bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional Needs of Low-Birth-Weight Infants
Authors:   Committee on Nutrition
Published: December 2021

The goal of feeding regimens for low-birth-weight infants is to obtain a prompt postnatal resumption of growth to a rate approximating intrauterine growth because this is believed to provide the best possible conditions for subsequent normal development. This statement reviews current opinion and practices as well as earlier reviews1-5 of the feeding of the low-birth-weight infant.

Caloric Requirement

The basal metabolic rate of low-birth-weight infants is lower than that of full-term infants during the first week of life, but it reaches and exceeds that of the full-term infant by the second week. Daily caloric requirements reach 50 to 100 kcal/kg by the end of the first week of life and usually increase to 110 to 150 kcal/kg in subsequent active growth.

A partition of the daily minimum energy requirements is shown in Table I.6

There are considerable variations from these average values, depending on both biological and environmental factors. Infants who are small for gestational age tend to have a higher basal metabolic rate than do premature infants of the same weight.7 The degree of physical activity appears to be a characteristic of the individual infant. Environmental factors may have a greater influence than biological variation in determining the total caloric requirements. The maximal response to cold stress can increase the resting rate of heat production up to 2½ times.6Calories expended for specific dynamic action and for fecal losses are dependent on the composition of the milk or formula fed, as well as on individual variations in absorption of
Drs. Long and Rogers Reply
Authors: LONG THOMAS , ROGERS KENNETH D.
Published: December 2021

Margolis concludes from our data that (1) information in physicians' office records is valid and (2) an association exists between charting and performing a procedure. We agree.

Margolis makes a further inference that “improving charting might bring about improved clinical performance.” He supports this conclusion not by our data (which neither support nor refute it) but by the study of Zuckerman et al. and his own as yet unpublished review article. Our report identified limitations
Oral Syringes and Aspiration Risk
Authors: GRANOFF DAN M.
Published: December 2021

To the Editor:

The report of the Committee on Drugs entitled “Inaccuracies in Administering Liquid Medication (Pediatrics 56:327, August 1975) is highly relevant. The suggestion to use a calibrated syringe for measuring and administering liquid medication should better enable parents to give the exact amount prescribed. In a letter to the editor which appeared subsequently(Pediatrics 56:613, October 1975), Dr. Schunk comments on the safety of this method when the medication is given “a drop
Act of 1975
Authors: BLOCKSTEIN ZAGA
Published: December 2021

To the Editor:

The Education for All Handicapped Children Act (S6) of 19751 not only provides special appropriations for education of handicapped children, but has the potential to add considerably to the progress and development of better health care for handicapped children.

Act S6 stipulates that all handicapped children 3 to 21 years of age may enjoy the right to education in the least restrictive environment, at no cost to parents. Such legislation will reduce
Twenty-Six Years of Experience
Authors: HARVEY NORMAN A.
Published: December 2021

To the Editor:

The present battle between family physician and pediatrician for the child care “market” is an unfortunate but inevitable result of our system, which in turn results from an evolutional problem in the specialty of pediatrics.

Something has been wrong with primary-care pediatrics for many years, as seen in the high rate of dissatisfaction, the low economic return, the frequent dropouts, and what could now be described as a dog-in-the-manger attitude toward family
Coughs Should Be Suppressed
Authors: SAFIR DAVID E.
Published: December 2021

To the Editor:

In response to the letter by Drs. Ivey and Kattwinkel concerning Actifed-C,what a peculiar letter for academicians.

I am not surprised at the sweeping statement regarding banning the use of codeine in infancy; apparently academic pediatricians feel we should not treat symptoms such as cough. I am surprised at their shoddy example of the danger. They claimed that an infant suffered respiratory arrest while a serum level taken three days after
Temperament as a Factor in Early School Adjustment
Authors: Carey William B. , Fox Marian , McDevitt Sean C.
Published: December 2021

Infant temperament profiles of "difficult," "intermediate," and "easy" in a randomly selected group of 51 children were shown to correlate with impulsivity and school adjustment at ages 5½ to 7 years. However, the nonlinear relationship makes this a finding of uncertain significance. On the other hand, contemporaneous temperament determinations using the Behavioral Style Questionnaire completed by the children's mothers showed a significant correlation between the adaptability subscale and teacher judgments of school adjustment. This latter finding adds support to the view that temperament is a significant factor in school adjustment and that it can be measured by a clinical instrument appropriate for pediatric use.
Flame-resistant sleepwear: Have the bird-watchers gone ape?
Authors: Bergman Abraham G.
Published: December 2021

I know it sounds ghoulish, but the staff of the burn unit in my hospital practically danced around the beds of the three children who were admitted in the past year with burns incurred when their pajamas ignited. The reason was that they were wearing garments that had been treated with a flame-retardant chemical. The burns, therefore, were trivial. The children were quickly treated and sent home. A few short years ago, before flame-resistant sleepwear was on the market, these same children would either have been dead or sentenced to a life of pain and disfigurement. Our experience has been mirrored at burn centers throughout the country.
Application of a Live Varicella Vaccine in Children With Acute Leukemia or Other Malignant Diseases
Authors: Izawa Tadasu , Ihara Toshiaki , Hattori Akihiko , Iwasa Toshiaki , Kamiya Hitoshi , Sakurai Minoru , Takahashi Michiaki
Published: December 2021

