bluuebunny/crossref_metadata_2025 huggingface dataset:
O TEMPORA, O MORES!1—Cicero
Authors:   Student
Published: December 2021

1954: "All premature infants were alternately placed in a group to be [gradually] weaned from oxygen (Group A) and a group to be suddenly withdrawn from oxygen (Group B)....

If an infant was thought to be developing the disease [progressive RLF] the infant was placed back in oxygen at the same concentration from which he had been removed. Because our results with oxygen therapy had been uniformly successful, we did not feel it was fair to withhold treatment in order to obtain control cases."2

1981: "We undertook a double-blind clinical study to determine the efficacy of vitamin E in preventing the development of severe retrolental fibroplasia.... Any infant found to have Grade III was removed form the study and treated surgically."3

1981: "In this center, surgical intervention with cryotherapy and scleral buckling procedures have produced favorable responses in RLF cases."4
Mast Cells in Hemangiomas and Vascular Malformations
Authors: Glowacki Julie , Mulliken John B.
Published: December 2021

Common pediatric vascular birthmarks, classified as hemangiomas or malformations, were analyzed for the presence of mast cells. Hemangiomas in the proliferative phase contained large numbers of mast cells (27 ± 15 cells/high-power field [HPF]) in comparison with hemangiomas in the involuting phase (2.6 ± 2.9), vascular malformations (1.7 ± 3.2), and normal skin (5.0 ± 1.0). Inasmuch as hemangiomas are characterized by endothelial proliferation and increased numbers of mast cells, these data raise the possibility that mast cells may have an important role in the formation and/or maintenance of these lesions.
Brain Neurotransmitters and Neuromodulators in Pediatrics
Authors: Johnston Michael V. , Singer Harvey S.
Published: December 2021

Neurotransmitter and neuromodulatory systems provide the mechanism for communication between nerve cells in the central nervous system. Studies of synaptic neurotransmission within the brain during development and in pathologic conditions are furthering our knowledge of various pediatric disorders. Basic concepts of synaptic neurochemistry, evaluation strategies, and the development of neurotransmitter pathways are reviewed. Sections on movement and psychiatric disorders, hyperactivity, epilepsy, and hyperphenylalaninemia relate clinical pediatric situations to recently reported alterations of neurotransmitter substances. The emerging story of neuropeptides and their association with pain further illustrate the importance of neurotransmitter research.
DEATH AT HOME
Authors:   Student
Published: December 2021

Paediatricians responsible for neonatal care have been increasingly involved in, and aware of, the importance of parent infant interactions. These interactions are of major importance when concerned with the dying newborn. Over the past few years parental involvement in decision making related to life and death of newborn babies is becoming increasingly accepted ... more and more parents are opting to take their baby home to die. As changing patterns of birthing increasingly involve fathers and children, so death is once again becoming a family affair.
A Neonatal Screening Test for Argininosuccinic Acid Lyase Deficiency and Other Urea Cycle Disorders
Authors: Talbot Henry W. , Sumlin Adam B. , Naylor Edwin W. , Guthrie Robert
Published: December 2021

A simple enzyme-multiple auxotroph assay has been developed for the identification of newborn infants with several of the inherited metabolic defects in the Krebs cycle for the detoxification of ammonia and in the ornithine metabolic pathway. This mass screening test is used with dried filter paper blood specimens and can easily be added to existing multiple testing programs presently used in screening for phenylketonuria or congenital hypothyroidism. This assay can be used to detect patients with citrullinemia, argininosuccinic acid lyase deficiency, and argininemia. In addition to these urea cycle disorders, the several types of ornithinemia, which can result in gyrate atrophy of the retina or mental retardation, should be detectable with this assay. The strengths and weaknesses of this assay are discussed and a large-scale pilot screening trial is proposed.
‘Hide-a-bed’ Hideaways: A Potential Source of Entrapment
Authors: Cavanaugh Robert M.
Published: December 2021

Although there have been many recent advances in the field of pediatrics, accidents still remain a significant cause of morbidity and mortality. Adolescents are particularly challenged by adventuresome activities that are potentially dangerous. This is especially true when peer pressure is applied. The following case is presented to alert clinicians to another source of entrapment and potential suffocation. It should also remind us that the role of the physician caring for adolescents, as well as infants and children, includes effective counseling concerning possible sources of injury. Ultimately, prevention is more important than treating the injury itself.

CASE REPORT

J.D., a 14-year-old boy who was in good health, was playing in the house with two friends who coaxed him into lying on the ‘hide-a-bed’ and allowing them to close the bed completely.
NEUROPSYCHIATRIC STATUS OF INCARCERATED DELINQUENTS
Authors: Haggerty R. J.
Published: December 2021

The neuropsychiatric status of a sample of incarcerated white female juvenile offenders is compared with that of a sample of incarcerated white male juvenile offenders. Males and females had a similar prevalence of psychiatric and neurologic impairment. More violent males were significantly more impaired than less violent males. There was a tendency for more violent females to have greater impairment than less violent females. The study questions the prevailing literature indicating greater psychopathology in female offenders than male offenders. It explores issues of sex and race bias in the assessment of the neuropsychiatric status of offenders.
SUICIDAL BEHAVIOR IN CHILDREN
Authors: Haggerty R. J.
Published: December 2021

