lipids to the developing preterm and term infant has served to focus investigations upon the mechanisms of fat digestion and absorption. The unique physical-chemical properties of the human milk fat globule have been reviewed. Emphasis is placed on the newer understandings that have emerged concerning the intraluminal phase of triglycerides hydrolysis and solubilization of the lipolytic products. The mechanisms of action of the pancreatic lipase, colipase, and phospholipase A2 system, and the importance of intragastric lipolysis for initiating the lipid digestion are explored. Lastly, aspects of bile acid micelle formation and its role on nutrient lipid solubilization and absorption are examined in view of the postnatal adaptations that occur with weaning and the introduction of alternative nutrient sources to the older infant.
Impact of Digestion and Absorption in the Weaning Period on Infant Feeding Practices
Authors: Lebenthal Emanuel
Published: December 2021

Weaning is a transition period in which solid and table foods replace milk or formula. Such a shift involves not only a change in the texture but also the nutrient constituents in the diet of the infant. Appropriate dietary changes, although known to affect the physiologic and biochemical function of the gastrointestinal tract in adults, have not been established clearly in infants. The relationship between diet and gastrointestinal development during the weaning period is explored. New concepts such as alternate pathways for digestion and absorption during infancy and the possible effects of new feeding modalities such as total parenteral nutrition and elemental diet are discussed. The influence of exogenous factors such as malnutrition and diseases on the development of the gastrointestinal function, particularly that of the small intestinal brush border hydrolytic enzymes and exocrine pancreatic enzymes, are also reviewed because of their potential influence on the weaning process.
Partitioning of Heat Losses and Gains in Premature Newborn Infants Under Radiant Warmers
Authors: Baumgart Stephen
Published: December 2021

The partition of heat loss into convective and evaporative components, and heat gain into metabolic rate of production and radiant heat needed to maintain thermal equilibrium was determined in ten premature neonates (weight 1.39 ± .08 [SEM] kg, gestation 31 ± 1 weeks) who were nursed naked and supine on open radiant warmer beds. Warmer beds were servocontrolled to maintain each infant's abdominal skin temperature at three different levels: 35.5, 36.5, and 37.5°C. The quantity of radiant heat delivered by the warmer in vivo was measured directly and compared with the heat need calculated from the partition. Convective heat loss comprised the major component of net heat loss and increased significantly with servocontrol temperature from 2.86 ± .24 to 3.27 ± .23 kcal/kg/h (P < .01), and to 3.72 ± .26 kcal/kg/h (P < .001). Evaporative heat loss increased with servocontrol temperature from .96 ± .13 to 1.41 ± .33 kcal/kg/h, and to 1.35 ± .32 kcal/kg/h, but this increase was not significant. Metabolic rate decreased from 2.08 ± .17 to 1.90 ± .14 kcal/kg/h, and to 1.78 ± .16 kcal/kg/h with increased servocontrol temperature, but this decrease was not significant. Radiant heat needed to maintain infants at higher temperatures increased from 1.73 to 2.80 kcal/kg/h, and to 3.32 kcal/kg/h. The radiant heat delivered by the warmer to infants was directly proportional to the heat need calculated from the partition (r = .68, P < .001).
Haemophilus influenzae Type b Septic Arthritis in Children: Report of 23 Cases
Authors: Rotbart Harley A. , Glode Mary P.
Published: December 2021

Twenty-three cases of Haemophilus influenzae type b septic arthritis seen over a recent 5-year period are reviewed. The natural history of the disease includes a mean three days of fever and joint symptoms prior to hospitalization, often accompanied or immediately preceded by a viral illness and/or otitis media. Concurrent H influenzae type B meningitis was present in 30% of patients and concurrent osteomyelitis in 22%. Infants remained febrile in the hospital for a mean of 3.6 consecutive days. However, secondary and prolonged fevers were common. Clinical improvement in the joint examination was first seen at a mean of 2.5 days. Characteristic laboratory findings during recovery included a decline in total WBC count, neutrophil count, ESR, and hematocrit, with a concomitant increase in lymphocyte and platelet counts. Outpatient follow-up for a mean duration of 20 months found only two of 21 infants with residual impairment. The time to total healing in the remaining 19 infants, however, varied widely—from nine days to 17 months (mean of 4 months).
Cardiovascular and Catecholamine Changes After Administration of Pancuronium in Distressed Neonates
Authors: Cabal Luis A. , Siassi Bijan , Artal Raul , Gonzalez Felipe , Hodgman Joan , Plajstek Carolyn
Published: December 2021