A live varicella vaccine was used in 11 susceptible children in remission from acute leukemia, ten of whom had been in remission for six months or less, and in 6 children with neuroblastoma and retinoblastoma. In the immunological checkup before vaccination, most of them showed a positive reaction in the skin tests with dinitrochlorobenzene, phytohemagglutinin, purified protein derivative, and viral antigens. Leukopenia (three cases, less than 3,000/cu mm) and decreased IgC level (two cases, 380 mg/dl and 445 mg/dl) were observed in the children with leukemia. Anticancer medication was suspended from one week before vaccination to one week after vaccination. The only clinical reaction was a minute rash that appeared three weeks after vaccination in two children with leukemia and that disappeared within three days. Serological responses by complement fixing and neutrahzmg (NT) tests were detected in all the vaccinated children four weeks after vaccination, and NT antibody was still detected 28 months after vaccination in the two patients tested. Three of the vaccinees were exposed to natural varicella at home and in the classroom 2 to 18 months after vaccination, but they were free from any varicella symptoms.
ON THE CARE OF THE PREMATURE INFANT BY LAURENCE STERNE AS DESCRIBED IN HIS NOVEL TRISTRAM SHANDY (1760)
Authors: C. T. E.
Published: December 2021

One of the earliest descriptions of the care of the premature infant is that of the English clergyman and novelist Laurence Sterne (1713-1768) in his preposterously comic novel, Tristram Shandy. Sterne described the case of Licetus Fortunio (1577-1657), an Italian physician who was born prematurely as follows:

. . . And for Licetus Fortunio . . . all the world knows he was born a foetus. [He] was no larger than the palm of the hand, but the father, having examined it in his medical capacity, and having found that it was something more than a mere embryo, brought It living to Rapallo, where it was seen by Jerome Bardi and other doctors of the place. They found it was not deficient in anything essential to life, and the father, in order to show his skill, undertook to finish the work of nature and to perfect the formation of the infant by the same artifice as is used in Egypt for the hatching of chickens. He instructed a wet-nurse in all she had to do, and having put his son in an oven, suitably arranged, he succeeded in rearing him, and in making him take on the necessary increase of growth, by the uniformity of the external heat, measured accurately in the degrees of a thermometer, or other equivalent instrument.
Relationship of Serum Theophylline Concentration to Inhibition of Exercise-Induced Bronchospasm and Comparison With Cromolyn
Authors: Pollock James , Kiechel Fred , Cooper David , Weinberger Miles
Published: December 2021

Exercise-induced bronchospasm was induced by treadmill running in 12 children on two days preceding either inhaled cromolyn sodium (Intal) or oral theophylline (Slo-Phyllin tablets), 7.5 mg/kg, administered in a double-blind manner. A second exercise period identical to the first followed two hours later; the medication administration had been timed so that the second exercise stress followed two hours after theophylline administration and 15 minutes following cromolyn administration. The patients subsequently were exercised twice more at two-hour intervals on both days. Blood was drawn for serum theophylline measurement immediately after each of the exercise periods. There was little demonstrable exercise-induced bronchospasm resulting from the first postmedication exercise period following theophylline administration. The two subsequent exercise periods were associated with some return of postexercise bronchospasm. The degree of inhibition of exercise-induced bronchospasm correlated with serum theophylline levels that averaged 16, 13, and 10 µg/ml at two, four, and six hours after the theophylline dose (mean Spearman rank correlation coefficient = .71, P < .01). The effect of cromolyn in suppressing exercise-induced bronchospasm was generally much less, but two of the 12 patients exhibited suppression of exercise-induced bronchospasm that matched or excelled that seen with theophylline.
ON THE EVILS OF CHILD LABOR IN 1907 BY THE AMERICAN POET EDWIN MARKHAM
Authors: C. T. E.
Published: December 2021

Edwin Markham (1852-1940), an American poet, achieved worldwide fame for the poem "The Man with the Hoe." Inspired by Millet's famous painting, the poem was a forceful protest against the degradation and exploitation of labor. Markham's description of child labor, written in 1907, stirred the nation with its bitter depiction of the evils of child labor.

And the children are called in from play to drive and drudge beside their elders. The load falls upon the ones least able to bear it—upon the backs of the little children at the base of the labor pyramid.

All the year in New York and in other cities you may watch children radiating to and from such pitiful homes. Nearly any hour on the East Side of New York City you can see them—pallid boy or spindling girl—their faces dulled, their backs bent under a heavy load of garments piled on head and shoulders, the muscles of the whole frame in a long strain. The boy always has bowlegs and walks with feet wide apart and wobbling.

In the rush times of the year, preparing for the changes of seasons or for the great "white sales," there are no idle fingers in the sweatshops. A little child of "seven times one" can be very useful in threading needles, in cutting the loose threads left on, or for any stitch broken by the little bungling fingers. The light is not good, but baby eyes must "look sharp."

