bluuebunny/crossref_metadata_2025 huggingface dataset:
HOW SUSANNA WESLEY, MOTHER OF THE FOUNDER OF METHODISM FED HER CHILDREN (1732)
Authors: C. T. E.
Published: December 2021

Susanna Wesley (d. 1742), the mother of 19 children, one of whom was John Wesley (1703-1791), the founder of Methodism, knew the importance of food in shaping the character of her children. This is evident in the following quotation taken from her letter of June 24, 1732, to hen son, John, in which she described how the Wesley children were brought up.

As soon as they were grown pretty strong they were confined to three meals a day. At dinner their little table and chairs were set by ours, where they could be overlooked; and they were suffered to eat and drink (small beer) as much as they would; but not to call for anything. If they wanted aught, they used to whisper to the maid that attended them, who came and spake to me; and as soon as they could handle a knife and fork they were set to our table. They were never suffered to choose their meat, but always made to eat such things as were provided for the family.

Mornings they had always spoon-meat; sometimes at nights. But whatever they had, they were never permitted to eat at those meals, of more than one thing; and of that sparingly enough. Drinking or eating between meals was never allowed, unless in case of sickness; which seldom happened. Nor were they suffered to go into the kitchen to ask anything of the servants, when they were at meat: if it was known they did, they were certainly beat, and the servants severely reprimanded....
Individualization of Theophylline Dosage Using a Single Serum Sample Following a Test Dose
Authors: Shapiro Gail G. , Koup Jeffrey R. , Furukawa Clifton T. , Pierson William E. , Gibaldi Milo , Fuquay Diane , Bierman C. Warren
Published: December 2021

Because formulas for theophylline requirement based on weight alone carry the risk of overdosing and toxicity, this study was designed to test a clearance nomogram for determining daily theophylline requirement after a known initial dose of theophylline. Twenty asthmatic children who had not taken theophylline for at least 36 hours fasted and were given one dose of anhydrous theophylline (5 mg/kg). Six hours later the serum level was measured and the appropriate dosage of sustained-release theophylline to achieve a serum level of 10 µg/ml was selected from the clearance nomogram. Three to seven days later a six-hour theophylline level was obtained. Of 20 patients, therapeutic levels of 10 to 20 µg/ml were achieved in 15, and the remaining five patients had levels close to this (range 6.2 to 16.0 µg/ml). The dosage requirement per 24 hours ranged from 10 to 32 mg/kg/24 hr. This method of determining theophylline requirements for children required measurement of the serum theophylline level only once for the determination of a safe and effective daily dose. It is especially valuable when follow-up is difficult and is a safe way to avoid serious overdosing while being certain of effective dosing.
Medical Evaluation of Sexually Abused Children: A Review of 311 Cases
Authors: Rimsza Mary Ellen , Niggemann Elaine H.
Published: December 2021

The case records of 311 children and adolescents who were medically evaluated for sexual abuse are reviewed. Only 18% of these victims were assaulted by strangers; 131 of the assailants were relatives. Thirty percent of the victims reported multiple assaults over a time period of one week to nine years. Physical examination showed no abnormalities in only 23% of the patients. Twenty-one patients had gonorrhea and seven patients were pregnant. Guidelines for the medical evaluation of patients suspected to be victims of sexual abuse are discussed.
Diagnosis of Vein of Galen Arteriovenous Malformation by Two-Dimensional Ultrasound and Pulsed Doppler Method
Authors: Sivakoff Mark , Nouri Soraya
Published: December 2021

An arteriovenous malformation of the vein of Galen was diagnosed using two-dimensional ultrasound and pulsed Doppler method. These revealed an echo-free intracranial mass with venous flow, thus confirming the clinical impression. As a result of these findings, the patient was not subjected to cardiac catheterization; and the next phase of patient management was computed tomography.
Mild Head Trauma in Children: When Is a Roentgenogram Necessary
Authors: Leonidas John C. , Ting Windsor , Binkiewicz Anna , Vaz Rosalind , Scott R. Michael , Pauker Stephen G.
Published: December 2021

Review of 354 infants and children who had skull roentgenography for head trauma over a 2½-year period revealed a low incidence of fractures (4.2%) and no serious intracranial complications. With the exception of one patient with an elevated surgically depressed skull fracture, treatment was not changed because of the detection of a fracture. Thus, in the usually mild head trauma sustained by most children, routine skull roentgenography is inefficient. To make efficient use of resources, clinical criteria are necessary to select patients for skull roentgenography. Criteria previously defined for adult patients are, however, less useful in children. On the basis of the present study, additional criteria were identified so that fractures may be detected among children with mild head trauma, at much reduced cumulative cost and exposure to radiation. Nevertheless, the clinical importance of detection of skull fractures remains uncertain.
Projecting Physician Requirements for Child Health Care—1990
Authors: Morgan Beverly C.
Published: December 2021

