bluuebunny/crossref_metadata_2025 huggingface dataset:
Necrotizing External Otitis
Authors: Rubinstein Ethan , Ostfeld Ervin , Ben-Zaray Shlomo , Schiby Ginnette
Published: December 2021

Necrotizing external otitis in an infant receiving cytostatic therapy for neuroblastema has been described. The disease is characterized by invasion and necrosis of the skin and cartilage of the external ear. P aeruginosa is the usual pathogen isolated in this infection. The disease should be suspected in infants with severe underlying conditions and who have external otitis that does not respond to local therapy. Vigorous antibiotic therapy and possible surgical intervention are indicated.
Contraindications to the Pill
Authors: Emans S. Jean
Published: December 2021

I was pleased to see the well-written article by D. E. Greydanus and E. R. McAnarney on "Contraception in the Adolescent" (Pediatrics 65:1, 1980) initiating the decade of the 80s. In their statement about oligomenorrhea, I believe it would be more helpful to emphasize the need to evaluate the underlying cause of the oligomenorrhea. In our recent review of oligomenorrhea in adolescent girls (S. J. Emans, E. A. Grace, and D. P. Goldstein, unpublished data), 14/42 had hirsutism and polycystic ovaries; in these cases, suppression with birth control pills is often the treatment of choice.
Psychoactive Medicinal and Nonmedicinal Drug Use Among High School Students
Authors: Roush George C. , Thompson W. Douglas , Berberian Rosalie M.
Published: December 2021

Although concern has been voiced regarding the medical profession's relationship to nonmedicinal drug use, few data are available. In a random sample of more than 1,000 New Haven area high school students, nonmedicinal use was 1.9 to 11 times greater among those students with a history of three or more recommendations of a psychoactive drug by a physician as compared to those students who had never received such a recommendation. The relationship between medicinal psychoactive drugs and nonmedicinal drug use persisted while potentially confounding variables were controlled and was statistically significant for cigarettes, marijuana, amphetamines, barbiturates, and heroin use with odds ratios of 2.0, 1.6, 3.1, 4.0 and 6.2, respectively. The relationships of cigarette, marijuana, amphetamine, and heroin use to physician recommendation of a psychoactive drug appeared to be as strong as those of previously identified correlates of nonmedicinal drug use. The results were not attributable to artifacts of reporting. Although causal mechanisms cannot be inferred from these cross-sectional data, the results may have implications for preventive programs aimed at decreasing nonmedicinal drug use.
Immunodeficiency in Congenital Chyluria
Authors: Arnold Watson C. , Steele Russell W.
Published: December 2021

Chronic thoracic duct drainage in the experimental animal has been employed to deplete thymic dependent lymphocytes with resultant cellular immune deficiency.1-3 The human clinical correlate is the patient with chylothorax or even more analogous, chronic chyluria. The most common cause of chyluria worldwide is filariasis. Other causes include trauma, tuberculosis, neoplasms, infections, lymphactic aneurysm, and thoracic duct stenosis.4 We recently evaluated a child with this defect, giving us the opportunity of evaluating the effect of chronic T-cell depletion on immune reactivity.

CASE REPORT

J.K. is a 6-year-old Korean boy who was adopted at 2 years of age. Family history is unknown.
Liver Glycogenosis Caused by a Defective Phosphorylase System: Hemolysate Analysis
Authors: Baussan C. , Moatti N. , Odievre M. , Lemonnier A.
Published: December 2021

Investigated were 24 cases of glycogenosis caused by a reduction in liver phosphorylase activity. The intravenous glucagon tolerance test could not discriminate between phosphorylase kinase deficiency [glycogen storage disease (GSD) IX] and phosphorylase deficiency (GSD VI). These two subgroups were distinguished by hemolysate enzyme assays: (1) GSD IX was characterized by a residual phosphorylase kinase activity, a low activation curve for endogenous phosphorylase b and increased amylo-1,6-glucosidase activity. (2) GSD VI was characterized by a normal or increased phosphorylase kinase activity, a slight activation of endogenous phosphorylase b and a normal amylo-1,6-glucosidase activity.
Questions About tcPo2 Transport Study
Authors: Ferrara Angelo
Published: December 2021

The introduction of noninvasive oxygen monitoring equipment for sick neonates has facilitated the stabilization and care of such patients. The field experience of this technology as described by Clarke and colleagues ("Transcutaneous Oxygen Monitoring During Neonatal Transport," Pediatrics 65:884, 1980) is both timely and important to evaluate. In an attempt to understand this study more fully, I would like some elucidation of the research design and results.

First of all, it is difficult to appreciate the randomization process.
More Comments on Early Intervention
Authors: Crain Lucy S. , Hanson Marci J.
Published: December 2021

Piper and Pless (Early Intervention for Infants with Down Syndrome: A Controlled Trial. Pediatrics 65:463, 1980) present a very controversial topic in an unfortunately negative frame. This could lead the majority of primary pediatricians to view their article as a damning indictment of any meritorious effect of early intervention programs for children with Down syndrome.