In New York City alone, 60,000 children are shut up in the home sweatshops.
ETHICS OF EXPERIMENTATION
Authors: Barber B. ,   Student
Published: December 2021

. . . Medical institutions and individual investigators operate today with two powerful sets of values and goals. On the one hand there is the pursuit and advancement of scientific knowledge. On the other there is the provision of humane and effective therapy for patients. . . . There is evidence that the enhanced excitement attending scientific achievement and the rewards bestowed on it in recent decades have skewed the decision-making process in many cases of conflict. . . . Our data show that the social structure of competition and reward is one of the sources of permissive behavior in experimentation with human subjects...
HEALTH TECHNOLOGY
Authors: Mahler H. ,   Student
Published: December 2021

Essential health care requires essential health technology, a technology which people can understand and which the non-expert can apply. The identification or generation of such technology forms part of the revolution in community health and thus presents a tremendous challenge to [W.H.O.].

We just cannot afford to continue the indiscriminate use of methods, machines and medicines, so many of which have never undergone the critical evaluation of a controlled trial, let alone a proper cost/effectiveness analysis. . . . We must break the chains of dependence on unproved, oversophisticated and overcostly health technology by developing another kind of technology that is more appropriate because it is technically sound, culturally acceptable and financially feasible.
Chorioretinitis in the Adolescent: Two Case Presentations With Discussion
Authors: Greydanus Donald E. , Noble Kenneth G. , Hofmann Adele D.
Published: December 2021

Two cases of chorioretinitis in adolescence demonstrate the characteristic course of events. It is typically caused by Toxoplasma gondii and is usually acquired congenitally. Toxocara infection must be considered in younger children. Other etiologic agents are rarely implicated in children and youth.

Diagnosis of toxoplasmic chorioretinitis is based on a characteristic history of visual disturbance and specific funduscopic appearance, along with confirmatory serological studies. Management is complex, utilizing pyrimethamine (Daraprim), sulfadiazine, and prednisone in combination for several weeks or months. The combined long-term care by the physician generalist and ophthalmologist is essential. Recognition of adolescent developmental issues is important to insure optimal compliance.

The prognosis is guarded, with 5% to 30% recurrence rates noted after treatment. Severe visual impairment may be seen.
Current Trends in Pediatric Urology
Authors: Woodard John R. , Belman A. Barry , Walker R. Dixon , Kaplan George W. , Firlit Casimir F.
Published: December 2021

More than 40 papers were read before the Urology Section of the annual meeting of the American Academy of Pediatrics in Chicago, October 17 to 2i, 1976. Some of those papers were presented as parts of symposia currently important to both pediatricians and urologists. Three such symposia are summarized in this report.

EFFECT OF VESICOURETERAL REFLUX ON THE KIDNEY

Vesicoureteral reflux continues to be a controversial topic and one in which the parameters for management are being constantly reassessed. The Joint Action Committee on Vesicoureteral Reflux presented a panel discussion emphasizing the effects of reflux on the kidney.

The most fundamental facts about reflux concern its relationship to bacteriuria and chronic renal scarring.1 While prevalence of bacteriuria in preschool girls is about 1%, in school-age girls it rises to about 2%. In these children the emergence rate of urinary tract infection is between 3% and 5%. Among girls found to have bacteriuria the prevalence of reflux is 20% to 30% with renal scarring being present in 15% to 20% of this group. These latter figures are considered to be conservative estimates. Actually, 90% of children with renal scarring demonstrate evidence of current or previous vesicoureteral reflux.2 The data of Winberg et al. indicate that the kidney is most vulnerable to scarring during the first year of life.3

In 1969 Hodson introduced the concept that intrarenal reflux may be the primary factor leading to renal scarring. In support of his concept Hodson et al. carried out extensive experimental studies in swine, an animal selected because of the similarities between the kidney of the pig and that of the humans.4
Febrile seizures: An end to confusion
Authors: Freeman John M.
Published: December 2021

After years of conflicting advice from numerous experts about treatment or nontreatment of febrile seizures, there is now a sound basis on which the pediatrician can make decisions. Recent studies1-4 have approached the problems of febrile seizures from different viewpoints and are beginning to present a coherent, understandable picture of their outcome and the results and problems of therapy.

Nelson and Ellenberg in this issue (p. 720) present the last in a series of articles on the 1,706 children with febrile seizures from the 54,000 pregnant women enrolled in the Collaborative Perinatal Project and followed up to the age of 7. All data were collected prospectively.
Relative Effects of Drugs and Diet on Hyperactive Behaviors: An Experimental Study
Authors: Williams J. Ivan , Cram Douglas M. , Tausig Frances T. , Webster Evelyn
Published: December 2021

In a test of Feingold's hypothesis that food additives trigger the hyperactive response, 26 hyperactive children were randomly assigned to treatment conditions whereby they were given active or placebo medications in combination with challenge cookies with artificial food colors or control cookies without the additives. The children were crossed over into each of the four treatment conditions and experimental procedures were employed, including double-blind assessments through the completion of behavior checklists, by teachers and parents.

Stimulant medications were clearly more effective than diet in reducing hyperactive behavior. The parent ratings indicate strong drug effects and inconclusive diet effects. Drug effects are marked in teacher ratings as well. However, when the children were receiving placebos, their hyperactive behaviors in the classroom were greater when eating cookies with artificial colors than when eating cookies without artificial colors.

