bluuebunny/crossref_metadata_2025 huggingface dataset:
VENTILATION AND RESPIRATORY GAS TRANSFER OF INFANTS WITH INCREASED PULMONARY BLOOD FLOW
Authors: Lees Martin H. , Way R. Clifton , Ross Benjamin B.
Published: December 2021

Ventilation and respiratory gas transfer was studied in 44 infants; 13 of whom had pulmonary overperfusion without pulmonary edema or transposed great arteries. In order to assess the evenness of ventilation/perfusion ratios throughout the lung, (VA/Q distribution) measurements were made of the urine-alveolar nitrogen tension difference (U-Ā)DN2 in a separate group of six normal children and seven children with pulmonary overperfusion.

Infants with pulmonary overperfusion (left-to-right shunts) had normal alveolar ventilation (149.6±18.2 ml/minute/kg). Respiratory rate (38.1±10.2) was slightly increased and tidal volume (6.0±1.3 ml/kg) was diminished, possibly due to reduced lung compliance. Measurements of dead space, dead space/tidal volume ratio, and alveolar ventilation/oxygen consumption ratio were unremarkable.

No significant arterial-alveolar CO2 difference was detected in either normal subjects or those with heart disease, but a significantly increased alveolar-arterial O2 tension difference (A-a)DO2 of 22.4±8.6 mm Hg was found in infants with overperfused lungs.

Measurements of (A-a)DO2 during 100% oxygen breathing and measurements of (U-Ā)DN2 in the air-breathing subjects both suggested that intrapulmonary venous admixture rather than VA/Q unevenness was the principal factor causing lowered oxygen tensions in the arterial blood of infants with overperfused lungs.

Lowered arterial oxygen tension was associated with only trivial arterial unsaturation (92.8±2.4%) due to the high affinity of hemoglobin for oxygen.
Treatment of Tetanus Neonatorum
Authors: ANZARI MANZOOR
Published: December 2021

The successful treatment of newborn tetanus has continued to be a challenge. An appreciable drop in the mortality rate for this disease from a high percentage of some 80% to a current 36% has occurred only within the past 10 years. In a retrospective appraisal of treatment, it would seem that antitoxin serum has not been specific in the treatment of tetanus or in a decrease of the mortality rate; whereas heretofore, neglected supportive treatment was the primary factor contributing to a high mortality rate.
CONGENITAL DIAPHRAGMATIC HERNIA AND HYPOPLASTIC LEFT HEART
Authors: Firestone Frederick N. , Popper Robert W. , Taybi Hooshang , Leonards Richard
Published: December 2021

An infant with the rare combination of congenital diaphragmatic hernia and hypoplastic left heart has been reported. Although herniated viscera in the chest impair bronchial division and cause hypoplastic lungs, this patient demonstrated lung growth and histologic maturation after successful correction of the diaphragmatic hernia. No subsequent change of the hypoplastic left heart toward normal occurred. There is no apparent causal relationship between these two defects.

Creation of an atrial septal defect has been useful in the treatment of hypoplastic left heart. Further clinical trials are encouraged.
THE EFFECTS OF TOBACCO SMOKING IN CHILDREN
Authors: C. T. E.
Published: December 2021

The very first issue of the Journal of the American Medical Association contained the following abstract of a paper published originally in the French Revue d'Hygiene of March 20, 1883 on the evil effects of tobacco smoking in children.

Dr. G. Decaisne, in a paper read before the Paris Société de Médicine Publique, gives observations upon thirty-eight children, between nine and fifteen years of age, where decided effects [due to smoking] were produced in twenty-seven.

Twenty-two had disturbances of the circulation, bruit de souffle in the carotids, palpitation of the heart, difficulty in digestion, indolent intelligence and a decided taste for strong drinks.

Thirteen had an intermittent pulse.

Eight showed a notable diminution of blood corpuscles.

Twelve had frequent attacks of nosebleed.

Ten were restless in their sleep with nightmares.

Two showed slight ulcerations of the buccal membrane, which disappeared promptly on their giving up smoking for a few days.

In one case pulmonary phthisis seemed to have resulted from a profound alteration of the blood due to the long continued use of tobacco.

In eleven children who gave up smoking entirely, with six these symptoms disappeared in less than six months; three still suffered in a minor degree at the end of a year.

He concludes, as the result of his observations collected through twenty years, that the pernicious effects of smoking upon children are incontestable. That it produces intermittence of the pulse, alteration of the blood, and the principal symptoms of chloroanemia, pallor of the countenance, emaciation, bruit de souffle in the carotids, palpitation of the heart, diminution of the normal quantity of the blood corpuscles, and difficulties of digestion. That the mental faculties become sluggish, with a fondness for strong drinks. That the ordinary treatment for chloroanemia produces no effect while the habit continues, and, finally, that with those children who are without organic lesion, all these disorders disappear promptly and without leaving any traces behind, when the habit is discontinued.

Could French tobacco of the 1880's have been all that potent, or was Doctor Decaisne an alarmist?
COMMITTEE ON NUTRITION
Authors: LOWE CHARLES U. , COURSIN DAVID BAIRD , HEALD FELIX P. , HOLLIDAY MALCOLM A. , O'BRIEN DONOUGH , OWEN GEORGE M. , PEARSON HOWARD A. , SCRIVER CHARLES R. , FILER L. J. , KLINE O. L.
Published: December 2021

Despite an imposing body of information derived from research, our ignorance concerning the etiology, pathogenesis, and treatment of obesity is remarkable.

