bluuebunny/crossref_metadata_2025 huggingface dataset:
THE RELATIVE RATES OF SYNTHESIS OF HEMOGLOBINS A AND F IN IMMATURE RED CELLS OF NEWBORN INFANTS
Authors: Bard Harry , Makowski Edgar L. , Meschia Giacomo , Battaglia Frederick C.
Published: December 2021

Studies were carried out to explore whether the proportion of adult and fetal hemoglobin synthesized by immature red cells of cord blood would provide a precise correlation with the degree of maturity of the newborn infant.

Cord blood samples were obtained from newborn infants ranging from 25 to 43 weeks' gestation in whom the gestational age estimates from menstrual history and physical examination, including neurological examination, were in close agreement. The blood samples were incubated in an amino acid mixture containing Cl4 leucine, followed by column chromatography on DEAE Sephadex for separation of adult and fetal hemoglobin fractions. The radioactivity in the adult and fetal hemoglobin fractions was measured. The percent of radioactive fetal hemoglobin synthesized by immature red cells provided a more precise correlation with the infant's gestational age than the percent of fetal hemoglobin present in cord blood at the time of birth. The percent of radioactive fetal hemoglobin was unaffected in infants with severe erythroblastosis who had in utero transfusions. In infants with intra-uterine growth retardation, the proportion of fetal hemoglobin being synthesized was significantly greater than expected for the estimated gestational age.
CHARLES DICKENS AND HENRY MORLEY DESCRIBE THE DIFFERENCES BETWEEN THE PRACTICE OF PEDIATRICS AND ADULT MEDICINE
Authors: C. T. E.
Published: December 2021

Between 1850 and 1859, Charles Dickens published his own magazine, Household Words; The articles for which were written by Dickens alone or in collaboration with less wellknown writers.

The issue of April 3, 1852, contained an article called Drooping Buds, written by Dickens with the assistance of Henry Morley; in this article Dickens and Morley point out the particular needs a physician must consider when treating the illnesses of infants and children. The following superbly expresses these differences:

It does not at all follow that the intelligent physician who has learnt how to treat successfully the illnesses of adults, has only to modify his plans a little, to diminish the proportions of his doses, for the application of his knowledge to our little sons and daughters. Some of their diseases are peculiar to themselves; other diseases, common to us all, take a form in children varying as much from their familiar form with us as a child varies from man. Different as the ways are, or ought to be, by which we reach a fault in a child's mind, and reach a fault in the mind of an adult; so, not less different, if we would act successfully, should be our action upon ailments of the flesh. There is another thing, also, which puzzles the physician who attends on children. He comes to us when we are ill, and questions us of this symptom and of that; and on our answers he is taught, in very many cases, to base a large part of his opinion.
RESEARCH ISSUES IN CHILD HEALTH A HEAD START RESEARCH SEMINAR
Authors: Wagner Marsden G.
Published: December 2021

This and the two following articles (pages 874 and 884) conclude the Seminar. Papers I and II by Drs. A. Frederick North and Robert J. Haggerty appeared in Pediatrics, 45: 690 and 702, 1970. Reprints for the entire series, to be bound aS one, will be available through Dr. North's office, 2125 Thirteenth Street, N.W., Washington. D.C. 20009.

It has been stated that a health problem, to be of importance, must have a definite impact on the day-to-day functioning of the child. Perhaps this criterion applies equally to any aspect of a program such as Head Start, whose goal is increased health and development of children. Is there research data or can we obtain data to answer questions such as, "What does this program mean to the family?," and "Can a school or Head Start health program be so integrated into the family subculture as to initiate desirable change in family health behavior?" This family health behavior, including nutritional habits, sleeping habits, traditional health remedies, child care arrangements, and so forth, is, of course, infinitely more important to the health of the young child than those rare visits to a physician or clinic which are most likely far removed from his own milieu. The field of medical anthropology provides a number of documented examples of attempts to superimpose an outside system of health care onto groups.1-8 The subsequent failure of most of these attempts has been due to a failure to consider such questions as those just raised concerning Head Start.
Infants of Diabetic Mothers
Authors: McCann Michael L.
Published: December 2021

The intriguing study reported in the September issue of Pediatrics by Drs. King, Adam, Clemente, and Schwartz1 suggesting that "infants of diabetic mothers do not have excessive insulin output" deserves comment. Their conelusions do not appear to be justified by the data presented. The question is not whether their data are reliable, but whether the methods used to analyze their small population were appropriate. The authors assume that these infants represent a single homogeneous population.
Letter To The Editor
Authors: Berenberg William , Goldman Herbert I. , Amadio Peter
Published: December 2021

Our recent report offered no argument against a judicious use of skimmed milk in the management of diarrheal disease. It emphasized the hazards of feeding unrestricted, large volumes of such milk or lesser volumes in which solute content was unduly concentrated by boiling. The danger is greatest in febrile, acidotic infants with diarrhea in whom water loss is excessive.
Letter To The Editor
Authors: Milman Doris H.
Published: December 2021

The questions posed about marijuana in your series of articles and commentaries in the issue of January 1970 are indeed challenging. Many of these questions have received more attention and more pertinent response in the literature than your contributors are aware of or, if aware, acknowledge. In fact, I am disquieted by an eclectic approach that emphasizes that lack of evidence for harmful effects of marijuana while reiterating the contrary. For example, Drs. Nader and Haggerty say "it is clear that we don't know how dangerous marijuana is," and Dr. Dews says "we know the acute toxicity is vanishingly small" (45:3).
EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE: REVIEW
Authors: Webb Clarence H.
Published: December 2021

In view of the fact that this reviewer has spent a considerable part of his professional career rendering the type of service which Dr. Anderson decries as unnecessary, it is difficult to review the article without doing what the author found difficult to avoid, which is to be swayed by preconceptions. It is hoped that the author will temper his bias with the reviewer's bias to bring conclusions and recommendations out of the study which the figures justify and which are nearer the middle of the road.