According to the ratings, approximately seven children were no longer hyperactive. There is evidence to suggest that the behavior of three to eight children was diet-responsive, depending on the criteria used. There is evidence, particularly in teacher ratings, in support of Feingold's hypothesis if it is modified.

Further research is required to specify which subtypes of hyperactive children respond to a diet free of artificial food colors.
OLIVER AND NATURE
Authors: Dickens Charles
Published: December 2021

"Although I am not disposed to maintain that the being born in a workhouse is in itself the most fortunate and enviable circumstance that can befall a human being, I do mean to say that in this particular instance it was the best thing for Oliver Twist that could by possibility have occurred. The fact is, that there was considerable difficulty in inducing Oliver to take upon himself the office of respiration-a troublesome practice, but one which custom has rendered necessary to our easy existence; and for some time he lay gasping on a little flock mattress, rather unequally poised between this world and the next; the balance being decidedly in favor of the latter. Now, if, during this brief period, Oliver had been surrounded by careful grandmothers, anxious aunts, experienced nurses, and doctors of profound wisdom, he would most inevitably and indubitably have been killed in no time. There being nobody by, however, but a pauper old woman, who was rendered rather misty by an unwonted allowance of beer; and a parish surgeon who did such matters by contract; Oliver and Nature fought out the point between them. The result was, that, after a few struggles, Oliver breathed, sneezed, and proceeded to advertise to the inmates of the workhouse the fact of a new burden having been imposed upon the parish, by setting up as loud a cry as could reasonably have been expected from a male infant who had not been possessed of that very useful appendage, a voice, for a much longer space of time than three minutes and a quarter.

As Oliver gave this first proof of the free and proper action of his lungs, the patchwork coverlet which was carelessly flung over the iron bedstead, rustled; the pale face of a young woman was raised feebly from the pillow; and a faint voice imperfectly articulated the words, "Let me see the child, and die."
Early Increase in Intracranial Pressure in Preterm Infants
Authors: Donn Steven M. , Philip Alistair G. S.
Published: December 2021

Noninvasive measurement of intracranial pressure is now available via the anterior fontanel in newborn infants. We measured intracranial pressure during the first week of life in 18 preterm infants and found a statistically significant increase from birth to age 24 hours and a significant decrease by 48 hours (13.8 vs. 24.4 vs. 14.3 cm H20). This did not seem to be the result of postnatal head shrinkage. There were no other apparent correlations. We suspect that hypoxia may play an important role in the etiology of increased intracranial pressure. We believe that these findings may have important implications for intracranial hemorrhage in preterm infants.
PUNDITS
Authors: Mccabe Chas. ,   Student
Published: December 2021

"On the occasion of his taking over the seat of English Literature at Cambridge University in 1913, Sir Arthur Quiller-Couch said: ‘Definitions, formulae (some would add creeds) have their use in any society in that they restrain the ordinary unintellectual man from making himself a public nuisance with his private opinions.’ . . . The blasted thing is that the statement is almost precisely true. In most human beings there exists a terrible need to be told what to think. . . . There is this hunger for definitions. The guys who provide these consolatory formulae are called pundits. . . . The pundit, it may be argued, serves a useful function in society. . . . If enough predigested opinion is foisted upon the world, the grumblings of the malcontents are muted. You may have noticed that the people who have the most violent opinions are those who read either superficially or not at all. . . . If the world were filled with people of this stripe, it would be virtually ungovernable. . . . It is the steadying influence of the pundit, the priest and the professor that puts all this mental ferment down. . . . In return for your confusion, [they] offer the comfort of certainty. In return for your instinctive knowledge that there are two sides to every story, [they] offer the resounding authority that there is only one."
Cost of Living for Infants Weighing 1,000 Grams or Less at Birth
Authors: Pomerance Jeffrey J. , Ukrainski Christinia T. , Ukra Tara , Henderson Diane H. , Nash Andrea H. , Meredith Janet L.
Published: December 2021

This article reports the in-hospital cost of caring for 75 infants weighing 1,000 gm or less at birth who were born during the 2½-year period between January 1973 and June 1975. Thirty infants (40%) survived. Nineteen of 27 infants tested (70%) appear to be neurologically and developmentally "normal" at 1 to 3 years of age.

Hospital charges were adjusted to September 1976 rates and corrected for a 94% collection rate. Physicians' fees represented less than 5% of the total bill and were not included. The average adjusted daily and total costs for the 45 infants who died were $825 and $14,236, respectively. The average adjusted daily and total costs for the 30 survivors were $450 and $40,287, respectively. The average adjusted total cost per "normal" survivor was $88,058. It is our belief that the outcome justifies this expense. Society, however, must be the ultimate judge.
FAMILY DIFFICULTIES IN CITIES
Authors:   Student
Published: December 2021