While critiques regarding selection factors, use of assessment instrument (the Griffiths scale), and duration and timing of intervention could be directed toward this study, more important points are at stake.
Letters to the Editor
Authors: Barness Lewis A.
Published: December 2021

Dr Ganelin has stated very well many of the arguments that occurred in the Committee during the development of the latest commentary on supplemental foods. Trying to convert from previous practices of feeding solids at 1 month of age to the present recommendations must be done stepwise. I am sure that Dr Ganelin would be surprised at the number of bitter letters we have received stating that solid feedings at 1 month have untold advantages.
Controlled Study of Transpyloric and Intermittent Gavage Feeding in the Small Preterm Infant
Authors: Pereira Gilberto R. , Lemons James A.
Published: December 2021

There were 53 appropriate for gestational age infants with a birth weight of less than 1,700 gm admitted to the Children's Hospital in Denver who were randomly assigned to two groups for gavage or transpyloric (nasojejunal) feedings. The two groups were not significantly different in terms of gestational age, birth weight, and morbidity. No significant differences were observed for caloric intake after 4 days of age, growth parameters (weight, length, and head circumference), serum total protein levels, feeding-related complications, duration of intravenous fluid supplementation, and length of hospitalization. The results indicate that intermittent gastric gavage feedings are as efficacious as transpyloric feedings in supplying nutrition to the low birth-weight infant. Because of inherently greater risks, costs, radiation, and requisite personnel expertise, transpyloric feedings cannot be recommended as a routine method of feeding for the low birth-weight infant.
Familial Third and Fourth Pharyngeal Pouch Syndrome with Truncus Arteriosus: DiGeorge Syndrome
Authors: Raatikka Marja , Rapola Juhani , Tuuteri Leena , Louhimo Ilmo , Savilahti Erkki
Published: December 2021

A family is presented in which three of four siblings had truncus arteriosus and other anomalies compatible with the third and fourth pharyngeal pouch syndrome (DiGeorge syndrome). The syndrome is uncommon and most of the reported cases have been solitary. In this family an autosomal recessive inheritance is possible.
Comment on Burnout
Authors: Gordon Harry H.
Published: December 2021

The "quote attributed to Hillel" (Pediatrics 65:1161, 1980) is an incorrect translation from the Hebrew. The quote (p 1163) should read: "He used to say; if I am not for myself, who will be for me? And if I am only for myself, what am I? And if not now, when?" The saying is customarily used to encourage consideration of others.

Implementing the individual and organizational strategies recommended by Marshall and Kasman should help personnel develop a desirable "detached concern."1
Nephrotic Syndrome Family Self-Assessments Questioned
Authors: Sabbeth Barbara F.
Published: December 2021

The report by Vance et al "Effects of Nephrotic Syndrome on the Family: A Controlled Study"1 warrants further comment. The authors conclude that in general the frequency of serious problems experienced by parents and siblings of children with nephrotic syndrome may not be as great as was once assumed. Their conclusion is inadequately supported by data which consist mainly of self-assessments.

Usually an individual's assessment of his/her problems differs considerably from an interviewer's more objective judgment and from scores on a standardized test.
Letters to the Editor
Authors: Pless I. B.
Published: December 2021

We certainly appreciate the concerns expressed by Dr Sabbeth about the interpretation of the results presented in our paper. In the "Discussion" we acknowledged some of the limitations associated with the methods employed and agreed that the defense mechanisms cited may well conceal much of what we expected to find. We were somewhat surprised at the results, but in view of the fact that so few previous studies used appropriate control subjects, perhaps we should not have been.
Intramural Gastric Hematoma in a Hemophiliac with an Inhibitor
Authors: Gordon Robert A. , d'Avignon Marc B. , Storch Alan E. , Eyster M. Elaine
Published: December 2021

A rare complication of an intramural gastric hematoma developed in a hemophiliac with an inhibitor. Ultrasonography assisted in making the correct diagnosis.
Paper Diapers and Positive Ferric Chloride Test
Authors: Porter George E.
Published: December 2021

We have had an interesting experience in our office where we do routine ferric chloride tests on our newborn infants as well as a check for glucose at the time of their first visit.

We recently came up with a positive ferric chloride test on a child's diaper. Urine was collected and sent to the Metabolic Disorders Laboratory at the Massachusetts Department of Public Health State Laboratory in Jamaica Plain; test results were normal. Results of tests performed at the time of the child's birth were also normal.
Letters to the Editor
Authors: Pereira Gilberto
Published: December 2021

I think it is important to stress that the dose of Intralipid used in the study in the amount of 1 gm/kg over a four-hour infusion was selected for two major reasons. The first reason was that the dose was the one used by Andrew and others in the initial studies of Intralipid clearance in newborn infants. We wanted to compare the peak levels of free fatty acids and triglycerides in our patients following a similar dose given over a similar period of time.
Dose of Mannitol for Increased Intracranial Pressure
Authors: Porayko Michael K. , Baptist Errol C.
Published: December 2021

We read with interest the recent article on Reye's syndrome by Shaywitz et al1 with its excellent treatment protocol.