It is clear that when considering a given patient the terms "overweight" and "obese" are not necessarily synonymous. Evidence derived from various viewpoints suggests that obesity cannot be regarded as an etiologically unique metabolic disorder. It is likely that an excess of adipose tissue in man will ultimately prove to represent a clinical end-point common to a variety of hereditary and acquired disorders, as in the case of experimental animals, rather than a singular morbid condition with unique pathogenesis. The identification and evaluation of the inherited, acquired, metabolic, and psychogenic determinants of obesity still present an urgent challenge for future research.

Mortality and morbidity rates for diabetes and cardiovascular disease are higher in obese adults than in those of average weight. These risks appear to be diminished by weight reduction. Because the majority of obese children do tend to remain obese as adults and because our society exerts considerable pressure towards relative leanness as a criterion for social acceptability, early treatment of obesity would seem to be a worthy objective. However, the fact is that no methods of treatment have as yet achieved more than minor success in significant sustained weight reduction. Since the natural history of childhood obesity remains ill-defined, the results of testimonials from inadequately controlled studies with short follow-up periods (less than 2 or 3 years) must be viewed with skepticism.

Any attempts to achieve lasting weight reduction in obese children and adolescents should be tempered by a realization of the inherent difficulties of treatment and by sympathy for those children who, for reasons poorly understood by their physicians. lack the ability to regulate the delicate balance between physical activity and caloric intake. It appears that when treatment is directed at only a single element of the thermodynamic equilibrium, caloric intake, the chances of successful and lasting weight reduction are small.

Prophylaxis may offer the most logical method for dealing with obesity. Prevention is necessary in high-risk families and should be undertaken by the family physician. The role of public health programs implemented by education may decrease the level of obesity in the remainder of the population. The efficacy of either approach remains to be determined.

While there is knowledge of some of the metabolic derangements characteristic of the obese adult, little is known about these in childhood. In view of the apparent hazards of obesity in adult life, the patent failures characteristic of virtually all therapeutic approaches and the scientific void in knowledge of pathogenesis or pathophysiology make the study of obesity a compelling undertaking for the investigator.
Reactions of Those Who Treat Children with Cancer
Authors: Rothenberg Michael B.
Published: December 2021

IT IS MY impression that the reactions of those who treat or otherwise work with children who are dying of cancer or other fatal illnesses develop from a core conflict within each worker. This conflict arises because two powerful and normal, but antithetical emotional responses are elicited simultaneously when one is involved with the care of the dying—or even possibly dying—child. On the one hand, there is the response of compassion which produces the impulse to move toward the child with aid and comfort at every level. On the other hand, there is the response of repulsion by the threat of death which produces the impulse to move away from the dying child in order to begin to protect oneself from the impending shock of separation and loss. The degree of success with which this conflict is resolved determines the degree of success of the individual health care worker in providing comprehensive care for the child with cancer. Before discussing some suggested ways to approach a successful resolution of this conflict, I should like to outline some of the more common feelings and reactions of those who treat children with cancer which may interfere with such a resolution.

All those who have chosen the provision of health care services to the sick as their vocation—be they physicians; nurses; practical nurses; nurses' aides; occupational, physical, or recreational therapists; or medical social workers—have in common the desire to help sick people get well. One may ask why one should find it necessary to make such a blatantly obvious statement.
DEVELOPMENTAL CHARACTERISTICS OF ABUSED CHILDREN
Authors: Elmer Elizabeth , Gregg Grace S.
Published: December 2021

The account of these patients documents the necessity for critical attention to the entire environment, including cultural factors believed to be especially important in the care and development of the injured child. It further documents the necessity for early intervention when abuse is suspected. Drastic management by removal from the home, the only method of intervention referred to in this paper, is indicated when the caretaker cannot respond to milder measures designed to improve his relations with the infant. Other methods such as home helps, intensive psychotherapy, or day care for the infant should be carefully tried if the child is considered safe from further assault. Of course, ongoing evaluation should be part of any attempt at intervention.
RESTRICTION VERSUS EXPLORATION IN THE NEWBORN NURSERY
Authors: S. C. A.
Published: December 2021

THE last few decades have witnessed interesting developments in the hospital care of newborn infants. But the visible manifestations of these may have been less significant than the changes in fundamental principles underlying them. Two brief items in this issue of Pediatrics suggest that such a shift of basic theory is now finding expression.

One who participated in the efforts which culminated in the first Standards and Recommendations for Hospital Care of Newborn Infants in 1943 recalls the procedure unconsciously or consciously followed. Indeed, it is explicit in the name of the publication. We searched for rules and routines.
RUBELLA ANTIBODY DETERMINATIONS
Authors: Sever John L. , Fuccillo David A. , Gitnick Gary L. , Huebner Robert J. , Gilkeson Mary Ruth , Ley Anita C. , Tzan Nancy , Traub Renee G.
Published: December 2021

Four methods were used to determine rubella antibody titers in patients with acquired and congenital rubella and in gamma-globulin. These methods include hemagglutination inhibition (HI), neutralization (Neut), fluorescence (FA), and complement fixation (CF). With acquired rubella, all four methods showed a rapid development of antibody shortly after the occurrence of rash. Maximum titers appeared within a few weeks, following which HI and CF titers began to decrease and the FA tests showed a weakening of fluorescence. HI titers were four- to sixteenfold higher than Neut, FA, and CF levels. Ten or 20 years after rubella, HI, Neut, and FA tests continued to show detectable antibody but half of the patients no longer had CF antibody. HI titers were still higher than Neut and FA but were considerably lower than convalescent levels. There was complete agreement between HI and Neut tests in the detection of antibody in young adults.