In 1976 the Secretary of the Department of Health, Education and Welfare appointed the Graduate Medical Education National Advisory Committee (GMENAC) with the charge to advise the Secretary on five national health planning objectives, including estimates of the numbers of physicians required to meet the health care needs of the nation, recommendations regarding the most appropriate specialty distribution of these physicians, and development of strategies to achieve the recommendations formulated by the committee. GMENAC evaluated projected supply and requirements for all major specialties, including child health care, for 1990, and recommended strategies to bring supply and requirement into reasonable balance. Despite the range of error of the methodology used, these data represent the most detailed scientific study to date on this subject. Pediatrics, the portion of child health care accruing to the pediatrician in 1990 was projected to be in "near balance" for supply/requirement ratio. Inasmuch as GMENAC recommended that larger surpluses be created deliberately in the three primary care fields, it is unlikely that the number of pediatric residency training programs will be decreased. As several hundred pediatric residency positions are unfilled each year, a concomitant decrease in residency offerings in oversupplied fields would be required to accomplish the recommended subspecialty distribution.
Coarctation of the Aorta: A Study in Delayed Detection
Authors: Strafford Maureen A. , Griffiths Sylvia P. , Gersony Welton M.
Published: December 2021

The findings and presentations of 65 consecutive patients in whom uncomplicated coarctation of the aorta was diagnosed after 1 year of age were reviewed. Significant delays in diagnosis occurred in the great majority of patients. The median age at diagnosis was 10 years (range 1 to 36 years). Pediatricians made 75% of the referrals. However, the diagnosis of coarctation of the aorta was made before referral in only 14% of these cases. The remaining referrals were made after the incidental notation of hypertension or a heart murmur out of the context of routine medical care (eg, emergency room, school nurses, working paper and insurance physicals, pregnancy, etc). Cardiac murmurs (median age at diagnosis 6 years) and hypertension (median age at diagnosis 18 years) accounted for referrals in whom the condition was not diagnosed. Prompt referral to a cardiologist after the detection of an abnormal finding did not always occur. Additional delays in referral occurred in 29 patients. All of the patients had cardiac murmurs and differential blood pressure between upper and lower extremities. Elevated systolic blood pressure in the upper extremities was found in 89%; femoral pulses were absent in 40%; and pedal pulses were absent in 77%. It is concluded that coarctation of the aorta is a diagnosis that is often overlooked despite specific physical findings. The importance of upper and lower extremity blood pressure determination as part of an initial routine physical examination is emphasized. The impact of delayed diagnosis has yet to be fully defined, but may well be significant in terms of cardiovascular sequelae of prolonged hypertension.
Subcapsular Hemorrhage of the Liver in the Newborn
Authors: French Charles E. , Waldstein Gail
Published: December 2021

Infants with large subcapsular hemorrhages of the liver may have signs that mimic hypovolemic shock commonly seen with intraventricular hemorrhage. A retrospective clinicopathologic study of 783 neonates spanning ten years disclosed an incidence of 15% for subcapsular hemorrhage of the liver. Infants at risk were not clearly distinguishable clinically from control cohorts, but tended to be premature male infants with chronic problems during gestation and more complications during labor and delivery. Physical manipulations including umbilical venous catheter placement, tracheal intubation, and chest tube placement were typically seen in the affected neonates.
Ampicillin-Resistant, β-Lactamase-Negative Haemophilus influenzae Type b
Authors: Offit Paul A. , Campos Joseph M. , Plotkin Stanley A.
Published: December 2021

Haemophilus influenzae type b isolates resistant to ampicillin have been reported with increasing frequency since 1973.1 The mechanism of resistance is usually via production of a plasmid-mediated β-lactamase.2 We report the second clinical isolate of an ampicillin-resistant strain of H influenzae type b with no detectable β-lactamase activity.

CASE REPORT

A 20-year-old white woman was admitted to The Children's Hospital of Philadelphia with a three-day history of fever to 39 C, cough, tachypnea, and diarrhea. Past medical history was significant for the following: (1) recurrent upper and lower respiratory tract infections first noted at 5 years of age, (2) a selective deficiency of IgG and IgA documented at 8 years of age necessitating monthly immune serum globulin injections, (3) chronic, interstitial pulmonary fibrosis with resultant obstructive and restrictive lung disease, (4) severe cachexia, (5) a chronic, maculopapular facial rash, and (6) recurrent, bilateral serous otitis media and sinusitis.
‘Promoters of the Health Code Believe Fervently’
Authors: Katz Michael
Published: December 2021

Your commentaries, statements, and editorials on the subject of "Infant Formula Controversy," in the September 1981 issue, have poured oil not on troubled waters, but right into the raging fire. As a pediatrician with experience and interest in the Third World, I cannot let your message stand unchallenged.

The fundamental issue before us is active promotion of breast-feeding throughout the world, not just in developing countries. The evidence of the beneficial effects of this natural product is not a matter of controversy.
Management of Asthma
Authors: Easton James , Hilman Bettina , Shapiro Gail , Weinberger Miles , Anderson John , Buckley Jerome , Eggleston Peyton , Bierman C. W.
Published: December 2021

