bluuebunny/crossref_metadata_2025 huggingface dataset:
CHARLES DICKENS ON THE MEDICAL USE OF TAR-WATER
Authors: C. T. E.
Published: December 2021

Bishop George Berkeley (1685-1753), the Anglo-Irish philosopher and Bishop of Cloyne, a remote diocese in County Cork, published a remarkable book in 1744 on the panacean value of tar-water.

Berkeley recommended that tar-water be prepared by pouring a gallon of water over a quart of tar, then stirring and mixing thoroughly for three or four minutes with a ladle or flat stick. After standing for 48 hours to allow the tar to settle, the clear supernatant layer was poured off and kept for use. Berkeley claimed that a pint of tar-water a day would cure almost every disease then known.1

Although the tar-water craze had abated by the end of the 18th century, it was apparently still in use in England as late as 1861, as is evident in this quotation from Dickens's Great Expectations.2
Pontosubicular Necrosis and Hyperoxemia
Authors: Ahdab-Barmada Mamdouha , Moossy John , Painter Michael
Published: December 2021

Pontosubicular necrosis (PSN) is confined to a short perinatal developmental period and is apparently related to asphyxia at birth. Neuronal necrosis with karyorrhexis and proliferative changes in astrocytes are most prominent in the pontine gray matter and subiculum of the hippocampus. We have observed a striking association of PSN in neonates with high arterial blood oxygen (Po2) levels during the first week of life. All autopsies performed on neonates in 1977 at Magee-Womens Hospital (University Health Center of Pittsburgh) were reviewed, and all 64 neonates who survived long enough to have multiple Po2 determinations were studied. All had severe hypoxia, respiratory distress, and/or apnea. Twenty-seven (group I) did not have Po2 levels higher than 150 torr whereas 37 (group II) had Po2 levels higher than 150 torr for a sustained period. PSN was not seen in group I; it was prominent in group II. PSN was most severe between the gestational ages of 26 to 36 weeks. Hyperoxemia may decrease cerebral blood flow selectively at this critical phase of development or there may be a greater sensitivity to the toxic action of high blood oxygen levels in the presence of acidosis and hypoxia. A combination of these factors seems most probable.
Arteriohepatic Dysplasia: Association of Liver Disease with Pulmonary Arterial Stenosis as Well as Facial and Skeletal Abnormalities
Authors: Levin Solomon E. , Zarvos Paniyotis , Milner Selwyn , Schmaman Arthur
Published: December 2021

The clinical features and course of five children with the recently described syndrome of arteriohepatic dysplasia are presented. All had bilateral pulmonary arterial stenosis, proven at cardiac catheterization, as well as associated liver disease of varying severity. In one of the fatal cases, a hitherto undescribed anomaly was found—stenosis of the right coronary artery ostium. A viral etiology, eg, the congenital rubella syndrome, was considered most likely, but detailed investigations proved to be negative.
Health Outcomes of a Community-Based Therapy Program for Children with Cancer—A Shared-Management Approach
Authors: Kisker C. Thomas , Strayer Faye , Wong Kwan , Clarke William , Strauss Ronald , Tannous Raymond , Janco Robert , Spevak Jack
Published: December 2021

Critical to providing cancer therapy to children in rural areas is finding dependable sources of therapy near the patients' homes. In this study, comparison was made of 668 visits by 24 patients to nearby private practitioners, who carried out 70% of the therapy, with 712 visits by 22 other patients for whom all care was managed by pediatric hematologist-oncologists. There was no significant difference by Wilcoxon rank sum test between the two groups in the accuracy with which protocol rules were followed, in the incidence of neutropenia, infection, fever, thrombocytopenia, drug toxicity, or the proportion of days hospitalized. The findings indicate that the private practitioners participating in a shared-management system were a dependable resource for providing 70% of the total cancer therapy to these patients.
Cost-Effectiveness of a Shared-Management Delivery System for the Care of Children with Cancer
Authors: Strayer Faye , Kisker C. Thomas , Fethke Carol
Published: December 2021