Seventy-six children, aged 5 to 14 years, consecutively discharged from an inpatient psychiatric unit, were assigned by stringent operational criteria to either suicidal, depressed, or psychiatric control groups. Through a review of medical records, children were compared on measures of life stress and symptomatology for their total lifespan, for four defined developmental periods, and for the year preceding admission. Compared to both depressed and psychiatric control children, suicidal children experienced increasing and significantly greater amounts of stress as they matured, including a number of specific chaotic and disruptive family events which resulted in losses and separations from important people.
The Developmental Status of Children Undergoing the Kasai Procedure for Biliary Atresia
Authors: Burgess David B. , Martin Harold P. , Lilly John R.
Published: December 2021

Children with biliary atresia who have undergone the Kasai procedure suffer prolonged illness and recurrent hospitalizations, both of which may interfere with normal growth and development. The developmental status of 20 children with this disorder is described. The mean cognitive developmental quotient of the entire group of children was within the normal range. The mean motor developmental quotient was within the borderline normal range. The developmental test results suggested an interesting pattern of development including normal cognitive and motor development until the age of 6 to 8 months, followed by a decreasing rate of development between ages 8 and 24 months with the potential for improved developmental outcome at the age of school entry. The overall developmental status of these children was better than might be expected considering the numerous high-risk medical/surgical and social/emotional stresses that these children must face. The effort required in the care of children with this disorder certainly seems warranted by their subsequent developmental outcome.
Child Abuse in Huntington's Disease
Authors: Pearlstein Louis S. , Brill Charles B. , Mancall Elliott L.
Published: December 2021

A case of child abuse occurring in a family in which the mother had Huntington's disease is presented. Families affected by Huntington's disease are at high risk in this regard. The literature and family dynamics are reviewed.
A New Age For Pediatrics: Change, Challenge, and Cost
Authors: Austin Glenn
Published: December 2021

The motif for the Academy's current campaign to promote pediatrics and pediatricians is A New Age for Pediatrics. One of the implications of this campaign and motif is that we will officially state that US pediatricians, the specialists in growth and development, take better care of the health needs of infants, children, adolescents, and young adults, and that the scope of our practice is broadening. Another implication is that pediatrics is in a new era of increasing strength, vigor, assertiveness, and provision of satisfaction to both its patients and practitioners. Realization of these goals spells change, challenge, and cost.

Neither change nor challenge are new to our field. The early pediatricians were sick-baby specialists. Pioneers such as Abraham Jacobi recognized the need to emphasize prevention, particularly among the underprivileged. Others were later farsighted enough to recognize the importance of extending the concept of well-child care to all children and began to convince parents to bring their children for visits when they were well so that immunizations could be given, growth and development could be assessed, and advice on matters of diet and hygiene could be given. Immunization rates went up and the frequency and severity of contagious diseases began to diminish. Recognizing the intrinsic value and distinct promise of pediatrics as a field, medical schools expanded their pediatrics departments, and an increasing number of young physicians began to enter pediatrics, especially in the post-World War II years. All were superbly trained in the care of sick children and, to a considerable degree, they functioned as consultants to general practitioners.
Pathophysiology, Live
Authors: Deuel Ruthmary K.
Published: December 2021

In the August issue of Pediatrics, Delpy et al1 provided a detailed description of changes in intracerebral, intracellular constituents before, during, and after severe ischemic events in rabbits using a nuclear magnetic resonance technique. The constituents, ATP, phosphocreatine (PCr), and sugar phosphates, are the basic energy substrates of the body. Intracellular pH was also monitored throughout. As the authors correctly point out, such noninvasive, in vivo biochemistry would be invaluable to the pediatric clinician, not only to gather direct metabolic information on the status of the brain, but also to increase knowledge about muscle.2 In fact, applications of this technique to other organs such as the liver,3 the kidney,4 and the heart5 are likely to be made soon.
Letter to the Editor
Authors: Colletti Richard B.
Published: December 2021

Your letter suggests that commercially manufactured crash-tested child restraint devices meeting strict Federal standards are too expensive for many families to obtain and that home-made substitutes can provide adequate protection. I believe both premises are incorrect.

State-wide networks of car seat rental programs are developing throughout the country (including your home state, Washington1). These rental programs, operated by volunteers or state health departments, provide infant car seats for little or no cost. In Vermont, for example, 98% of babies are born in a hospital that rents car seats for $1 per month (3.3 cents per day) or less.
Letter to the Editor
Authors: Odell Gerard B.
Published: December 2021

I read with curiosity the articles and editorial concerning bilirubin in the March issue of Pediatrics.