In the article "Management of Asthma" by the Section on Allergy and Immunology of the American Academy of Pediatrics (Pediatrics 68:874-879, 1981) corrections should be made on p 876, fourth paragraph, as follows: Line 15, sentence should read: After the loading dose, a constant maintenance infusion of aminophylline of 0.85 mg/kg/hr for children 1 to 9 years old, 0.65 mg/kg/hr for children 9 to 16 years old, and 0.45 mg/kg/hr for adults usually will maintain serum concentrations of approximately 10 µg/ml. Line 23, sentence should read: Average theophylline dosage for infants less than 1 year old relates to age and can be estimated by a regression formula: dose (milligrams per kilogram per day) = 0.3 x age in weeks + 8.
Growth Hormone Deficiency in Twins: Three Cases with Normal Co-twins
Authors: Lindsay Alan N. , MacGillivray Margaret H. , Voorhess Mary L.
Published: December 2021

Idiopathic growth hormone deficiency is unusual in twin sibships. We report three twins with growth hormone deficiency whose co-twins are growing normally and have no evidence of hypothalamicpituitary dysfunction. It is likely that the affected children sustained perinatal insult. The data illustrate that idiopathic growth hormone deficiency should be considered in the differential diagnosis when there is a major discrepancy in height between twins.

CASE REPORTS

Case 1

Male twins I were born at 36 weeks' gestation to a 27-year-old gravida 3, para 2. There was no history of abnormal vaginal bleeding, infection or, toxemia. Labor was spontaneous and lasted two hours.
Transluminal Arterial Dilation of a Postsurgical Stenosis of Renal Artery Implant in a Child with Recurrent Hypertension
Authors: Goertz Kenneth K. , Linshaw Michael A. , Lee Kyo R. , Hermreck Arlo , Mattioli Leone , Bailie Michael D.
Published: December 2021

Renal artery stenosis accounts for 12% of secondary causes of hypertension1 and must be considered in the evaluation of a child with sustained hypertension. The surgical treatment for renal artery stenosis is preferably renovascular reconstruction or partial or complete nephrectomy if the former procedure is not possible.2 In recent years, percutaneous angioplasty has been performed in adult patients with renal artery stenosis with encouraging results.3,4 However, there has been little experience with this procedure in pediatric patients. This report describes the successful use of this technique in a 4½-year-old boy with recurrent hypertension following renal artery reconstruction for unilateral stenosis.
Gas Formation in the Pleural Space of a Child with an Anaerobic Streptococcal Pneumonia and Empyema
Authors: Fischer Philip R. , Stanberry Lawrence R. , Glasgow Lowell A.
Published: December 2021

Anaerobic pleuropulmonary infections are common in adults1 but are unusual in children.2 Since the advent of antimicrobial chemotherapy, intrathoracic gas formation associated with these infections in children has not, to our knowledge, been reported.3 The purpose of this report is to describe a severe anaerobic streptococcal pneumonia and empyema with gas formation in a 9-year-old child and to review the diagnostic considerations stimulated by the presence of intrathoracic air-fluid levels.

CASE REPORT

A 9-year old white girl was transferred to the Primary Children's Medical Center, University of Utah for treatment of an apparent lung abscess. Thirteen days prior to transfer this previously healthy girl had been admitted to another hospital with a one-day history of lower midabdominal pain.
Carbamazepine-Isoniazid Interaction
Authors: Block Stanley Hoyt
Published: December 2021

Carbamazepine (Tegretol) is a frequently prescribed anticonvulsant that is particularly effective against complex partial and generalized tonic-clonic seizures.1 Manifestations of carbamazepine toxicity include aplastic anemia, rashes, stomatitis, dizziness, diplopia, confusion, headache, anorexia, and nausea.2

Carbamazepine has been noted to have a variety of interactions with other medications. The use of carbamazepine in combination with oral anticoagulants, contraceptives, or doxycycline, decreased the effectiveness of these medications by the probable induction of microsomal enzymes by carbamazepine. When taken with propoxyphene or troleandomycin, an increased carbamazepine effect has been noted, probably due to inhibition of microsomal enzymes by those drugs.3

The following case report describes the interaction of carbamazepine with isoniazid.
Salt and Caffeine Intake in a 19-Month-Old Child
Authors: Rider Paul S.
Published: December 2021

I recently saw at his regular checkup a 19-month-old male child with a history of marked polydipsia and polyuria. The mother stated that for the past month she had been using at least 20 diapers a day and he was awakening 15 to 20 times a night for a drink. The mother said she had begun keeping a pitcher of water at her bedside to meet the child's needs.

The child's growth and development were normal.
Predicting When Children with Progressive Renal Disease May Reach High Serum Creatinine Levels
Authors: Leumann Ernst P.
Published: December 2021

A method for predicting when children with progressive renal disease may reach high levels of serum creatinine (SC) was recently described in this journal.1 The authors did not seem to be aware that the same technique, ie, plotting the reciprocal (1/SC) or the logarithm (log SC) vs time has been tested in two slightly larger series of pediatric patients and was published some time ago.2,3 I agree that the reciprocal plot (1/SC vs time) is, in general, more appropriate than the semilog plot in predicting when a critical concentration of SC, say 10 mg/100 ml, may be reached.
Letters to the Editors
Authors: Walker Stuart H.
Published: December 2021

My letter1 called attention to the frequency with which in the United States hypernatremia has been associated with the unsupervised administration of solutions containing sodium in amounts as low as 20 to 50 mmoles/liter.2,3 It has not been demonstrated that solutions similar to that recommended by the World Health Organization (80 to 90 mmoles of sodium per liter), designed for supervised use in the management of the infantile diarrheas of developing countries, are safe in unsupervised use in the United States.
Oral Aqueous Suspension of Indomethacin Should Be Abandoned
Authors: Scanlon John W.
Published: December 2021

Despite considerable clinical and experimental data that indomethacin can close the patent ductus arteriousus (PDA) in human newborns, reports of therapeutic failures have been published. Brash et al1 note pharmacokinetic vagaries after intravenous administration and these relate to clinical response, but most previous reports discuss orally administered indomethacin. There may be a simple pharmacologic explanation for some therapeutic failures after oral indomethacin in the newborn.