For congenital rubella, HI, Neut, and FA antibody persisted in the affected children at least through adolescence. HI and CF antibody increased occasionally during the period 8 to 12 months after birth.

Gamma-globulin titers with the HI and Neut methods were in close agreement. Convalescent rubella gamma-globulin gave titers two- to fourfold higher than standard commercial gamma-globulin.

Variations in the HA and HI tests were caused by modification of the method of treatment of the antigen, the concentration of red cells used, the size of the test (macro versus micro), the pH of the test, and the treatment of sera. The most significant effects were related to the treatment used to eliminate nonspecific inhibitors in the sera. Improper treatment can give false negative or false positive tests. When properly performed and appropriately controlled, the HI test gives results essentially identical to the Neut method, although the titers are consistently higher than the Neut test. This new method, then, is rapid and convenient for obtaining reliable information on the antibody status and susceptibility of patients.
A FATAL CASE OF DENGUE HEMORRHAGIC FEVER IN AN AMERICAN CHILD
Authors: Russell Philip K. , Chumdermpadetsuk Saowani , Piyaratn Prapont
Published: December 2021

DENGUE HEMORRHAGIC FEVER has occurred in yearly epidemics in Thailand since 1958. During the past 8 years, approximately 18,000 Thai children in Bangkok alone have been hospitalized; there have been over 1,000 deaths. Approximately 30% of the hospitalized hemorrhagic fever patients have a severe form of the disease, termed the dengue shock syndrome, which is manifested by hypoproteinemia, hemoconcentration, shock, hepatomegaly, and a bleeding tendency. In spite of the high incidence of this disease in the indigenous Thai and Chinese population, dengue hemorrhagic fever has not been observed in Caucasians of European descent, even though over 200 dengue virus infections have been serologically confirmed in Americans and Europeans living in Bangkok during the past 4 years. These persons, however, had mild undifferentiated febrile illnesses or classical dengue fever, and none of the studied patients exhibited the manifestations of hemorrhagic fever.

The apparent lack of susceptibility of Americans or Europeans to dengue shock syndrome suggested theories that genetic or nutritional differences were responsible for the apparent difference in susceptibility. However, no substantial evidence has been presented to support these theories, and recent correlations of clinical, epidemiologic, and serologic observations indicate that the severe form of dengue hemorrhagic fever occurs in persons previously infected by dengue virus.

The serologic observations reported on patients with dengue shock syndrome in Singapore also are indicative of previous dengue infections and tend to confirm the observations made in Bangkok.

A third theory of the pathogensis of dengue hemorrhagic fever is that dengue virus strains of unusual virulence are the causative agents of the severe manifestations.
TRANSLOCATION/NORMAL MOSAICISM IN D1 TRISOMY
Authors: Wilson Miriam G. , Melnyk John
Published: December 2021

A case of D1 trisomy syndrome with classical facial appearance and central nervous system abnormalities is described in which the cytogenetic abnormality appeared to be a C-D translocation/normal mosaicism. Autoradiographic studies indicated that the DNA labeling pattern of the translocation chromosome was similar to that of the D1 chromosome. Mosaicism of this type most likely results from chromatid arm interchange and subsequent segregation in the post-zygotic stage. Failure to find increased fetal hemoglobin in this instance may have been related to mosaicism or deletion effect.
THROMBOCYTHEMIA IN THE MYELOPROLIFERATIVE DISORDER OF DOWN'S SYNDROME
Authors: Miller James McC. , Sherrill John G. , Hathaway William E.
Published: December 2021

A patient with Down's syndrome and associated myeloproliferative disease is described. The patient had the unique finding of increased platelet number and size. This finding adds further support to Ross's hypothesis of the existence of ineffective regulation of production and maturation of bone marrow elements in association with Down's syndrome.
EFFECT OF TRANSPLACENTAL TRANSFER OF ANTIBODY TO INTRINSIC FACTOR
Authors: Goldberg Leonard S. , Barnett Eugene V. , Desai Rajendra
Published: December 2021

The absence of detectable intrinsic factor (I.F.) was observed in the gastric juice of a newborn with transplacentally transferred blocking antibody to I.F. (titer of 1:16). I.F. was first detected in the infant's gastric juice at 1 month of age when the circulating I.F. antibody had decreased to a titer of 1:4. Evidence is presented to suggest that, at least in newborns, circulating antibody to I.F. may suppress the gastric I.F. The possible mechanisms responsible for this suppression are discussed.
HYPERMAGNESEMIA IN THE NEWBORN INFANT
Authors: Lipsitz Philip J. , English Inman C.
Published: December 2021

This report describes 16 cases of hypermagnesemia in neonates of toxemic mothers treated with MgSo4 only. The maternal and fetal serum levels of magnesium were greater than the normal values given in the literature and in our studies. The clinical manifestations in the newborn are similar to adults with hypermagnesemia. Awareness of this problem will help in the management of these infants.
HEARING LOSS IN RETINITIS PIGMENTOSA
Authors: Goode Richard L. , Rafaty F. Mark , Simmons F. Blair
Published: December 2021

