bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Severe Apnea in Prematures With Orally Administered Theophylline
Authors: Uauy Ricardo , Shapiro Donald L. , Smith Barbara , Warshaw Joseph B.
Published: December 2021

Twelve premature infants with primary apnea were treated with theophylline as an alternative to mechanical ventilation. There was a significant (P< .005) reduction in the mean daily number and the severity of apneic episodes after treatment. The only significant side effect noted was a rise in heart rate.
The Pediatric Pneumogram: A New Method for Detecting and Quantitating Apnea in Infants
Authors: Stein Israel M. , Shannon Daniel C.
Published: December 2021

A clinically useful diagnostic method has been developed for detecting and quantitating periods of apnea in pediatric patients. This procedure, called the pediatric pneumogram, permits the continuous recording on magnetic tape, for periods of up to 13 hours, of the respiratory pattern of infants utilizing an impedance technique. This test has been employed successfully in a variety of infants to evaluate respiratory activity and has permitted the objective documentation of apneic and cyanotic episodes, as well as an assessment of the effectiveness of therapy.
Laryngeal Chemosensitivity: A Possible Mechanism for Sudden Infant Death
Authors: Downing S. Evans , Lee John C.
Published: December 2021

In 32 anaesthetized piglets 1 to 42 days of age the distal trachea was cannulated and pressure changes were recorded. The proximal trachea was cannulated for introduction of test fluids into the laryngeal area. Arterial pressure, heart rate, and central venous pressure were continuously recorded. Arterial blood samples were obtained at intervals and analyzed for Po2, PCO2, pH, and hematocrit. Normal saline produced no, or brief, transitory alterations of the respiratory pattern and arterial pressure. In contrast, instillation of distilled water produced apnea in 29 of 30 piglets. In 20 the apnea was sustained. Eleven died within approximately 50 minutes of asphyxia. An additional nine were expected to die with continuing apnea (P02. 10 to 15 mm Hg; Pco2 ≥ 100 mm Hg; pH ≤ 6.8) but the sequence was interrupted by replacement of water with saline. Twentythree of 29 piglets showed an apneic response to cow's milk similar to that seen with distilled water. Seven died of asphyxia and an additional three showed sustained respiratory inhibition until milk was replaced with saline. The responses were completely abolished by superior laryngeal nerve (SLN) sectioning. Electrical stimulation of the SLN produced sustained apnea in seven of eight piglets tested. Studies in two 3-day-old lambs showed similar discrimination but only transitory apnea with water or cow's milk, Both died during SLN stimulation. Two ewes showed insignificant responses. These findings suggest a lethal reflex mechanism with implications for the SIDS problem.
Observations on Effects of a Central Stimulant Drug (Methylphenidate) in Children With Hyperactive Behavior
Authors: Schain Richard J. , Reynard Carol L.
Published: December 2021

Ninety-eight hyperactive children, ages 6 to 12 years, have been treated with methylphenidate or placebo under double-blind conditions. Only one of the 48 children receiving placebo (2%) was judged to be a drug success. Seventy-nine percent of the 94 children receiving methylphenidate were judged to be drug successes at the end of the 16-week trial period. A wide range of dosage (0.2 to 1.9 mg/kg) was required for optimum drug effects. Drug failures were due either to appearance of withdrawn, apathetic behavior in the child (6 cases) or lack of evidence of drug effectiveness (14 cases). Overweight children did not respond well to medication even though milligram per kilogram dosage was equivalent to that in children who were categorized as drug successes. The most dramatic successes were seen in children who might be characterized as exhibiting "developmental hyperactivity," i.e., hyperactivity in the absence of other evidence of neurological or emotional disturbances. We conclude that a trial of stimulant drugs is clearly indicated in hyperactive children manifesting significant impairment of educational and social progress. Dosage adjustment and judgment of drug success or failure require regular reports from teachers and parents.
Broken Appointments: Questions, Not Answers
Authors: Barkin Roger M. , Duncan Burris
Published: December 2021

Our experience suggests that the implications of Nazarian et al.'s study that mailed appointment reminders significantly increase return rates to clinic need to be reevaluated. Although the approach has been found useful in some settings, we attempted a similar form of intervention in the setting of a pediatric neurology clinic at the University of Colorado Medical Center and found no statistically significant impact.

All patients seen during a two-month period with a scheduled return appointment were included in the study and alternatively assigned to the study or control group.
Lettrt To The Editor
Authors: Lauer Brian , Broeck Elsa Ten , Grossman Moses
Published: December 2021

In our report of battered children admitted to San Francisco General Hospital we used as controls children hospitalized for other causes. This methodology was adopted so that the abused and control children would both be drawn from the same racially mixed, indigent part of the population that traditionally utilizes our hospital and therefore would be likely to have in common important socioeconomic features, thereby minimizing bias. However, as Dr. Stover correctly points out, all potential bias was not eliminated.
Retrolental Fibroplasia Revisited
Authors: Scratcher
Published: December 2021