There are physicians in pediatrics who consider regular examination of infants and children to be desirable and productive; there are physicians who prefer that a variety of methods be used in pediatrics until it is fully demonstrated that one is superior to the other and do not wish to be forced into a "new pediatrics" unless it is demonstrably better; and, there are parents who bring their babies to pediatricians for reasons other than those mentioned, i.e., for treatment or prevention of abnormal conditions.

Their babies are precious commodities and they wish to know that the babies do not have abnormalities but also want reassurance that they are caring for the babies properly, affording them attention and supervision which is not just good but is superior, and being good parents who are helping their babies in every way to develop the best of their potentials. Herein lies an innate difference between public health and private health in pediatrics which seems to have been highly desirable to pediatricians and parents in the past.
Local Atrophy Following Triamcinolone Injection
Authors: Dyment Paul G.
Published: December 2021

A 3-year-old-girl is described who had marked local atrophy at the site of an intragluteal injection of triamcinolone acetonide. The atrophy began to improve spontaneously after 6 months, and by 14 months the buttocks appeared normal. Poorly soluble parenteral corticosteroids should be used only with regard for this complication.
Letter To The Editor
Authors: Papadatos Constantine , Pavlatou Maria , Alexiou Demosthenes
Published: December 2021

We would like to thank Dr. W. Hughes for his stimulating comment on our paper on "Cephalosporium Meningitis."

It is true that the term "yeast-like" organisms was misleading, as the elements seen on the direct smear were not budding cells but elliptical spores.

In our patient, as Dr. Hughes mentions, Candida albicans was isolated from the nose, throat, and rectal cultures but not from the Cerebrospinal fluid. We were led to believe cephalosporium was the etiologic agent of the disease in this baby because the same elliptical spores, distinct from C. albicans, have been isolated in two different CSF cultures taken with all possible precautions for accidental contamination.
FETAL HEART SIZE MEASURED IN VIVO BY ULTRASOUND
Authors: Garrett William J. , Robinson David E.
Published: December 2021

In the course of routine, two-dimensional ultrasonic echoscopy, echograms have been obtained which show the outline of the fetal heart and interventricular septum. Measurements of the echograms show the fetal heart to occupy 21% of the cross-sectional area of the chest at its widest transverse diameter and to occupy 52% of the transverse diameter of the chest at the same level.

The ratio of the tranverse diameter of the left ventricle to that of the right (L.V. ÷ R.V.) is 1.23. The fetal heart grows at the same rate as the fetal chest in the last 8 weeks of pregnancy.
Letter To The Editor
Authors: Rosenlund Mary Loretta , Koop C. Everrett
Published: December 2021

Doctors Rosenlund and Koop comment as follows:

We are sorry Drs. Prouty and Oakley missed the objective of our article, which was merely to share the experience of a pediatric hospital regarding the incidence of duodenal ulcer disease. We did this because of the many conflicting reports, not to initiate further conflict. If our study presents a "distorted picture" regarding the incidence of ulcer disease in children, perhaps this is because of our strict criteria for the diagnosis (see article).
Left Ventricular Rhabdomyoma: A Rare Cause of Subaortic Stenosis in the Newborn Infant
Authors: Kuehl Karen S. , Perry Lowell W. , Chandra Roma , Scott Lewis P.
Published: December 2021

A newborn infant with cardiac failure resulting from a rhabdomyoma of the left ventricle obstructing the aortic outflow tract is described. Mild subvalvular pulmonary stenosis was also present because of a tumor in the ventricular septum. Tuberous sclerosis occurs in at least half of infants with such tumors and was present pathologically in this child, although not apparent clinically.

Rhabdomyomas must be considered in the differential diagnosis of heart disease in the newborn infant and may be associated with tuberous sclerosis even when nervous system and cutaneous signs are not present.
SOME COMPARATIVE COSTS IN COMPREHENSIVE VERSUS FRAGMENTED PEDIATRIC CARE
Authors: Heagarty Margaret C. , Robertson Leon S. , Kosa John , Alpert Joel J.
Published: December 2021

Studies of cost of medical care often concentrate on such factors as capital and personel expenditures but ignore costs of such items as laboratory studies which are a major factor in direct cost to the patient. This study compares the use of laboratory studies and related costs in a comprehensive pediatric care program with those of an emergency clinic providing fragmented care to control groups. Laboratory studies are less often done and thus cost less in the comprehensive program. These differences can be attributed to greater knowledge of the patients in the comprehensive program and the different modes of teaching in the two environments. These and other data from this study point to the conclusion that alternatives to the current trend toward primary medical care being delivered in hospital emergency rooms should be sought.
CONGENITAL DEFICIENCY OF FACTOR XIII: REPORT OF A FAMILY FROM NEWFOUNDLAND WITH ASSOCIATED MILD DEFICIENCY OF FACTOR XII
Authors: Hanna Mary
Published: December 2021

In a family with 14 children severe deficiency of factor XIII was found in three living members who suffered from moderate to severe bleeding manifestations. A fourth child died with intracranial hemorrhage. In addition to the above deficiency, two of the three propositi and two siblings were mildly deficient in factor XII. The bleeding manifestations of these cases are solely due to factor XIII deficiency; siblings with factor XII deficiency alone were asymptomatic. Both factor deficiencies here seem to be separately inherited.

