bluuebunny/crossref_metadata_2025 huggingface dataset:
Red Cell Oxygen Affinity, Hemoglobin Type, 2,3-Diphosphoglycerate, and pH as a Function of Fetal Development
Authors: Bard Harry , Teasdale Francois
Published: December 2021

Studies were carried out on fresh cord blood obtained at delivery from nonstressed normal fetuses ranging from 24 to 42 weeks of gestation, to determine the relationship of 2,3-diphosphoglycerate (DPG), the intracellular red cell and extracellular pH, and the proportions of adult and fetal hemoglobin in regulating the position of fetal red cell oxygen affinity in utero. There was a significant positive correlation between P50 and gestational age (r = .62, P < .001), the linear regression increased from 17.8 to 22.5 mm Hg. There was also a significant positive correlation between P50 and the percentage of adult type hemoglobin (HbA) (r = .67, P < .001). In contrast gestational age had no effect of 2,3-DPG levels, the mean and SD was 14.86 ± 2.04 mol/gm of Hb or ΔpH between plasma and red cell, the mean was 0.187 ± SD 0.032. However, there was a significant negative correlation between the intraerythrocyte hydrogen ion concentration and DPG level (r = .5, P < .025). It is concluded therefore that the decrease in fetal oxygen affinity as gestation progresses is related mainly to the increase in the amount of HbA and the levels of DPG or ΔpH between plasma and red cells are not a function of gestational age.
Pancreatitis Associated with Valproic Acid Therapy
Authors: Batalden Paul B. , Van Dyne Bruce J. , Cloyd James
Published: December 2021

Since submission of this manuscript, two additional cases of pancreatitis associated with valproic acid therapy have been reported.18
Neonatal Ticarcillin Dosage
Authors: Nelson John D.
Published: December 2021

We recently reported our experience with ticarcillin in neonates.1 We concluded that the dosage schedule tested, which is currently in the package insert, was needlessly complex and probably excessive. Based upon thepharmacokinetics, a simplified dosage schedule was proposed.

The proposed schedule was intended to produce peak serum concentrations one hour after a dose of 125 to 150 µg/ml and trough concentrations of 25 to 50 µg/ml immediately before a dose. The simplified schedule has been tested in neonates being treated for presumed sepsis and, as shown in the Table, the results are consistent with the predictions. The higher peak levels found in low birth weight babies in the first week of life are desirable in that they assure that adequate serum concentrations persist through most of the 12-hour interval between doses.
The Role of the MHC Antigens in the Mature and Immature Host
Authors: Gatti Richard A. , Kempner David H. , Leibold Wolfgang
Published: December 2021

During the past ten years, we have witnessed an explosion of knowledge regarding the histocompatibility antigens of man. Following the realization that the inheritance of this information was localized to one major histocompatibility complex (MHC) in each species, bone marrow transplantation was reassessed as a treatment for primary immunodeficiencies, aplastic anemia, and leukemia.1-3 Not long thereafter, disease associations with particular HLA alleles and phenotypes began to be appreciated.4,5 More recently, studies of 5everal complement deficiencies have linked the genes coding for such components to this same genetic complex, in man and in rhesus monkey, guinea pig, mouse, and chicken.6,7

The MHC of man is located on the short arm of chromosome 6. At this writing, it includes approximately ten boci with several others mapping nearby (Fig 1). The alleles at four loci are identified on lymphocytes by classical complement-dependent cytotoxicity: HLA-A, -B, -C, and -DR. HLA-D typing involves leukocyte interactions. (The relationship between the HLA-D and HLA-D related (HLA-DR) loci is presently unclear.) Three complement components (C2, C4, and Bf) and 21-hydroxylase deficiency have been mapped to the human MHC by linking serum deficiencies with particular MHC haplotypes. Allotypes for GLO-1 (glyoxylase) and PGM-3 (phosphoglucomutase) are defined by electrophoretic patterns.

The associations of MHC antigens with diseases such as ankylosing spondylitis, multiple sclerosis, cebiac disease, dermatitis herpetiformis, diabetes mellitus, rheumatoid arthritis, and psoriasis have renewed interest in the pathogenetic mechanisms of these diseases and raised the question of what primary functions these genes serve. For the complement loci, we know that the products translate into complement components. It is provocative that each of these complement components are directly involved in the activation or production of C3, a pivotal component in both the alternate and classical pathways.
Children's Car Seat Restraints: When Top-Tether Straps Are Ignored, Are These Restraints Safe?
Authors: McDonald Quentin H.
Published: December 2021

Children's car seat restraints are impact sled-tested to evaluate their safety qualities. To determine whether these restraints can protect the child, it is necessary to test in two different ways those restraints that require a top-tether strap: (1) installed in accordance with the manufacturer's directions; and (2) installed in the manner they are actually used. In this study the five children's car seat restraints top-rated by a leading consumer organization were impact sled-tested with a top-tether strap in use. They were then tested without the top-tether strap—the way such restraints are often being used as indicated by an Insurance Institute for Highway Safety survey. In addition, two leading restraints not requiring a top-tether strap, but secured by the auto lap belt, were tested. This study shows that the five top-tethered restraints, when installed with top-tether and lap belt, and the two restraints not requiring a top-tether give good protection in a frontal crash. It also shows that, with one possible exception, the five restraints that require a top-tether strap do not provide adequate protection if the top-tether strap is not used.
Campylobacter fetus Infections in Chlidren
Authors: Torphy Daniel E. , Bond Walter W.
Published: December 2021