In published papers, and in many nurseries, indomethacin is usually prepared by dissolving the contents of one 25-mg capsule in 10 ml of distilled water.
A Controlled Field Trial of a Poisoning Prevention Method
Authors: Fergusson D. M. , Horwood L. J. , Beautrais A. L. , Shannon F. T.
Published: December 2021

A controlled field trial was conducted to determine the effectiveness of Mr Yuk labels as a poisoning prevention aid for children aged 2 to 3 years. Comparison of poisoning rates and levels of household hazard in a group of 583 families supplied with Mr Yuk labels and a control group of 543 families not given Mr Yuk labels failed to reveal any significant differences. Consumer reactions to the program were mixed: approximately 60% of users gave a favorable evaluation of the method and 40% either did not use the method or made adverse comments. Examination of the reasons for the failure of the experimental manipulation suggested that three factors were involved: parents failed to provide an adequate coverage of all poisons in the home; a significant number of poisonings occurred with substances that could not be labeled with Mr Yuk; and, in a minority of cases, clear failures of the method were observed. Results of the study do not support the view that simply supplying Mr Yuk stickers to families with young children reduces risks of accidental poisoning. However, the method may be effective with older children or as an adjunct to an integrated poisoning prevention campaign.
Children Who ‘Outgrew’ Cerebral Palsy
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: December 2021

A diagnosis of cerebral palsy was made for 229 one-year-old children enrolled in a large longitudinal study. Of these children, 118 were free of motor handicap at the age of 7 years. Mild early cerebral palsy, and the monoparetic, ataxic/dyskinetic, and diplegic forms of the disorder, resolved with high frequency. Normalization of motor signs was observed more frequently in black than in white children. However, 13% of white children and 25% of black children whose motor signs resolved were mentally retarded (IQ below 70) at 7 years of age. Nonfebrile seizures, abnormalities in speech articulation and extraocular movements, and certain abnormalities of behavior were more frequent among children who "outgrew" cerebral palsy than in the general population of the study.
Factors Associated with Maternal Opinion of Infant Development—Clues to the Vulnerable Child?
Authors: McCormick Marie C. , Shapiro Sam , Starfield Barbara
Published: December 2021

A mother's expectations about the development of her infant have been found to be a strong determinant of child development, but little is known about the factors that may affect maternal assessment of development. In this study, the relationship of the mother's opinion of the development of her infant with several sociodemographic, antenatal, intrapartum, and infant health variables was examined for a large sample of 1-year-old infants for whom gross motor observations were also obtained at the time of the interview. Among those observed to be developing at an appropriate rate, 4.0% were perceived by their mothers as developing more slowly than the mothers considered normal; among infants developing more slowly, 28.6% were considered to be developing slowly by their mothers. In both groups, the major determinants of maternal opinion of slow development concerned the infant's health: low birth weight, congenital anomalies regardless of severity, hospitalization during the first year of life, and high ambulatory care use. These results indicate that maternal perception of infant development may not reflect the infant's level, but past or present illness, and raise questions about the influence of infant health on maternal-infant interactions and the effect of such interactions on subsequent development in the child.
Effect of Parenteral Calcium Treatment on Blood Pressure and Heart Rate in Neonatal Hypocalcemia
Authors: Salsburey Donna J. , Brown David R.
Published: December 2021

Treatment of hypocalcemia in the normotensive but moderately ill neonate has been associated with an increase in blood pressure and heart rate. Blood pressure increased within five minutes after the end of a parenteral bolus infusion of calcium and remained elevated for approximately 50 minutes before returning to pretreatment values. Heart rate increased by 20 minutes after calcium infusion and the effect lasted through 90 minutes. Arterial and venous infusions of calcium were both followed by similar elevations in blood pressure and heart rate whereas infusions of saline were followed by no changes in either heart rate or blood pressure. The absence of other obvious explanations for the acute blood pressure elevation suggests that the increases in blood pressure and heart rate are directly related to or indirectly mediated by calcium therapy.
Combined Treatment of Severe Hyponatremia Due to Inappropriate Antidiuretic Hormone Secretion
Authors: Weizman Zvi , Goitein Kalman , Amit Yair , Wald Uri , Landau Heddy
Published: December 2021