The most striking findings in factor XIII deficiency are bleeding from the umbilical cord, which is invariably found, and intracranial hemorrhage frequently encountered in the pediatric age group. The present communication, for the first time, reports on gastrointestinal hemorrhage as a manifestation of this disease. Also, in this family hemarthrosis was not uncommon and characteristically did not lead to residual crippling.
ATYPICAL PHENYLKETONURIA IN A FAMILY WITH A PHENYLKETONURIC MOTHER
Authors: Yu J. S. , O'Halloran M. T.
Published: December 2021

A family study demonstrates the current complexity of the phenylketonuria group of diseases.

Conventional testing methods are unable to discriminate confidently between the carrier state of atypical and classical phenylketonuria. It is therefore impossible at the present time to evaluate the possibility of multiple alleles at the phenylalanine hydroxylase locus or to exclude the effects of one or more modifying genes as the cause of atypical phenylketonuria.

In the family reported, a phenylketonuric mother and father, heterozygous for the phenylketonuric gene, have produced three children, two with atypical phenylketonuria and the other a heterozygote. All the children were microcephahic and retarded, reflecting the intra-uterine damage caused by the mother's phenylketonuria.
DIGITALIS TOLERANCE IN YOUNG PUPPIES
Authors: Halloran Katherine H. , Schimpff Steven C. , Nicolas Jean G. , Talner Norman S.
Published: December 2021

Tolerance to acetyl strophanthidin, a rapid-acting cardiac aglycone, was determined in 28 anesthetized mongrel puppies, ages 16 to 56 days, and compared to tolerance in 16 littermate puppies in whom acute hypercapnic acidemia was produced. The tolerance was also compared to that of four adult mongrel dogs. The toxic dose was defined as the intravenous amount required to produce four consecutive premature ventricular contractions.

A marked variation in the toxic dose was found in the 28 control puppies (range 83 to 353 µg/kg, mean 169 µg/kg) which could not be correlated with age, arterial blood gases or pH, serum potassium or sodium, arterial pressure, or heart rate. The toxic dose was significantly greater in the puppies than in the adult dogs, in whom the mean toxic dose was 64 µg/kg (range 50 to 89 µg/kg). A significant increase in tolerance was also observed in the puppies with hypercapnic acidemia (mean toxic dose 220 µg/kg, range 93 to 375 µg/kg) in comparison to tolerance in the control puppies and despite the wide range of tolerance, each of the puppies with hypercapnic acidemia showed greater tolerance than its littermate control puppy. Assessment of the clinical implications of these findings will require study of the effects of alterations in acid-base balance on the inotropic effect of acetyl strophanthidin in addition to the toxic electrophysiologic effects.
HODGKIN'S DISEASE IN THE FIRST DECADE OF LIFE
Authors: Strum Stephen B. , Rappaport Henry
Published: December 2021

This report is based on a study of 35 children with Hodgkin's disease. The longest survival periods were 9.8 years in a patient who has expired and 9 years in a patient who is still alive. Fourteen patients are still alive at the time of submission of this paper; the survival periods range from 0.2 to 9 years; 11 are known dead and their survival periods range from 0.3 to 9.8 years. The outcome in 10 cases is not known. A striking predominance of males was noted (91%). In 30 of 31 classifiable cases, the histologic sections showed either nodular sclerosing Hodgkin's disease or Hodgkin's disease with lymphocytic predominance.

Regardless of classification, a striking preponderance of mature lymphocytes in tissue sections was evident in most cases. These findings suggest that a particular host response characterizes the disease in the young.
Oxygen Tension Measurements on Digital Blood in the Newborn
Authors: Corbet A. J. S. , Burnard E. D.
Published: December 2021

In a series of 36 babies, most of them ill at the time, arterial oxygen tension was compared with the oxygen tension of blood obtained by pricking the finger in the arteriolar bed of the digital artery. Agreement between the measurements was generally close.
The Clinical and Radiological Presentation of Blowout Fracture of the Orbit in Children
Authors: Heller Richard M.
Published: December 2021

The pediatrician often has the first opportunity to recognize the blowout type of injury of the orbit in children. Diagnosis of blowout fracture will depend upon a history of trauma to the eye with resultant diplopia, limitation in vertical gaze, possibly enophthalmus, and downward displacement of the affected eye. Sinus films and possibly tomograms will demonstrate one or both of the primary signs of blowout fracture of the orbit which include visualization of a depressed fragment of bone and herniation of orbital soft tissue into the maxillary sinus. Less reliable signs of blowout fracture are hemorrhagic opacification of the maxillary antrum, orbital emphysema, and haziness (blood) within the ethmoidal air cells. Surgical treatment is aimed at replacing herniated orbital contents and buttressing the orbital floor. Successful therapy for blowout fracture demands prompt recognition of the injury and early treatment to prevent atrophy of orbital contents.
Diabetes Insipidus, Chlorpropamide, and Hypoglycemia
Authors: Pinto Luciano , Stoppoloni Giampiero
Published: December 2021

In the article by Dr. Ehrlich and Kooh,1 they draw attention to the occurrence of hypoglycemia during the first days of treatment of diabetes insipidus with chlorpropamide. Of 17 cases studied by them, 6 showed hypoglycemia within 48 and 96 hours after the beginning of therapy. Three more had hypoglycemia after going home, in two cases during intercurrent illness and in one after 6 months of treatment with chlorpropamide.