There has been a gradual accumulation of reported Campylobacter fetus human infections since the first description in 1947. The taxonomy ofthese fastidious and morphologically confusing organisms has been recently revised and, in the past few years, through the use of selective culture medium for stool isolation C fetus has been implicated as a frequent pathogen in children. There are three relatively distinct patterns of human C fetus infection. The first, most frequent, pattern of disease is enteritis which is usually uncomplicated and due to C fetus subsp jejuni. A second form of disease consists of focal infections, often associated with vasculitis and/or chronic bacteremia. These infections, due to C fetus subsp intestinalis, are seen most often in older, debilitated, or chronically ill men. The third pattern, perinatal infections causing abortion, prematurity, and neonatal meningitis, is the least frequent, but these infections are usually fatal to the fetus or infant and are also due to C fetus subsp intestinalis.
Isolated Pulmonary Leukemic Relapse Following Successful Bone Marrow Transplant in a Child with Acute Lymphoblastic Leukemia
Authors: Georgitis John , Eigen Howard , Provisor Deborah , Baehner Robert L.
Published: December 2021

Leukemic relapse and interstitial pneumonitis are common complications for leukemic patients following bone marrow transplantation. We present the case of a successful bone marrow transplantation patient who developed an interstitial infiltrate on chest roentgenogram 212 days post-transplant that was diagnosed by open lung biopsy and found to be a leukemic relapse of the lung parenchyma. No extrapulmonary sites were involved and the infiltrate cleared in three weeks with systemic chemotherapy. Pulmonary function tests continued to demonstrate restrictive disease. The patient remained in remission for nine months following pulmonary relapse on systemic chemotherapy. This patient illustrates an unusual site of leukemic relapse and the importance of open lung biopsy in the diagnosis of the immunosuppressed patient with a pulmonary infiltrate.
Thoracic Transillumination: Aid in the Diagnosis and Treatment of Pneumopericardium
Authors: Cabatu Eresvita E. , Brown Edwin G.
Published: December 2021

A frequent complication of continuous positive airway pressure and mechanical ventilation used to treat neonates who have hyaline membrane disease and other forms of respiratory distress is an air leak from alveolar rupture. Pneumothorax and pneumomediastinum are common. Pneumopericardium does not occur often, but it can be life-threatening if it produces acute cardiac tamponade. In a review of the literature, Brans and associates1 found that pneumopericardium in neonates was treated by pericardiocentesis in one half of the published cases; 79% of them survived or they ultimately died of complications unrelated to pericardial tamponade. However, only 32% of the infants treated conservatively survived.
Adolescents and Motorcycle Safety: The Case for Health Advocacy
Authors: Doolittle Robert Prince , Brown Robert T. , Boshell Allan
Published: December 2021

Accidents are the leading cause of death in children and adolescents in the United States, and more than one half of these are related to motor vehicles.1 More specifically increased morbidity and mortality in the adolescent population is related to motorcycle accidents. Recent studies document a greater death risk from motorcycle mishaps than from automobile accidents and indicate that the youthful population at risk is growing rapidly. In Alabama, a 14-year-old may be licensed to operate a motorcycle on public roads by passing an eye test and a written examination. A child of any age may use a cycle on off-road trails.
Gastric Reflux and Asthma
Authors: Leape Lucian L.
Published: December 2021

The article by Shapiro and Christie (Pediatrics 63:207, 1979) may mislead readers to the conclusion that gastroesophageal reflux (GER) is of no significance in the etiology of asthma, or that treatment of reflux is of no value. Both of these conclusions are open to question.

Although the authors rightfully point out that theophylline may have caused the reflux by decreasing lower esophageal sphincter pressure, such reflux would be none the less real, and this effect of theophylline must be kept in mind in treating patients with asthma.
Inherited Antithrombin III Deficiency and Cerebral Thrombosis in a Child
Authors: Ambruso Daniel R. , Jacobson Linda J. , Hathaway William E.
Published: December 2021

Identification of a family affected by antithrombin III-heparin cofactor (AT-III) deficiency was made after diagnosis of the index case, a 15-year-old boy who suffered cerebral thrombosis. The proband had a two-year history of recurrent thrombosis involving the lower extremities. His mother and sister were also affected. Studies showed a decreased biological activity (AT-IIIc) and antigen (AT-IIIag) by the Laurell technique in the proband (AT-IIIc = 0.32, AT-IIIag = 46%), his sister (AT-IIIc = 0.29, AT-IIIag = 47%), and his mother (AT- IIIc = 0.41, AT-IIIag 56%). Crossed immunoelectrophoresis (CIE) of the affected individuals' plasma in agarosecontaining heparin demonstrated a normal pattern of migration. Treatment with warfarin sodium (Coumadin) resulted in an increase in activity in two of three affected family members, and in antigen in all three. Anticoagulant therapy did not affect the pattern of AT-III on CIE. This family represents a quantitative deficiency in antithrombin III. A review of the reported cases of antithrombin III deficiency indicates that individuals with this disorder may have thromboembolic disease in childhood.
Noise and Hypoxemia in the Intensive Care Nursery
Authors: Long John G. , Lucey Jerold F. , Philip Alistair G. S.
Published: December 2021