In October 1974 your readers were reminded, quite accurately, of a seldom recalled detail in the protocol of the cooperative study on retrolental fibroplasia and the use of oxygen. Oxygen use in the first two days of life was not restricted by study protocol. Infants who weighed 1,500 gm or less at birth and who survived 48 hours were admitted to the study and assigned to "routine oxygen" (oxygen in concentrations of over 50% for 28 days) or to "curtailed oxygen" (added oxygen from age 48 hours onward only if in the pediatrician's opinion the clinical condition of the infant demanded it, the concentration of oxygen not to exceed 50%.
Incidence of Exercise-Induced Asthma in Children
Authors: Bierman C. Warren , Kawabori Isamu , Pierson William E.
Published: December 2021

The incidence of exercise-induced asthma (EIA) was studied in 134 asthmatic, 102 nonasthmatic atopic, and 56 nonatopic children. Pulmonary function tests measuring forced vital capacity (FVC) and one-second forced expiratory volume (FEV1) were performed on each child prior to and serially for 20 minutes following free running exercise. The incidence of EIA among the asthmatic and atopic nonasthmatic children was 63% and 41% respectively, and 7% among control subjects.

Airway function was studied prior to and after a standardized free running exercise test. Forty-one percent of the nonasthmatic and 63% of the asthmatic atopic children had a significant decrease in airway function as compared to 5% of the nonallergic subjects.
Elevated Blood Lead in a 6-Month-Old Breast-Fed Infant: The Role of Newsprint Logs
Authors: Perkins Kathaleen C. , Oski Frank A.
Published: December 2021

Lead is an ubiquitous substance in our environment. Although the ingestion of materials containing lead-based paints remains the primary cause of markedly increased body lead burdens in children, the role of environmental pollutants is gradually becoming appreciated.

Atmospheric lead is a particular hazard; 30% to 50% of lead inhaled by the lungs may be retained by the body.1 The percentage of lead absorbed through the intestine in children is unknown, although recent studies suggest that it may be as high as 50%.2

We wish to describe an apparently unusual example of elevated blood lead in a 6-month-old infant who had been exclusively breast-fed.
Camphor Poisoning: Over-the-Counter Dangers
Authors: Phelan William J.
Published: December 2021

Intoxication from camphor has been reported frequently in the literature for decades, most cases involving the accidental ingestion of camphorated oil, mistaken for castor oil or other similar products. Over 20 years ago, Smith and Margolis1 collected 130 nonfatal and 18 fatal cases from literature dating back to 1833. Recent data from the National Clearinghouse for Poison Control Centers reveal an increasing proportion of ingestions of other over-the-counter camphor-containing preparations.2-3

Two cases with documented serum camphor levels have prompted this report and discussion of camphor's role in the self-medication over-the-counter armamentarium.

CASE REPORTS

Case 1

A 3-year-old girl was transferred to the University of Michigan Medical Center from a local emergency room.
Cholecystitis and Cholelithiasis Masking as Abdominal Crises in Sickle Cell Disease
Authors: Ariyan Stephan , Shessel Frederick S. , Pickett Lawrence K.
Published: December 2021

A case of sickle cell (HbSS) disease is presented in a patient with a history of recurrent admissions for abdominal pain, jaundice, and abnormal liver function tests. Although he was believed to have a sickle cell abdominal crisis, his abdominal X-ray films revealed three calcified stones. Each of these stones progressively passed through the common duct and into the duodenum while awaiting surgery. He has been followed for two years since his cholecystectomy without further hospitalizations.

This case led to the investigation of cholelithiasis in sickle cell disease to dispel the following misconceptions. Some physicians and pediatricians believe that (1) cholelithiasis and cholecystitis are uncommon in sickle cell disease; (2) the complications of gallstones are not significant; (3) the operative risk in patients with sickle cell disease is high; (4) these patients with HbSS disease do not live long enough to get into trouble with gallstones.

A review of the literature on cholelithiasis and HbSS disease presents adequate evidence to cause us to urge investigation of the gallbladder in all patients with HbSS disease and abdominal crises, and cholecystectomy as an elective procedure should stones be present.
Two Programs for Predicting Adult Stature for Individuals
Authors: Wainer Howard , Thissen David
Published: December 2021

Two computer programs are described which use the new RWT method to predict adult stature for individuals. This method, developed and described by Roche et al. is the best and most accurate one available to date. The two programs are prepared with different aims in different languages. Program 1 is interactive, written in BASIC and is aimed for the clinician who needs predictions for just a few individuals at a time. Program 2 is written in FORTRAN and is meant for large-scale batch processing. It is thought that this mode is better for the researcher who is more interested in large-scale testing of hypotheses about such things as the efficacy of intervention programs in human growth.
Aminophylline, a Weak Bilirubin Displacer
Authors: Brodersen Rolf , Andersen Signe
Published: December 2021

We have examined the bilirubin-displacing effect of aminophylline, using the peroxidase method.1 It was found that the free bilirubin concentration is increased by 1% for each 2 mg of aminophylline per liter of blood plasma. The results are practically independent of varying concentrations of albumin and fatty acid, within the usual limits. Control experiments indicated that aminophylline does not interfere with the reagents of the test and does not form a bilirubin complex in significant amounts.
Why Accept Stories About China?
Authors: Fisch Robert O.
Published: December 2021

I am always amazed by the fascination of the American public with the "stories" from behind the Bamboo Curtain.