Dr. Vallet, et al.2 observed hypoglycemia only during the first days of treatment in 5 of 10 cases studied.
CONGENITAL MENTAL RETARDATION: ADVANCES IN MENTAL SCIENCE I, edited by Gordon Farrell, M.D. Austin, Texas: The University of Texas Press, 1969, 356 pp., $10.00
Authors: Crocker Allen C.
Published: December 2021

This reviewer would like to propose a coda for the publication of scientific conference proceedings: (a) the printed work must be distributed within 12 months of the time of the conference; and, (b) minimal cost (paperback) presentation should be utilized as a demonstration of the transient value of the arbitrary collection of papers represented. The volume reported here illustrates well the hazards of conference publication–many of the chapters included are splendid, but the work is in no sense systematic or lastingly authoritative, and a full 2 years elapsed between the original preparation of the 1967 current-status data reports and its appearance in published form.
RESULTS OF TREATMENT AND TERMINATION OF THE DIET IN PHENYLKETONURIA (PKU)
Authors: Kang Ellen Song , Sollee Natalie D. , Gerald Park S.
Published: December 2021

The mean I.Q. of 27 PKU patients at the mean age of 3 years 10 months treated before 3 weeks of age was comparable to that of their unaffected siblings. The mean I.Q., of 12 patients at the mean age of 5 years 6 months treated between 3 and 6 weeks of age fell significantly below the mean I.Q. of their unaffected siblings. Seventeen patients treated after 8 months of age did not differ in their mean I.Q. at the end of treatment from 11 untreated patients, despite the observation that more than half of the late-treated patients achieved significant gains during the course of their treatment. Patients off dietary therapy did not appear to deteriorate over a follow-up duration of 2 to 3½ years. Eleven were followed for 6 years without evidence of deterioration. Thirteen atypical PKU's showed normal intellectual development. An unexplained predominance of males was observed in our group of atypical PKU patients.
THE CRITICALLY ILL CHILD: HYPOGLYCEMIA
Authors: Greenberg Robert E. , Christiansen Robert O.
Published: December 2021

HYPOGLYCEMIA represents a significant emergency situation in pediatrics. Although recent studies indicate that cerebral tissue can utilize substrates other than glucose, cose, especially in the newborn period and during prolonged fasting,1 no substrate can successfully correct the neurophysiologic sequellae of glucose deprivation on the central nervous system. Since permanent neurological effects of hypoglycemia correlate with the duration of time that cerebral tissue is deprived of glucose, early recognition and treatment of hypoglycemia is essential.

The diagnosis of hypoglycemia obviously depends on demonstration of a significant reduction in blood glucose concentration. Diagnostic criteria, similar to those developed by Cornblath and Schwartz,2 have been widely accepted: two or more blood glucose values of less than 30 mg/100 ml in full-term infants; concentration of blood glucose less than 20 mg/100 ml in the neonate weighing less than 2,500 gm; blood glucose values of less than 40 mg/100 ml in the older infant and child. Since hypoglycemia is defined in terms of the concentration of blood glucose, it is essential to utilize analytic methods which are specific for glucose. The most common method utilizes glucose oxidase, although other methods provide appropriate specificity. A rapid modification of the glucose oxidase method is represented by Dextrostix,* although accurate application of this diagnostic aid to hypoglycemia requires considerable training and experience.3 Recently, a modification of the Dextrostix method has been reported, enabling reproducible measurement of values in the range of 20 to 40 mg/100 ml.4 Confirmation of results obtained by Dextrostix with reliable laboratory methods should be effected upon recognition of hypoglycemia.
Letter To The Editor
Authors: Barbero Giulio J.
Published: December 2021

It has indeed been a pleasure to have received such a range of letters to Pediatrics on the experiences of various physicians with recurrent abdominal pain. It does appear that one can really open Pandora's box with such a common symptom as recurrent abdominal pain in childhood.