Heart rate, blood pressure, transcutaneous gases, and catecholamine changes following intravenous injection of pancuronium were evaluated in seven ill newborn infants (birth weight: 1,280 to 4,500 g; gestational age, 29 to 42 weeks). Each infant was monitored continuously for 30 minutes before and 50 minutes after infusion of the paralyzing agent. There were no significant changes in transcutaneous gases, whereas significant increases in heart rate; systolic, diastolic, and mean blood pressures; and blood norepinephrine and epinephrine levels were found. The increase in heart rate lasted for 30 minutes, and the increase in blood pressure persisted for 50 minutes after administration of the drug. Because of the potential relationship between increased blood pressure and intraventricular hemorrhage and myocardial dysfunction, heart rate and blood pressure must be monitored during infusion of pancuronium in distressed newborns. These data suggest that pancuronium stimulates sympathetic activity in distressed newborns.
Traumatic Deaths of Children in the United States: Currently Available Prevention Strategies
Authors: Rivara Frederick P.
Published: December 2021

The causes of traumatic deaths of children 14 years of age and younger in the United States are presented. Available prevention strategies to decrease injury fatalities due to various causes are described, and the number of preventable deaths is calculated. With the implementation of only 12 currently available prevention strategies, childhood deaths from trauma could be reduced by 29% in the United States. The implications of these strategies are discussed, as well as the areas for which no effective countermeasures exist and which require further epidemiologic and investigative research.
Battery Ingestions: Product Accessibility and Clinical Course
Authors: Litovitz Toby L.
Published: December 2021

Results of 125 battery ingestions in 114 separate episodes over an 11-month period are analyzed. The 125 batteries included 119 button batteries and six cylindrical cells. The location of batteries just prior to ingestion (loose or discarded [48.7%], in product [34.4%], in manufacturer's battery packaging [3.4%]) determined the need for consumer education of this potential hazard. The observation that hearing aid batteries were the most common type swallowed (33.9%), and that 14 batteries were ingested by hearing-impaired children after they removed the batteries from their own aids, further directs appropriate prevention efforts. All the larger cylindrical batteries and 89.9% of the button cells passed through the gastrointestinal tract spontaneously. Endoscopic retrieval was unsuccessful in 66.7% of cases attempted. Ipecac syrup, administered to 11 patients, uniformly failed to expel the battery. Transit time was within 48 hours for 68.8% of button cells, and 85.4% of the batteries were passed by 72 hours, with a range of 12 hours to 14 days. Once beyond the esophagus, arrested battery progression failed to correlate with adverse outcome. Symptoms developed in 11 patients but were only severe in the single case of esophageal lodgment. The vast majority of battery ingestions are benign and can be managed without endoscopic or surgical intervention.
Early Experience with Illuminated Endotracheal Tubes in Premature and Term Infants
Authors: Heller Richard M. , Cotton Robert B.
Published: December 2021

A major problem in the care of premature and other newborn infants is obtaining and maintaining correct position of an endotracheal tube. Improper placement of the distal tip of the endotracheal tube above the larynx or below the carina is a life-threatening hazard that not only impairs ventilation, but also may result in serious pulmonary complications such as lobar atelectasis and air leak. This problem was addressed by testing the hypothesis that a light source at the end of the endotracheal tube could be seen on the neck and chest and that, therefore, the endotracheal tube could be positioned and repositioned without radiologic guidance. The validity of this concept was confirmed in animals using a rigid bronchoscope light source and conventional endotracheal tubes. Then an endotracheal tube in which a fiberoptic strand was incorporated in the wall and which terminated near the tip of the tube was used. The illuminated endotracheal tube was used 33 times in 25 infants. This technique has been shown to provide a safe method (not requiring ionizing radiation) for positioning of the endotracheal tube by virtue of external visualization of a circle of light on the surface of the baby. This system will not permit differentiation of tracheal from esophageal intubation.
Progressive Varicella in Three Patients with Wiskott-Aldrich Syndrome: Treatment with Adenine Arabinoside
Authors: Wade Nancy A. , Lepow Martha L. , Veazey James , Meuwissen Hilaire J.
Published: December 2021

Patients with Wiskott-Aldrich Syndrome have an increased incidence of serious infections, often with microorganisms that usually produce mild disease in immunologically normal subjects. Three patients with Wiskott-Aldrich syndrome complicated by progressive varicella are reported. There have been no previous reports of similar cases. Two of the patients were treated with adenine arabinoside and had rapid recovery.
Relationships Between Neurodevelopmental and Educational Findings in Children Aged 6 to 12 Years
Authors: Berninger Virginia Wise , Colwell Sarah O.
Published: December 2021