A 6-year-old girl developed generalized seizures followed by coma, five days after surgical removal of a craniopharyngioma. Low serum sodium levels and low serum osmolality with inappropriately high urinary sodium output confirmed the diagnosis of inappropriate antidiuretic hormone (ADH) secretion. Treatment with 3% hypertonic saline solution and repeated doses of furosemide (1 mg/kg) improved her clinical condition; serum sodium levels, however, rose slowly and urinary excretion remained high. Deoxycorticosterone acetate (DOCA), 4 mg/sq m/day, was added to the above regimen. A striking clinical improvement was noted. Serum sodium levels returned to normal with a concomitant sharp decline in urinary sodium output. The clinical course of this patient demonstrates the efficacy of the addition of deoxycorticosterone acetate to hypertonic saline and furosemide in the treatment of severe, lifethreatening hyponatremia due to the syndrome of inappropriate antidiuretic hormone seretion.
Defects of Tooth Structure in Congenital Cytomegalovirus Infection
Authors: Stagno Sergio , Pass Robert F. , Thomas Joe P. , Navia Juan M. , Dworsky Meyer E.
Published: December 2021

In most populations congenital cytomegalovirus (CMV) infections occur with a frequency of 0.5% to 2% of live births. In the newborn period this infection is largely clinically inapparent; only 5% to 10% of infected infants manifest illness.1 In this small group of symptomatic babies, both the type and severity of abnormalities have a wide spectrum.2 The most frequent manifestations are microcephaly, hepatosplenomegaly, petechia, jaundice, and growth retardation. Although signs of central nervous system involvement are not usually evident at birth, they become apparent within the first few years of life in nearly 90% of children with symptoms at birth. The most common manifestations are microcephaly (70%), intellectual impairment (60%), neuromuscular disorder (35%), hearing loss (30%), and chorioretinitis or optic atrophy (22%).
X-Linked Mental Retardation and Fragile-X or Marker-X Syndrome
Authors: Rhoads Frances A.
Published: December 2021

Gerald's commentary1 on this subject is timely. We have been investigating this disorder, and I offer a few additional comments that are based on our own observations and on those of others working in the field and which may be helpful for pediatricians:

1. The term nonspecific sex-linked mental retardation covers a heterogeneous group of disorders with individuals with the fragile site or marker, now designated fra(X)(q28), estimated to account for one third to one half of all cases.
Letters to the Editor
Authors: Gerald Park S.
Published: December 2021

Rhoads provides some interesting facts. It is my opinion that insufficient information is available to conclude that males hemizygous for the fragile-X cytogenetic defect are infertile. Indeed, some evidence to the contrary may be available (for example, Rhoads' reference 6).

The mutation frequency for the fragile-X has yet to be determined and is vital for informed genetic counseling. The conclusion that one third of fragile-X males will be new mutations is derived from Haldane's well-known analysis.
Treatment of Fragile-X
Authors: Harpey Jean-Paul
Published: December 2021

In their commentary, "Fragile Sites on Chromosomes," (Pediatrics 69:121, 1982) Hecht, Glover, and Kaiser-Hecht stress the possibility of therapy in cases of fragile-X linked mental retardation. I have had the opportunity to treat three members of a family with the fragile-X chromosome.

A 21-year-old man with mental retardation and psychotic symptoms, had macroorchidism and fragile-X site in 13% of his cells in 199 medium. A first therapeutic trial with folic acid, 10 mg, orally, per day and vitamin B12, 1 mg, orally, per day resulted in a great improvement of his comportment without change in the percentage of the fragile-X site.
Letters to the Editor
Authors: Shenai Jayant P. , Huston Robert K. , Reynolds John W.
Published: December 2021

We wish to thank Professor Prinsloo for his comments on our paper.1 He correctly points out some similarities in the findings of our study on soy-based formula in premature infants and the study in which he participated.2 We found that nitrogen retention was significantly lower, urinary nitrogen excretion (% of intake) was significantly higher, and serum urea nitrogen was significantly higher in soy protein formula-fed infants than in milk formula-fed infants. However, we do not feel that it is justified to conclude from these findings that soy protein is of suboptimal quality.
Effects of Parent Training on Teenage Mothers and Their Infants
Authors: Field Tiffany , Widmayer Susan , Greenberg Reena , Stoller Sherilyn
Published: December 2021

Parent training was provided for 80 low-income, black teenage mothers during their infants' first six months. Half of the mothers were visited biweekly in their homes to be instructed in caregiving and in sensorimotor and interaction exercises, and half were trained as CETA (Comprehensive Employment Training ACT)-paid, teacher's aides in a medical school infant nursery that provided care for their infants and infants of medical faculty. Growth and development during the first two years were superior for the infants whose mothers received training, particularly those who received paid parent training as teacher's aides in the infant nursery. Repeat pregnancy rates were lower and return to work/school rates were higher for the infant nursery mothers, most of whom subsequently pursued nurse's aide training.
Diaphragm Strength in Near-Miss Sudden Infant Death Syndrome
Authors: Scott Charles B. , Nickerson Bruce G. , Sargent Charles W. , Dennies Paula C. , Platzker Arnold C. G. , Keens Thomas G.
Published: December 2021