It is obvious that there is a great variety of diagnostic and therapeutic possibilities, such as food allergy, urinary tract disease, periodic disease, lactase deficiency, abdominal epilepsy, duodenal ulcer, and others.
Letter To The Editor
Authors: Mortimer Edward A.
Published: December 2021

The report by Pross, Bradford, and Krueger1 regarding the use of peritoneal dialysis in Reye's syndrome prompts me to beat a drum that I have beaten noisily on previous occasions2,3. I believe that many cases of this syndrome are a consequence of excessive doses of salicylate, and this case report1 reinforces this belief. I suspect that the administration of salicylate is missed in the histories of many children with the syndrome because it isn't considered in the usual history and because the physician is preoccupied with life-saving measures.
Letter To The Editor
Authors: Pross Diane C. , Bradford William D. , Krueger Ronald P.
Published: December 2021

Doctors Pross, Bradford, and Krueger comment on these two letters as follows:

We appreciate the comments of Dr. Shaw and Dr. Mortimer. The question of a relationship between salicylates and Reye's syndrome has been raised by various authors.1-3 Utian reported 14 patients with this syndrome in which "several" had received aspirin, but serum salicylate levels were never more than "mild to moderately elevated." Norman,3 in describing 21 cases measured salicylate levels in 10 patients and all were below 25 mg/100 ml.
Instruments for Anthropometry
Authors: Pryor Helen B.
Published: December 2021

exhibit various deviations from normal growth patterns. Anthropometry is a valuable method of studying these physically handicapped children. The December 1969 issue of Pediatrics (44:973) published my paper called "Objective Measurement of Interpupillary Distance. Objective Measurement of Interpupillary Distance." Following this a general interest in the subject has prompted a number of doctors to ask where they can buy sliding and spreading calipers to do the measurements described and also other head and face measurements.
THE ROLE OF THE PEDIATRICIAN IN RHEUMATIC FEVER CONTROL
Authors: Mortimer Edward A.
Published: December 2021

In a recent publication1 the Rheumatic Fever and Rheumatic Heart Disease Study Group has reviewed the current status of rheumatic fever and rheumatic heart disease. This review, which should be must reading for all physicians who care for children, emphasizes the persistent significance of the disease and describes in systematic fashion various community approaches to its control.

It is first pointed out by the authors that rheumatic fever and rheumatic heart disease remain numerically significant problems. Approximately 100,000 new cases are recognized each year, and in 1968 16,000 deaths were recorded as due to rheumatic fever or rheumatic heart disease. The cost of physicians' visits alone for rheumatic fever and rheumatic heart disease in 1968 approximated 28 million dollars.
Excerpt VII: Throwing Stones
Authors: Cone Thomas E.
Published: December 2021

The lesson below dramatically illustrates two of our universally held tenets until about a century ago.1 These are that boysleft to their own devices are "wicked and malicious," and that no children's lesson is complete without moral and spiritual precepts. This lesson's severe tone may surprise modern readers; it is important to recall that once it was the bounden duty of parents to curb any propensity toward amusement as being an obstacle to salvation.2
Static Ability, Cognitive School Readiness, Minimal Brain Damage: Sex Differences
Authors: Haller Jerome S.
Published: December 2021

In the article by R. Kohen-Raz,1 the author has a remarkable definition of the Romberg position. Classically, the Romberg position is defilled as standing with feet together, parallel, rather than one behind the other, and eyes open. I would suggest that he consider consultation with a neurological textbook, for exampie. The Neurological Examination by Russell DeJong or any other basic handbook for medical students on the neurologic examination. I would hope that all the children included in the study, regardless of grouping, had a neurological examination to rule out any neuromuscular disease that would interfere with maintenance of static balance.
Letters to the Editor
Authors: Kohen-Raz Reuven
Published: December 2021

The designation of postures used in this study is not identical with the traditional Romberg sign which essentially consists in the conspicuous increase of body sway precipitated by the closure of eyes, while the area of support is restricted by putting the feet close together. The modified heel to toe positions were designed in order to restrict further and gradually the width of the support area; thus, we were able to increase the sensitivity of the ataxiametric method within the range of normal and borderline populations.
Paying the Doctor: Systems of Remuneration and their Effects, by William A. Glaser. Baltimore: The Johns Hopkins Press, 1970, 323 pp., $10.00
Authors: Butler Allan M.
Published: December 2021

From his personal studies, Glaser analyzes the establishment and summarizes the methods of paying doctors in 16 European countries that have national health insurance programs. Unfortunately, to quote Glaser, "a country's current payment system under its public medical services is usually the arrangement it had before the services were created.

. . . Most payment systems in public schemes are simply those inherited from prior practice, since the doctors would be disturbed by changes. Most payment procedures under ‘socialized medicine’ are simply more bureaucratized versions of the methods that were used and often even invented by the doctors under earlier private practice."
CLINICAL RESPONSE TO IMMUNIZATION WITH CENDEHILL STRAIN RUBELLA VACCINE
Authors: Rogers K. D. , Ramirez George , Cortez Manuel , Michaels Richard , Savin Michael , Montgomery Robert , Welty Thomas , Taylor Floyd , Hingson Robert A.
Published: December 2021

Approximately 1,100 institutionalized Costa Rican children and young women were observed daily for 25 days following immunization with Cendehill strain rubella vaccine or placebo. Observations were made double blind by specially trained public health nurses supervised by a physician.

Three subgroups were identified: preimmunization seropositive subjects receiving vaccine (S+); preimmunization seronegative subjects receiving vaccine (S-); and preimmunization seropositive and seronegative subjects receiving placebo (P). The 25 day observation time was divided into 5-day periods. For both sexes, two age groups, and each time period the number of days was recorded on which was present one or more of 13 signs and symptoms considered likely to reflect vaccine reaction. S-and P,S+ groups were compared statistically for each symptom or sign, time interval, and age sex subgroup.