"It has been found in developed countries that mental health problems in children are more common among those living in inner cities than among those in towns or rural areas. It appears that this is due in large part to the higher rates of family difficulties in inner city areas. Children's psychosocial functioning can be more frequently impaired in the cities because more children live in discordant unhappy homes or have depressed or deviant parents. However, relatively little is known about the specific features of city life that have this adverse effect on family functioning. It is not urbanization per se because many medium-sized towns have rates of disorder comparable to those in rural areas; nor is it a function of population density or of industrialization, because industrial areas may have relatively low rates of psychosocial disorder. There is an urgent need to identify the features of city life that hamper family functioning and predispose to mental disorder, as knowledge on this matter carries the possibility of instituting effective preventive measures."
Certification for pediatric nurse practitioners and associates
Authors: McAtee Patricia R. , Goldstein Paul S. , Hochheiser Louis
Published: December 2021

Through the collaborative efforts of nursing and medicine, a national entry-level certification for pediatric nurse practitioners and associates has been developed and offered. This marked the culmination of a decade of effort in which the American Academy of Pediatrics (AAP) joined with pediatric nurse practitioners and associates and the faculty of nurse practitioners programs to develop a means of recognizing and accrediting the special skills and competencies of pediatric nurse practitioners and associates.

In May of 1977 the National Board of Pediatric Nurse Practitioners and Associates (which includes representation from the AAP, the National Association of Pediatric Nurse Associates and Practitioners [NAPNAP], and the Association of Faculties of Nurse Practitioner and Associate Programs [AFNPP]) announced the certification of 823 pediatric nurse practitioners and associates.
Drs. Allen and Bergman Reply
Authors: Allen David B. , Bergman Abraham B.
Published: December 2021

The gist of Dr. Reisinger's letter seems to be that we muttered rather than shouted our mea culpas. He is quite right that we should not have interchanged the terms "use" and "reported use." He's not right in charging that 60% of the population "refused" to participate in the study. Those subjects who chose not to view the safety film on the maternity ward, with few exceptions, did so because they were either receiving treatment or involved with visitors.
Phenobarbital and Febrile Seizures
Authors: Hamburger David
Published: December 2021

I read with great interest the article on febrile convulsions by Wolf et al. (Pediatrics 59:378, March 1977). It is always enjoyable to read an article which confirms one's personal bias.

I would like to offer one point for discussion. In group 1, which received phenobarbital continuously, the daily dose of 3 to 4 mg/kg/day was at the low range of the commonly used anticonvulsant dose of 4 to 6 mg/kg/day.1 Perhaps the continuous use of a dose of 5 mg/kg/day would have further decreased the incidence of recurrent febrile convulsions.
EPIDEMIOLOGY AND CHILD PSYCHIATRY
Authors: Haggerty Robert J.
Published: December 2021

The best evidence is that around 10% of children have a recognizable psychiatric disorder. This is a sobering reminder of the impact of this major public health problem today. This issue of the journal reports a series of papers presented at an institute of epidemiology on child psychiatry, and it provides important facts for any pediatrician interested in the behavioral issues of children. There is a useful series of papers on causation and also on treatment. For instance, Needleman and colleagues present data on the correlation of increasing lead burden in a population of schoolchildren with psychological disturbance. Rutter presents the Isle of Wight studies of a total population of children, demonstrating how different behavioral problems are correlated with different epidemiologic factors, thus allowing separation of what had seemed similar problems. Suicide, one of the few causes of death that is increasing in incidence in children, is examined and shown to be a special phenomenon of recent cohorts of children. Robbins' classic follow-up of a group of children who persisted with behavioral problems in adult life demonstrated that this group mainly comprised those who had shown antisocial rather than other behavioral disorders in childhood. Kellam and colleagues describe a treatment phenomenon, namely, that adolescents use mental health services on the basis of the nature of the service, and how it is perceived, more than on the severity of their illness.

A short summary cannot do justice to a 141-page monograph, but the quality and the importance of this epidemiologic section makes this required reading for serious students of child behavior.
Choking: The Heimlich Abdominal Thrust vs Back Blows: An Approach to Measurement of Inertial and Aerodynamic Forces
Authors: Day Richard L. , Crelin Edmund S. , DuBois Arthur B.
Published: December 2021

Back blows produce less pressure than the Heimlich maneuvers in seated subjects. In addition, back blows throw the head and neck forward and upward due to straightening the spine. Such blows theoretically can displace supraglottic foreign bodies further downward and backward into the throat or larynx.
Incidence of Apnea in Siblings of Sudden Infant Death Syndrome Victims Studied at Home
Authors: Kelly Dorothy H. , Twanmoh Joseph , Shannon Daniel C.
Published: December 2021

Victims of sudden infant death syndrome (SIDS) have been shown to have pathologic abnormalities consistent with chronic hypoxia.1-7 Two groups of infants at high risk of dying of SIDS, near miss infants and subsequent siblings of SIDS victims, have been studied in attempts to demonstrate physiologic abnormalities that could account for these pathologic findings. Investigators have found abnormalities in breathing pattern and the respiratory control system in the former consisting of prolonged sleep apnea, excessive short apnea, periodic breathing, hypoventilation, and depressed response to hypercarbia.8-13 However, studies in the SIDS sibling group have demonstrated varying results of excessive periodic breathing in the home14 and decreased apnea in the laboratory.15
Asymptomatic Neonatal Familial Hypercalcemia
Authors: Eichenbrenner Timothy J. , Schwartz Robert P.
Published: December 2021

In the article by Orwoll et al,1 an infant with a serum calcium of 12.4 mg/100 ml at 2 hours of age is described. The mother was reported as having primary hyperpara-thyroidism, but the urine calcium was not mentioned and she most likely had hypocalciuric hypercalcemia.