The clinical course of hearing loss associated with retinitis pigmentosa is outlined in four brief case summaries. This incidence of hearing loss in retinitis pigmentosa is 10% and occurs several years before clinical visual abnormalities. A battery of audiometric tests all suggest that the hearing defect is within the cochlea and that it is not rapidly progressive. Onset age has not been established. The employment of more than routine hearing tests, testing of other family members, electroretinograms, and historical information about certain features of familial vision are useful in establishing early diagnosis.
THYROTROPIN DEFICIENCY IN A CHILD RESULTING IN SECONDARY GROWTH HORMONE DEFICIENCY
Authors: Fink Chester W.
Published: December 2021

The first child with apparent isolated thyrotropin deficiency is described. Prior to treatment with thyroid, the plasma growth hormone response to insulin-induced hypoglycemia was decreased. Growth hormone secretion was normal following thyroid therapy.
Intensive Transfusion Therapy in Thalassemia Major
Authors: BEARD MICHAEL E. J. , NECHELES THOMAS F. , ALLEN DONALD M.
Published: December 2021

A hemoglobin level of over 10 gm per 100 ml has been maintained by transfusion in six children with thalassemia major. Chelating agents have been used to minimize the increase in iron loading. Striking clinical improvement with regression of abnormal cardiac symptoms and signs was seen in all these patients. It is concluded that, in thalassemia major, this therapy provides at least short-term clinical benefits to severely affected children.

The rationale for long-term, intensive transfusion therapy is based on the assumption that it is the degree of anemia rather than the degree of iron loading which leads to the eventual cardiac failure and death in these patients. Proof of this hypothesis will depend to some extent on the subsequent clinical course of these children.
Prevention and Treatment of Mental Retardation
Authors: CROCKER ALLEN
Published: December 2021

This book presents a splendid, warm, positive, and far-ranging discussion of the problems of the mental retardate and his world. Particularly notable is the inclusion (in a basically medically-oriented text) of much valuable non-medical material—such as detailed treatment of the sociological, community planning, and legal aspects of the field, plus an unusually sympathetic and analytic discussion of the psychologic aspects of mental retardation.

The volume suffers from excessive editorial tolerance, by allowing a disturbingly leisurely and repetitive style from its many contributors.
CLINICAL APPLICATION OF THE AUDITORY AVERAGED EVOKED RESPONSE AT SLEEP ONSET IN THE DIAGNOSIS OF DEAFNESS
Authors: Ritvo Edward R. , Ornitz Edward M. , Walter Richard D.
Published: December 2021

A consistent and well defined high amplitude auditory averaged evoked response (AER) was found at sleep onset in all of 31 children (ages 2 to 12 years) and in 6 out of 7 babies (ages 7 to 15 months) without clinical evidence of deafness. Thirteen of the 31 children were diagnosed as having the syndrome of early infantile autism and could not be reliably tested while awake.

Three emotionally disturbed children in whom deafness had been suspected but not definitely established showed no auditory AER at sleep onset. This finding supported the diagnosis of a severe hearing loss.

There is a consistent enhancement of the auditory AER at sleep onset. Thus, measuring the AER during this stage of consciousness is suggested as a method of establishing the diagnosis of profound hearing loss in young, uncooperative, or emotionally disturbed children. Such a procedure will minimize the occurrence of false negative results.
Regional Development of the Brain in Early Life: A Symposium
Authors: DEKABAN ANATOLE S.
Published: December 2021

A brief review of a published symposium which encompasses a multidisciplinary approach on such a broad topic as the development of the brain is not easy. First, some background information. The symposium was organized by the Council for International Organizations of Medical Sciences established under the joint auspices of UNESCO and WHO and by the Délégation à la Recherche Scientifique et Technique. It was held on December 3-5, 1964, in Paris. Doctor A. Minkowski, Centre de Recherches Biologiques Neonatales, Paris, very ably edited the proceedings.
SAFETY AND VALUE OF LIVER BIOPSY
Authors: L. J. F.
Published: December 2021

PEDIATRICIANS rarely use percutaneous liver biopsies in diagnostic studies of jaundiced patients. A vague fear seems to prevail that this procedure is associated with "a greater risk in children than in adults" and some pathologists are unhappy with the small amount of tissue usually obtained for study. The time has now arrived to seriously question these fears and reservations. The studies of Walker, Krivit, and Sharp in this issue, if combined with others, now bring the total published experience with percutaneous liver biopsies in children using the Menghini needle to over 300. These authors have all found this procedure to carry a very small risk of minor complications.
LUNG FUNCTION AND PATHOLOGY IN A PREMATURE INFANT WITH CHRONIC PULMONARY INSUFFICIENCY (WILSON-MIKITY SYNDROME)
Authors: Aherne W. A. , Cross K. W. , Hey E. N. , Lewis Sheila R.
Published: December 2021

Detailed lung function studies at the age of 8 months and 1 year are reported for an infant who weighed 992 gm at birth and who developed chronic progressive pulmonary insufficiency 2 weeks after birth. The symptoms and signs were similar to those described by Wilson and Mikity in 1960. A confirmatory lung biopsy was obtained when the child was 11 months old.