Relationships between neurodevelopmental and educational findings were investigated in a clinic sample of 241 successive patients (aged 6 to 12 years) over a period of 6 months. Ratings of "definite," "possible," and "no problem" were compared between seven neurodevelopmental areas or three language functions and seven academic skills. Of the 40 associations tested in each of seven age groups, only one association (Boston Naming Test and reading comprehension) was statistically significant in a majority of the ages tested. Of the 280 comparisons (40 associations x seven age groups), only 37 (13%) were significant at P ≤ .05. The findings of this study do not support the use of the neurodevelopmental and educational measures employed in diagnosis of specific learning disabilities in a referred population. Health care professionals, however, may find neurodevelopmental assessment useful as a format for systematic observations of the child with performance disabilities.
An Autosomal Recessive Bone Dysplasia Syndrome Resembling Hypochondroplasia
Authors: DESCH LARRY W. , HORTON WILLIAM A.
Published: December 2021

Hypochondroplasia is an autosomal dominant skeletal dysplasia characterized by mild-to-moderate shortening of the limbs, a stocky build, lordosis, and occasionally mental deficiency.1-4 Hall and Spranger5 have recently defined distinct radiographic criteria for the diagnosis of this condition. We wish to describe two siblings of normal parents whose features are quite similar to those of individuals with hypochondroplasia. The characteristics that these siblings exhibited are distinguishable from hypochondroplasia by subtle radiographic differences as well as the differing inheritance pattern.

The mother and father of these two girls are, respectively, 167.6 cm and 180.3 cm tall. The third and fourth children in this family, a girl and a boy, have normal stature.
Hot Tub Drownings
Authors: TRON V. A. , BALDWIN V. J. , PIRIE G. E.
Published: December 2021

Drownings are a major source of morbidity and mortality for children in Canada, accounting for 9% of accidental deaths in children less than 5 years of age.1 Several aspects of drowning in a hot tub are worth emphasizing. This paper describes the treatment of two children following resuscitation after submersion in a hot tub. The clinical and pathologic implications are also reviewed.

CASE REPORTS

Case 1

An 11-month-old male infant was found submerged in a hot tub (water temperature 38°C). The duration of submersion was approximately ten minutes. The infant was rushed to a local hospital where he was found to be asystolic.
Neonatal Intensive Care: Cost-Benefit Analysis
Authors: MANGRAVITE DONALD N.
Published: December 2021

To the Editor.—

I would like to commend Walker and colleagues1 for their comprehensive examination of the costs and benefits of neonatal intensive care for infants weighing less than 1,000 grams. However, examining only one group of infants served by a tertiary neonatal intensive care unit (NICU) can be misleading.

By definition, a tertiary level NICU is designed to provide a broad range of services to infants with a wide variety of illnesses. As is true for any system expected to provide a broad range of services, some services will result in a more favorable cost-benefit ratio than others.
Rehydration Therapy
Authors: BARNESS LEWIS A.
Published: December 2021

To the Editor.—

A significant change, as evidenced by recent advertisements, has been made in the composition of Pedialyte oral rehydration solutions. Pedialyte, flavored or unflavored, now contains 45 mEq of sodium per liter (an increase of 15 mEq) and 2.5% glucose (a decrease of 2.5%), and it is suitable for maintenance as well as mild dehydration. The sodium content of Pedialyte RS has been increased to 75 mEq/L, suitable for initial repair of losses of moderate or severe diarrhea, but it should be used with caution in any maintenance regimen in young infants.
Idiopathic Hypothalamic Dysfunction and Impaired Control of Breathing
Authors: DURIVAGE S. KENT , WINTER ROBERT J. , BROUILLETTE ROBERT T. , HUNT CARL E. , NOAH ZEHAVA
Published: December 2021

Hayek and Peake1 described a syndrome of hypothalamic dysfunction consisting of obesity, hypodipsia, recurrent hypernatremia, hyperprolactinemia, and hypothyroidism without evidence of a structural hypothalamic lesion. We report two additional children with this syndrome of hypothalamic dysfunction, both of whom also had central hypoventilation syndrome. 2 The concurrence of hypothalamic dysfunction and central hypoventilation syndrome suggests that common pathophysiologic mechanisms may be involved. The future study of additional patients may help in determining the fundamental cause of the endocrine and respiratory dysfunction.