Levine et al1 are apparently espousing a view that bilirubin is nontoxic to CNS tissue unless it is bound to albumin. There are serious deficiencies in his arguments:

1. Patients with analbuminemia do survive neonatal life, but no one has reported albumin concentrations in such infants during the first two weeks of life. Since the molecule is only 69,000 daltons in molecular size, it is conceivable the fetus could acquire albumin from the maternal circulation during the last trimester and could have protective concentrations of albumin in the circulation during neonatal life, since t1/2 of passively infused albumin is actually prolonged in analbuminemic patients.2
Teenagers and Breast-Feeding
Authors: Pascoe John M.
Published: December 2021

As a pediatrician with training and interest in school health, I was pleased that the Academy's policy statement on the promotion of breast-feeding1 emphasizes the inclusion of breast-feeding facts in school health curricula. I recently surveyed 571 girls from high school health classes to determine their attitude toward and knowledge of breast-feeding. I used a 20-item "forced choice" questionnaire developed by Berger and Winter.2 Each "pro" response to an attitude item was scored "1 point."
Use of Restriction Enzymes to Investigate the Source of a Primary Cytomegalovirus Infection in a Pediatric Nurse
Authors: Yow M. D. , Lakeman A. D. , Stagno S. , Reynolds R. B. , Plavidal F. J.
Published: December 2021

The risk of transmission of cytomegalovirus (CMV) infection from congenitally infected infants to nonimmune medical attendants is unknown. The case of a CMV-seronegative, pregnant nurse who seroconverted after caring for an infant with symptomatic CMV infection is reported. She elected to be aborted and the fetal tissue contained CMV. Isolates from the nurse, the fetal tissue, and the infant to whom the nurse was exposed were examined for genetic relatedness by restriction enzyme analysis. As expected, the isolates from the nurse and the fetal tissue were identical. However, the virus isolated from the symptomatic infant was different from the strain infecting the nurse. These data indicate that the nurse acquired her infection from a source other than the index infant, either within the hospital or within the community.
Restriction Endonuclease Analysis of Cytomegalovirus Deoxyribonucleic Acid as an Epidemiologic Tool
Authors: Wilfert Catherine M. , Huang Eng-Shang , Stagno Sergio
Published: December 2021

The possibility of transmission of cytomegalovirus (CMV) from congenitally infected infants to susceptible medical personnel produces anxiety because the risks have not been defined. A physician conceived her first child while caring for an infant in the intensive care nursery who died with congenital CMV infection. The physician had serologic evidence of active CMV infection confirmed by isolation of virus from multiple sites. She elected to have her pregnancy interrupted. CMV was isolated from the placenta and fetal brain. Restriction enzyme analysis was employed to test all the CMV isolated for genetic relatedness. Virus isolated from the physician and her fetus was identical. The virus from the index nursery infant was different from the strain infecting the physician and her fetus. These data indicate that the physician acquired her virus from a source other than the index infant.
Delineation of Pediatric Privileges in Hospitals
Authors: Bergeson Paul S. , Amler Alfred V. , Bushore Martha , Gold Harvey R. , Lynn Hugh B. , Shattuck Gerald B. , Wingert Willis A. , Widmann Donald , Turner C. Randolph , Marienau Fred W. , Donnelly Paul A. , Seabury Barbara-Jeanne , Lockhart Charles H.
Published: December 2021

The initial statement and format suggested by the Hospital Care Committee of the American Academy of Pediatrics in 1973 has been used successfully in its present form or in modified form throughout the United States. It combines a list approach with a level of competence approach. We believe that its general format is still appropriate but constitutes only one of several alternatives available. The appendix provides an example of a current modification of the 1973 format. Most important is that the principles, as described in this article, are followed in order to protect the patient, hospital, and physician through the process of delineation of hospital privileges.
Neural Tube Defects Decreasing in England
Authors: Owens J. R. , Harris F.
Published: December 2021

Stein and colleagues1 report a steadily decreasing incidence of myelomeningocele in the Brooklyn area of New York from 1968 to 1979, and which was independent of maternal age, birth order, and socioeconomic group. We have recently demonstrated a similar decrease in incidence of all neural tube defects in the conurbation of Liverpool and Bootle which commenced in the early 1970s, and which was more marked in anencephalus than myelomeningocele.2 The decrease in incidence was not due to smaller affected families as the recurrence risk for the period 1961 to 1969 was similar to that for 1970 to 1979.
Isoniazid and Other Drugs
Authors: Bourgeois Blaise F. D. , Dodson W. Edwin , Ferrendelli James A.
Published: December 2021

We read with interest the paper by Block on carbamazepine-isoniazid interaction.1 Although this report mentions that isoniazid has been previously shown to interfere with phenytoin metabolism,2 it fails to mention the interaction between isoniazid and primidone. Sutton and Kupferberg3 have described a patient in whom the addition of isoniazid prolonged the half-life of primidone (Mysoline) and decreased its biotransformation to phenobarbital and phenylethylmalonamide (PEMA). In 1964, Kato et a14 had already demonstrated the inhibitory effect of isoniazid on the metabolism of certain barbiturates in vitro.
Agoraphobia and Imipramine Withdrawal?
Authors: Shrand Hyman
Published: December 2021

A recent report calls attention to antidepressant withdrawal effects in the newborn when these drugs are taken by the mother. We recently had a patient with imipramine withdrawal.