Diaphragm muscle strength was measured as maximal transdiaphragmatic pressure during airway occlusion in ten near-miss sudden infant death syndrome infants aged 4.1 ± 0.6 (SE) months post-term, range 2 to 7 months, and ten control infants aged 4.5 ± 0.8 months post-term, range 0.8 to 8 months. In the near-miss sudden infant death syndrome group, the mean maximal transdiaphragmatic pressure was 106 ± 6 cm H2O, range 78 to 132 cm H2O, compared with a mean maximal transdiaphragmatic pressure of 86 ± 4 cm H2O, range 69 to 106 cm H2O, in the control group. Diaphragm strength is normal or increased in near-miss sudden infant death syndrome infants.
Respiratory Behavior in Near-Miss Sudden Infant Death Syndrome
Authors: Hodgman Joan E. , Hoppenbrouwers Toke , Geidel Susan , Hadeed Anthony , Sterman Maurice B. , Harper Ronald , McGinty Dennis
Published: December 2021

Seventeen infants with unexplained prolonged apnea that has been designated near-miss sudden infant death syndrome were monitored for sleep and cardiorespiratory variables during a 12-hour, all-night recording session. Infants were matched for gestational age, sex, and age at recording with control infants. Respiratory variables studied included respiratory rate, respiratory variability, apnea duration, apnea density, and periodic breathing. No statistically significant differences were found in sleep state or respiratory variables between near-miss and control infants. Eight infants (47%) had no recurrence of prolonged apnea, whereas three (17.6%) had recurrent apneic episodes for six weeks to eight months following the original episode. No clinical or polygraphic finding predicted which infant would exhibit recurrent apnea. None of the infants was monitored at home. All infants were developing normally when examined at 1 to 2 years of age.
Zinc Deficiency Following Surgery in Zinc-Supplemented Infants
Authors: Palma Paul A. , Conley Susan B. , Crandell Sharon S. , Denson Susan E.
Published: December 2021

Total parenteral nutrition has become a mainstay in the management of infants following complicated abdominal surgery. As we have become sophisticated in our understanding of micronutrient nutrition, the term total parenteral nutrition has proved more a goal to be attained than a reality. In an effort to bypass the gastrointestinal tract and nurture critically ill postoperative patients intravenously, a new setting for the manifestation of deficiency states has emerged. This is illustrated by three infants who developed zinc deficiency during postoperative parenteral alimentation despite intravenous zinc supplementation (Fig 1). The pathogenesis of this syndrome and its complications are described, possible etiologies are considered, and recommendations for prevention and therapy are suggested.
Aspirin and Reye Syndrome
Authors:   Committee on Infectious Diseases, Fulginiti Vincent A. , Brunell Philip A. , Cherry James D. , Ector Walton L. , Gershon Anne A. , Gotoff Samuel P. , Hughes Walter T. , Mortimer Edward A. , Peter Georges
Published: December 2021

Because of the unique nature and importance of this report, the Committee urges that members read it in its entirety, and examine the report of the Reye Syndrome Working Group convened by the Centers for Disease Control (National surveillance of Reye syndrome 1981: Update, Reye syndrome and salicylate usage. Morbidity Mortality Weekly Rep 31:53-56, 61-63, 1982).

For some years there has been a suspicion that Reye syndrome is due, at least in part, to one or more drugs administered during an antecedent viral illness, usually influenza or chickenpox. Suspected drugs have included antiemetic and antipyretic preparations. More recently, concern has centered on salicylates.

In November 1980, summaries of epidemiologic studies of Reye syndrome performed for two consecutive years in Ohio and in Michigan were reported (Morbidity Mortality Weekly Rep 29:532, 1980). These studies demonstrated an association of Reye syndrome with the administration of aspirin during the antecedent illness. In December 1980, a full report of a small study of Reye syndrome in Arizona by Starko and colleagues (Pediatrics 66:859, 1980) produced similar results. The membership was made aware of these studies by the Committee on Infectious Diseases and the Committee on Drugs via News & Comment in March 1981.

More recently the Committee has had an opportunity to review full reports of the Ohio and Michigan studies, not yet published. The Committee believes that the results of this review should be brought to the attention of the membership.

Each of these studies, including that from Arizona, was performed using the case-control method.
Neonatal Seizures II. A Multivariate Analysis of Factors Associated with Outcome
Authors: Mellits E. David , Holden Kenton R. , Freeman John M.
Published: December 2021

A multivariate analysis of perinatal events occurring in infants with neonatal seizures who were enrolled in the National Collaborative Perinatal Project allowed prediction of outcome. This prediction of death or of mental retardation, cerebral palsy, or epilepsy was empirically confirmed 64% to 83% of the time. In an infant with neonatal seizures, a five-minute Apgar score of less than 7, the need for resuscitation after 5 minutes of age, the onset time of the seizures, and a seizure lasting more than 30 minutes are the best early predictors of which infants will die or will have significant neurologic sequelae. It is hypothesized that neonatal seizures may be a better indicator of the severity or duration of intrauterine asphyxia than the Apgar score. In the neonate with seizures, the use of the formula may allow identification of infants at high risk for adverse outcomes.
STATISTICAL PYROTECHNICS
Authors:   Student
Published: December 2021

The term medical research dignifies a heterogeneous group of activities. These range from well-designed studies intended to test clearly articulated hypotheses to anecdotal accounts of arbitrarily selected cases. The former speak eloquently for themselves, and of the latter the least said the better. Somewhere between lies a category of studies known disparagingly as "fishing expeditions." These arise when investigators have no clear idea of what is being sought but collect data in the hope of finding some hitherto unsuspected associations between measurable variables . . . the cynic may perhaps be forgiven for objecting that fishing expeditions often beg far more questions than may feasibly be answered . . . .