Noise levels in the neonatal intensive care unit (NICU) have received intermittent attention in the pediatric literature.1-4 While risk criteria for the prevention of induced sensorineural hearing loss in adults are well established, little is known about the response of the newborn to environmental noise. The AAP Committee on Environmental Hazards3 has recommended that physicians and hospital personnel be alert to and eliminate unnecessary noise in nurseries. So far, attention has been directed primarily at incubator noise1,5 and that associated with life-support equipment.6 To our knowledge, little has been done to identify other sources of "noise pollution." We wish to report the results of measures taken in one NICU to quantitate and lower the ambient noise levels.
Consumer Cost-Sharing as a Means to Reduce Health Care Costs
Authors: Davidson Stephen M. , Connelly John P. , Blim R. Don , Strain James E. , Taylor H. Doyl
Published: December 2021

The National Commission on the Cost of Medical Care1 states in part (Recommendation 2) that "insurance policies should include provisions through which the consumer shares in the cost of care received, at the time of service, for selected benefits and for selected groups...." These cost-sharing provisions are expected to reduce national medical care expenditures by encouraging consumers to reduce their use of services in order to avoid paying additional money out of their own pockets. They will thus moderate the demand-inducing tendency of insurance, leading the rational consumer to seek only necessary services and to forego those services contributing to what is believed to be over-utilization. As the Commission states in its supporting statement:
Attempts at Use of Strychnine Sulfate in the Treatment of Nonketotic Hyperglycinemia
Authors: MacDermot Kaye D. , Nelson William , Reichert Cheryl M. , Schulman Joseph D.
Published: December 2021

In two cases of nonketotic hyperglycinemia treated from early ages with strychnine sulphate, the patients demonstrated persistent severe psychomotor retardation and seizures. Strychnine therapy improved tone and feeding, but did not seem to alter fundamentally the course of the disease in either patient.
Fatal Cytomegalovirus Bronchiolitis in a Patient with Nezelof's Syndrome
Authors: Tanner David D. , Buckley Patrick J. , Hong Richard , Shearer William T.
Published: December 2021

A 4-year-old girl who had received a fetal thymus gland by intraperitoneal transplantation 41 months previously sustained acute, fatal bronchiolitis due to culture-proven cytomegalovirus despite the fact that a specific antibody response to this organism was detected. While the thymic transplantation had increased the number of circulating T lymphocytes and had permitted immune sensitization to delayed-hypersensitivity skin test antigens, there was still an incomplete state of T lymphocyte function. In particular, isolated lymphocytes failed to respond to stimulation with phytohemagglutinin at several concentrations and, more important, the pathologic examination demonstrated a severe anatomic deficiency of lymphoid tissue associated with T lymphocyte function. The unusual infection that caused the death of this child emphasized the necessity of acquiring sufficient T lymphocyte function in immunologic reconstitution attempts.
Excretory Urography for Evaluation of Enuresis
Authors: Seibert Joanna J. , Felman Alvin H. , Glazer Norman , McSweeney William , Merten David F. , Northway William , Goldman Harold S. , Grossman Herman
Published: December 2021

Enuresis is the involuntary discharge of urine occurring beyond the age when control of the urinary bladder should have been acquired.1 Eighty percent of children with enuresis have problems staying dry at night, 5% in the day, and 15% both day and night.2 The age at which children can be expected to stay dry at night is not well established and is often cause for extreme concern for parents and children alike. Most children are still not dry at night by age 2 years. In a study of 315 children, Klackenberg reported 87% dry by 3 years and 96% dry by 6 years. Essen and Peckham,4 reviewing the records of 12,000 children, found enuresis more prevalent in older ages. More than 10% of their patients were enuretic between ages 5 and 7 years and almost 5% were still having problems at 11 years of age.

The etiology of enuresis is also difficult to define, and many different theories have been advanced. Bindelglas5 grouped these into five major categories: (1) organo-urogenic, including urologic malformations; (2) psychogenic; (3) developmental; (4) genetic; (5) environmental. The first of these categories must be of primary concern to the physician when confronted with an enuretic child, ie, could the symptoms possibly reflect a surgically correctable urologic abnormality? Radiologic procedures such as excretory urography and mictunition cystourethrography are the studies usually relied on to exclude an underlying anatomic lesion. Because of the potential risk and expense of any radiologic procedure as well as the possible low yield in this condition, the Committee on Radiology examined the utility of these studies in the routine evaluation of enuresis.
Role of Pediatrician in Fostering Good Parenting
Authors: Thomas Howard P.
Published: December 2021

More and more articles have appeared on the negative consequences of poor parenting. Klaus and Kennel studied the impact of early separation or loss on family development. C. Henry Kemp has related the observation of faulty parent-child bonding to the subsequent occurrence of child abuse. In the April 1977 issue of Pediatrics (59:489, 1977) appeared a plea by William Turtle for group prenatal pediatric counseling to prevent childhood behavior problems.

On the consumer side of the picture, groups such as the Childbirth Education Association have promoted the coming together of husband and wife in joint preparation for a more natural childbirth.
Emotional Implications of Primary Familial Hyperlipoproteinemia in Childhood and Adolescence
Authors: Froese Arthur P. , Rose Vera , Allen D. Marilyn
Published: December 2021

To determine whether 43 patients and their 23 unaffected siblings were at increased risk for psychologic upset, 28 families of children being treated for primary familial hyperlipoproteinemia were studied. Nine fathers but no mothers had died of the disease. The families were interviewed for psychiatric assessment, and the parent(s) scored a questionnaire concerning eight behavioral factors. Male patients had significantly higher scores for impulsive hyperactive behavior than their male siblings. Fatherless female patients had the highest scores for perfectionism and the lowest scores for conduct problems and impulsive hyperactive behavior. Fatherless children scored lower for impulsive hyperactive behavior than children with fathers; fatherless male children were more anxious than fatherless female children.