Baby F. was born at term after a normal vaginal delivery; Apgar scores were 8 and 9. Findings from the newborn examination were normal. Rapid breathing, which reached 100/mm, began at age 5 hours. Baby F.'s color remained pink in air, but the infant became terribly irritable, crying all the time, and could not be consoled. At all times the baby looked well and fed avidly.
CHARGE Association
Authors: Pagon Roberta A. , Zonana Jonathan , Graham John M.
Published: December 2021

Bartoshesky et al1 reported a male infant with bilateral ocular coloboma, complex cardiac malformations, hypoplastic genitalia, unilateral microtia with an incompletely formed helix, facial asymmetry, and bilateral cleft lip and palate. They ascribed the etiology of the malformations to in utero diphenylhydantoin exposure. Subsequent to the submission of their paper, we reported our experience with 23 patients with a similar constellation of anomalies.2 We have termed this nonrandom combination of malformations the CHARGE association, a mnemonic (C-coloboma, H-heart disease, A-atresia choanae, R-retarded growth and/or development, G-genital hypoplasia, and E-ear anomalies and/or deafness).
Ostensible Versus Actual Reasons for Seeking Pediatric Attention: Another Look at the Parental Ticket of Admission
Authors: Bass Lee W. , Cohen Richard L.
Published: December 2021

The presentation of parental anxiety that appears excessive in view of the nature of the child's "chief complaint" is a frequent occurrence in pediatric practice. This study reviews 370 sick-patient visits in one pediatric office during a three-month period. Additional questioning in the area of parental anxieties concerning these symptoms revealed that in 125 instances (33.8%), the parent was entertaining unverbalized fears that something much more serious was wrong with the child than could be anticipated from the ostensible reason for seeking assistance. An analysis of the "actual reason for coming" reveals that the child's presenting complaint has become associated for the parent with (1) family history of serious life-threatening illness; (2) fears of loss and separation; (3) death; (4) the fears of another family member who is pressing for "answers" about the problem; (5) fears of loss of vital functions and a variety of other thought processes that have somehow become linked to the child's symptom. Techniques for recognizing and ameliorating this parenting difficulty are discussed.
National Surveillance for Reye Syndrome: A Five-Year Review
Authors: Hurwitz Eugene S. , Nelson David B. , Davis Cornelia , Morens David , Schonberger Lawrence B.
Published: December 2021

National surveillance for Reye syndrome conducted during five years, including the period 1973-1974 and December 1976 through November 1980, has resulted in the reporting of more than 2,000 cases of Reye syndrome. The highest reported incidence of Reye syndrome occurred during years of primary influenza B and A (H1N1) activity; the reported incidence during one period of influenza A (H3N2) activity was somewhat lower. Regional outbreaks of Reye syndrome have been associated with influenza A (H1N1) and B but not with influenza A (H3N2). Cases of Reye syndrome in whites tend to be distributed throughout all age groups whereas a large percentage of cases in blacks have been reported in infants <1 year of age in three of the past four years. Nationally, there has been a decline in the case-fatality ratio in recent years.
DEATH AND LAWYERS
Authors: Student
Published: December 2021

It is perhaps difficult to write dispassionately about the constant intrusions of the legal profession into the practice of medicine, . . . yet what is one to think of thugs roaming the streets unpunished and the backlog in the criminal courts mounting to high heaven while judges tinker with respirators and ponder on the indications for dialysis? Even some of the legislators in Congress are now beginning to think that the courts are all too often exceeding the bounds of their prerogatives in a variety of social issues.

. . . so skewed are the prevailing arrangements that doctors are constantly being told that they must not play God, while judges, being "detached but passionate," always may.
The Teaching of Crisis Counseling Skills to Pediatric Residents: A One-Year Study
Authors: Jewett Leslie S. , Greenberg Larrie W. , Champion Lorraine A. A. , Gluck Rita S. , Leikin Sanford L. , Altieri Michael F. , Lipnick Robert N.
Published: December 2021

Pediatric residents should learn to manage family crises such as informing parents that their child has a potentially life-threatening illness. Unfortunately, few training programs prepare residents to counsel parents of a child with cancer. An experiential parent crisis counseling program has been developed at the Children's Hospital National Medical Center in Washington, DC; this program has demonstrated that pediatric residents, with limited instruction, can be taught to give bad news to parents using effective information-giving and interpersonal skills.
Maternal Alcohol Use and Infant Development
Authors: Golden Nancy L. , Sokol Robert J. , Kuhnert Betty R. , Bottoms Sidney
Published: December 2021

A prospective controlled study of the effect of fetal alcohol on infant development was performed. Twelve infants were identified as possibly having fetal alcohol effects based on the maternal history of alcohol abuse and the neonatal physical examination. Physical characteristics, growth, and development of these infants were compared with those of 12 control infants at birth and at a mean age of 12 months; control infants were matched for gestational age, sex, and race. Data were evaluated by descriptive statistics and analysis of differences between matched pairs of study and control infants. The results showed a significant correlation between the history of heavy antenatal maternal alcohol use and delayed mental and motor development, physical abnormalities, and growth retardation in the infants. This study suggests that infants with fetal alcohol effects can be correctly classified at birth and their outcome accurately predicted.
INPATIENT STATISTICS AT THE HOPITAL DES ENFANTS MALADES IN PARIS FOR THE YEAR 1822
Authors: C. T. E.
Published: December 2021

The HÔpital des Enfants Malades, the world's first children's hospital, was founded in Paris in 1802. Twenty years later it contained 560 beds, 491 for medical and 69 for surgical patients.