Data generated by fishing expeditions do not have any logical structure imposed upon them by prior hypotheses and therefore they tend to be numerous, messy, and difficult to interpret. Generally help is sought from statistics, in the form of significance tests which are performed on all conceivable associations in the data. Associations found to be statistically significant at, say, the 5% level are reported and all too often these are widely and uncritically accepted as genuine. Regrettably, the dangers of data-dredging by significance tests are insufficiently recognised.
Vulvovaginitis in Premenarcheal Girls: Clinical Features and Diagnostic Evaluation
Authors: Paradise Jan E. , Campos Joseph M. , Friedman Harvey M. , Frishmuth Gertrude
Published: December 2021

Fifty-four premenarcheal patients (median age 5.8 years) with symptoms or signs of vulvovaginitis were studied, and the results of cultures of vaginal secretions were compared with those from an age-matched control group. Vaginal discharge was found on examination in 24 of 42 patients with a complaint of discharge, and in two of 12 patients without a complaint of discharge. Convincing evidence of bacterial or monilial infection was found in 14 of the 26 patients with discharge on examination, but in none of the 28 patients without discharge (P < .001). In the latter group pinworm infestation was present in one patient. Moniliasis occurred exclusively in girls who were pubertal (P < .001). Four patients were found to have gonorrhea. No patient appeared to have symptoms or signs caused by Bacteroides sp, Chlamydia trachomatis, viruses, or Trichomonas vaginalis. Noninfectious causes were identified in four patients with and 13 without discharge (P < .025); the most common cause was poor hygiene, implicated in six patients. Bubble bath use was implicated in only one patient. In 22 patients, no specific cause could be identified. All patients with poor hygiene as the only cause, and most with no demonstrable etiology, recovered after being advised to institute improved perineal hygiene. Patients with vaginal discharge are likely to have specific infections, and therefore cultures should be taken, in particular for Neisseria gonorrhoeae. Genital pruritus in prepubertal girls has little or no etiologic specificity, but in pubertal girls with vaginal discharge it suggests the presence of monilial vaginitis.
Hospital Infection Control for Varicella Zoster Virus Infection
Authors: Myers Martin G. , Rasley Dorothy A. , Hierholzer Walter J.
Published: December 2021

More than 500 hospital employees and 209 patients were exposed to varicella zoster virus (VZV) as a consequence of 22 uncontrolled hospital introductions that occurred over a period of 34 months. Five introductions of varicella were by hospital employees who acquired the infection outside the hospital. Successful infection control of VZV requires an accurate definition of the susceptible population and the limitation of transmission. Individuals with prior VZV infection are epidemiologically not at risk for developing clinical illness. Serologic screening of hospital employees with uncertain prior VZV history is effective in identifying those at risk of developing the infection. A prior history of intimate exposure to VZV does not imply immunity in the absence of clinical illness.
ISAAC WATTS ON OBEDIENCE TO PARENTS, AS VIEWED IN THE EIGHTEENTH CENTURY
Authors: C. T. E.
Published: December 2021

Isaac Watts (1674-1748), a non-conformist English preacher, was famous in his own time for his textbooks on Logick and on the Principles of Geography and Astronomy. Today he is best remembered for his hymns and certain moralistic verses for children. A favorite verse known to many past generations of British and American children is the following1:

Obedience to Parents

Let children that would fear the Lord,

Hear what their teachers say;

With reverence meet their parent's word,

And with delight obey.

Have you not heard what dreadful plagues

Are threatened by the Lord,

To him that breaks his father's law,

Or mocks his mother's word?

What heavy guilt upon him lies!

How cursed is his name!

The ravens shall pick out his eyes,

And eagles eat the same.

But those who worship God, and give

Their parents honor due,

Here on this earth they long shall live,

And live, hereafter too
Pulmonary Paragonimiasis in Laotian Refugee Children
Authors: Burton Karen , Yogev Ram , London Naomi , Boyer Kenneth , Shulman Stanford T.
Published: December 2021

Three Laotian refugee children with chronic pulmonary complaints and findings were found to have pulmonary paragonimiasis during a one-year period in Chicago. These patients ranged from 8 to 11 years of age and the diagnosis was delayed five to six months in two children because of the unfamiliarity of American physicians with signs and symptoms of this disorder. Clinical manifestations included chronic cough for up to two years, apparent hemoptysis in two patients, lack of fever or sweats, and family history negative for tuberculosis. Physical findings included rales and dullness to percussion, clubbing (one patient), and lack of fever or respiratory distress. All three patients showed interstitial infiltrates on chest roentgenogram whereas two had multiple small cystic areas. Moderate eosinophilia was present. Paragonimus westermani ova were found in stools of two patients, in sputum of two patients, and in bronchoscopic specimens in one patient. All patients demonstrated striking clinical and radiologic improvement following treatment with bithionol (50 mg/kg every other day for 15 doses), which was well tolerated. Lung fluke infestation must be considered in Indochinese refugee children with apparent hemoptysis or chronic pulmonary symptoms, and sputum and stool should be examined for P westermani ova.
Importance of Early Ileostomy Closure to Prevent Chronic Salt and Water Losses after Necrotizing Enterocolitis
Authors: Rothstein Fred C. , Halpin Thomas C. , Kliegman Robert J. , Izant Robert J.
Published: December 2021