We have seen two similar infants. The 23-year-old mother had a serum calcium of 12.8 mg/100 ml and an elevated parathormone level. She underwent exploratory surgery at another hospital.
Violaceous Cellulitis
Authors: Nudelman Robert , Bral Masood , Sakhai Yussef , Wesselius Dirk , Cohen Myles J.
Published: December 2021

In light of the two articles which appeared in Pediatrics concerning Group B streptococcal skin infections of the head and neck,1,2 we would like to relate our experience with a young infant who had group B streptococcal cellulitis of the hand.

An 11-week-old white female infant was in her usual state of good health, except for a seborrheic appearing rash present since 3 weeks of age, until 5 AM on the day of admission when she became fussy, starting crying excessively, and refused to breast-feed.
Pitfalls in Screening for Neonatal Hypothyroidism
Authors:   Report of the New England Regional Screening Program,   New England Congenital Hypothyroidism Collaborative
Published: December 2021

This report reviews problems encountered during the first five years of operation of the New England Regional Screening Program. Human error was responsible for either overlooked or delayed diagnosis and treatment in 14/159 infants with hypothyroidism. This group consisted of three infants who were never tested, six infants whose diagnosis was missed because of errors during the processing of the blood specimens, and five additional children in whom the diagnosis of hypothyroidism could not be made at birth because the concentrations of thyroid-stimulating hormone were not elevated. Many of the problems, most of which occurred during the first two years of the study, have been eliminated by improved communication and monitoring. This study emphasizes the potential vulnerability of all screening programs and underscores the need for physicians to continue to exercise their best clinical judgement regardless of the circumstances.
Increasing the Protection of Newborn Infants in Cars
Authors: Christophersen Edward R. , Sullivan Margaret A.
Published: December 2021

Recently the American Academy of Pediatrics instituted a major campaign ("The First Ride—A Safe Ride") in order to encourage all parents to use an infant restraint seat for their newborn's first ride in an automobile—the ride home from the hospital. In the present study the effect of the behavior of the hospital staff on parents' use of infant restraint seats was examined. This study involved 30 mother-infant pairs who were selected sequentially from an obstetrics unit and randomly assigned to two groups. A control group was discharged from the obstetrics unit with no particular emphasis on car safety and no loaner restraint seat available. An experimental group was offered a loaner restraint seat at the time of discharge, with a staff person demonstrating how to put the infant into the restraint seat, how to carry the infant in the seat out to the car, and how to fasten the restraint seat in the automobile with the auto lap belt. Correct use of the loaner restraint seat on the first ride home was observed in 67% of the experimental mothers and in none (0%) of the control mothers. Although this difference was no longer significant at four- to six-week follow-up this study points out the short-term impact that hospital staff can have on the parents' use of restraint seats. Additional techniques are needed to maintain parents' use of restraint seats throughout childhood.
Intentional Poisoning of Children—An Overlooked Category of Child Abuse: Report of Seven Cases and Review of the Literature
Authors: Dine Mark S. , McGovern Mark E.
Published: December 2021

Seven instances of child abuse due to poisoning are reported; two of the children died. Forty-one cases of this form of poisoning are found in the literature. Of the total of 48 children, eight (17%) died as a result of the incident; and one was mentally retarded. The seven different agents described here are alcohol, glutethimide (Doriden), propoxyphene hydrochloride (Darvon), diazepam, insulin, lye, and pepper, constituting 27 different types of poison used by abusing guardians. The most common cause of abuse reported is excessive salt ingestion with water restriction. Excessive ingestion of water is the second most common cause. Barbiturates and tranquilizers are also frequent agents. In 30% of the cases, poisoning persists even after hospitalization. Child abuse by battering is associated in 20% of the cases. The need for a high index of suspicion of abuse in bizarre presentations of children for medical care when the etiology is obscure is emphasized.
Probable Graft-vs-Graft Reaction in an Infant After Exchange Transfusion and Marrow Transplantation
Authors: Lauer Brian A. , Githens John H. , Hayward Anthony R. , Conrad Paul D. , Yanagihara Richard T. , Tubergen David G.
Published: December 2021

A newborn with graft-vs-host (GVH) disease following an exchange transfusion was treated by attempting to eradicate the incompatible graft and to reconstitute the child hematologically and immunologically with a bone marrow transplant. The patient was a female term infant (blood group B, Rh+ Coombs test positive) who received a one-unit group O, Rh- exchange transfusion from an unrelated female donor for hyperbilirubinemia due to ABO incompatibility on day 2. Signs of acute GVH disease began on day 8 and the clinical diagnosis was supported by skin biopsy. With antithymocyte globulin and high dose dexamethasone, the GVH reaction improved somewhat. Cyclophosphamide, 200 mg/kg total dose, was given over four days followed by a marrow graft from a brother who was HLA-A, B identical, and probably also D locus compatible in mixed lymphocyte culture. All signs of GVH resolved with cyclophosphamide treatment and hematologic reconstitution was evident by 14 days after transplant. Two weeks later the GVH reaction and aplastic anemia recurred and Y chromatin was detected in only 6% of marrow cells. The infant died on day 80. Autopsy showed disseminated candidiasis, disseminated cytomegalovirus infection, thymic dysplasia, hypoplastic marrow, and other histopathologic changes consistent with GVH disease. The persistence of female cells in blood and bone marrow and the destruction of the reconstituted marrow suggest that the original incompatible transfusion-derived graft was not eliminated and that it ultimately rejected the histocompatible marrow graft.
Hereditary Cutis Marmorata Telangiectatica Congenita
Authors: Kurczynski Thaddeus W.
Published: December 2021