There were more significant differences in scores for children whose father was still alive vs those whose father had died than in scores for affected children vs unaffected siblings. Thus, the emotional impact of the premature death of an affected parent appears greater than that of having the disease. Therefore, one should be alert for changes in behavior in children with primary familial hyperlipoproteinemia when a parent dies of the disease and as the patients approach the age at which the parent died.
Comparison of Noninvasive and Direct Measurements of Intracranial Pressure
Authors: Myerberg D. Z. , York C. , Chaplin E. R. , Gregory G. A.
Published: December 2021

After creating "fontanelles" in infant rhesus monkeys, we measured intracranial pressure of these monkeys directly with an indwelling cannula and indirectly with a Ladd 1700 sensor. Values obtained with the Ladd sensor placed over the shaven fontanelle closely approximate directly measured pressure in acute experiments in these animals and in human cadavers. Application of the device is simple and application pressure need not always be the same for multiple determinations. The response time is 1.6 cm H20/sec, which is adequate to record changes in intracranial pressure caused by changes in the partial pressure of CO2 in arterial blood.
Effect of Electrode Temperature and in Vivo Calibration on Accuracy of Transcutaneous Estimation of Arterial Oxygen Tension in Infants
Authors: Pollitzer Melanie J. , Whitehead Michelle D. , Reynolds E. Osmund R. , Delpy David
Published: December 2021

Previous studies showed that a skin oxygen electrode with a macrocathode, when heated to 43 C, underestimated arterial oxygen tension (Pao2). At 44 C the skin was damaged. The purpose of the present study was to assess the accuracy of the macrocathode electrode when set at 43.5 C. Transcutaneous oxygen tension (tcPo2) recorded by the macrocathode electrode at 43.5 C was compared with Pao2 measured continuously with an intravascular oxygen electrode, and with tcPo2 recorded by a microcathode electrode which has been shown earlier to work well at a temperature of 44 C. Both the skin electrodes were calibrated in vitro and in vivo. Particular attention was given to the details of calibration. Twelve newborn infants with respiratory illnesses were studied, each for six hours. Transcutaneous Po2 recorded by both skin electrodes was found to estimate Pao2 resonably accurately for the entire six-hour duration of the study, with the exception of a large and unexplained overestimation of Pao2 by the macrocathode electrode in one infant. This overestimation was corrected by in vivo calibration. Serious skin lesions were not seen after the skin electrodes were removed. We conclude that (1) The temperature setting of skin electrodes is crucial to their satisfactory performance. (2) For use on newborn infants, 43.5 C is the optimal temperature for the macrocathode electrode. (3) The optimal temperature for the microcathode electrode was confirmed as 44 C. (4) At these temperatures, both electrodes could be left on the same site on the skin for six hours. (5) Periodic in vivo calibration of skin electrodes is advisable.
Effects of Methadone on Thyroid Function in Mother, Fetus, and Newborn
Authors: Jhaveri Ramesh C. , Glass Leonard , Evans Hugh E. , Dube Shiv K. , Rosenfeld Warren , Khan Farida , Salazar J. Delfor , Chandavasu Oradee
Published: December 2021

The effects of maternal use of methadone during pregnancy on tests of thyroid function were studied in 14 women and their offspring. Twelve normal nonaddicted women and their infants served as a control group. Concentrations of thyrotropin (TSH), thyroxine (T4), and triiodothyronine (T3) were not significantly different in maternal and cord serum, and in infant serum at age 24 hours. There was no significant difference in infants' TSH concentrations at 2, 3, and 7 days of age. At 2 and 7 days, T3 levels were significantly higher in the methadone than in the control group (P = .01 and < .01, respectively). At 3 days, differences were of borderline significance (P = .08). Increased T4 levels in the methadone group of infants were statistically significant at 2 days (P < .01) and at 3 and 7 days (P = .05). The mechanisms responsible for the biochemical evidence of hyperthyroidism were not determined, but may have been related to altered autonomic function and/or increased metabolic activity which occurs during neonatal narcotic withdrawal.
Subclinical Hepatic Changes in Varicella Infection
Authors: Pitel Paul A. , McCormick Kenneth L. , Fitzgerald Eileen , Orson Jay M.
Published: December 2021

Varicella is a common viral disease of children which frequently occurs in epidemics. The diagnosis is generally obvious from clinical criteria. The disease is usually self-limited and benign, but the complications of pneumonia and encephalitis are well recognized.1 Recently, chicken pox has been implicated in 10% to 18% of cases of Reye's syndrome, and varicella hepatitis is being increasingly recognized.2-4 However, the incidence of subclinical liver involvement in children or adults with varicella is not known.4,5

In this study we have obtained historical, physical, and biochemical data on patients with varicella infections during the active phase of their disease. Patients were questioned about previous hepatic disease, the use of salicylates or phenothiazine class drugs, the onset and sequence of their symptoms, and signs of neurologic or hepatic involvement.
What is Scientific Proof?
Authors: Crook William G.
Published: December 2021

Can adverse or allergic reactions to what a person eats cause him to be pale, tired, and drowsy on the one hand, or irritable and hyperactive on the other? Can such reactions to food also cause headaches, abdominal pain, and limb pains? Can they make an individual depressed, and can they cause even more bizarre nervous system symptoms, or are such reactions a myth?