The article, however, contains a serious error in the dose of mannitol given, both in Table 3 and in the text. The dose of 0.25 to 1 mg/kg/dose is far too low and should have read 0.25 to 1 gm/kg/dose, in accordance with the dose in current use.
ABRAHAM JACOBI ON MEDICAL SPECIALIZATION, AS VIEWED IN 1880
Authors: C. T. E.
Published: December 2021

Abraham Jacobi (1830-1919), this country's first professor of infantile pathology and therapeutics, and the first to establish a children's clinic in the United States (1860), had strong views concerning medical specialization. This is evident in the quotation below, taken from an address he gave at the 1880 meeting of the American Medical Association.1

We are surrounded by specialists of all sizes and regions. The human body is held no longer to be an organism, but a conglomerate of organs which have no connection with each other. One man doctors the eye as another plays on the violin; another the larynx, as one plays the harp; another on the rectum, as one handles the bass. Eyes are by this time a recognized specialty, the practice on which requires a great deal of practical skill and dexterity. The ears have been thrown in, as, though the diagnosis of their diseases has made great progress, their medication and other treatment is, in many cases, rather a thankless task. Nose, throat, and larynx have been conquered as special property. Lungs and heart are also claimed as such; the urinary organs are invaded by specialists; the sexual organs of the male are the field of operation on the part of specialists; the sexual organs of the female, with their appendages, are sacred property of another class, and these appendages are said to extend from top to toe; the skin, this fourteen square feet domain, is no longer subject to the general practitioner; the hair is coveted by one specialist, corns by another, nervous diseases by this, rheumatism by that specialist.
Transient Erythroblastopenia of Childhood Presenting with Reticulocytosis and Erythroid Hyperplasia in the Bone Marrow
Authors: Dickerman Joseph D.
Published: December 2021

Transient erythroblastopenia of childhood (TEC) is a benign condition, occasionally preceded by an upper respiratory tract infection, affecting infants and children between 1 month and 6 years of age. At presentation, it is characterized by anemia, which may be quite severe, reticulocytopenia, and absent or markedly decreased erythroid precursors in the bone marrow. Spontaneous resolution occurs in two to eight weeks without therapy. With the exception of pallor, there are no abnormal physical findings.1-3 It has recently been demonstrated that serum and IgG specimens obtained at the time of diagnosis in four patients with TEC uniformly suppressed erythroid colony development from CFU-E whereas one patient had a serum inhibitor of erythropoiesis; thus, a transient immune suppression phenomenon is implicated as a possible factor in the development of anemia.4
Neonatal Necrotizing Enterocolitis Associated with Penicillin-Resistant, Toxigenic Clostridium butyricum
Authors: Sturm Randall , Staneck Joseph L. , Stauffer Larry R. , Neblett Wallace W.
Published: December 2021

In the article "Neonatal Necrotizing Enterocolitis Associated with Penicillin Resistant, Toxigenic Clostridium butyricum" by Sturm et al (Pediatrics 66: 928-931, 1980) reference 2 (p930) should read as follows: Burrington JD: Necrotizing enterocolitis in the newborn infant. Clin Perinatol 5:29, 1978.
Letters to the Editor
Authors: Baron Michael A. , Fink Howard D.
Published: December 2021

Drs Paulson and McClelland are correct in pointing out that some undetected cases of bacteremia may have been present in those patients whose blood was not cultured. However, these babies were significantly different ent from the eight infants with proven bacteremia, as none of them developed complications while two of the eight developed cellulitis: According to the X2 test, the probability that these two groups are different only by chance is considerably less than 1:100, and the two statistical analyses in the paper showed similar results.
Letters to the Editor
Authors: Campbell L. Rebecca , Zedd Arnold J. , Michaels Richard H.
Published: December 2021

Dr Walker has presented a concise summary of distinctions between epiglottitis and meningitis due to Haemophilus influenzae type b, suggesting that there may be a difference in pathogenesis for these two conditions. Two epidemiologic distinctions can be added. Ounsted1 has shown that children with Haemophilus meningitis almost invariably have siblings. This is not true for those with pneumococcal or meningococcal meningitis, and it is also not true for children with epiglottitis. 2 There is also a seasonal distinction.>
Prophylaxis of Otitis Media
Authors: Kishel Mark , Borg Sandra
Published: December 2021

We read with interest Dr Paradise's article1 on otitis media and would like to comment on the appropriate use of penicillin G in the chemoprophylaxis of otitis media in susceptible children.

Although Drs Klein and Finland2 found lower minimal inhibitory concentrations (MICs) needed for penicillin G than penicillin V against Haemophilus influenzae, we found subsequent studies that indicate even higher MICs are necessary for penicfflin G.3,4 Maintaining adequate blood levels with penicillin G presents problems, in that the drug is excreted rapidly by the kidneys, and excreted even more rapidly in children.5
Must We Teach ‘Clinical Judgement’?
Authors: Bloom Henry R.
Published: December 2021

The senior clinician enters the examination room with the resident, intern, and student. On the examination table sits a disconsolately crying toddler with a temperature of 40 C. The mother sits anxiously next to the table.