Dynamic lung "compliance" was very significantly reduced while a static estimate of lung compliance was within normal limits. These and other lung function findings are interpreted as indicating that uneven alveolar ventilation was the probable functional basis for all the signs and symptoms observed.
Screening for Hidden Congenital Anomalies
Authors: Van Leeuwen G. , Glenn L.
Published: December 2021

Results of a survey for hidden congenital anomalies in 2,000 consecutive live-born infants are described. Because of the simplicity, and economic feasibility, we believe that these procedures should be performed on all infants.
AN EPIDEMIC OF ASEPTIC MENINGITIS, PRIMARILY AMONG INFANTS, CAUSED BY ECHOVIRUS 11-PRIME
Authors: Miller David G. , Gabrielson Mary O. , Bart Kenneth J. , Opton Edward M. , Horstmann Dorothy M.
Published: December 2021

In the summer of 1965 an epidemic of aseptic meningitis and other acute febrile illness occurred in New Haven, Connecticut. The agent responsible proved to be echovirus 11-prime, a distantly related variant of the prototype Gregory strain of echo-11, which has not heretofore been associated with a community outbreak. The age group attacked was unusual in that more than half the virus positive patients with meningitis were under 6 months old. Other syndromes encountered, chiefly in the 1 to 4 year age group, were nonspecific febrile illnesses and respiratory infections, including pneumonia. A serologic survey indicated that echovirus 11-prime had not been active in the area previously; but, several months following the outbreak more than half the children in the crowded central area of the city, where most of the cases had occurred, possessed antibody to the epidemic strain. The strain of echo-11 prime was unlike other echoviruses in that it grew well in continuous line HEp-2 cells and primary isolations could be made in this cell system. Postinfection antibody titers in patients were in general low; one patient whose spinal fluid had yielded virus had no detectable antibody against the epidemic strain 6 months after onset.
EPIDEMIOLOGIC AND SEROLOGIC STUDIES OF E. COLI 04:H5 IN A PREMATURE NURSERY
Authors: Balassanian Neron , Wolinsky Emanuel
Published: December 2021

A multiple drug-resistant strain of E. coli, serotype 04:H5, was found to be prevalent as a commensal organism among newborns in a premature nursery. Rectal colonization occurred earliest at 2 days of life (average 12 days) and continued up to 6 months. The umbilicus and throat also were often colonized. The organism was not found in the nursery environment; on rectal, vaginal or throat swabs from the mothers; or from rectal and throat cultures of nursery personnel. It was concluded that transmission probably occurred via the nurses' hands. Serological studies using indirect hemagglutination showed that most of the maternal bloods had significant titers, whereas the cord bloods did not. All of 27 colonized babies showed significant titer increases, and 11 non-colonized babies with measurable cord blood titers subsequently showed a decrease. There was no relationship between antibody level and occurrence or termination of colonization. The only disease manifestation of the study strain was that of urinary tract infection in two colonized male babies who had normal genitourinary systems.
Neonatal Hypertension Associated with Renal Artery Hypoplasia
Authors: Angella J. J. , Sommer L. S. , Poole C. , Focel B. J.
Published: December 2021

A newborn infant was presented with severe hypertension, associated with congenital hypoplasia

See Images in the PDF file

of the abdominal aorta and bilateral renal hypoplasia.
Failure to Achieve Oxygen Supplementation with Hydrogen Peroxide
Authors: Morgan Beverly C. , Guntheroth Warren C. , Breazeale Donald , McGough George A.
Published: December 2021

Hydrogen peroxide, administered rectally or intraperitoneally, has been reported to improve systemic oxygenation. Therefore, the effectiveness of intraperitoneal administration of hydrogen peroxide, 0.3%, was investigated in hypoxic rabbits as a possible method of supplementation of oxygenation in respiratory distress syndrome or in the postoperative cardiac patient. Although hydrogen peroxide initially caused a slight increase in arterial oxygen saturation, this increase was brief and was followed by a marked fall in arterial oxygen saturation. Hypotension occurred in all rabbits. It is suggested that the intraperitoneal administration of hydrogen peroxide for the purpose of extrapulmonary oxygenation is largely ineffective and hazardous, and it probably should not be attempted in the human subject.
REASSURANCE REGARDING INFECTIOUS LYMPHOCYTOSIS
Authors: Clement David H.
Published: December 2021

Lymphocytosis has long been associated with several disease entities. In children, Pertusis, infectious mononucleosis, and leukemia are examples. More recently, certain adenovirus infections have been implicated. In view of the normal preponderance of lymphocytes over granulocytes during the first few years of life, lymphocytosis in young children must be interpreted with caution.