The data of Dr. Wray in his article1 are biased, i.e., "I was told," etc. Any other article based upon similarly described data, especially from the United States, would not even be considered for publication by an editor, especially not by the editors of the official journal of the American Academy of Pediatrics.

Dr. Wray's last sentence, "... Chairman Mao's command: ‘Serve the People!’" sounds more like a Marxist manifesto than the conclusion of a scientific report.
Questions Intrauterine Poisoning
Authors: Furuta Mutsuhiro
Published: December 2021

I would like to make a few observations concerning the article by Amin-Zaki et al.1 First, I challenge the wisdom of using "intrauterine" in the title. The article does not give conclusive evidence that the poisoning was actually intrauterine. It gives no data on blood examinations of the infants at birth, which is of utmost importance. Without these data, can one say it is "congenital" methylmercury poisoning?

Furthermore, there is no discussion of the method of transmission of the methylmercury from mother to fetus or unchallengable proof that this is true.
Now Let's Review Decongestants
Authors: Stallings James H.
Published: December 2021

I read with great interest the article "A Review of Antihistamines and the Common Cold,"1 which can remain a classic for years to come.

I anticipate with equal interest the sequel, entitled "Decongestants and the Common Cold."

I believe the health of children will be considerably improved if an objective evaluation of the noneffectiveness of the so-called decongestants was available to all pediatricians.
Letters to the Editor
Authors: Fulginiti Vincent A.
Published: December 2021

Dr Macknin's point is well taken. Infection with Haemophilus influenzae has extended up and down the age spectrum, from the newborn period into adult life. Even though the other pyogenic organisms are predominant pathogens beyond early childhood, H influenzae must be considered and antimicrobial therapy adjusted for its potential presence. I'm appreciative of his constructive suggestion modifying my statement in the commentary.
Exchange Transfusion for Severe Neonatal Septicemia
Authors: Bossi Emilio , Meister Beat , Pfenninger Juerg
Published: December 2021

Exchange transfusion (ET) for neonatal septicemia is commonly used in many centers. To our knowledge, however, no controlled study on its efficacy has yet been published. Authors usually report satisfying clinical impressions or compare the mortality of newborns with septicemia treated with ET to the results generally reported or experienced in their unit prior to the introduction of this form of treatment.

During a four-year period, we have performed a prospective study on our patients.
Growth Acceleration Following Renal Transplantation in Children Less Than 7 Years of Age
Authors: Ingelfinger Julie R. , Grupe Warren E. , Harmon William E. , Fernbach Sandra K. , Levey Raphael H.
Published: December 2021

Of 110 consecutive renal allografts performed at Children's Hospital Medical Center 12 were in 11 patients aged 3 to 7 years. Patient and graft survival and linear growth were evaluated in these 11 children. All 11 are surviving, seven (64%) with functioning allografts 12 to 92 months after transplant. Six of these seven have normal renal function (on alternate day prednisone dose <0.7 mg/kg every two days plus daily azathioprine) and all seven have shown catch-up growth, reaching and maintaining normal height for age. An eighth patient, now returned to dialysis, grew from below the third percentile at age 3 years to the 25th percentile at age 8 years, after which renal function deteriorated. Three patients rapidly rejected allografts and have had decreased growth velocity for age. In contrast, although many of the remaining 76 patients who received 98 transplants after age 7 years are growing, none showed accelerated linear growth sufficient to catch up if below the third percentile for age or to cross centile lines if above. Neither the degree of pretransplant bone age retardation nor steroid dose per kilogram accounted for lack of growth acceleration of those more than 7 years of age. Despite small sample size, the growth of renal transplant recipients less than 7 years of age suggests that they are good, and in some ways, favored transplant candidates.
Russian Roulette in the Nursery—Again
Authors: Silverman William A.
Published: December 2021

In 1980, a review appeared in the ophthalmology literature1 that summarized attempts at active treatment of the neovascular changes in retinopathy of prematurity (ROP) (referred to in the past as "proliferative retrolental fibroplasia [RLF]") and of retinal detachment which may occur in the disorder. The author of the survey observed (among a number of treatments tried) that the effectiveness of transscleral cryotherapy for treatment of proliferative changes was difficult to evaluate and he pointed out that "no prospective clinical trial has demonstrated the value [of this approach]." In respect to scleral buckling, as treatment for detachments in ROP, he remarked that although the approach seemed to be rational, the "ultimate fate of [treated] eyes remains uncertain."
Lack of Predictive Indices in Kernicterus—Or Lack of Power?
Authors: Guess Harry
Published: December 2021

Kim et al1 recently reported a case-control study of kernicterus in which they concluded that "analysis of previously suggested risk factors has failed to identify any single factor or combination of factors that could be predictive of the development of kernicterus." Emphasis in their paper was on the lack of statistical significance for most of the factors studied.

The value of this study can be increased by providing a measure of the extent to which the lack of statistical significance stems from the (understandably) small sampie size and concomitant lack of statistical power rather than from a true lack of association of the factors with kernicterus.
Asthma and Reflux
Authors: Stein Mark R.
Published: December 2021

I congratulate Berquist and colleagues1 on their important contribution, demonstrating the effectiveness and safety of fundoplication in pediatric patients with recurrent pneumonias or chronic asthma and documented gastroesophageal reflux (GER). I would like to address three aspects of this paper.