In 1822, 2,641 patients were admitted; their diagnoses were as follows: [SEE TABLE IN SOURCE PDF.]

The overall mortality among inpatients was about 27 percent. The mortality for smallpox was 47 percent, and for measles 35 percent.

Contrary to current practice in our children's hospitals, inpatients at the Hôpital des Enfants Malades, at least in 1822, were hospitalized for exceedingly long periods. For example, patients with scabies spent between 21 and 69 days in the hospital; for tinea the average hospital stay was 156 days; and for scrofula 288 days.
Intramuscular Injections in Children
Authors: Bergeson Paul S. , Singer Stanford A. , Kaplan Allen M.
Published: December 2021

The most common serious complications of intramuscular injections in children are muscle contractures and nerve injury. Muscle contracture occurs most commonly after injections in the anterior and lateral thigh, and sciatic nerve injury is the most frequently reported serious complication of the gluteal area. The technique of administering intramuscular injections involves attention to the appropriate site of needle insertion, needle size, and angle of injection. Suggested techniques with illustrations are included. The appropriate site of injection depends upon the age and size of the child. Multiple injection sites may be preferable in some cases. Compliance with meticulous technique may reduce the incidence of complications; however, complications can occur in spite of every appropriate precaution.
Cerebral Venous Sinus Thrombosis: Report of a Case and Review of the Literature
Authors: Imai Walter K. , Everhart F. Richard , Sanders Joe M.
Published: December 2021

Cerebral venous sinus thrombosis is a condition that is well documented as a complication of the latter stages of pregnancy and with an even greater incidence during the puerperium. More recently this entity has been associated with the use of oral contraceptives. A case is presented of a 15-year-old girl with this condition, in whom the occurrence as well as the resolution of a superior sagittal sinus thrombosis was demonstrated with serial computed tomography (CT) scans and radionuclide studies. The discussion of this case, coupled with a review of the literature, describes the clinical presentation, explores the possible etiology, offers a noninvasive technique for confirming the diagnosis, and presents the medical management of this condition. It is postulated that cerebral venous sinus thrombosis occurs with a greater frequency than is currently recognized. Health professionals involved with monitoring the health care of adolescents during pregnancy and in the puerperium should be aware of this potential complication. In addition, association of this condition with oral contraceptive use should be recognized.
Hemolysis and Acute Renal Failure Following a Portuguese Man-of-War Sting
Authors: Guess Harry A. , Saviteer Peter L. , Morris C. Richard
Published: December 2021

Portuguese man-of-war stings occur frequently at North American beaches. Most produce only local pain and pruritis. A 4-year-old girl who developed a hemolytic reaction and acute renal failure following a severe sting is described. As neither sequela has been previously reported, it is speculated that either the large dose of venom or chance intravenous inoculation may have been responsible. Evidence of hemolysis should be sought in small children with extensive Portuguese man-of-war stings.
Abnormal Platelet and Vascular Prostaglandin Synthesis in an Infant with Hemolytic Uremic Syndrome
Authors: STUART MARIE J. , SPITZER ROGER E. , COPPE DAVID
Published: December 2021

The hemolytic-uremic syndrome (HUS) is a disorder characterized by a microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Pathologic examination reveals thrombotic occlusions in the microcirculation, with the kidney being the main target organ involved. Recently, Remuzzi et al1,2 have demonstrated abnormalities in vascular prostacyclin or prostaglandin I2 (PGI2) formation in HUS. We report further characterization of the abnormality in PGI2 synthesis in a patient with HUS. An abnormality in platelet prostaglandin endoperoxide formation was also observed.

CASE REPORT

A 4-month-old male infant was hospitalized with anemia, thrombocytopenia, and proteinuria. The neonatal period had been complicated by hyperbilirubinemia necessitating an exchange transfusion.
Acute Urinary Retention as Presenting Symptom of Ascaris lumbricoides Infection in Children
Authors: HEYMAN H. , ALADGEM M. , LAVER J. , BEER S.
Published: December 2021

In endemic areas, Ascaris lumbricoides is one of the most common causes of helminthic infections of the intestinal tract. Acute intestinal, pancreatic, or biliary tract obstruction due to the physical presence of the adult parasites has been reported previously.1 Extraintestinal manifestations such as acute respiratory diseases, due to the migration of the larvae to the lung, or intrahepatic or pericholangitis abscesses, due to the deposition of ova in the liver, have also been described.1,2

Urinary retention as a manifestation of intestinal ascariasis has not, to the best of our knowledge, been previously reported. We describe two children with urinary retention and intestinal ascariasis. Clinical and nadiologic evaluation excluded any other cause for urinary retention.
Ultraviolet Radiation Affects the Immune System
Authors: PARRISH JOHN A.
Published: December 2021

Photoimmunology is the study of the effects of nonionizing radiation on normal and abnormal immune function. Photoimmunology is therefore an intersection of photobiology, dermatology, and immunology. Ultraviolet radiation (UVR) definitely can affect the immune system. Scattered reports about effects of UVR on lymphocytes have been available for years, but it is only recently that systematic studies have shown that circulating and noncirculating components of the immune system can be selectively altered by ultraviolet radiation of intact normal skin. Effects are not confined to irradiated skin but are also systemic; for example, exposure of normal skin of animals to UVR inhibits contact sensitization of unexposed skin and diminished antigen processing by spleen cells.
Children with Sinusitis
Authors: FURUKAWA CLIFTON T. , SHAPIRO GAIL G. , RACHELEFSKY GARY S.
Published: December 2021

Inasmuch as the paranasal sinuses hide within the calvarium, they are literally out of sight and too often out of mind. Although the pediatrician is quick to recognize an abnormal eardrum or an impetiginous rash, the presence of copious purulent rhinorrhea may be labeled an upper respiratory tract infection even when the history suggests chronic duration. Frequently these children are dismissed as being "just" allergic.