As long ago as 1916, and on repeated occasions since that time, observers, including Hoobler,1 Shannon,2 Rowe,3 Rinkel et al,4 Randolph,5 Speer,6 Deamer and colleagues,7,8 Gerrard,9 Alvarez,10 and many others,11-18 have described patients with systemic and nervous system reactions caused by a specific hypersensitivity to foods.
Excretory Urography for Evaluation of Enuresis
Authors: Seibert Joanna J. , Felman Alvin H. , Glazer Norman , McSweeney William , Merten David F. , Northway William , Goldman Harold S. , Grossman Herman
Published: December 2021

Enuresis is the involuntary discharge of urine occurring beyond the age when control of the urinary bladder should have been acquired.1 Eighty percent of children with enuresis have problems staying dry at night, 5% in the day, and 15% both day and night.2 The age at which children can be expected to stay dry at night is not well established and is often cause for extreme concern for parents and children alike. Most children are still not dry at night by age 2 years. In a study of 315 children, Klackenberg reported 87% dry by 3 years and 96% dry by 6 years. Essen and Peckham,4 reviewing the records of 12,000 children, found enuresis more prevalent in older ages. More than 10% of their patients were enuretic between ages 5 and 7 years and almost 5% were still having problems at 11 years of age.

The etiology of enuresis is also difficult to define, and many different theories have been advanced. Bindelglas5 grouped these into five major categories: (1) organo-urogenic, including urologic malformations; (2) psychogenic; (3) developmental; (4) genetic; (5) environmental. The first of these categories must be of primary concern to the physician when confronted with an enuretic child, ie, could the symptoms possibly reflect a surgically correctable urologic abnormality? Radiologic procedures such as excretory urography and micturition cystourethrography are the studies usually relied on to exclude an underlying anatomic lesion. Because of the potential risk and expense of any radiologic procedure as well as the possible low yield in this condition, the Committee on Radiology examined the utility of these studies in the routine evaluation of enuresis.
Children Having Children
Authors: Townsend Irene , Philipsborn Herbert F.
Published: December 2021

Although McAnarney et al (Pediatrics 61: 199, 1978) reported good obstetric outcome for teenage mothers and their babies, adolescent pregnancy is still a societal problem and, in particular, an adolescent health problem that we feel is underemphasized in both the pediatric literature and curriculum. The quotation from The Economist (Pediatrics 61:339, 1978) points out the magnitude of the problem. In addition, about 30,000 girls under 15 years of age conceive annually, and in 1975 over 12,000 of these were reported to have actually delivered.1
What Are Nonepileptic Seizures?
Authors: Livingsron Samuel , Pauli Lydia L , Pruce Irving
Published: December 2021

We are writing in regard to the impressive article by Nelson and Ellenberg (Pediatrics 61:720, 1978), in which the authors present data based on the findings of a National Institute of Neurological and Communicative Disorders and Stroke Collaborative Perinatal Project (NCPP). The study of 1,706 children concerns the consequences of seizures associated with an elevated temperature, and their relationship to certain "risk factors." In our opinion, the most important of the results of the NCPP investigation is the finding that the development of epilepsy subsequent to a simple febrile convulsive disorder is infrequent (0.9%), a finding that we initially reported in 1954.1
The Immotile Cilia Syndrome: Phase Contrast Light Microscopy, Scanning and Transmission Electron Microscopy
Authors: Veerman A. J. P. , van Delden L. , Feenstra L. , Leene W.
Published: December 2021

In the immotile cilia syndrome, transmission electron microscopy of the cilia shows abnormalities in the arrangement of the central pairs of tubules and in the dynein arms on the peripheral tubules, or in the radial spokes. We studied four nonrelated children, 9/12, 5, 6, and 6 years old, with situs inversus and a history of chronic sinusitis and bronchitis (Kartagener's syndrome) and four children in the same age group and with the same history, but without situs inversus. Under the phase contrast microscope no motile cilia were seen in the four patients with Kartagener's syndrome and in two of the four other children. Transmission electron microscopy showed aberrations in the cilia (absence of dynein arms, random orientation of central tubules) in the patients with Kartagener's syndrome. Scanning electron microscopy revealed differences in morphology and arrangement of cilia between patients and controls. In the patients much more mucus was present on the mucosal surface. Furthermore, the cilia were in a state of disorder, with a multidirectional orientation instead of the parallel orientation seen in controls.
ECHO Virus Type 9 Meningitis Simulating Tuberculous Meningitis
Authors: Malcom Bradley Scott , Eiden Joseph John , Hendley J. Owen
Published: December 2021

An infant with mononuclear pleocytosis, hypoglycorrhachia, and elevated protein in cerebrospinal fluid emphasizes the occasional difficulty in distinguishing viral and tuberculous meningitis at the time of presentation. Although the cerebrospinal fluid values were compatible with tuberculous meningitis, ECHO virus type 9 was grown from the spinal fluid.
A Rapid Fluorometric Method for Determining Bilirubin Levels and Binding in the Blood of Neonates: Comparisons with a Diazo Method and with 2-(4'-Hydroxybenzene)azobenzoic Acid Dye Binding
Authors: Brown Audrey K. , Eisinger Josef , Blumberg William E. , Flores Jorge , Boyle Gerard , Lamola Angelo A.
Published: December 2021