The clinician tells the mother to put the child on her lap and begins, in a quiet, sympathetic way, to talk with the mother about the child's history. The clinician listens carefully, repeating the mother's phrases back to her. She begins to relax and smile a bit as her child accepts a shiny penlight from the clinician who is listening to her recital.
Chloride Deficiency and Alkalosis
Authors: Finberg Laurence
Published: December 2021

I was pleased to see the excellent paper by Grossman et al entitled "The Dietary Chloride Deficiency Syndrome" (Pediatrics 66:366, 1980). The very carefully reported growth data will be useful to all of us interested in electrolyte abnormalities. I should like to add a nuance concerning the pathophysiology of alkalosis secondary to chloride deficiency.

Whereas everything the authors said is surely correct insofar as our present understanding is concerned, there is now evidence that makes it even easier to understand how a chloride-deficient state leads to alkalosis.
Expanding Horizons on a Diminishing Planet
Authors: Henderson Donald A.
Published: December 2021

I am honored and pleased to be given the opportunity to participate with you today in your celebration of an extraordinary 50 years of achivement1—a history which, even when viewed through a critical retrospective lens, can bear with distinction the appellations of prescient, bold, imaginative, and progressive. I doubt there is today any other professional medical organization which can display with pride such a record without developing a revisionist history adapted to the flow of subsequent events. It is obvious that the Academy has led, not followed; that it has deliberately and aggressively pursued concepts in prevention which were often more visionary than those advocated by leaders in my own field; and that this year, it has boldly extended its purview to embrace an even broader range of objectives in stating its "National Child Health Goals."2

Rightly, the Academy has recognized that solutions today must transcend the conventional boundaries of curative medicine. In enunciating your goals, you have implicitly recognized this in identifying objectives which will require an active partnership with educators and environmentalists, behavioral scientists, and politicians alike in the interests of healthier children.

The past 50 years have witnessed unprecedented changes in medicine, in science in its totality—indeed, in our entire social structure and values. We can be confident that the next 50 years will bring even more revolutionary changes, but can we anticipate them any better than we anticipated the computer, organ transplantation, or the atom bomb? At a far more mundane level could the surgeon-general in the midst of a 1930 Washington heat wave have anticipated that the now ubiquitous air-conditioner would be in common use only 20 years hence?
Indomethacin and Its Effect on Renal Function and Urinary Kallikrein Excretion in Premature Infants with Patent Ductus Arteriosus
Authors: Betkerur M. V. , Yeh T. F. , Miller K. , Glasser R. J. , Pildes R. S.
Published: December 2021

In the course of a double-blind trial of intravenous indomethacin therapy in premature infants with patent ductus arteriosus, renal function and urinary kallikrein were studied in 21 infants following one dose of either saline placebo or indomethacin. Ten infants were assigned to the control group and 11 were in the indomethacin group. Significantly lower urine output, fraction excretion of sodium, fraction excretion of chloride, and urinary kallikrein were noted by 45%, 59%, 63%, and 51%, respectively, in the indomethacin group as compared to the control group. There was a concomitant decrease in serum sodium concentration (P .05) at 24 hours following indomethacin therapy. No significant difference in glomerular filtration rate was seen between the control group and the indomethacin-treated infants.
THE FIRST JOURNAL DEVOTED EXCLUSIVELY TO PEDIATRICS (1834)
Authors: C. T. E.
Published: December 2021

The first pediatric journal ever published appeared in 1834 and was known as the Analekten über Kinderkrankheiten; it was published in Stuttgart and lasted for only three years. During its short life this journal contained several notable articles which could stifi be read with interest by present-day pediatricians.

Among the authors whose articles were published were: C. W. Hufeland (1762-1836), Court physician at Weimar and author of one of the most popular books of its time on personal hygiene, published in 1797; J. B. Bouillard (1796-1881), who in 1835 was the first to demonstrate the frequency and importance of heart disease coincident with acute articular rheumatism; and P. DuBois (1795-1871), who published the first detailed description of hyperemesis gravidarum in 1852.
ON THE PROPER TREATMENT OF INFANTS ACCORDING TO DAVID RAMSAY OF SOUTH CAROLINA (1790)
Authors: C. T. E.
Published: December 2021

David Ramsay (1749-1815), a pupil of Benjamin Rush, was a Revolutionary patriot and statesman, historian, and practitioner. In 1790, in a dissertation which he read before the Medical Society of South Carolina, he offered the following suggestions to those caring for infants.

The foundation of good health through life, should be laid in a proper treatment of infants. Their limbs should be unconfined, and frequently rubbed. Their food ought to be plain and simple. They should be constantly clean, and never suffered to remain wet for any length of time. Caps should be laid aside after the third or fourth month in winter, and much sooner in summer. Shoes and stockings may well be dispensed with through the whole period of infancy. Every prudent exertion should be early made for hardening the constitution against sudden changes of the atmosphere. To this end exercise should be freely and daily taken in the open air. When the weather turns suddenly cold, some additional clothing may be proper; but it is often more for the interest of children to habituate them to all the differences of our weather, and even to expose them to occasional colds, than by an excess of care and tenderness to induce a delicacy of habit....