1. The authors clearly noted that theophylline therapy was stopped 24 hours before esophageal function tests were performed. This was done to avoid false-positive studies from the effect of this drug on lower esophageal sphincter pressure (LESP).
Letters to the Editor
Authors: Berquist William E. , Rachelefsky Gary S.
Published: December 2021

In our retrospective study1 of several asthmatic children, attempts were made to use the minimum amount of medication to control bronchospasm and thus enable the evaluation to proceed. It was medically impossible to discontinue all acute asthmatic medication.

In the majority of cases, a short course of steroids or β-adrenergics were used. We admit that the effect of anticholinergics and β-adrenergics on the lower esophageal sphincter has not been evaluated thoroughly in asthmatics, and as with theophyffine they may well produce some relaxation of the lower esophageal sphincter.
President's Address
Authors: SHAW EDWARD B.
Published: December 2021

THIS 19th annual meeting of the Academy marks the end of an eventful year. I reach the end of my stewardship with the hope that many important decisions of the past year will prove to be for the best interest of the Academy.

It is the privilege of this moment to philosophize and to express one's own opinions. Many of my predecessors have spoken of organizational aspects of the Academy. I should prefer first to speak a few words about the many individuals who comprise its membership. I like to think of the Academy as an association of those with kindred interests and with many bonds of keen personal friendship. I am happy that my lot has been cast with pediatricians and I am sure I share with all of you great enjoyment of the fellowship which has proceeded from our confraternity of interest.

The Academy exists only to express our mutual interest in childhood and to translate this interest into everything which can benefit the condition of childhood. We were early reminded by Dr. John Lovett Morse that we must strive to function not for ourselves alone and our history will well attest that the welfare of children and not the aggrandizement of our members has been the principle objective of this organization.

One who enters any profession does so with the expectation of contributing more to society than he will receive in return in terms of visible reward. The pediatrician may not wish to sentimentalize his concept of his profession but must recognize that the financial returns from his efforts cannot be compared with those provided by many occupations with an eight hour day and a five day week.
TISSUE CHANGES IN THE NEPHROTIC SYNDROME: DEMONSTRATION OF POTASSIUM DEPLETION
Authors: FOX CHARLES L. , SLOBODY LAWRENCE B.
Published: December 2021

Analyses of skeletal muscles, obtained at autopsy from six children with the nephrotic syndrome, reveal losses of from one fourth to two thirds of their potassium content per unit dry weight or cell solids. Their phosphorus content is only moderately reduced. These muscles have gained large amounts of water, sodium and chloride in ratios approximating extracellular fluid.

The muscle values are compared with other types of potassium loss from muscle, e.g., after experimental potassium deprivation, desoxycorticosterone therapy, alkalosis and muscle trauma.

Since potassium is the intracellular cation, its depletion may be associated with important effects on intracellular anions, enzymes or catalysts and, together with cellular hydration and hypotonicity, contribute to the physiologic alterations found in this syndrome.

Analyses of kidneys from these patients reveal somewhat similar changes; liver, in contrast, showed minimal alteration.
PULMONOCARDIAC FAILURE
Authors: O'CONNELL W. F. , LEE Y. C.
Published: December 2021

Pulmonocardiac failure is a clinical entity caused by severe spinal and thoracic deformity, usually ending fatally in early adult life.

Right ventricular hypertrophy and dilatation without any significant pulmonary vascular or interstitial fibrotic changes are prominent findings at autopsy.

The etiology, incidence, clinical manifestations and possible mechanism are discussed.

A typical case occurring in childhood with certain unusual features is presented.
T WAVE CONTOUR IN THE PRECORDIAL LEADS DURING CHILDHOOD
Authors: REYNOLDS R. W.
Published: December 2021

The T wave in the precordial V leads was studied in 187 normal children and young adults in the age range of 2 weeks to 20 years and in 164 individuals of like age with cardiovascular disease or with disease or medication capable of affecting the cardiovascular system.

On the basis of this analysis correlated with a survey of the literature, it is concluded that:

a. An upright T wave in lead V2 or leads further to the right should be considered abnormal in children between 2 weeks and 9 years of age until proved otherwise.

b. The normal sequence in the direction of the T wave from V4R to V6 is from a negative to a positive wave with transitional forms which may be notched or diphasic. The reversal of this pattern is to be considered abnormal.

c. The presence of unexpected T wave contours in specific leads at the different ages should be considered as evidence demanding re-examination of the ECG and of the child for abnormalities.
NEPHROTIC SYNDROME
Authors: RILEY CONRAD M.
Published: December 2021

The effects of short term ACTH treatment (4 to 6 days) in 14 patients with the nephrotic syndrome are presented. Five patients given eight courses showed complete clearing of edema in seven instances, one failing to show any response to a second course. Four patients given six courses showed significant but incomplete clearing of edema each time. Five patients showed no clinically significant response to seven courses.[See Table 5 in Source Pdf]

The type of diuresis with regard to salt and water excretion was similar to that seen with spontaneous diuresis. In all but one instance the patients who failed to have a clinically significant response did, nevertheless, show a slight sodium diuresis after with drawal of the drug. There were no consistent changes in the significant chemical findings in the blood, except that in most cases, regardless of clinical results, a drop in the level of total cholesterol was observed after treatment. Several patients who received sodium lactate by mouth following diuresis did not accumulate edema and had a pronounced increase in the urinary sodium. This suggests that at least temporarily their kidneys were capable of dealing with sodium in normal fashion.