A simple, rapid fluorometric method for determining the albumin-bound bilirubin concentration, total blood bilirubin concentration, and the bilirubin reserve-binding capacity of albumin was clinically evaluated using blood specimens from 79 neonates. This study showed that these bilirubin determinations, made by means of the Bell Laboratories hematofluorometer, correlated well with plasma biirubin levels obtained by a diazotization (Jendrassik-Grof) method. Hematofluorometer reserve-binding capacities correlated very well with 2-(4'-hydroxybenzene)azobenzoic acid (HABA) dye reserve-binding capacities for specimens of artificially jaundiced adult blood. For specimens of neonatal blood the HABA dye reserve capacity was, on the average, higher than the hematofluorometer reserve-binding capacity, particularly for specimens from low-birth-weight babies (<2,000 gm). Comparison of HABA reserve capacity and hematofluorometer reserve capacity for high-birth-weight babies (>2,000 gm) gave data very similar to those for adult blood specimens. The specific bilirubin-binding capacity of albumin was found to be greater for infants whose birth weight exceeded 2,000 gm than for the lower birth weight group. The total blood bilirubin concentration obtained by the hematofluorometer is shown to be significantly higher than the concentration of bilirubin bound to albumin, an indication of other important compartments of bilirubin in blood.
Effect of the Pediatrician on the Mother-Infant Relationship
Authors: Casey Patrick H. , Whitt J. Kenneth
Published: December 2021

Child development literature suggests a relationship between mother-child interaction and enhanced infant development. We conducted a randomized clinical trial to determine if a pediatrician's guidance improves the mother-infant relationship and the infant's development. Thirty-two normal mothers and their healthy first-born infants were followed by one pediatrician at 2, 4, 8, 15, and 21 weeks of age. These dyads were randomly assigned to a control group, who received customary care, or to an intervention group, who also received guidance based on the infant's developmental status at each age. Just prior to a 27-week visit, the mother-infant relationship was assessed by a person blind to group assignment. Infant development was assessed with the Bayley Mental Scales of Infant Development and two of the Uzguris-Hunt Ordinal Scales. Intervention group mothers were rated significantly higher on sensitivity, cooperation, appropriateness of interaction, and appropriateness of play (P < .05). Experimental infants were advanced on the Vocal Imitation ordinal scale. This study shows the effectiveness of this intervention on both the mother-infant relationship and infant development and supports pediatric involvement in this biosocial approach to well child care.
PACE 8 Report
Authors: Oliver William J. , Allan David M. E. , Beazley Luther A. , Dodge Warren F. , Fijan Kenneth J. , Ganelin Robert S. , Howard William A. , Pearson Howard A. , Walker Dixon , Wasserman Edward , Bergh Rodney M. , Montgomery William C.
Published: December 2021

PACE 8 is the final Academy examination in the PACE series. The self-assessment program for pediatricians began in 1970 with SEEP followed by PACE in 1976-1979 and is currently continued as part of the PREP program.

This report summarizes the data of the PACE 8

See Table in the PDF File

See Images in the PDF File

multiple-choice examination. Of the 3,635 subscribers, 1,155 returned answer sheets to the Academy for CME credit. All participants had the option of completing the assessments open book (using references), closed book, or both. All of the examinations (577) designated as "closed book" were scored to compile these data. The descriptive statistics generated provide an opportunity for PACE 8 participants to compare their performance with that of the sample.

Table 1 gives the statistical summary for the total examination. Table 2 lists the mean percent scores for the topic areas. Table 3 gives information on the difficulty of each question in terms of the percent of participants answering the item correctly. A histogram of PACE 8 total scores is presented in the Figure.

The data have been presented in a similar format to the PACE 7 Report (Pediatrics 63:922, 1979) for comparison. PACE 8, like the previous examinations, was designed as an educational activity, only sampling knowledge base, and was not given in the usual controlled conditions.

ACKNOWLEDGMENT

Floy Helwig, MD, FAAP, PACE Science Editor, and the Academy gratefully acknowledge the assistance of Melton E. Golmon, PhD, Director of Medical Education, Northwestern University Medical School, in the preparation of the statistics.
General Anesthesia in Sickle Cell Disease
Authors: Homi John , Serjeant Graham R.
Published: December 2021

The decision to conduct otherwise necessary surgery in patients with sickle cell disease may be influenced by reports of surgical and anesthetic risks in this condition. It is important therefore that isolated case reports should be viewed in the context of relatively large numbers of patients successfully undergoing surgical procedures. The recent case report of myocardial necrosis following general anesthesia for dental surgery in sickle cell-hemoglobin C (SC) disease1 might exert a disproportionate influence on this decision and requires critical appraisal.
Letters to the Editor
Authors: Adelman Raymond D. , Halsted Charles H.
Published: December 2021