In nursing cradles are hurtful. They add much to the heat of the infants who are confined between their narrow sides. A hard mattress is much cooler and on many accounts preferable. The youths who are accustomed to sleep on the floor with bare blankets will pass through life with more independence and with greater advantages than they who are accustomed to the relaxing indulgencies of soft beds....
THE HEALTHIEST COUPLE
Authors: Carlyon William
Published: December 2021

They brush and they floss with care every day, But not before breakfast of both curds and whey.

He jogs for his heart she bikes for her nerves; They assert themselves daily with appropriate verve.

He is loving and tender and caring and kind, Not one chauvinist thought is allowed in his mind.

They are slim and attractive well-dressed and just fun. They are strong and well-immunized against everything under the sun.

They are sparkling and lively and having a ball. Their diet? High fiber and low cholesterol.

Cocktails are avoided in favor of juice; Cigarettes are shunned as one would the noose;

They drive their car safely with belts well in place; at home not one hazard ever will they face.

1.2 children they raise, both sharing the job. One is named Betty, .2 is named Bob.

And when at the age of two hundred and three they jog from this life to one still more free,

Theyll pass through those portals to claim their reward and St. Peter will stop them "just for a word."

"What Ho" he will say, "You cannot go in. This place is reserved for those without sin."

"But weve followed the rules" she'll say with a fright. "We're healthy"– "Near perfect"– "And incredibly bright."

"But thats it" will say Peter, drawing himself tall "You've missed the point of living By thinking so small."

"Life is more than health habits, Though useful they be, It is purpose and meaning, the grand mystery."

"You've discovered a part of what makes humans whole and mistaken that part for the shape of the soul."
THE APPALLING INDUSTRIAL HAZARDS TO WHICH AMERICAN WORKING CHILDREN WERE EXPOSED IN 1900
Authors: C. T. E.
Published: December 2021

In 1900 one-third of the workers in our Southern mills were children. For the United States at large about twenty percent of all children between 10 to 15 years of age were employed as full-time factory workers. At the turn of the century child labor was a practice encouraged by industry, agreed to by parents, and generally ignored by government. To call attention to the evils of child labor, John Spargo, an American reformer and author, published his impassioned book entitled, The Bitter Cry of Children, in 1906.

In it he wrote:

It is a sorry but indisputable fact that where children are employed, the most unheathful work is generally given them. In the spinning and carding rooms of cotton and woollen mills, where large numbers of children are employed, clouds of lint-dust fill the lungs and menace the health. The children have often a distressing cough, caused by the irritation of the throat, and many are hoarse from the same cause. In bottle factories and other branches of glass manufacture, the atmosphere is constantly charged with microscopic particles of glass. In the wood working industries, such as the manufacture of cheap furniture and wooden boxes, and packing cases, the air is laden with fine sawdust. Children employed in soap and soap-powder factories work, many of them, in clouds of alkaline dust which inflames the eyelids and nostrils. Boys employed in filling boxes of soap-powder work all day long with handkerchiefs tied over their mouths. In the coal-mines the breaker boys breathe air that is heavy and thick with particles of coal, and their lungs become black in consequence.
Testing for Polychlorinated Biphenyls in Human Milk
Authors: Wickizer Thomas M. , Brilliant Lawrence B.
Published: December 2021

Reports of polychlorinated biphenyl (PCB) contamination of human milk have raised questions about the possible risks of breast-feeding and whether nursing mothers ought to have their breast milk tested. Current data on contamination of human milk are needed so that pediatricians can make informed recommendations about breast milk testing and breast-feeding. With consideration of recent findings of PCB contamination of human milk in Michigan, recommendations concerning breast milk testing and breast-feeding are made. No major changes in current breast-feeding practices are advised. However, breast milk testing is recommended for certain nursing mothers who have had potentially high exposure to PCBs. Limiting the duration of breast-feeding may also be advisable for mothers with high PCB milk fat levels in order to reduce infant exposure to PCBs.
The ‘Infant Formula Controversy’: A Notorious Threat to Reason in Matters of Health
Authors: May Charles D.
Published: December 2021

Few pediatricians could have spared the time to follow the so-called "infant formula controversy" closely enough to sift out the main issue, nor could much help have come from the confused coverage in the mass media. The infant formula controversy refers to intemperate attacks on those companies marketing prepared infant formulas in Third World countries, in which epithets like "Baby Killers" and "Declaring War on Babies" were broadcast.

The agitation behind these outbursts was originally stimulated by a growing concern shared by many that the already frightful infant morbidity and mortality in underdeveloped countries could be aggravated by a decline in prevalence of breast- feeding observed in some regions.
The World Health Organization Code of Marketing of Breastmilk Substitutes
Authors:   Board of Directors of the Ambulatory Pediatric Association
Published: December 2021

At its business meeting in April 1981, the Ambulatory Pediatric Association voted to urge the United States delegation to the World Health Assembly to vote for the adoption of the International Code of Marketing of Breastmilk Substitutes. (The APA resolution, which summarizes salient features of the Code, is shown in the Table.) This action followed two prior resolutions: one at the 1979 meeting expressing concern about "significant risks to child health ... associated with artificial feeding in the developing world," and the second in 1980, supporting the boycott of Nestle's products. In May 1981, the United States was the only nation to vote against the Code. Following the vote, the US House of Representatives condemned the Administration's position by a vote of 301 to 100, and the Senate expressed its concern by a vote of 89 to 2. In view of the current controversy and the crucial role pediatricians play in influencing feeding practices, we think it important to consider (1) the effects of promotion of infant formulas, (2) criticisms of the Code, and (3) the responsibility of pediatricians toward promotion of infant formula.