The period of post-treatment studies on these patients varies from 7 to 15 months. Some of the patients have remained symptom-free, others have relapsed several times but responded to subsequent periods of treatment, still others after early successes have failed to respond to later ACTH administration. Only one of the group has shown clearing of the urine suggesting a permanent remission. Thus the use of this hormone at best offers only a means of controlling edema of the nephrotic syndrome. Whether its repeated use may alter the over-all prognosis can only be determined after a much longer period of observation. It should, however, prove useful in the study of the mechanism of diuresis.
STUDIES IN STEATORRHEA
Authors: CHUNG ARTHUR W. , MORALES SOLEDAD , SNYDERMAN SELMA E. , LEWIS J. M. , HOLT L. EMMETT
Published: December 2021

Metabolic observations were carried out in three patients with "idiopathic" celiac disease and three patients with cystic fibrosis of the pancreas at different levels of fat intake.

It was found that fat absorption remained proportional to fat intake even at high levels. Increasing the intake thus led to improved absorption.

Deleterious clinical or metabolic effects were not encountered with one possible minor exception.

The implications of these observations are discussed.
HYPERTENSION IN POLIOMYELITIS WITH RESPIRATORY PARALYSIS
Authors: SENNETT L. W. , PERLSTEIN M. A. , ANDELMAN M. B. , BARNETT H. E. , JOSEPHY H.
Published: December 2021

A case of sustained hypertension complicating acute protracted poliomyelitis with respiratory involvement is presented. Data of studies of the autonomic nervous system and the kidneys are given. Complete necropsy findings, including detailed examination of the central nervous system, are presented. The role played by the nervous system and kidney is discussed, and it is suggested that in this case the hypertension probably was due to neurogenic factors.
Fatal Hepatitis B in Early Infancy: The Importance of Identifying HBsAg-Positive Pregnant Women and Providing Immunoprophylaxis to Their Newborns
Authors: Delaplane Dietra , Yogev Ram , Crussi Frank , Shulman Stanford T.
Published: December 2021

Infants born to women who are asymptomatic hepatitis B surface antigen (HBsAg) carriers frequently acquire hepatitis B virus infection in infancy. The spectrum of disease in such affected infants includes mild transient acute hepatitis B, chronic active hepatitis with or without cirrhosis, chronic persistent hepatitis, chronic asymptomatic HBsAg carriage, and, rarely, fulminant fatal hepatitis B. Recently, the administration of hepatitis B immunoglobulin has been demonstrated to reduce the risk of infantile acquisition of hepatitis B virus; hepatitis B vaccine may also be preventive in this setting. Three young infants, aged 8 to 16 weeks, who died of acute fulminant hepatitis were studied. In each instance, the mother was found, retrospectively, to be asymptomatic but HBsAg positive. One of these mothers was hepatitis B e-antigen-negative but hepatitis B e-antibody positive. All three babies were HBsAg positive; two who were tested for hepatitis B core antibody were positive. These three fatalities serve to dramatize both the importance of HBs Ag screening of pregnant women, particularly those with demographic factors that place them at increased risk for HBsAg carriage, as well as the significance of effective immunoprophylaxis for hepatitis B in all offspring of women with HBsAg seropositivity.
Homicide as a Cause of Pediatric Mortality in the United States
Authors: Jason Janine , Gilliland Jeanne C. , Tyler Carl W.
Published: December 2021

Homicide is a major cause of pediatric mortality. National law enforcement data were analyzed to characterize and differentiate neonaticide, infanticide, filicide, and overall child homicide. Results include the following: Neonaticides often involved parents or unidentified perpetrators and occurred proportionately more in rural areas than did other types of child homicide. Infanticide appeared to be one end of the spectrum of child homicide and not a distinct entity. Filicide rates were higher for sons than daughters and the crime was committed by more fathers than mothers. Overall child homicide predominately involved young male offenders who were acquaintances of the victim. At remarkably early ages, homicide characteristics began to resemble those of adult homicide. Further research in this area should attempt to gain detailed information concerning the child, his family, and their social network. Pediatricians should be actively involved in determining risk factors for child homicide and in screening children for risk when these factors are determined.
Direct Computer Recording of Premature Infants and Nursery Care: Distress Following Two Interventions
Authors: Gorski Peter A. , Hole William T. , Leonard Carol H. , Martin John A.
Published: December 2021