Six infants with necrotizing enterocolitis were discharged after periods ofprolonged hospitalization (two to nine months) with intact ileostomies. Their initial hospitalization was complicated by feeding difficulties, chronic diarrhea, sepsis, rickets, and developmental delay. All were rehospitalized within three months, with severe acidosis and dehydration after a presumed viraltype illness. Each had large-volume ileostomy output, which was rich in electrolytes and bicarbonate. A prolonged recovery phase (two to eight months) again was punctuated with episodes of diarrhea, problems in starting oral feeding, and sepsis. After reanastomosis of the remaining bowel, no infant has had a similar life-threatening episode. It is speculated that the infants' recurrent "salt-and-water-losing states" are secondary to either an anatomic or functional loss of the colon. This problem appears to be a poorly recognized sequela of bowel surgery and necrotizing enterocolitis, and early reanastomosis of discontinuous bowel should be of benefit.
Probable Toxic Shock Syndrome Without Shock and Multisystem Involvement
Authors: Bass James W. , Harden Lewis B. , Peixotto John H.
Published: December 2021

Three menstruating adolescents using tampons colonized with Staphylococcus aureus developed high fever, vomiting, diarrhea, and abdominal pain followed by conjunctival injection and a sunburn-like rash. Two girls had transient orthostatic hypotension but none developed shock or evidence of multiple organ injury. They are reported as having probable toxic shock syndrome without shock or multiple organ system involvement.
Pyloric Stenosis in Identical Triplets
Authors: Janik Joseph S. , Nagaraj Hirikati S. , Lehocky Ronald
Published: December 2021

Pyloric stenosis has been reported in nonidentical male triplets in the past. This is the first report of pyloric stenosis occurring in identical male triplets in a family with no previous history of pytoric stenosis. The appearance of this disease in both identical and nonidentical triplets supports the view that pyloric stenosis is the result of a single main dominant gene and a multifactorial background working together.
Valproic Acid: Benefits and Risks
Authors:   Committee on Drugs (1981-1982)
Published: December 2021

Until more data are available, the committee recommends that physicians adopt a conservative approach and utilize VPA only in carefully selected situations. Potential toxic complications of this drug, which occur at an unknown frequency, are of major concern and require precautions during its use.
Letter to the Editor
Authors: Farber Jon Matthew
Published: December 2021

The article by Shaywitz et al1 calls to mind two points that have been made in the past but perhaps not strongly enough, so I would just like to reemphasize them. First, the authors described the children in their article as having symptoms of thought disorder, but the authors appear to refrain from calling them psychotic. I am very pleased to see this. It must be remembered that the language of a 2-year old, analyzed by adult criteria, is "psychotic" in nature, with such characteristics as rambling nature, sterotypical utterances, and neologisms.
Persistent Neonatal Hypoglycemia Due to Hyperinsulinism: Medical Aspects
Authors: Landau H. , Perlman M. , Meyer S. , Isacsohn M. , Krausz M. , Mayan H. , Lijovetzky G. , Schiller M.
Published: December 2021

Eight neonates with persistent hypoglycemia were seen over a four-year period and a ninth infant with neonatal onset was treated from 9 months of age. Seven infants had high absolute insulin levels (range 12 to 50 µU/ml) during hypoglycemia whereas two patients had normal levels which were, however, inappropriate for the low blood glucose levels. Six patients with severe intractable hypoglycemia resistent to intensive medical therapy (including high dose diazoxide) had partial or total pancreatectomy, whereas three with relatively controllable hypoglycemia eventually had spontaneous remissions. In one of the medically treated patients, remission occurred at the unusually early age of 4 months. In the six surgically treated patients and in a seventh patient who had a biopsy only, the pancreas showed characteristic pathologic changes compatible with those described as nesidioblastosis or "endocrine-cell dysplasia." Of the six patients followed up for ≥ 24 months, four have normal psychomotor development, despite periods of arrested head growth in early infancy in three of them.
Fetal Smoking
Authors: Christoffel Katherine K.
Published: December 2021

In their fine article concerning the perinatal metabolism of carbon monoxide derived from cigarette smoke, Bureau et al1 speculate that fetal adaptations to cigarette-induced hypoxia may be demonstrable. In fact, Garn et al2,3 have already described such an adaptation: elevated neonatal hemoglobin levels related in a dose-related fashion to maternal cigarette use. The fetus does apparently need to compensate for chronic hypoxia induced by maternal smoking.
Newborn Screening for Phenylketonuria
Authors: Berry Helen K. , Porter Leonard J.
Published: December 2021

The Committee on Genetics of the American Academy of Pediatrics recently reviewed problems of screening for phenylketonuria (PKU).1 They recognized that some affected infants will be missed by screening and made recommendations on the structure of screening programs and timing of collection of blood samples. We have also examined some of the issues regarding the reliability of screening for PKU at a given age.

Several factors affect the reliability: the rate of rise in level of phenylalanine in an affected infant after birth, the effect of protein intake on the rate of rise of phenylalanine, and the sensitivity of the procedure for measuring phenylalanine.