Despite claims to the contrary, marketing of infant formula influences maternal feeding practices. In recent testimony before the House Subcommittee on International Economic Policy and Trade, Carl Taylor, Professor and Head of the Department of International Health at the Johns Hopkins School of Hygiene and Public Health presented some evidence:1 Massive advertising and availability of formula have been associated with a decline in breast-feeding in oil-rich Arab countries so that only 15% of mothers are nursing their babies at 3 months of age.
Letters to the Editor
Authors: Starko Karen M. , Ray C. George
Published: December 2021

We believe the evidence presented by Drs Clark and Fitzgerald is insufficient to reject the hypothesis that salicylate causes or contributes to the cause of Reye's syndrome.

First, at least for single-dose ingestions, a critical factor in the interpretation of serum salicylate bevels is the time between ingestion and the determination of the level.1 Although the salicylate levels described by Clark and Fitzgerald are within the range of what is generally considered nontoxic, the significance of these levels is unclear without knowledge of the time that had elapsed since ingestion.
Letters to the Editor
Authors: McAnarney Elizabeth R.
Published: December 2021

The article entitled "Teenaged and Pre-teenaged Pregnancies: Consequences of the Fetal-Maternal Competition for Nutrients" (Pediatrics 67:146, 1981) is a timely and important contribution. One of the greatest strengths of the paper is that Dr Naeye considered factors other than maternal age that affect fetal growth: namely, maternal pregravid body weight for height, pregnancy weight gain, parity, and cigarette smoking.

There are several comments that might be pertinent in considering these data as the debate still continues whether the very young adolescent (10 to 14 years of age) has a biologic predisposition to bear more low birth weight babies than older adolescents or adults or whether the increased incidence of low birth weight infants born to the very young adolescent reflects fewer prenatal visits and inadequate care and thus, with good care, might be eliminated.
Aflatoxin and Reye's Syndrome: A Case Control Study
Authors: Wray Betty B.
Published: December 2021

What may be one of the most significant findings of our time was noted by Nelson and coworkers in reporting the finding of aflatoxin in the serum of 23% of the subjects in their study. Aflatoxins, which are potent carcinogens in animals,2 are widespread in our environment, and the effects are noted to be more potent in the young of the species.3 Hayes et al4 found aflatoxin in a significant number of soybean infant formula samples, and we have found aflatoxin in the serum of two patients with primary hepatic carcinoma5 as well as two children with leukemia who never went into remission (B. B. Wray and A. W. Hayes, unpublished data).
JOB LEWIS SMITH ON MATERNAL IMPRESSIONS AS A CAUSE OF CLEFT LIP AND PALATE (1890)
Authors: C. T. E.
Published: December 2021

Job Lewis Smith (1827-1897), a founder of the American Pediatric Society and who, with Abraham Jacobi, established pediatrics as a specialty in our country, was a firm believer that strong mental impressions during pregnancy might be a cause of congenital malformations.

He gave the following explanation of the cause of cleft lip and palate in the seventh edition of his textbook, published in 1890.1

Mrs. D[unknown], Eighth avenue, New York, seven months before the birth of her child, when visiting at a distance, accidentally broke the plate of a full set of upper teeth. The line of fracture was antero-posterior and through the centre of the plate. Being away from home, she was much annoyed by the accident and retained the fragments of the plate in situ by pressure with the tongue. As she could not open her mouth without the plate falling out, except it was retained by pressure with the tongue, her mind was dwelling almost constantly on the accident during the few days of her visit. Her boy, born seven months subsequently, had a hare-lip and cleft palate. The mother stated that the deficiency in the lip and palate corresponded precisely to the location of the fracture in the plate.
Neonatal Mortality Review: A Basis for Improving Care
Authors: Hem Herman A. , Brown Cynthia J.
Published: December 2021

Neonatal deaths in Iowa were reviewed to assess educational needs at each of the three levels of care. The review was oriented toward a clinical rather than a pathologic impression of cause of death. Five major categories of disease accounted for 90% of the deaths surveyed in the two years reported, 1978 and 1979. They were: congenital anomalies, birth weight ≤750 gm, respiratory distress syndrome, bacterial sepsis, and asphyxia. Defects in the care system were noted and remedial measures suggested. Based on the mortality data accumulated, an idealized neonatal death rate was calculated, and from this, an estimate of potentially salvageable deaths was offered. Small hospitals with low neonatal death rates were found to be an important source of potentially preventable deaths. Other states and regions interested in evaluating a regionalized system of perinatal health care may wish to consider a review of causes of neonatal deaths similar to the approach illustrated for Iowa.
MY COLD
Authors: Anderson Lori
Published: December 2021

Gag

cough

sneeze

wheeze

I have a cold!

I just can't, please!

No matter what they have me take.

I have a cold!

I just can't take.

Cough

wheeze

gag

sneeze

I have a cold!