Prematurely born neonates are born with an immature central nervous system. Temporal associates between care-giver interventions and infant biobehavioral responses can be recorded. A new methodology for continuous naturalistic computer-assisted recording of infants in nursery care is described. To illustrate a clinical implication of this recording, an infant's responses to two seemingly contrasted care-giver interventions were analyzed: chest physical therapy and close social interaction. There was significantly increased subtle as well as gross behavioral and physiologic distress following both chest physical therapy and close social interaction when compared with base line distress incidence. Perhaps timing of interventions is as consequential as their content toward safeguarding a preterm infant's developing autonomic regulation, motor patterns, and sleep/wake state.
Polymicrobial Bacteremia Due to Polle Syndrome: The Child Abuse Variant of Munchausen by Proxy
Authors: Liston Thomas E. , Levine Peter L. , Anderson Charles
Published: December 2021

Infectious disease due to multiple organisms results from underlying disease or invasive procedures and is uncommon in the pediatric age group. We report a case of polymicrobial bacteremia in an infant in whom no underlying disease was substantiated despite extensive evaluation. The presence of Polle syndrome—an adult-induced illness—was subsequently proved. This diagnosis should be considered early in the evaluation of children for whom repeated blood culturing indicates polymicrobial bacteremia.
The Role of the Pediatrician in Substance Abuse Counseling
Authors:   Committee on Adolescence
Published: December 2021

The past two decades have been marked by both an increasing recognition of the pediatrician's responsibilities toward the adolescent and the emergence of substance abuse as a critical concern for those who care for children and youth. The use and abuse of psychoactive substances have become common even among young adolescents, and the pediatrician must be prepared to address this issue as part of routine health care. In addition, the counsel of the pediatrician regarding substance abuse is often sought by families, schools, and community agencies. Familiarity with the extent and nature of adolescent drug use, as well as the health consequences of such use, has become a necessary part of the body of pediatric knowledge. The pediatrician must possess the skills necessary to determine which young patients are at risk from substance abuse and be able to offer appropriate counseling to the adolescent and his or her family so as to minimize the risk of future illness and dysfunction.

The pattern of substance abuse among teenagers has undergone rapid change during the past 15 years. During the late 1960s the abuse of psychoactive drugs, previously a predominantly adult phenomenon, became widespread among adolescents. Opiates, amphetamines, barbiturates, hallucinogens, and inhalants were all used and abused by large numbers of teenagers.1 The use of tobacco in this age group represents a significant health threat, and during the past decade the use of cocaine and other intoxicants, in particular alcohol and marijuana, has increased dramatically among adolescents. These drugs now cause major concern to those who provide health care for teenagers.
Letter to the Editor
Authors: Mitchell Marvin L.
Published: December 2021

The authors are indeed fortunate that they have (1) a small case load, (2) serum specimens and not dried blood on filter paper, and (3) the opportunity to measure both thyroxine (T4) and thyroid-stimulating hormone (TSH) in all samples. Unfortunately, in the current economic climate most mass screening programs must limit their laboratory approach to T4 supplemented by TSH measurements or forego the T4 procedure and rely on TSH as the sole marker.

In the latter instance, infants with hypothyroidism secondary to hypothalamic or pituitary disease will be missed and even those with mild primary thyroid insufficiency could be overlooked because of the large coefficient of variation in the assay at TSH concentrations between 20-25 µU/ml in dried blood on filter paper.
Obstructive Sleep Apnea
Authors: Southall D. P.
Published: December 2021

Kahn and colleagues1 point out that their findings of a decrease in transcutaneous PO2 after episodes of obstructive apnea could be due to a "... redistribution of blood flow away from the skin... ." Their suggestion, however, that the latter is due to a decrease in cardiac output is unlikely. Studies using indwelling arterial catheters during apnea and bradycardia have suggested that, if anything, there is an increase in cardiac output.2,3 Moreover, blood flow measurements3 have shown that there is often a peripheral vasoconstriction during such episodes.
The Death Setting
Authors: Ziegler John M.
Published: December 2021

I laud the spirit of concern behind Silverman's commentary on neonatal death.1 However, I take issue with the assumption that a "natural death" cannot take place in a hospital. Furthermore, I believe that physicians and nurses, along with clergy, can and should care for the needs of a terminally ill neonate and his family.

Physicians and nurses are not limited to doing "something to prolong earthly existence," as Silverman suggests. On the contrary, medicine historically has served the dying: "I esteem it to be clearly the office of a physician, not only to restore health but also to mitigate the pains and torments of diseases and not only when [a cure is expected] but also when all hope of recovery being gone, it serves only to make a fair and easy passage from life."2
Validity of Mass Blood Pressure Screening in Children
Authors: Fixler David E. , Laird W. Pennock
Published: December 2021

The validity of a mass blood pressure screening program carried out on Dallas high school students who were followed for at least 3 years is reported. Blood pressure results on initial screening in the tenth grade were related to outcome blood pressure status. The frequency of initial blood pressure elevation (systolic and/or diastolic pressure above the 95th percentile) was 10%, whereas the prevalence of sustained elevation in the tenth grade was less than 2%. The initial screening correctly identified 72% of those who had sustained elevations on all three tenth grade examinations (sensitivity), and correctly identified 91% of those who did not have sustained elevations (specificity). However, the predictive value of an initial positive screening result was low, at only 17% (152/900). The high proportion of false-positive results represents a significant cost to any blood pressure screening program, both in economic terms and in its potential for creating anxiety among families with children having only transiently elevated blood pressure. Because the costs are high and the yield from mass screening of children low, case finding of childhood hypertension should remain the responsibility of the physician who sees children in the clinical setting.
Validity of Doppler Measurements of Anterior Cerebral Artery Blood Flow Velocity: Correlation with Brain Blood Flow in Piglets
Authors: Hansen Nancy B. , Stonestreet Barbara S. , Rosenkrantz Ted S. , Oh William
Published: December 2021