CASE REPORT

Case 1

A 4-year-old white girl referred for obesity, had a height age of 4.5 years and a weight age of 11 years.
Effects of Changes in Oxygen Tension on Vascular and Platelet Hydroxyacid Metabolites II. Hypoxia Increases 15-Hydroxyeicosatetraenoic Acid, a Proangiogenic Metabolite
Authors: Setty B. N. Yamaja , Ganley Carolyn , Stuart Marie J.
Published: December 2021

Current strict O2 management may be precipitating more severe retinopathy of prematurity than would occur with a more lenient approach. Hypoxemia in an animal model has also been found to worsen retinal neovascularization. It has recently been shown that the hydroxyeicosatetraenoic acids can modulate angiogenesis. 15-Hydroxyeicosatetraenoic acid is proangiogenic, whereas 12-hydroxyeicosatetraenoic acid is an antiangiogenic metabolite. In vitro exposure of paired human neonatal vessels (n = 7) to hypoxia enhanced the production of total vascular hydroxyacids (232 ± 36 pmol/mg of protein [experimental group] v 168 ± 31 pmol [control group]; P < .01). The increase in vascular 15-hydroxyeicosatetraenoic acid under hypoxic conditions was even more significant (P < .001). However, platelet production of 12-hydroxyeicosatetraenoic acid was not significantly affected by hypoxia. These observations suggest a possible biochemical basis for the abnormal angiogenic process that occurs during the proliferation phase of the retinopathy of prematurity. The production of local hydroxyeicosatetraenoic acids in tissues manifesting abnormal neovascularization needs to be further evaluated.
Cognitive Deficits in Adolescents Who Developed Diabetes Early in Life
Authors: Ryan Christopher , Vega Arthur , Drash Allan
Published: December 2021

A comprehensive battery of neuropsychological tests was administered to 125 adolescents with a history of insulin-dependent diabetes, and to 83 demographically similar nondiabetic control subjects. To test the hypothesis that developing this disease early in life greatly increases the risk of manifesting significant cognitive impairments, diabetic subjects were assigned to an "early-onset" (diagnosis before age 5 years) or a "lateronset" subgroup. Results showed that subjects with early onset of diabetes performed more poorly than either subjects with later onset of diabetes or nondiabetic control subjects on virtually all tests, including measures of intelligence, school achievement, visuospatial ability, memory, motor speed, and eye-hand coordination. Moreover, multiple regression analyses demonstrated that the age at onset and the duration of diabetes seem to affect neuropsychological functioning in very different ways. The duration of the disease best predicted performance on those tests requiring highly overlearned, primarily verbal, skills whereas the age at onset best predicted scores on tests requiring the ability to process relatively unfamiliar, typically nonverbal, information in novel ways. Although the etiology of these deficits remains unclear, there is a possibility that they are secondary to mild brain damage that develops as a consequence of multiple episodes of serious hypoglycemia early in life.
Clinical, Laboratory, and Environmental Features of Infant Botulism in Southeastern Pennsylvania
Authors: Long Sarah S. , Gajewski James L. , Brown Lawrence W. , Gilligan Peter H.
Published: December 2021

Forty-four cases of botulism occurred in infants in Southeastern Pennsylvania between 1976 and 1983. Forty-three were caused by Clostridium botulinum type B. Progressive weakness necessitated ventilatory support in 39 infants. Complications during hospitalization included otitis media in 13 patients and aspiration pneumonia in 11. Eight infants developed the syndrome of inappropriate secretion of antidiuretic hormone and two developed adult respiratory distress syndrome. One infant died of progressive bradycardia despite adequate control of ventilation. Manifestations of autonomic nervous system dysfunction recognized on admission to the hospital were constipation, distention of the urinary bladder, and decreased salivation and tearing. During hospitalization, some infants had unexpected fluctuations of skin color, blood pressure, and heart rate. Infants' strength improved despite persistent intestinal elaboration of toxin. C botulinum was isolated from seven of nine home or work environments sampled. All 44 infants were white and were receiving breast milk at the time of onset of symptoms. The majority had first feedings of nonhuman food substances within 4 weeks prior to onset of symptoms. Delineation of fecal flora in seven infants revealed predominance of enterobacteriaceae. Perturbations of intestinal flora during infancy, especially at weaning, may cause transient permissiveness to colonization by C botulinum.
Adolescent Pregnancy and Childbearing: New Data, New Challenges
Authors: MCANARNEY ELIZABETH R.
Published: December 2021

According to a study published by Zelnik and Kantner in 1980,1 approximately 70% of unmarried young women reported having had coitus by 19 years of age. In a recent study by Clark and colleagues,2 approximately 87% of black male adolescents attending an inner-city school in Baltimore reported having had coitus. An estimated 1 million adolescent pregnancies result from this coital activity; approximately two thirds eventuate in births and one third in abortion.3 Most pregnant adolescents are unmarried; of those who give birth, most keep their children.