We recognize, as Dr Pascual suggests, that hypophosphatemia may lead to increased urinary calcium excretion. As stated in the first paragraph of our discussion, "Hypophosphatemia, which may be associated with hypercalciuria,1 is a recognized complication of some TPN programs. Serum phosphorus levels in our patient averaged 3.3 mg/100 ml, slightly below normal when compared to reported pediatric values. However, there was no difference in average serum phosphorus levels before and after return to normocalciuria. Furthermore, serum phosphorus reached its lower level, 2.3 mg/100 ml, on the 13th day when, along with removal of calcium, phosphorus inadvertently was removed from the TPM solution for 24 hours.
The ‘Vulnerable Child’: Intimations of Mortality
Authors: Green Morris
Published: December 2021

Pediatrics has been at the forefront in its attention to populations and individuals at risk of death or disease. Much attention has been directed toward health vulnerabilities or potential precursors of disease. When preventive services, which now occupy about half of the pediatrician's time in the United States, are regularly utilized by parents who also consult the physician appropriately when their child is sick, pediatric care is effective and efficient; on the other hand, failure to utilize such resources parsimoniously is an issue deserving of examination.

As documented by Levy in this issue (p. 956), a common reason for excessive utilization of health services is a parent's belief that a particular child is especially vulnerable to illness.
Effect of Acute Hemorrhage on Transcutaneous, Subcutaneous, Intramuscular, and Arterial Oxygen Tensions
Authors: Matsen Frederick A. , Wyss Craig R. , King Racheal V. , Simmons Charles W.
Published: December 2021

Although transcutaneous Po2 is a close approximation of arterial Po2 in most neonates, infants in shock often show lower transcutaneous than arterial Po2 values. For a better understanding of this discrepancy, we investigated the effect of acute hemorrhage on transcutaneous, tissue, and arterial Po2 in rabbits. With progressive hemorrhage, transcutaneous and tissue Po2 values declined steeply while arterial Po2 values did not. We speculate that the progressive decrement in transcutaneous and tissue Po2 values with hemorrhage is produced by diminished peripheral blood flow. Rather than representing a failure of the transcutaneous Po2 monitoring method, we speculate that transcutaneous hypoxia with shock may be a clinically valuable danger signal.
Effects of Nephrotic Syndrome on the Family: A Controlled Study
Authors: Vance John C. , Fazan Louis E. , Satterwhite Betty , Pless Ivan B.
Published: December 2021

The hypothesis that the parents and siblings of children with nephrotic syndrome are more likely to develop psychosocial problems than those of healthy children was tested. Seventy-nine siblings from 36 such families were compared with 79 healthy children from closely matched families using interviews, parent rating scales, teachers' reports, and psychological tests. Although few striking differences were found between the two groups, the findings suggest several areas of increased vulnerability among the parents and siblings of children with nephrosis. Parents often denied the existence of apparently stressful events, but the personality profiles of the siblings suggested decreased social confidence and a lesser degree of self-acceptance. Evidence of inhibition, such as less aggression and poorer academic performance, were also described in response to questions in the interview. These results should prove useful to clinicians in the management of families of children with this or other chronic illnesses.
INSTRUCTIONS OF AN EIGHTEENTH CENTURY ENGLISH FATHER TO HIS DAUGHTER ON HOW TO RAISE HER SON
Authors: C. T. E.
Published: December 2021

John Taylor (1694-1761), the editor of the first Hebrew Concordance of the English Bible, offered his daughter in his pamphlet entitled The Value of a Child (1752) the following advice on raising her son.1

Let him be well established in liberty (liberty to use and improve his understanding) and the rights of conscience; but for others as well as himself. Address his understanding; encourage his enquiries, and use him betimes to think and reason. Represent vice in the most odious, virtue in the most amiable colours. Especially give him a deep sense of truth and integrity, and an abhorrence of all manner of falsehood, fraud, craft, subterfuge and dissimulation, as base and dishonourable, and highly displeasing to God. You cannot cherish veracity too much. Never be severe for any fault he ingenuously acknowledges. But while you are convincing him of the wrong he has done, honour and commend him for the truth he has spoken. Make him sensible [that] bodily appetites and passions are very dangerous, if not duly restrained. Give him a low, opinion of splendor and show, and deceive him not into wrong thoughts of himself by gaudy ornaments. Teach him to reverence the human nature even in the poorest and suffer him not to treat any with contempt. Cherish modesty and check a forward, bold behaviour; it may grow into an unruly dissolute insolence. Suffer him not to be a man, but as years and understanding allow. Boys are by no means fit to govern themselves, or to direct others.
Exercise Performance of Hypertensive Adolescents
Authors: Nudel Dov B. , Gootman Norman , Brunson Sandra C. , Stenzler Alex , Shenker I. Ronald , Gauthier Bernard G.
Published: December 2021

Ten adolescents with sustained essential hypertension (group 1) and eight youngsters with labile hypertension (group 2) were compared to ten agematched normotensive controls (group 3) during progressive maximal exercise tests. Patients' ages ranged from 13 to 19 years and none received any medications within six months prior to the study. Systolic pressure during maximal exercise in group 1 ranged from 170 to 240 mm Hg (mean 204 ± 6.9) and was significantly higher (P < .005) than in groups 2 (177 ± 5.2) and 3 (175 ± 6.2). The diastolic pressure in group 1 (93 ± 4.5) was also significantly higher than in group 2 (74 ± 25 P < .01) and group 3 (64 ± 3.1 P < .005). In group 2 systolic pressure was not significantly different than in group 3 but increments in pulse pressure were significantly lower (P < .01). There were no significant differences in oxygen consumption and anaerobic threshold among all three groups. Conclusions are: (1) Maximal exercise testing in hypertensive adolescents is safe. (2) Their exercise performance is normal. (3) The systolic and diastolic pressures in patients with persistent essential hypertension is significantly higher during exercise than in those with labile hypertension and normal control subjects. (4) The systolic pressure of patients with labile hypertension is not significantly different from that in control subjects, but their systemic bed is less compliant during exercise. (5) Exercise tests are recommended for all hypertensive adolescents to identify those with an excessive response in blood pressure.
Selected Hormone Levels in Victims of the Sudden Infant Death Syndrome
Authors: Naeye Richard L. , Fisher Russell , Rubin H. Robert , Demers Laurence M.
Published: December 2021