Over 25 years ago, Carl H. Smith1 described a syndrome which he called acute infectious lymphocytosis. The majority these patients have been without signs or symptoms of illness, an important feature of the disorder. Institutional outbreaks have supported the infectious nature of the disorder. Leukocytosis has been extreme, occasionally in excess of 100,000 white cells per milliliter.
Infancy in Uganda: Infant Care and the Growth of Love, by Mary D. Salter Ainsworth. Baltimore: The Johns Hopkins Press, 1967, 471 pp., $12.00
Authors: Brazelton T. Berry
Published: December 2021

This is a fine book which reflects a marvelous sensitivity on the part of the author to factors likely to be encountered in Uganda. It concerns an investigation of mother-infant relationships in that country by using a sample of 28 babies and 26 mothers for the first 2 years of the babie's lives. The author attempts to clarify the variables of mothering in that culture e hich she believes apply universally in the rearing of children.
Acute Transient Gastrointestinal Protein Loss
Authors: Herskovic T. , Spiro H. M. , Gryboski Joyce D.
Published: December 2021

A 6-year-old boy developed transient, generalized edema and hypoproteinemia following an episode of acute gastroenteritis. These were associated with peripheral and bone marrow eosinophilia, with increased fecal excretion of chromium-labeled albumin, and with abnormally enlarged gastric musocal folds. Spontaneous recovery began at 1 week with diminution of the edema and increment in the serum protein. By 6 weeks minimal hypoproteinemia and an abnormal gastric biopsy with changes suggestive of Menetrier's disease were apparent. Serum proteins were normal 3 months after the acute onset of this illness.
Definition of Mortality
Authors: Thomas John M.
Published: December 2021

I was quite disappointed to see, in Dr. Myron Wegman's "Annual Summary of Vital Statistics" (Pediatrics, page 1035, December 1967) that he and the editorial board of Pediatrics accept the international comparison of infant mortality as valid.

When the various reporting countries use different definitions of terms and varying methods of collecting statistics, the comparisons have little meaning.

The National Center for Health Statistics states in their 1967 report, ‘The methods of registering vital events vary among countries included in this study.
Synovial Sarcoma in the Scapular Region of a 12-Year-Old Child
Authors: Letts H. , Singh I.
Published: December 2021

A case of synovial sarcoma involving an unusual site and occurring in a 12-year-old child is described.
Pinpoint Meatus: Iatrogenic?
Authors: Graves John
Published: December 2021

Casual observations on the apparent increase in incidence of pinpoint urinary meatus in male infants suggest that such a condition has become more common since the advent of some of the more recent circumcision techniques. While I have not gone into measurements and statistics, it is my distinct clinical impression that infants circumcised with the plastic bell method have the highest incidence of pinpoint meatus, those with the Gomco clamp tend to fall into an intermediate group, and those circumcised without the use of either of these techniques have the traditional slitlike meatus.
PLASMA RENIN ACTIVITY AND ALDOSTERONE SECRETION IN CONGENITAL ADRENAL HYPERPLASIA
Authors: Godard Claude , Riondel Anne M. , Veyrat Robert , Mégevand Albert , Muller Alex F.
Published: December 2021

Experiments were undertaken to study simultaneously plasma renin activity (PRA) and aldosterone secretion (Aldo-SR) in seven patients with congenital adrenal hyperplasia (CAH), aged 5 months to 12 years, and four normal subjects. Control values of renin on a liberal salt intake in 28 children were 19 ± 16 ng/l/minute, which is considerably higher than in adults (9 ± 7.6 ng/l/minute).

Of the seven patients, four had PRA levels between 26 and 39 ng/l/minute. The other three had levels of 115, 249, and 1,250 ng/l/minute on a liberal salt intake. Aldo-SR was between 131 and 264 µg/24 hours in four subjects and was low in two (12 and 37 µg/24 hours).

Salt restriction increased PRA 3.5 to five times in four patients, compared with two times in four normal subjects. Despite the high renin values, Aldo-SR increased at the utmost threefold, compared with a four- to eightfold increase in the normal children. That discrepancy between PRA and Aldo-SR points to a defect in aldosterone synthesis in all forms of CAH.

PRA and Aldo-SR were both lowered by steroid therapy.
HYPOPITUITARISM AND DIABETES MELLITUS: EFFECT OF HUMAN GROWTH HORMONE
Authors: Kogut Maurice D. , Donnell George N. , Ling Shun M. , Frasier S. Douglas
Published: December 2021

Although hypoglycemia and insulin sensitivity are characteristic of hypopituitarism, the association of hypoglycemia, diabetes mellitus, and pituitary insufficiency has not been previously described in a child. Studies in a 44-month-old male with these features and observations following human growth hormone administration are reported.

The patient weighed 7 lb, 9 oz at birth and was 20 in. long, but he did not grow or gain weight as expected. There was a strong family history of diabetes mellitus. At age 17 months hypoglycemic seizures occured (blood glucose < 5 mg/100 ml). An oral glucose tolerance test was abnormal. Subsequently, hyperglycemia and glycosuria, but not ketonuria, occured. Serum immunoreactive insulin following intravenous tolbutamide rose, suggesting endogenous insulin production. The treatment of diabetes mellitus with insulin was extremely difficult because of marked sensitivity, suggesting an additional cause for altered glucose homeostasis. Endocrine studies (PBI, I131 uptake before and after TSH, 24-hour urines for 17-ketosteroids and 17-ketogenic steroids following metopirone and ACTH, and immunoassays of serum growth hormone following intravenous administration of insulin and L-arginine) indicated lack of normal activity of thyrotropin, ACTH, and growth hormone. Human growth hormone, 1.0 mg. daily, resulted in a growth of 5½ in. and a weight gain of 11 lb in 8 months. There were no further episodes of hypoglycemia which facilitated control of the diabetes with insulin. These observations have demonstrated the importance of HGH in glucose homeostasis and that HGH is not necessary for the development of diabetes mellitus.
Reported Neurologic Disorders Following Live Measles Vaccine
Authors: Nader Philip R. , Warren Robert J.
Published: December 2021

In the 26 months from January 1965 through February 1967, 23 instances of neurologic disorder following measles vaccination were reported to the National Communicable Disease Center. Analysis of data for individual cases reveals that one was probably caused by herpes simplex and three (possibly four) patients had no serologic response to vaccination. In no case was it possible to determine whether the illness was actually vaccine induced or whether the temporal association with vaccine inoculation was merely coincidental.