Even though the demographic data have not changed over time, our understanding of the risks of adolescent childbearing has improved.
Transcutaneous Oxygen Monitoring: Economic impact on Neonatal Care
Authors: Peevy Keith J. , Hall Michael W.
Published: December 2021

Five years (1978 to 1982) of respiratory care data were reviewed to determine the changes in patient charges, hospital costs, and frequency of neonatal blood gas analysis created by the introduction of transcutaneous oxygen monitoring. During the 4 years of transcutaneous oxygen monitoring (1979 to 1982), an estimated $196,000 reduction in patient charges was accomplished. When reduced patient charges were balanced with the increased cost to the hospital for equipment, supplies, and personnel time, a net reduction of more than $100,000 for health care delivery was achieved. Transcutaneous oxygen monitoring is an example of technologic achievement in which society receives both economic and medical benefits.
Efficacy and Safety of Captopril in the Treatment of Severe Childhood Hypertension: Report of the International Collaborative Study Group
Authors: Mirkin Bernard L. , Newman Thomas J.
Published: December 2021

The safety and efficacy of captopril therapy in children with severe and refractory hypertension has been evaluated in a collaborative international study which enrolled a group of 73 patients, 15 years of age or younger. Most patients had hypertension associated with renal disease or vascular abnormalities. Captopril was administered for periods of less than 3 months to more than 1 year. A significant decrease in both systolic and diastolic blood pressures was produced by the administration of captopril, usually in conjunction with other antihypertensive agents (most commonly diuretics and/ or β-blockers). Systolic blood pressures were normalized in 62% and 53% and diastolic blood pressures in 56% and 45% of reported patients after the second and sixth months of captopril therapy, respectively. The response to captopril was sustained over a 12-month period. Adverse reactions were reported in 49% of the 73 patients; 48% of patients had experienced adverse reactions to other antihypertensive agents prior to entering the study. The reactions most frequently observed during captopril therapy were hypotension, vomiting, postural symptoms, anemia, rash, and anorexia. Leukopenia was reported in six patients, all of whom had renal impairment. Two of these patients had received concomitant therapy with immunosuppressants, and one had systemic lupus erythematosus. Captopril was discontinued in two of these six children. Statistically significant increases in mean serum urea nitrogen and potassium concentrations and decreases in mean serum CO2 levels were observed during the course of therapy. These effects could not be exclusively attributed to captopril administration as the study population received multidrug therapy and had significant intrinsic disease. Captopril was demonstrated to be an effective and safe drug for the treatment of children with severe hypertension.
Violence on Television and Imitative Behavior: Impact on Parenting Practices
Authors: Wharton Robert , Mandell Frederick
Published: December 2021

In the past 30 years, four federal government commissions have reported on the relationship between television violence and aggressive behavior. The latest report concluded categorically that there is a causal relationship between television violence and aggressive behavior. Two infants were seen at an emergency room as a direct consequence of their socially isolated single mothers seeing a particular made-for-television movie. In one case, the infant died as a possible result of a parent imitating an act of child abuse; in the other case, early medical intervention precluded possible tragedy. These cases illustrate another way in which children may be victimized by violence on television; namely, by parents imitating inappropriate parental behavior. The origins of imitative behavior are discussed with specific reference to the impact on vulnerable parents. The concept of media-influenced parenting behavior is presented and implications for physicians are discussed.
Too Long for Too Little
Authors: OSKI FRANK A.
Published: December 2021

In 1974, the National Institute of Child Health and Human Development initiated a six-institution collaborative study to evaluate phototherapy as a therapeutic modality for the management of neonatal hyperbilirubinemia. The first phase of the study was completed in 1976; the results of this work were published in 1985. Too long to wait.

The study was undertaken primarily, we are told, to answer two important questions: (1) "Is phototherapy effective in preventing brain injury from hyperbilirubinemia, when employed to lower serum bilirubin levels?" and (2) "Is phototherapy as effective as exchange transfusion at predetermined serum bilirubin levels for preventing brain damage from neonatal hyperbilirubinemia?" The answers to these questions are not provided in the published report.