Hormone levels were measured in victims of the sudden infant death syndrome (SIDS) to look for clues to the cause of death. SIDS victims who had petechiae on their intrathoracic organs had higher blood levels of cortisol than victims without such petechiae (25 vs 9 µg/100 ml, P < .005). This raises the possibility that SIDS victims who had petechiae had a longer period of predeath stress than did victims without petechiae since experimental studies have shown that the circulation must continue for a time after stress begins to produce such petechiae. The low normal level of cortisol (9 µg/ 100 ml) in SIDS victims who did not have petechiae raises the possibility that their circulation stopped rather promptly after the final stress began. Hypoxemia may have been the mechanism of death in many of the SIDS victims with petechiae. These victims had 20% more muscle in their pulmonary arteries than did victims without petechiae (P < .05). This muscle increase is a presumed marker for chronic hypoventilation which leads to hypoxemia.
Serum 25-Hydroxyvitamin D Concentrations in Sudden Infant Death Syndrome
Authors: Hillman Laura S. , Erickson Marilyn , Haddad John G.
Published: December 2021

Among the many theories put forth to explain sudden infant death syndrome (SIDS) is a theory of vitamin D deficiency. 25-Hydroxyvitamin D (25-OHD) serum concentrations were measured in 31 SIDS and 24 postmortem control infants. 25-OHD was 19.0 ± 7.9 mg/ml in SIDS, 16.9 ± 5.2 ng/ml in acute death control infants, and 11.9 ± 4.4 ng/ml in in-hospital deaths. For four "near miss" infants the mean serum 25-OHD concentration was 21.1 ± 4.1 ng/ml. The mean serum 25-OHD concentration of 39 living premature or small-for-gestational-age infants at 3 months of age was 26 ± 9.9. Serum calcium and serum copper concentrations were also the same in SIDS and control infants. Parathyroid hormone was measured in ten and was detectable in five SIDS infants. These data eliminate a simple vitamin D deficiency or a 25-OHD deficiency as a significant contribution to the pathophysiology of SIDS.
Failure of Strychnine Treatment during the Neonatal Period in Three Finnish Children with Nonketotic Hyperglycinemia
Authors: von Wendt Lennart , Similä Seppo , Saukkonen Anna-Liisa , Koivisto Maila
Published: December 2021

Three Finnish infants with a severe neonatal-onset-type of nonketotic hyperglycinemia were treated with strychnine nitrate in a daily dosage of 0.2 to 0.9 mg/kg, given orally in four doses. In order to lower the plasma and CSF-glycine concentrations concomitant exchange transfusions (200 to 300 ml/kg of heparinized blood) were carried out in two of these infants. Although the strychnine therapy was started at ages 15, 40, and 62 hours, the strychnine produced no clinical effect, and the exchange transfusion caused only a transient decrease in the plasma glycine level. Despite treatment, the clinical course was the same as in the majority of children with the severe form of the disease—all died within the first ten days of life. Impressive effects of strychnine treatment initiated in two infants at ages 5 and 6½ months, and given in addition to sodium benzoate and anticonvulsants, have been reported. These cases, however, probably represent a less severe type of nonketotic hyperglycinemia. Nevertheless, the therapeutic failure in the present cases probably indicates that strychnine treatment does not solve the therapeutic problems of severe forms of NKH.
Opinions on Teenage Pregnancy Statement
Authors: Gioia Phillip C.
Published: December 2021

I would like to comment on the American Academy of Pediatrics "Statement on Teenage Pregnancy" by the Committee on Adolescence (Pediatrics 63:795-979, 1979).

The Statement describes the environment leading to teenage pregnancies only in sociologic terms. This type of information is hard to apply in clinical situations. A review of longitudinal studies of factors antecedent to teenage pregnancies1-3 would be more helpful to clinicians trying to prevent unwanted teenage pregnancies. Individual psychologic changes may be directed as sociologic changes take place.
Letters to the Editor
Authors: Cohen M. I. , Dudenhoeffer F. , Guthrie A. , Hammar S. , Heald F. , Hofmann A. , Jenkins R. , Long W. , Millar H. E. C. , Wasserman M. , Wolfish M.
Published: December 2021

The Committee on Adolescence was aware of the differing and deeply held opinions by fellows of the Academy about pregnancy and abortion in adolescents. Nevertheless, the Committee believed that the membership of the Academy desired information and guidance on this subject. The Committee is aware that the subjects of pregnancy and abortion during the teenage years are not the sole province of pediatrics, but encompass many elements of society. Nevertheless, the pediatrician dealing with the adolescent is confronted with these difficult issues and needs guidance in dealing with them.