That 23 known cases of encephalitis have been reported indicates the need for active surveillance of all suspect cases. However, it is obvious that the risk of encephalitis is much greater after the natural disease than after vaccination.
A CASE OF HISTIDINEMIA CONTROLLED WITH A LOW HISTIDINE DIET
Authors: Corner Beryl D. , Holton J. B. , Norman R. M. , Williams P. M.
Published: December 2021

An attempt to treat a case of histidinemia using a low histidine protein hydrolysate is described. The diet was started at the age of 7 months in a male infant with severe clinical disorder. The diagnosis was made at 24 weeks, which is the youngest recorded case.

Good control of histidine metabolism was achieved. There was an initial improvement in growth rate but very little effect on development otherwise. Death from bronchopneumonia occurred in the fourth year.

The brain showed cerebral maldevelopment, likely to be of prenatal origin, as well as typical postepileptic encephalopathy. The etiology of this malformation is discussed in relation to histidinemia and the family history of neurologic disorder.
ON MERRIMENT FOR CHILDREN IN THE VICTORIAN HOME OF 1865
Authors: C. T. E.
Published: December 2021

Most of us would assume that the home, especially in the first half of the Victorian era, was a far sterner place for children than it is nowadays This was the age when father's orders were observed without question, stemming I believe from the general acceptance that if the Crown was the fount of honor, so the home had father as its head and his word was law. Yet, dourness was not an all-pervasive part of family life as is evident in this sentimental discussion of merriment in the home which appeared in 1865 in one of the most widely read Victorian books on the domestic management of infants and children.1

A little innocent fun, amusement, and buoyancy of spirits at home, instead of being repressed, should rather be encouraged by every legitimate means. Young people must have mirth and relaxation sometimes, and somewhere; and where more appropriately and profitably can this be sought, than in the happy social circle, of their own domestic hearth? Let the evening fire bum brightly therefore, and the home of childhood and youth be rendered cheerful and attractive, with all the little arts a parent should best understand. The comfort and pure delight of haff an hour so spent, will be more conducive than almost anything else, to blot out the rememberance of those hours and days of petty annoyances and childish griefs, too common to us all; and these "evenings at home" with the other happy unseen, unspoken, unwritten reminiscences of the little sanctum, will be the best safeguard children can take with them into the strifes and struggles, the fluctuations of the cold, unsympathizing outer world, in which ere very long, they will have to take their places, and discover the niche which they are qualified to fill.
THE PEDIATRICIAN AND THE JUNIOR COLLEGE
Authors: Skaggs K. G.
Published: December 2021

The staff of the American Association of Junior Colleges has recently completed a definitive study of current trends, developments, issues, and concerns in the junior colleges.1 A short summary of some of the findings and recommendations of this study is pertinent to the planning and implementation of training programs for all allied health workers. It has particular pertinence to pediatricians who, more than any other group of medical practitioners, are faced with pressures to provide health care for more and more children.

If we accept, and most of us do, the premise that the nation faces an acute shortage of personnel in the service and supportive fields of health and medical care, then careful attention should be given to making the most effective use of the nation's 2-year colleges to educate many who will go into the health and medical services. The capacity for absorbing larger and larger enrollments is apparently one of the most striking features of the 2-year college of higher education. In addition to this apparently infinite capacity, the junior college is also responsive to the needs of a heterogeneous student body and provides a comprehensive program designed to meet varying needs and all ages of students, as well as a uniquely qualified staff that differs in its preparation and interest from the traditional academic staffs so long recognized as a part of the academic community. Individual junior colleges apparently have widely differing objectives, goals, organizational patterns, and procedural methods. Another characteristic is an absence of preconceived notions of what is or is not collegiate subject matter, or what is or is not college material.
THE IMPORTANCE OF VENTILATION ALONE IN A LYING-IN HOSPITAL AS A MEANS OF LOWERING NEONATAL MORTALITY
Authors: C. T. E.
Published: December 2021

Before the era of Pasteur, physicians attributed far greater importance to the therapeutic value of climate and ventilation as a means of lowering infant mortality than we do today. The following quotation is typical of many written during the late eighteenth and nineteenth centuries:

The following statement, taken from the history of the Dublin Hospital, shows in an extraordinary degree the advantages resulting from free ventilation. In this hospital, 2944 infants out of 7650 died in the years 1782-83-84 and 1785, within the first fortnight after their birth–that is to say, nearly one child out of every six died of convulsions, which were called nine days' convulsions by the nurses. These children foamed at the mouth, the jaws became locked, the face swelled, and looked blue as though they were choking. [These infants probably had tetanus neonatorum–editor's note.] This last circumstance led the physician in attendance to attribute the disease and great mortality to the close and crowded state of the hospital, causing a deficiency of good air so that, since ventilation has been properly effected, out of 4243 children there died 165; whereas the average number of deaths from the same number previously to ventilation was 1632!1
Vitamin D and Infantile Hypercalcemia
Authors: Forbes Gilbert B. , Cafarelli Cenie , Manning James
Published: December 2021