I just can't, Please!!!
A NEW BREED OF NURSES NEEDS TO BRIND NURSING BACK TO THE BEDSIDE
Authors: Roberts A. D.
Published: December 2021

What are we offered today by the aggressive new breed of leaders and educators in nursing? An angry, dwindling profession, failing with increasing frequency to meet the needs of patients and physicians and in the process making themselves and everyone else miserable. The idealistic young people who come into the profession to actually nurse patients are sometimes made to feel like Aunt Jemiinas, become discouraged and leave, or, if they remain, are denied status, promotions and raises.

The "new model" nursing leaders and educators pursue higher status, higher incomes, more respect and recognition—as indeed most of us do. There's nothing wrong with that. What is damaging is the mode of attack.

By striving to capture some independent middle ground between classical nursing and medical practice, nursing leaders threaten to make of their professionals neither nurses nor physicians, fit only to cause trouble: trouble for people who really want to nurse, trouble for physicians and administrators who can't get the help they need and, most of all, trouble for patients, who often cannot get timely medicines and competent ministrations without hiring a private-duty nurse. And even then competence is far from assured.

Many nursing leaders and educators seem intent on abandoning a badly needed profession in the search for a new category of health-care professional that no one has asked for and hardly anyone needs. They have not merely neglected and downgraded classical, basic nursing; they have also sought to restrict entry into the profession by raising the standards of accreditation of schools of nursing and of licensure of individuals in many instances beyond what is necessary for the basic skills that are in such short supply.
Pulmonary Embolism in a 14-Year-Old Following an Elective Abortion
Authors: Nudelman Robert , Best Lincoln , Tharp Susan
Published: December 2021

In the United States 300,000 or more adolescent pregnancies are terminated annually by legal abortions.1,2 Pulmonary embolism is an infrequent, yet known, complication of this procedure.3 To increase the awareness of this potential problem in pediatrics, we report the case of a 14-year-old girl with radiologically documented pulmonary embolism associated with a prior elective abortion.

CASE REPORT

A black 14-year-old gravida 2, para 1, abortus 1 was seen at the emergency room of another hospital with a four-day history of increasing left-sided pleuritic chest pain. During the first two days of her illness, the patient also complained of shaking chills and fever.
Burn Hazard of Isopropyl Alcohol in the Neonate
Authors: Schick James B. , Milstein Jay M.
Published: December 2021

Isopropyl alcohol is a commonly used disinfectant. In the hospital setting, alcohol pledgets have occasionally been substituted for conducting electrode paste beneath limb electrodes. To our knowledge, there are no reports of complications of this or any other use of isopropyl alcohol in the nursery. We report two cases of second-and third-degree burns in premature infants.

CASE REPORTS

Case 1

A 756-gm female infant of 27 weeks' gestation was born vaginally to a 22-year-old primigravida following 36 hours of bleeding. Apgar scores were 2 and 6 at one and five minutes, respectively. Initially, the infant required vigorous resuscitation, followed by gradual clinical deterioration on day 1, including increasing hypotension, ventilator dependency, and intraventricular hemorrhage.
Stretching a Minute
Authors: Ross Maurice
Published: December 2021

article by Reisinger and Bires entitled "Anticipatory Guidance in Pediatric Practice"1 and Hoekelman's commmentary, "Got a Minute,"2 in the December 1980 issue of Pediatrics offer a challenge to the practi perician.

The real issue may be whether or not time at a specific visit is an appropriate parameter for measuring anticipatory guidance. Does every patient require anticipatory guidance at every visit? Perhaps one should consider well-child visits as rituals that afford pediatricians an opportunity to assess the need for anticipatory guidance and offer it when indicated.

There are numerous methods of rapidly assessing patients' needs. These include measurements of height, weight, and head circumference plotted on growth charts; health questionnaires that include review of systems, emotional problems, and school performance; and developmental lag check lists such as the Denver Prescreening Developmental Questionnaires.
Letters to the Editor
Authors: Thompson Joel A.
Published: December 2021

Dr Shaw expresses concern over withholding honey from large numbers of infants in an effort to prevent infantile botulism. He suggests that the finding of spores in a few samples of honey does not justify withholding honey from a large number of children and also suggests that there is no proof that the spores grow in the honey and produce toxin. In our study of infants in Utah with infantile botulism we did fmd two honey specimens in which organism could be isolated.
Letters to the Editor
Authors: Korsch Barbara
Published: December 2021

The observations and conclusions of Schaff and Hoekelman are consistent with our own findings based on a systematic study of four internship years. We are glad to see others interested in the process and quality of the educational experience, although their emphasis primarily on scheduling and workload is slightly different from ours.

We also are pursuing ways of reducing the multiple stresses in the training program. However, many of these stresses are unavoidable, not only during the training period, but also in the subsequent clinical practice of pediatrics.
Airbags and Children
Authors: Beuf Francesco G.
Published: December 2021

The article "Effect of Pediatricians' Counseling on Infant Restraint Use," by Reisinger et al (Pediatrics 67: 201, 1981) is an excellent statement of the importance of constantly reminding parents to safely restrain children and infants while they are traveling by automobile. In addition, the authors' recommendation that pediatricians and other child care personnel actively support legislation to promote safer vehicle (including school bus) design and use is an important point.