A patient with cutis marmorata telangiectatica congenita inherited in an autosomal dominant manner is described. The variable expression of this condition and its possible association with other anomalies are reviewed.
School Progress and Cognitive Development of 6-Year-Old Children Whose Mothers Were Treated Antenatally with Betamethasone
Authors: MacArthur B. A. , Howie R. N. , Dezoete J. A. , Elkins J.
Published: December 2021

The cognitive development of children whose mothers had been included in the first Auckland trials of betamethasone therapy in premature labor were studied. An earlier study of these children used psychometric tests during the fifth year of life. In the present study tests were given during the seventh year of life (the second year of school) to 250 (82.2%) of 304 surviving children. Of the 250 children, 139 were in the group whose mothers had received betamethasone and 111 were in the control group. Further tests of cognitive development were made, together with assessment of the children's progress in school. Again, on the majority of measures there were no significant differences between children whose mothers had received betamethasone and the children in the control group. Calculations of statistical power showed that important differences were unlikely to have been missed.
β-Hydroxyisobutyryl Coenzyme A Deacylase Deficiency: A Defect in Valine Metabolism Associated with Physical Malformations
Authors: Brown Garry K. , Hunt Susan M. , Scholem Robyn , Fowler Kerry , Grimes Andrew , Mercer Julian F. B. , Truscott Roger M. , Cotton Richard G. H. , Rogers John C. , Danks David M.
Published: December 2021

An infant, born to parents who were first cousins had multiple physical malformations. An associated biochemical abnormality was suggested by the urinary excretion of cysteine and cysteamine conjugates of methacrylic acid. The coenzyme A (CoA) ester of this compound is an intermediate in the pathway of valine oxidation. Subsequent investigation revealed a deficiency of β-hydroxyisobutyryl-CoA deacylase, an enzyme unique to valine metabolism. The enzyme defect results in accumulation of methacrylyl-CoA, a highly reactive compound, which readily undergoes addition reactions with free sulfhydryl groups. Tissue damage due to reactions between methacrylyl-CoA and important sulfhydryl-containing enzymes and cofactors may account for the teratogenic effects seen in this patient.
Pediatric Nocardiosis
Authors: Law Barbara J. , Marks Melvin I.
Published: December 2021

Characteristics of Nocardia infection, which occurred in ten Oklahoma children between 1975 and 1980, are described. Fatal N asteroides infection occurred in three immunocompromised patients. Pneumonia was the presenting feature in each; one patient had disseminated disease. The first reported case of shunt-associated N asteroides ventriculitis occurred in a 2-month-old girl, who was successfully treated with oral trimethoprim-sul-famethoxazole. N brasiliensis was isolated from six immunologically competent children, five of whom had localized, uncomplicated, cutaneous infections. The sixth child developed osteomyelitis following a compound skull fracture. Based on this experience and a review of the literature, N asteroides infections are associated with immunocompromised hosts, and usually are seen as pneumonia with occasional dissemination to other sites. In contrast, N brasiliensis infections are more common than previously thought and usually occur in otherwise normal children as acute posttraumatic pyoderma.
The Relative Severity of Acute Versus Chronic Salicylate Poisoning in Children: A Clinical Comparison
Authors: Gaudreault Pierre , Temple Anthony R. , Lovejoy Frederick H.
Published: December 2021

To evaluate the relative severity of acute vs chronic salicylate poisoning in children, 112 Cases (65 acute and 47 chronic) of salicylate poisoning (salicylate concentration ≥20 mg/100 ml) admitted to The Children's Hospital Medical Center in Boston and Primary Children's Medical Center in Salt Lake City between the years 1967 and 1978 were analyzed. Hyperventilation (P < .01), dehydration (P < .001), and severe central nervous system manifestations (P < .001) occurred more frequently in the chronic group and remained more frequent (P < .01) when patients having disease states capable of producing these signs and symptoms were removed from statistical analysis. At three separate salicylate concentration ranges (20 to 39, 40 to 59, and ≥60 mg/100 ml) hyperventilation, dehydration, and severe CNS manifestations tended to occur with greater frequency in the chronic group. When severity of salicylate poisoning was categorized based on a combination of signs and symptoms, mild cases predominated in the acute group whereas severe cases occurred more frequently in the chronic group. Finally, systemic acidosis (pH < 7.32) was found more frequently in the chronic group (P < .01), more frequently in patients with severe manifestations than in those with mild manifestations, and in patients with dehydration (P < .01) and severe CNS manifestatations (P < .05). Based on the variables evaluated, chronic salicylism produces a greater morbidity than does acute salicylate poisoning in the pediatric patient.
CHEST PAIN AND DEPRESSION
Authors: Haggerty R. J.
Published: December 2021