The etiology of the severe form of this syndrome ( which includes supravalvular aortic stenosis, peculiar facies, and mental retardation) is still a matter of debate. Particularly vexing is the possible relationship to vitamin D. Massive amounts (of the order of 104 units per kilogram daily) given to pregnant or young animals have led to aortic lesions,1,2 and it is postulated (that the human syndrome may represent a form of hypersensitivity to the vitamin. On the other hand, Fraser, et al.3 and Antia, et al.4 are of the opinion that the evidence

See Table in PDF file

does not warrant such an implication. A recent experience of ours supports the latter view.
Hyaline Membrane Disease in Twins
Authors: Rokos Jan , Vaeusorn Oonjai , Nachman Richard , Avery Mary Ellen
Published: December 2021

In analyzing the evidence for the role of prematurity and the significance of added stress in the pathogenesis of hyaline membrane disease, it seems pertinent to examine the occurrence of the disease in twins. Were prematurity alone the determinant of the likelihood of developing the disease, one would expect the disease to occur in both twins. If perinatal stress were a significant factor in the pathogenesis of the disease, then Twin B should have it more commonly than Twin A.

A greater incidence in Twin B has been cited by several investigators in reviews of their experience with the disease. Crosse

See Table in the PDF file.

found hyaline membranes in 8.4% of liveborn autopsied twins delivered first, and in 15.1% of the second born.1
ARTERIAL BLOOD GAS AND ACID-BASE DISORDERS IN INFANTS AND CHILDREN WITH STATUS ASTHMATICUS
Authors: Downes John J. , Wood David W. , Striker Theodore W. , Pittman Joffie C.
Published: December 2021

The course of arterial oxygen tension (Pao2), pH, carbon dioxide tension (Paco2) and base deficit (negative base excess) was studied in 45 episodes of status asthmaticus occurring in 32 infants and children. The data indicate that arterial hypoxemia occurs in these patients due to alveolar hypoventilation and pulmonary arterial-venous shunts. Three fourths of the patients tested demonstrated a base deficit which was related in part to ketonemia. The Paco2 varied from below normal to 168 mm Hg, and arterial pH varied from 6.89 to 7.41 at the time of peak clinical severity.

Clinical signs of respiratory failure associated with a Paco2 above 65 mm Hg occurred in 13 patients (18 episodes), all of whom were successfully managed by mechanical ventilation. These studies indicate the variability in alveolar ventilation and acid-base balance during an asthmatic episode and the need for repeated assessment of arterial pH and blood gases if one is to provide optimal management.
MOTOR NERVE CONDUCTION VELOCITIES IN LOW BIRTH WEIGHT INFANTS
Authors: Ruppert Elizabeth S. , Johnson Ernest W.
Published: December 2021

Serial nerve conduction velocities were performed during the first year of life on 8 term infants and 11 prematurely born infants weighing under 2,500 gm. The slowest velocities obtained at birth were in the most immature infants. By 12 months, the two groups had attained similar values. This technique affords an objective measurement of the maturity of the peripheral nervous system and the gestational age of the infant.
IS TEETHING A FERTILE SOURCE OF DISEASE?
Authors: C. T. E.
Published: December 2021

Prior to a few decades ago, most physicians who cared for infants looked on teething as the cause of many serious pediatric complaints. For example, Harrison in 18621 offers this advice to a young practitioner:

But it is especially in reference to affections of the head that the condition of the gums becomes a source of solicitude. During dentition any twitchings in the face, or curious starings of the eyes, are full of meaning, and should never be suffered to pass over without due attention to the teeth. I think all well educated medical men, in this country, are advocates for lancing the gums, though I believe it is very seldom done on the Continent. Mothers, however, not unfrequently object; they think it a pity to hurt the little darling, and they would rather wait awhile and leave matters to nature. Some have an idea that the teeth will be more difficult to cut after the gums are lanced, if the teeth do not immediately protrude.

Kennedy, another respected nineteenth century practitioner, who wrote extensively about the management of children in health and disease tells us that:

Teething, when difficult, is apt to induce derangement of the vital functions, especially those of the alimentary and nervous systems. Acidity of the stomach with occasional vomiting; quick pulses, hot dry skin, and unnatural dejections, with swelling of the belly and emaciation, require being corrected by the remedies advised for moderating or removing the fevers of infants. . . . Little reasons is afforded by experience, for regarding local applications to the gums as having ever contributed to the relief of painful dentition:-pure air, frequent change of dress, tepid or cool sponging of the body and spine, with regularity of the bowels and salutary nourishment prove far surer instruments of obtaining a favourable result.
EFFECT OF AN ORAL OSMOTIC AGENT ON VENTRICULAR FLUID PRESSURE OF HYDROCEPHALIC CHILDREN
Authors: Hayden Patricia W. , Foltz Eldon L. , Shurtleff David B.
Published: December 2021

A typographical error appeared in the footnote for isosorbide in the May issue of Pediatrics (41:955, 1968). The footnote should have been:

1,4:3,6 Dianhydro D-glucitol, supplied as Hydronol by Atlas Chemical Industries, Wilmington, Delaware.