Most post-immunization signs and symptoms were not severe or disabling, of high prevalence, or usually more common in S- than P,S+ subjects. There were significantly higher frequencies of posterior auricular, posterior cervical, and occipital lymphadenopathy in S- than P,S+ children less than 15 years of age. Females had higher frequencies of headache and arthralgia than did the males studied, but frequencies in S- and P,S+ groups did not differ significantly.
A Lethal Syndrome of Microcephaly with Multiple Congenital Anomalies in Three Siblings
Authors: Neu Richard L. , Kajii Tadashi , Gardner Lytt I. , Nagyfy Stephen F. , King Saddie
Published: December 2021

The clinical findings are described in three siblings with a syndrome of microcephaly and multiple congenital abnormalities. All three infants had congenital anomalies of the limbs, described as flexion deformities. Infant 2 showed atrophic gyri and absence of the corpus callosum, with atrophy of cerebrum, cerebellum, and pons. Infant 2 exhibited unusual canine facies. Chromosomal studies were normal on infant 3 (leucocyte and skin cultures). Leucocyte cultures from the mother and father revealed no cytogenetic abnormality.
Letters to the Editor
Authors: Yaffe Sumner J.
Published: December 2021

The Committee on Drugs has reviewed Dr. Freeman's letter. Dr. Freeman is of course entitled to his views and the Committee welcomes this opportunity for him to make these public. The Committee would like to reiterate its view that such therapy must be based on objective, scientifically valid data rather than upon hearsay, belief, or other forms of unsubstantiated opinion.
Pediatric Aspects of Air Pollution (Continued)
Authors: Podolsky Morton L.
Published: December 2021

I realize that all aspects of air pollution could not be covered in the report "Pediatric Aspects of Air Pollution" by the Committee on Environmental Hazards (Pediatrics, 46:637). The material presented suggests that there is an established clinical "cause and effect" relationship between air pollutants and disease; unfortunately this is not so. We have some statistics which indicate that air pollution affects patients with myocardial infarctions, and that mortality in the aged increased during air polution catastrophies (Meuse Valley, 1930; Donora, Pennsylvania, 1948; and London, 1952 and 1962).
EFFECT OF BILIRUBIN ON DRUG CONJUGATIONS IN CHILDREN
Authors: Levy Gerhard , Ertel Inta J.
Published: December 2021

The formation of glucuronides of salicylate, salicylamide, and acetaminophen in two sisters with congenital unconjugated hyperbilirubinemia responsive to phenobarbital was normal at widely different (6 to 37 mg per 100 ml) serum bilirubin concentrations. The conjugation of salicylate with glycine, and the formation of salicylamide sulfate and acetaminophen sulfate were also normal. This shows that unconjugated hyperbilirubinemia per se does not affect the biotransformation of the three drugs tested. The clinical and pharmacokinetic characteristics of the children in this study are consistent with a recently proposed mechanism involving a deficiency in hepatic anion-binding protein (rather than glucuronyl transferase) as one cause of unconjugated hyperbilirubinemia.
CYTOGENETIC OBSERVATIONS IN CHILDREN WITH NEUROBLASTOMA
Authors: Wakonig-Vaartaja Theresa , Helson Lawrence , Baren Ann , Koss Leopold G. , Murphy M. Lois
Published: December 2021

Cytogenetic studies were performed on 21 children with neuroblastoma. Increased numbers of abnormal metaphases were observed in pretreatment samples of peripheral blood and bone marrow. Three bone marrows infiltrated with extrinsic cells had heteroploid cell lines with consistent marker chromosomes. Long-term survivors without evidence of active disease had chromosomal abnormalities in peripheral blood lymphocytes.

These findings evoke questions concerning prognosis, tumor formation, and long-term effects of radiotherapy.
Therapeutic Considerations in Reye's Syndrome
Authors: Brown R. E. , Madge C. E.
Published: December 2021

The article by Pross, et al.1 emphasizes the urgency of finding a suitable treatment for Reye's syndrome. This is underscored by the fact that most patients with this syndrome do not survive as noted in their article; that most conventional forms of therapy such as intravenous glucose, electrolyte and fluid replacement, and glucocorticoids do not seem to arrest the encephalopathy; and that as more physicians become acquainted with the syndrome the recognized incidence should increase.
BRACHIAL PLEXUS PALSY IN NEWBORN INFANTS
Authors: Eng Gloria D.
Published: December 2021

Experience in the diagnosis, treatment, and evaluation of residua of brachial plexus paralysis in 25 infants is presented. Associated defects substantiate the traumatic nature of the deliveries.

The electromyogram proved a valuable tool in the exact delineation of the pathology and in determination of prognosis.