The study reports on 100 children and adolescents evaluated in a pediatric cardiology department. The results state that 13% of the population met the criteria for Major Depressive Disorder based on DSM III. There were four patients who were referred because of chest pain. All of them were found to be free from cardiovascular disorders, but all were found to be in the depressed group. The authors emphasize the importance of chest pain in differential diagnosis of childhood depression.
Totally Vegetarian Diets and Infant Nutrition
Authors: Shinwell Eric D. , Gorodischer Rafael
Published: December 2021

Observations on the deleterious effects of a totally vegetarian diet in infancy are reported and the difficulties encountered in the prevention of nutritional deficiencies in a vegan religious community are discussed. Twenty-five infants of this community who were seen at the hospital showed evidence of protein-calorie malnutrition, iron- and vitamin B12-deficient anemia, rickets, zinc deficiency, and multiple recurrent infections. Evidence of growth retardation was also found in 47 infants seen at the local mother-child health (well-baby) clinic. Samples of breast milk showed low levels of carbohydrate (1.6 to 3.5 gm/100 ml), protein (0.8 to 1.4 gm/100 ml), and fat (2.4 to 4.1 gm/100 ml). The main constituent of the infants' diet after the age of 3 months ( a "soya milk" prepared at the community's central kitchen) was extremely dilute with a very low calorific value (13.7 kcal/100 ml). Persistent attempts to find dietary modifications that would satisfy both the vegan philosophy and also the recommended dietary allowances failed. This problem represents a scientific and medicosocial challenge to pediatricians and nutritionists.
Oral Herpesvirus Infection in Nursery Personnel: Infection Control Policy
Authors: Kleiman Martin B. , Schreiner Richard L. , Eitzen Harold , Lemons James A. , Jansen Robert D.
Published: December 2021

A survey of 161 neonatal referral centers in the United States revealed that 83% exclude personnel with overt oral herpes simplex virus (HSV) lesions from direct patient care. Twenty-seven percent of hospitals exclude infected personnel from all hospital work. The high incidence of overt HSV lesions and the excretion of HSV among asymptomatic hospital personnel associated with an extremely low incidence of recognized neonatal HSV infection (especially type 1 HSV), suggest that the current policy of excluding such personnel from patient care should be reexamined.
Combined Passive and Active Immunization for Preventing Perinatal Transmission of Hepatitis B Virus Carrier State
Authors: Tada Hiroshi , Yanagida Masahiko , Mishina Jun , Fujii Toshi , Baba Kiyoshi , Ishikawa Shuko , Aihara Shinobu , Tsuda Fumio , Miyakawa Yuzo , Mayumi Makoto
Published: December 2021

Prevention of perinatal transmission of hepatitis B virus carrier state in neonates at high risk was attempted by a combined passive and active immunization. Immediately after delivery, ten babies born to mothers who were asymptomatic carriers of hepatitis B surface antigen (HB8Ag) and seropositive for hepatitis B e antigen received an intravenous injection of F(ab’)2 fragments (200 IU) derived from hepatitis B immune globulin (HBIG). On the following day, none of them revealed detectable levels of the antibody to HB8Ag in their sera, and received an intramuscular injection of HBIG (200 IU) which was repeated at 2 and 4 months of age. Vaccination with 40 µg of purified, formalin-inactivated HB8Ag particles was given to the nine babies at three months and repeated at 4, 5, and 7 months after birth. All of them maintained detectable levels of the antibody and escaped infection throughout the first 12 months of their lives. The one baby who did not have detectable F(ab’)2 in serum for 24 hours developed persistent HB8 antigenemia which was noticed as early as seven days after birth.
The Relation Between Glucose Tolerance and Insulin Binding to Circulating Monocytes in Obese Children
Authors: Kida Kaichi , Watanabe Noriyoshi , Fujisawa Yoshiki , Goto Yoshinori , Matsuda Hiroshi
Published: December 2021

The quantitative relation between insulin binding to circulating monocytes in vitro and glucose tolerance in obese children in vivo is reported. Sixty-one obese children and 11 healthy control children participated in this study. The oral glucose tolerance test (OGTT) was performed by giving them glucose (1.75 gm/kg of body weight), orally in the morning, and the binding of 125I-labeled insulin to circulating monocytes in vitro was measured prior to OGTT. The glucose tolerance expressed by ΣBS (milligrams/100 ml), the sum of the plasma glucose (blood sugar [BS]) values at OGTT, was significantly correlated with the degree of overweight (r = .316, P < .01) and more highly with ΣIRI (microunits per milliliter), the sum of immunoreactive insulin (IRI) values at OGTT (r = .512, P < .001). Insulin binding to monocytes in vitro (picograms/106 cells) was inversely correlated with the degree of overweight (r = -. 687, P < .001). Furthermore, ΣBS was inversely correlated significantly with insulin binding to monocytes in vitro (r = -.435, P < .002). These data suggest that the decrease of insulin receptors might be one cause for the impairment of the glucose tolerance associated with obesity in children.