Why is sinus disease the source of confusion today? Much of the problem relates to radiologic studies that showed a significant incidence of abnormal sinus films in asymptomatic children1-3 as well as the casual comment in Caffey's radiologic textbook4 that any child who is crying would probably have cloudy sinuses, a statement never actually verified.
Theophylline-Furosemide Inactivation?
Authors: TOBACK JAMIE W. , GILMAN MILES E.
Published: December 2021

To the Editor.—

A recent report by Nakagawa1 suggested a possible increased theophylline clearance when furosemide was concomitantly administered. He postulated a decreased hepatic congestion with furosemide which increased theophylline clearance. Conlon et al2 originally investigated this possible interaction but reported an increase in serum theophylline levels, probably due to the apparent volume of distribution contraction associated with diuresis. Conversely, we have observed premature neonates whose serum theophylline concentrations have decreased when furosemide was administered simultaneously.
Febrile Neonates
Authors: JENISTA JERRI ANN , MENEGUS MARILYN A.
Published: December 2021

To the Editor.—

Voora et al1 report an interesting study of fever in the full-term newborn during the first four days of life. One percent of the infants had fever but only 0.1% had a proven bacterial etiology, an incidence similar to those reported.2 However, only one third of the febrile infants were studied for viral infection; no viruses were isolated although these data are difficult to interpret since there is no description of the culture techniques used.
Optimal Position for a Spinal Tap in Preterm Infants
Authors: Gleason Christine A. , Martin Richard J. , Anderson John V. , Carlo Waldemar A. , Sanniti Kathleen J. , Fanaroff Avroy A.
Published: December 2021

Inasmuch as spinal taps in preterm infants are frequently accompanied by clinical deterioration, the optimal position for this procedure was investigated. Three positions were each randomly assigned for five minutes to 17 healthy preterm infants without a spinal tap actually being performed: (1) lateral recumbent with full flexion (flexed position), (2) lateral recumbent with partial neck extension (extended position), and (3) sitting with head support and spine flexion (upright position). Transcutaneous Po2 and Pco2 were monitored in all infants, minute ventilation (V1) in seven, and heart rate and blood pressure in ten infants. Mean transcutaneous Po2 decreased in each of the three positions. This decrease was significantly greater in the flexed (28 ± 8 mm Hg) as compared with the extended (18 ± 8 mm Hg, P < .001) and upright (15 ± 11 mm Hg, P < .001) positions. Mean transcutaneous Pco2 increased only in the flexed position (3 ± 4 mm Hg, P < .005) and levels were still elevated five minutes after that position had been discontinued. The consistent decrease in transcutaneous Po2 was accompanied by a variable effect of positioning on V1 and there were no episodes of airway obstruction or apnea >10 seconds. Heart rate increased in each position whereas blood pressure remained unchanged. These data suggest that although hypoventilation may contribute to the observed decrease in transcutaneous Po2, ventilation/perfusion imbalance appears to be the major mechanism. As spinal taps performed in the widely accepted flexed position carry the greatest risk of potential morbidity, it is recommended that this position be modified with neck extension or that spinal taps be performed in the upright position.
Nonnutritive Sucking During Gavage Feeding Enhances Growth and Maturation in Premature Infants
Authors: Bernbaum Judy C. , Pereira Gilberto R. , Watkins John B. , Peckham George J.
Published: December 2021

The effects of nonnutritive sucking (NNS) by means of a pacifier during gavage feeding were studied in 30 premature infants whose birth weight was <1,500 g. The addition of NNS accelerated the maturation of the sucking reflex, facilitating a more rapid transition from gavage to oral feedings. Additionally, NNS decreased intestinal transit time and caused a more rapid weight gain despite comparable caloric intake resulting in a shortened hospital stay. Although the physiologic mechanisms resulting from this form of oral stimulation remain to be investigated, our data suggest that NNS may be an important factor to consider in the feeding of premature infants.
Clinical Estimation of Liver Size in Newborn Infants
Authors: Reiff Michael I. , Osborn Lucy M.
Published: December 2021

Liver size was measured in 100 healthy newborn infants of gestational ages 35 to 44 weeks. A mean liver span of 5.9 ± 0.8 cm was determined in these infants by measuring the distance between the percussed upper and palpated lower liver borders along the midclavicular line. This value correlated well with measurements derived from percussing both borders (r = .8) and correlated poorly with measurements of liver projection below the costal margin (r = .55). The practice of reporting liver projection below the costal margin as a single indicator of liver size should be discouraged.
Apnea Monitoring by Acoustic Detection of Airflow
Authors: Werthammer Joseph , Krasner Jerome , DiBenedetto John , Stark Ann R.
Published: December 2021