On one issue, however, I take strong exception to the authors' conclusions; their suggestion that pediatricians support legislation requiring the use of air bags is, in my opinion, incorrect.
Letters to the Editor
Authors: Ferry Peggy C.
Published: December 2021

I regret that Dr Lazar misinterpreted some of the statements in my paper, and I apologize if my intentions were unclear. My comments referred specifically (as stated) to the value of intervention programs with neurologically handicapped children. I am not opposed to programs for environmentally deprived children. I share Lazar's concern for sensible parental involvement in the development of children; however, I have not seen parents "often" abandon the child with special needs.

Since I stated specifically in the paper that "large- scale, systematic, and scientifically controlled studies with rigorous methodology are sorely needed," I fail to understand Lazar's comment that "my position discourages systematic longitudinal investigation of the effects of education on the physiologically damaged child."
Adverse Reactions to Parenteral Lincomycin
Authors: Liner Steven R.
Published: December 2021

I am somewhat disturbed by the conclusions that were drawn by Berry et al (Pediatrics 67: 389, 1981) based on their 13 years of experience with lincomycin. The incidence of pseudomembranous colitis associated with lincomycin has been estimated to be 0% to 10% in adults. If it was as low as 0.5% in children, the chance of not seeing any cases among your 265 patients would be (0.995)265 or 26.5%. With 265 patients, one may conclude that the incidence is probably less than 2% (P > .005), but further statements as to the occurrence of lincomycin-associated pseudomembranous colitis cannot be made without considerably more cases.
Cognitive and Psychosocial Development of 4-Year-Old Children Whose Mothers Were Treated Antenatally with Betamethasone
Authors: MacArthur B. A. , Howie R. N. , Dezoete J. A. , Elkins J.
Published: December 2021

The present study was part of a larger study investigating the long-term development of children of mothers included in a controlled trial of betamethasone therapy in preterm labor; the purpose was to determine whether there are any benefits or hazards of treatment detectable up to the seventh year of life. The first 318 children of mothers included in the trial because of spontaneous premature labor were selected for study. Of 305 survivors, 258 (84.6%) were included in this phase of the study. Detailed tests of psychological development, together with assessments of psychosocial background, were made during the fifth year. Of the 258 children 144 were in the betamethasone group and 114 were control patients. Despite a heavy weighting of the betamethasone group with more prematurely delivered infants and more boys (resulting from improved perinatal survival of these children associated with betamethasone therapy), no significant differences emerged between the groups in measures of outcome. It was concluded that betamethasone therapy, under the conditions of the original trial, was not hazardous to cognitive development as measured in this study.
Effect of Physical Training on Exercise Performance of Children Following Surgical Repair of Congenital Heart Disease
Authors: Goldberg Barry , Fripp Raymond R. , Lister George , Loke Jacob , Nicholas James A. , Talner Norman S.
Published: December 2021

The effect of physical training on the exercise performance of 26 patients following surgical repair of tetralogy of Fallot (16 patients) and ventricular septal defect (ten patients) was evaluated. Base line exercise testing was performed on a bicycle ergometer using the technique of Godfrey. Patients were placed on a six-week alternate day submaximal interval home exercise program of varying duration and intensity. Work loads at 50%, 60%, and 70% maximum oxygen consumption were selected to maintain heart rates between 130 and 160 beats per minute. Subjects completed an average of 18 of the possible 21 training sessions (range 11 to 21). A 25% improvement (P < .001) was noted in maximum work capacity (747 to 935 km). Sixty-five percent of the patients performed at less than expected maximum work capacity prior to training, but only 31% performed at less than expected maximum work capacity after training. Repeat testing at work loads of one-third, one-half, and two-thirds the original maximum work capacity revealed improved aerobic efficiency as manifested by significantly decreased oxygen consumption and heart rate at each level of work. No significant difference was noted in maximum oxygen consumption. It is concluded that physical training can improve the exercise performance of patients after surgical repair, permitting the individuals to function at levels of activity at, or closely approaching, normal.
Social Context of Child Development
Authors: Eisenberg Leon
Published: December 2021

Theories of child development, no less than the ways in which children develop, are influenced by social context. This thesis is illustrated by examples drawn from three areas relevant to pediatrics. First, given the data demonstrating that fewer biologic and social hazards result from first trimester abortion than from carrying an unwanted pregnancy to term, the current controversy about abortion can only be understood in relation to concerns about contemporary patterns of sexual behavior, contraceptive use, and preferred family size. Second, now that the majority of mothers are employed in the work force, stress on the importance of "bonding" in early infancy, on the basis of dubious evidence, leads to unwarranted implications for social policy. Third, in contrast to the traditional American belief in public schools as instruments for the democratization of our society, public education is now being assailed as useless (and thus undeserving of funding) despite data indicating that schools make a difference to both academic and behavioral outcomes. In these controversies, differing value commitments lead to the choice of different data sets to justify a priori conclusions. Social theories are, by their very nature, value-laden but they can nonetheless be effective guides to action if those values are made explicit.