Continuous wave Doppler ultrasonography through the anterior fontanel has recently been used to assess changes in cerebral blood flow in human neonates. There has been controversy concerning whether measurements of Doppler blood flow velocity indeed correlate with brain blood flow. An in vivo correlation was performed between brain blood flow as measured by the microsphere method and Doppler flow velocity measurements of the cerebral arteries via an artificial fontanel in young piglets. The peak systolic velocity (r = .76, P < .001), end diastolic velocity (r = .72, P < .001) and area under the velocity curve (r = .86, P<.001) all showed significant positive correlations with brain blood flow. The pulsatility index did not correlate with brain blood flow. Although continuous wave Doppler flow velocity measurements of the anterior cerebral artery cannot quantitatively assess cerebral blood flow, this methodology can be used to correlate changes in cerebral blood flow and provide a meaningful trend analysis following physiologic or pharmacologic perturbation of the cerebral circulation.
Joint Reply to `Maternal-Infant Bonding: A Joint Rebuttal'
Authors: LAMB MICHAEL E. , CAMPOS JOSEPH J. , HWANG CARL-PHILIP , LEIDERMAN P. HERBERT , SAGI ABRAHAM , SVEJDA MARILYN
Published: December 2021

To the Editor.—

It is clear that there is some disagreement about the effects of early skin-to-skin contact, and these issues are discussed below. We want to underscore, however, that there is no disagreement about the laudable humanization of birthing practices that Klaus and Kennell helped bring about. All are agreed that the maintenance and extension of these practices is desirable, and that we owe a great deal to Klaus and Kennell for their role in promoting them.
Use of Microcomputer for Self-Evaluation in Pediatric Practice
Authors: GOUYON J. B. , ALISON M. , NIVELON J. L. , DUSSERRE L.
Published: December 2021

To the Editor.—

We have been very interested in the various uses of microcomputers in pediatric units as proposed by Schwartz and Hammer.1 Following our experience in a neonatal unit, we have found another utilization.2 Microcomputers can be used for self-evaluation of the quality of care treatment in a pediatric unit. According to the number of variables studied, a microcomputer or minicomputer could be used.

For example, using a minicomputer (Hewlett-Packard 9045 B), we store 400 variables for each newborn.
Sulfisoxazole Prophylaxis for Otitis Questioned
Authors: PARADISE JACK L.
Published: December 2021

To the Editor.—

Sulfisoxazole prophylaxis may be effective in reducing the occurrence of otitis media, but the report by Liston et al1 provides no supporting evidence. As reported, the study embodied a number of key flaws in design and methodology, any one of which would have been sufficient to invalidate the study's conclusions. I will focus on those that seem most important.

First, it appears that not all the patients entering the trial were comparable from an otologic standpoint.
Cosleeping in Urban Families with Young Children in the United States
Authors: Lozoff Betsy , Wolf Abraham W. , Davis Nancy S.
Published: December 2021

The prevalence and correlates of sleeping in the parental bed among healthy children between 6 months and 4 years of age are described. One hundred fifty children were enrolled in an interview study on the basis of "well-child" care appointments in representative pediatric facilities. The sample created was similar in demographic characteristics to census data for the Cleveland area. In this cross section of families in a large US city, cosleeping was a routine and recent practice in 35% of white and 70% of black families. Cosleeping in both racial groups was associated with approaches to sleep management at bedtime that emphasized parental involvement and body contact. Specifically, cosleeping children were significantly more likely to fall asleep out of bed and to have adult company and body contact at bedtime. Among white families only, cosleeping was associated with the older child, lower level of parental education, less professional training, increased family stress, a more ambivalent maternal attitude toward the child, and disruptive sleep problems in the child.
Prognostic Factors in Neonatal Acute Renal Failure
Authors: Chevalier Robert L. , Campbell Fern , Brenbridge A. Norman A. G.
Published: December 2021

Sixteen infants, 2 to 35 days of age, had acute renal failure, a diagnosis based on serum creatinine concentrations > 1.5 mg/dL for at least 24 hours. Eight infants were oliguric (urine flow < 1.0 mL/kg/h) whereas the remainder were nonoliguric. To determine clinical parameters useful in prognosis, urine flow rate, duration of anuria, peak serum creatinine, urea (BUN) concentration, and nuclide uptake by scintigraphy were correlated with recovery. Nine infants had acute renal failure secondary to perinatal asphyxia, three had acute renal failure as a result of congenital cardiovascular disease, and four had major renal anomalies. Four oliguric patients died: three of renal failure and one of heart failure. All nonoliguric infants survived with mean follow-up serum creatinine concentration of 0.8 ± 0.5 (SD) mg/dL whereas that of oliguric survivors was 0.6 ± 0.3 mg/dL. Peak serum creatinine concentration did not differ between those patients who were dying and those recovering. All infants who were dying remained anuric at least four days and revealed no renal uptake of nuclide. Eleven survivors were anuric three days or less, and renal perfusion was detectable by scintigraphy in each case. However, the remaining survivor (with bilateral renal vein thrombosis) recovered after 15 days of anuria despite nonvisualization of kidneys by scintigraphy. In neonates with ischemic acute renal failure, lack of oliguria and the presence of identifiable renal uptake of nuclide suggest a favorable prognosis.
Fatal Myocardial Infarction Following Therapy with Prothrombin Complex Concentrates in a Young Man with Hemophilia A
Authors: Sullivan D. W. , Purdy L. J. , Billingham Margaret , Glader B. E.
Published: December 2021