An acoustic monitor to detect apnea in infants has been developed. Recordings of a signal derived from breath sounds at the nose were made in eight premature infants and compared with observation of the infant and with transthoracic impedance and ECG monitoring. The acoustic monitor detected 26 episodes of apnea lasting 15 seconds or longer which were confirmed by observation and by heart rate slowing of at least 20 beats per minute. Only seven of these episodes were detected by the impedance monitor. The ECG monitor alarmed during the nine spells in which heart rate dropped below 100 beats per minute, 27.5 ± 9.7 seconds after breath sounds ceased. Inasmuch as the acoustic device detects absent airflow during central or obstructive apnea before bradycardia occurs and is insensitive to body movements, it represents an improved monitoring technique for infants with apnea.
Accumulation of Aluminum in a Nondialyzed Uremic Child Receiving Aluminum Hydroxide
Authors: Griswold W. R. , Reznik V. , Mendoza S. A. , Trauner D. , Alfrey A. C.
Published: December 2021

A child with renal insufficiency was treated with the oral phosphate binder aluminum hydroxide from age 6 to 31 months. The prescribed dose of elemental aluminum varied from 31 to 108 mg/kg/d. Concurrently the patient developed vitamin D-resistant osteomalacia which failed to improve with parathyroidectomy. Encephalopathy with myoclonic seizures, loss of speech, and motor impairment also occurred. Serum and bone aluminum levels were elevated at 334 µg/L (normal 7 ± 3 µg/L) and 156 mg/kg (normal 3.3 ± 2.9 mg/kg), respectively. This case demonstrates that aluminum may accumulate in tissue of children receiving oral aluminum hydroxide. The accumulation of aluminum may have contributed to the vitamin D-resistant osteomalacia and the encephaiopathy in this patient. Children receiving aluminum-containing antacids as phosphate binders should be monitored for aluminum accumulation and signs of aluminum intoxication.
Effect of Parathyroid Hormone on cAMP and 1,25-Dihydroxyvitamin D Formation and Renal Handling of Phosphate in Vitamin D-Dependent Rickets
Authors: Aarskog Dagfinn , Aksnes Lage , Markestad Trond
Published: December 2021

Studies were carried out to compare the effects of parathyroid extract (PTE) on the serum concentration of 1,25-dihydroxyvitamin D (1,25[OH]2D), 24,25-dihydroxyvitamin D (24,25[OH]2D), 25,26-dihydroxy vitamin D (25,26[OH]2D) and cAMP, and the urinary excretion of calcium, phosphorus, and cAMP in two normal adult subjects, and in a girl with vitamin D-dependent rickets. The concentration of 1,25[OH]2D was markedly decreased even when she was receiving a daily dose of 25,000 IU of ergocalciferol. PTE infusion resulted in a prompt and distinct increase in the serum levels and the urinary excretion of cAMP in the patient and control subjects. In the control subjects the serum concentration of 1,25[OH]2D increased after the PTE infusion, whereas there was no response in the patient with vitamin D-dependent rickets. The two other dihydroxylated metabolites of vitamin D showed no consistent response to the PTE infusion in the control subjects or the patient. The patient showed no phosphaturic response to PTE while she was receiving high-dosage ergocalciferol treatment. By contrast, when the patient was re-studied after therapy with lα-hydroxyvitamin D, PTE infusion resulted in an increase in urinary phosphate excretion. These findings might lend support for the notion that 1,25[OH]2D has an effect on tubular phosphate resorption and has a permissive role in the phosphaturic effect of parathyroid hormone. The present findings also confirm that the formation of 1,25[OH]2D is impaired in vitamin D-dependent rickets and indicate that the renal 25-hydroxyvitamin D-lα-hydroxylase is unresponsive to the stimulatory effect of parathyroid hormone in this condition.
Development of Blind Infants and Children with Retrolental Fibroplasia: Implications for Physicians
Authors: Teplin Stuart W.
Published: December 2021

Despite an apparent increase in the incidence of retrolental fibroplasia (RLF) and renewed interest in its pathophysiology and prevention, clinicians are often ill prepared to help the family promote the optimal development of its blind or severely visually impaired child. The physician's management approach is molded by both knowledge about the effects of blindness and prematurity on subsequent development and attitudes about blindness. Both issues are reviewed, with particular focus on the developmental course of the infant or child who is blind due to RLF. Although the literature regarding developmental outcome of premature infants with RLF has failed to reach definitive conclusions, studies reveal a tendency toward an IQ distribution similar to or slightly lower than that of various control samples. Blind children with RLF may also be at increased risk for emotional problems, largely as a function of early maladaptive family interaction patterns. Implications of these and other developmental patterns are translated into general and specific interventions that neonatologists, ophthalmologists, and primary care physicians can facilitate. Such physician guidance can help assure the blind or severely visually impaired child's optimal cognitive and emotional development.
Head Growth and Developmental Outcome in Very Low-Birth-Weight Infants
Authors: Gross Steven J. , Oehler Jerri M. , Eckerman Carol O.
Published: December 2021