Early optimum treatment prevented atrophy and contractures. Of the 20 babies with adequate follow-up, approximately ⅓ recovered by 6 months with minimal deficit, over ½ recovered by 1 year with moderate residua to include persistent weakness, delay in bone growth, dislocation, and peculiar posturing of the arm; and the other three infants showed significant handicaps.
THE HISTOCHEMICAL NITROBLUE TETRAZOLIUM REDUCTION TEST IN THE DIFFERENTIAL DIAGNOSIS OF ACUTE INFECTIONS
Authors: Humbert James R. , Marks Melvin I. , Hathaway William E. , Thoren Christine H.
Published: December 2021

Nitroblue tetrazolium (NBT) reduction by phagocytic leukocytes was investigated histochemically in 296 subjects with and without infections. Among 130 patients with noninfectious diseases, osteogenesis imperfecta patients and their relatives, and hemophiliacs frequently displayed high NBT-reduction values in their neutrophils. Four percent of the other noninfected patients yielded NBT-reduction values higher than normal in their neutrophils and were considered to have "false-positive" NBT-reduction tests. Most patients with acute bacterial infections (83%) showed an increased percentage of NBT-positive neutrophils. In patients who did not respond to a bacterial infection by increasing their percentage of NBT-positive neutrophils, there was suggestive evidence of a state of neutrophil dysfunction. Eighty-four percent of patients with viral or tuberculous infections demonstrated normal percentages of NBT-positive neutrophils. Acute bacterial infections were most often associated with a high percent of NBT-positive neutrophils, while low values predominated in viral infections regardless of the patient's total leukocyte counts. The NBT histochemical test would appear to be a useful adjunct to microbiologic techniques in establishing the diagnosis in patients with suspected infection.
Unintentional Esophageal Intubation in the Newborn
Authors: Stool Sylvan E. , Johnson Dale , Rosenfeld Philip A.
Published: December 2021

Three cases of accidental esophageal intubation in the newborn infant are presented. The best way of preventing such accidents is to attech an adaptor to all tubes that will be used in the newborn. Such accidents should not be complicated by hasty and inappropriate attempts at therapy.
ON WEANING OF INFANTS ACCORDING TO DR. JAMES JACKSON
Authors: C. T. E.
Published: December 2021

Dr. James Jackson (1777-1876), first physician to the Massachusetts General Hospital and one of its founders, has been described as the most conspicuous physician in the medical annals of Massachusetts. His advice about the proper time to wean infants from the breast follows:

Children are benefited by living principally on the breast for twelve months; their vigor is evidently impaired in almost all cases, when they are nursed less than nine months. The safest period of the year for weaning is from the middle of October to the middle of March; provided they be not weaned under ten months after December, under eleven after January, nor under twelve after February. Children who are weaned at the age of twelve months in March are ordinarily safe; those who are weaned at this age in April are less so, one half of them perhaps suffering severely in the subsequent summer or autumn. In May the danger increases; and in the four subsequent months, if a child of any age be weaned, it will in most cases be very sick before the middle of the October ensuing. The disease does not immediately follow the weaning; though in many cases the diarrhœa of teething children ensues at once. But the instances in which children, who are weaned between May and October, escape severe cholera infantum, are extremely rare indeed.1
GROWTH HORMONE LEVELS DURING SLEEP IN NORMAL AND GROWTH HORMONE DEFICIENT CHILDREN
Authors: Underwood Louis E. , Azumi Kazuo , Voina Sandra J. , Van Wyk Judson J.
Published: December 2021

Plasma growth hormone levels were determined from samples drawn at 15-minute intervals during the first 2 hours of spontaneous, nocturnal sleep in 16 normal children, one nongrowth hormone deficient dwarf, and three children with hypopituitarism. Depth of sleep was assessed by continuous EEC monitoring. Daytime growth hormone responses to insulin-induced hypoglycemia were also assessed in most of these children and in a larger group of normal and hypopituitary children. In the normal children and in the nongrowth hormone deficient dwarf, increases in plasma growth hormone after the onset of the slow wave pattern on EEG were equivalent to those seen after insulin-induced hypoglycemia. No significant changes in growth hormone levels were seen in the hypopituitary patients. Interpretation of growth hormone levels in blood specimens obtained by serial sampling after the onset of deep sleep appears to be as reliable a method of assessing pituitary function as the levels resulting from insulin-induced hypoglycemia. Although growth hormone analysis of a single sample taken about 1 hour after the onset of deep sleep should exclude the diagnosis of growth hormone deficiency in as many as 70% of the nongrowth hormone deficient individuals, a positive diagnosis of hyposomatotropism must be based on either serial sampling during deep sleep or challenge with insulin and/or arginine.
PRESIDENT'S ADDRESS 1971
Authors: McKay R. J.
Published: December 2021

Iwould like to begin this address with a summary of activities and accomplishments during the past year, which, in my opinion, are new or of particular significance for the Academy and its Fellows, and for the health and welfare of children. In doing so, many, if not most, of our organization's established activities and functions will be ignored, not because they are unimportant, but because you are all well acquainted with them and their value.

Our Report on the Delivery of Health Care to Children has finally gone to the printer and will hopefully be in your hands by the end of the calendar year. Implementation of some of its recommendations is already under way, and plans are being made to implement the others.

A policy and statement on national health insurance has been completed and issued after 3 years of intensive effort. While it satisfies neither the advocates of total socialization of medical care, nor the advocates of the status quo, I believe that it does represent a view of the majority of our membership that changes must be made, that we must maintain an ability to influence these changes, and that the changes must provide options, flexibility, appropriate incentives, and economic feasibility for both the consumer and the deliverer of health care.

Under Academy leadership and sponsorship a Joint Committee on Quality Assurance of Child Health Care has been formed. Financed by a large federal grant, it will develop and test methods designed to assure the quality of child health care.
Iron-Fortified Formulas (Continued)
Authors: Melhorn David K. , Gross Samuel , Newman Arthur J.
Published: December 2021

The controversy surrounding the report of the Committee on Nutrition of the American Academy of Pediatrics regarding iron fortified formulas1 has stimulated us to submit the following further observations.