A fatal myocardial infarction in a 22-year-old man with hemophilia A and a factor VIII inhibitor is described. The catastrophic event occurred while the patient was receiving high doses of unactivated prothrombin complex concentrates. Autopsy examination revealed myocardial hemorrhage with no evidence of coronary artery disease or thrombosis. There also was postmortem evidence of previous myocardial infarctions. This is the fourth documented case of myocardial infarction occurring in a young hemophiliac patient using unactivated prothrombin complex concentrates. It is concluded that utilization of prothrombin complex concentrates in hemophiliac patients must be limited and closely monitored. Therapeutic guidelines are recommended.
Current Outlook for Children Around the World
Authors: SCHMIDT BENJAMIN JOSE
Published: December 2021

The most tragic impact of the deep economic recession of the 1980s is falling on the 1.8 billion children less than 15 years of age who represent 40% of the 4.5 billion inhabitants of this earth. Two fifths of the world population still lacks the comfort of even minimally adequate housing and one third of the world's work force is unemployed or underemployed.

The result is that 100 million children stay hungry every day. Most of the nutritional education programs of the World Health Organization have turned out to be useless in improving protein diet. Sixty percent of the mothers of malnourished children are unaware of the fact that their children are underdeveloped and suffering from inadequate nourishment; due to a high rate of illiteracy, infantile malnutrition passes unobserved in one fourth of the population of developing countries.
Primary Cytomegalovirus Infection in Adolescent Pregnancy
Authors: Kumar Mary L. , Gold Eli , Jacobs Irwin B. , Ernhart Claire B. , Nankervis George A.
Published: December 2021

In a prospective study of 3,253 pregnant adolescents, 1,404 were seronegative for cytomegalovirus (CMV). Specimen collection at each antenatal visit, including urine for viral culture and serum for complement-fixing antibody, allowed definition of primary CMV infection in 14 subjects (1%). Seven of 14 subjects delivered congenitally infected infants, including 5/7 subjects with third trimester infections, and 2/5 subjects with second trimester infections. The single mother with a first trimester infection delivered an uninfected infant, despite recurrent maternal viremia. The mean birth weight of congenitally infected infants did not differ significantly from the mean birth weight of uninfected infants. None of the infants had stigmata of cytomegalic inclusion disease. One infected infant died suddenly at 6 weeks of age from pneumonia. Follow-up examinations of the six living children failed to detect cognitive, behavioral, or audiologic sequelae. These data demonstrate that primary maternal CMV infection occurs in 1% of susceptible women and is associated with a 50% risk of intrauterine infection. Fetal infection, particularly if it occurs late in pregnancy, is not invariably accompanied by fetal damage.
Teaching Developmental Pediatrics to Pediatric Residents: Effectiveness of a Structured Curriculum
Authors: Bennett Forrest C. , Guralnick Michael J. , Richardson H. Burtt , Heiser Karen E.
Published: December 2021

A national Task Force on Developmental Pediatrics was convened in 1979 to produce a curriculum for pediatric residents pertaining to the detection, assessment, and management of children with atypical development. During a 2-year period, the task force developed a structured curriculum composed of specific goals, educational objectives, and matched learning activities that identified and described the basic knowledge, skills, and attitudes of developmental pediatrics to be acquired during a pediatric residency. Subsequently, the curriculum was implemented and evaluated in 11 pediatric programs with a developmental pediatrics rotation. On a seven-point subjective scale, the mean resident (n = 64) rating of the curriculum's usefulness was 6.0 and of their perceived competence in the skills of developmental pediatrics was 5.2; the mean percent of this competence attributed to the curriculum-based rotation was 56.6. On an objective case management test, residents who used the curriculum scored significantly (P < .005) higher than those who did not. These results suggest the efficacy of structured curricula in pediatric resident education.
Transcutaneous Oxygen Tension During Nonnutritive Sucking in Preterm Infants
Authors: Paludetto Roberto , Robertson Steven S. , Hack Maureen , Shivpuri Chandra R. , Martin Richard J.
Published: December 2021

The effects of nonnutritive sucking on transcutaneous oxygen tension, heart rate, and respiratory rate were studied sequentially in 14 sleeping preterm infants breathing room air. Transcutaneous oxygen tension increased during nonnutritive sucking in infants between 32 and 35 weeks postconceptional age, but not in those between 36 and 39 weeks. This response was not associated with a change in respiratory rate or sleep state, although heart rate tended to increase. These data offer further support for the beneficial effects of nonnutritive sucking in preterm infants.