The predictive role of early head growth for subsequent outcome was evaluated in 85 infants with birth weight <1,500 g. On the basis of head circumference at birth and head growth between birth and age 6 weeks, infants were divided into four groups: (1) microcephalic at birth with less (< 3.5 cm) postnatal head growth (n = 9), (2) microcephalic at birth with more (≥3.5 cm) postnatal head growth (n = 12), (3) normocephalic at birth with less head growth (n = 32), and (4) normocephalic at birth with more head growth (n = 32). At both 6 and 15 months of age the two groups of infants with less postnatal head growth had an increased incidence of growth failure, whereas the two groups with more postnatal head growth had a low incidence, similar to that for a matched full-term group (n = 95). Major neurologic defects occurred significantly more frequently among infants who were microcephalic with less postnatal head growth; two thirds showed evidence of blindness, hydrocephalus, or spastic diplegia. This group also performed more poorly on the Bayley Scales than any of the other groups. Infants who were normocephalic with greater head growth were free of neurologic defects and had Bayley scores that did not differ from those for the healthy full-term infants. The two groups of infants with only one poor measure of head growth demonstrated intermediate scores at age 6 months. At age 15 months, the group with normocephaly and less postnatal head growth continued to have intermediate scores. The group with microcephaly and greater postnatal head growth, however, showed developmental catch-up; their scores did not differ from those of the group that was normocephalic with greater head growth or the full-term group. Less postnatal head growth was associated with an increased requirement for mechanical ventilation, patent ductus arteriosus, sepsis, delayed tolerance of feeding, and slower weight gain. These data suggest that early postnatal head growth may summarize the adverse effects of many perinatal risk factors and that head circumference at birth and head growth by six weeks are strong predictors of early developmental outcome in very low-birth-weight infants.
Inherited Deficiency of the Third Component of Complement Associated with Recurrent Pyogenic Infections, Circulating Immune Complexes, and Vasculitis in a Dutch Family
Authors: Roord John J. , Daha Mohamed , Kuis Wietse , Verbrugh Henri A. , Verhoef Jan , Zegers Ben J. M. , Stoop Jan W.
Published: December 2021

A family is described in which 3/11 children showed a homozygous deficiency of C3, and both parents and six other children had subnormal levels of C3. The three children with selective C3 deficiency suffered repeatedly from bacterial infections, whereas the parents and the other siblings were clinically healthy. During infectious episodes the patients showed a maculopapular skin rash, and at such times immune complexes were present in the serum. Biopsy specimens of the skin lesions showed the picture of leukocytoclastic vasculitis.
Recurrent Polyneuropathy with Multiple Herpesvirus Infections
Authors: Crisp Darrell E. , Bray Patrick F. , Bloomer Linda C.
Published: December 2021

A 4-year-old boy developed typical acute polyneuritis at 2 years of age and returned to fully normal status in 2 months. When he was 4 years old, an identical neurologic syndrome recurred at the same time that his sister was determined to have classic infectious mononucleosis. Both siblings then had positive Monospot tests. The boy with recurrent symmetrical neuropathy had an initial Epstein-Barr virus-viral capsid antibody (EBVVCA) serum titer of 1:160 and this dropped to 1:40 after 1 month. A persistent complement fixation titer to cytomegalovirus (CMV) of 1:64 was measured in his serum and his concentrated CSF contained a CMV complement fixation antibody titer of 1:32, a rare finding in an age-matched control group. Cultures of his urine, buffy coat, and saliva for CMV were negative. Electrophoresis of his CSF revealed oligoclonal bands, several of which were also present in his serum. It seems most likely, but not proven, that the clinical paralysis was caused initially by a CMV infection and that the Epstein-Barr virus infection reactivated the latent CMV to produce the recurrent weakness.
Radionuclide Bone Scan in Neuroblastoma
Authors: Heisel Margaret A. , Miller John H. , Reid Barbara S. , Siegel Stuart E.
Published: December 2021

A comparison of radionuclide bone scans with other methods of monitoring disease status was undertaken in a series of 51 children with neuroblastoma. The radionuclide bone scan was more accurate than either conventional radiographic studies or physical examination in localizing the primary tumor. When the extent of bony metastatic disease was evaluated, the bone scan and radiographic skeletal surveys were generally both positive, but the bone scan tended to show evidence of greater metastatic disease than radiographs.
Parental Information and Circumcision in Highly Motivated Couples with Higher Education
Authors: Herrera Alfredo J. , Cochran Beverly , Herrera Anne , Wallace Barbara
Published: December 2021

Neonatal circumcision is a routine procedure performed in most male neonates. The American Academy of Pediatrics emphasizes the importance of parental information in the decision-making process. If correct medical information is going to make a difference in the performance of this procedure, the population more likely to show this difference is the highly motivated one with higher education. Parents attending childbirth classes (Lamaze) were randomized into two groups: group 1 was given verbal and written information on the risks and benefits of circumcision following the guidelines of the Ad Hoc Task Force on Circumcision at about the seventh month of pregnancy; group 2 was not given any special counseling. There were 181 couples: 97 in group 1 and 84 in group 2; both populations were closely matched. There was no statistically significant difference in the incidence of circumcision in these two groups. The implications of these findings are discussed.