It is evident that iron fortified formulas are efficient sources of iron. Equally well known is the fact that the incidence of nutritional iron deficiency is greatest in infants of lower socioeconomic groups. Providing these infants with iron supplemented formulas will effectively combat iron deficiency. However, despite an occasional comment to the contrary, it is our experience that the incidence of nutritional iron deficiency among infants in upper socioeconomic groups is exceedingly low.
Congenital Adrenal Hyperplasia: Case Report in Dizygotic Twins
Authors: Tze Wah Jun , Fisher Joseph N. , Crigler John F.
Published: December 2021

Congenital adrenal hyperplasia results from an inborn error of metabolism of adrenocortical steroidogenesis, genetically determined and inherited as an autosomal recessive. The condition has been described in identical twins (4,5). This paper reports the occurrence in dizygotic twins.

Case Reports

Patient L.R. was referred to The Children's Hospital Medical Center at 1 month of age because of ambiguous genitalia. She was the second born of twins delivered to a gravida 2, para 2 mother after an uneventful 34 weeks's gestation. The mother received no drugs and had no illness during the pregnancy. The birth weight was 4 pounds. The placenta and amniotic membranes were not examined.
Pesticides and the Nursing Mother
Authors: Gochfeld Michael
Published: December 2021

In these days of changing attitudes toward breast-feeding, the pediatrician often sees a mother who is experiencing difficulties with nursing. These young women, believing in "nature's proper food," feel that breast-feeding is psychologically and physically better for mother and child, yet at the same time complain about inadequate milk supply or local discomfort. Despite a sympathetic ear and reassurance, some of these mothers may stop nursing, but may retain a sense of guilt. Merely telling them that cow's milk has proven quite adequate for human infants in the past may not assuage their guilt feelings.
D-I-A-B-E-T-E-S
Authors: Mofenson Howard C. , Greensher Joseph , Horowitz Roy
Published: December 2021

Many physicians see few, if any, patients each year with juvenile diabetes mellitus. With this in mind, we have formulated a simple, easily remembered mnemonic using the letters in "Diabetes" to help physicians refresh their memories as to the minimum amount of knowledge to be imparted to the parents and the patients. The details will vary with the intellectual capacity of the parent and the patient.

To aid the physician, the following will constitute a minimum program of education.
Listeriosis, Royalty, and the British Parliament
Authors: Berlin Cheston M.
Published: December 2021

The article by Dr. W. B. Saxbe, Jr.1 was extremely interesting to me as a pediatrician and also as one interested in British History. I would like to take issue with its sentence: "Parliament made use of this situation [no heir of Queen Anne] to assume the initiative in government which it has maintained to the present." The failure of Queen Anne to produce an heir did not lead to independence of the Parliament from the Monarch.
LIGHT—A TIME FOR CHANGE TO "RADIANT FLUX," OR MICROWATTS PER SQUARE CENTIMETER (µW/CM2)
Authors: Lucey Jerold F.
Published: December 2021

Some simple therapies are often used but little understood. Anybody using phototherapy should read with care the two articles about light in this issue. That by Drs. MacLeod and Stern calls attention to and documents in the traditional way, using foot candles and a simple light meter, the wide daily and seasonal variations in environmental light conditions that can occur in nurseries. To many, even the term "foot candles" is a new unit with little meaning until recently. If you then turn to the article by Dr. Klein, a photobiologist, you will be convinced that it is not only a very crude, inaccurate way of expressing something important to us all, but it is actually the wrong unit!
THE CHILD'S LOSS OF CONSCIOUSNESS: A PSYCHIATRIC VIEW OF PEDIATRIC ANESTHESIA
Authors: Bothe Albert , Galdston Richard
Published: December 2021

Fifty healthy pediatric patients receiving general anesthesia for minor elective surgery were studied to assess how children experience and conceptualize induced unconsciousness. The techniques used by the patients and staff to minimize the psychological stress of anesthesia were observed. The findings confirm previous studies of the incidence of agitated behavior before and after anesthesia and suggest methods to decrease the frequency of occurrence. Behavioral signs predictive of agitation during anesthetic induction or emergence are discussed. The theoretical implications of these observations are related to ego development and to the capacity of the child to tolerate stress.
On the Incidence of Hiatal Hernia in Infants
Authors: Cuttman Frank M.
Published: December 2021

It is probable that there is an apparent difference in the incidence of uncomplicated and complicated hiatal hernia in infancy and childhood seen in Europe and North America.

The explanation of this apparent difference may be in the cultural pattern of infant rearing which results in early postural treatment of mild hiatal hernia in North America.
Letter to the Editor
Authors: Schmitt Barton
Published: December 2021

In answer to Dr. Crook's comments, I would like to make four points:

1. Although I recognize the existence of the allergic tension-fatigue syndrome, in my own experience it is a very uncommon disorder. Even children with "hard allergies" (e.g., asthma and allergic rhinitis) rarely have the findings diagnostic of this disorder.

2. School phobia, on the other hand, is a common problem that presents approximately twice a month in the average pediatrician's office. Although the tension-fatigue syndrome was considered in my patients with school phobia, none of them (including those with allergies) met Dr. Crook's criteria for diagnosis.