Costs of two alternative methods for obtaining comparable quality outpatient care for pediatric cancer patients were examined. Costs incurred in obtaining care from specialists, "specialist-management," were compared to costs incurred in obtaining "shared-management," care provided by specialists and primary physicians combined. Shared-management medical costs for outpatient care were 10% less than they would have been had the care been obtained from specialists. The nonmedical costs of transportation, parking, food away from home, and lost productivity or income were all less under the shared-management medical care delivery system than they would have been had specialist management been utilized. The total estimated cost differences between the alternative systems for the delivery of outpatient care ($2,191.34) represents for shared management a mean saving per patient of approximately 29% in direct out-of-pocket expenses and a 59% savings in the indirect costs of lost income or productivity. A total theoretical mean 41% saving per patient was shown to accrue through the use of shared management.
Adolescents' Self-Assessment of Sexual Maturation
Authors: Duke Paula M. , Litt Iris F. , Gross Ruth T.
Published: December 2021

The variability in time of onset and progression of puberty warrants the use of stage of sexual maturation rather than chronologic age in assessing biological and behavioral measures during adolescence. The necessity to undress the teenager has seriously curtailed the application of stage of sexual maturation to behavioral and developmental research. This study demonstrates that adolescents can accurately assess their own developmental stage according to Tanner's standard photographs. Self-ratings by 43 females, aged 9 to 17, and 23 males, 11 to 18, were compared to those based on physical examination by one of the investigators. Agreement with the physician rating occurred for breast stage in 37/43, for female pubic hair stage in 40/43, and for male combined pubic hair and genital stage in 21/2 (kappa coefficients: 0.81, 0.91, 0.88). The excellent agreement between physician and adolescent's assessment compared favorably with the interrater agreement of professionals. This study suggests the value of utilizing adolescent self-staging in research. In addition, this exercise provides teenagers with an objective way to understand the wide range of normal pubertal development and to follow their own sexual maturation.
The Winnicott Squiggle Game: A Vehicle for Communicating with the School-Aged Child
Authors: Berger Lawrence R.
Published: December 2021

The Squiggle Game, described by pediatrician/child psychiatrist D. W. Winnicott, is a pencil-and-paper technique for eliciting children's thoughts and feelings. Unlike drawing tests such as the Goodenough Draw-A-Person Test and the Bender-Gestalt Form Copying Test, the Squiggle Game has an entirely unstructured format. This allows maximal latitude for children to share ideas and feelings. Also, participation by the physician makes the approach fun, rather than simply another test or chore for the child. The Squiggle Game has wide applicability in the general practice of pediatrics. It is ideally suited to communicating with school-aged children who are often too young to articulate perceptions and feelings spontaneously, but are too old to be engrossed in play techniques utilizing doll houses, puppets, or other toys.
FRANCES CORNFORD'S PERCEPTIVE POEM ON CHILDHOOD
Authors: C. T. E.
Published: December 2021

Frances Cornford (1886-1960), an English poet and a granddaughter of Charles Darwin, has beautifully caught the dissimilitude between childhood and old age in this poem.1
Improved Survival of Ventilated Neonates with Modern Intensive Care
Authors: Schreiner Richard L. , Kisling Jeffrey A. , Evans G. Michael , Phillips Susan , Lemons James A. , Gresham Edwin L.
Published: December 2021

The records of 909 infants who required mechanical ventilation over a 42-month period were reviewed; 68.3% of the infants survived. The highest survival rate was in infants with persistent fetal circulation and hyaline membrane disease, and the lowest in infants with congenital anomalies and miscellaneous diseases. The survival rate for each year of the 3½-year study increased from the previous year. There was also a dramatic increase in the survival rate in infants with a birth weight greater than 1,250 gm.
Metabolic Alkalosis Secondary to Baking Soda Treatment of a Diaper Rash
Authors: Gonzalez Jose , Hogg Ronald J.
Published: December 2021

A 4-month-old infant was seen with hypokalemic metabolic alkalosis that was associated with prior application of liberal amounts of sodium bicarbonate (baking soda) to a diaper rash. After exclusion of other etiologies of the infant's acid-base disturbance, a complete resolution occurred following discontinuation of the baking soda applications. This case report provides a reminder of the significant side effects that may result from the excessive use of a seemingly harmless household substance.
Physician Incentives for Shared Management of Childhood Cancer Patients
Authors: Strayer Faye H. , Fethke Carol C. , Kisker Thomas , Dekrey Nancy G.
Published: December 2021

Four years' experiences of 69 primary care physicians who delivered more than 70% of the chemotherapy to 174 children with cancer were assessed. Five academic pediatric oncologists were responsible for diagnosis, assignment to a clinical trial protocol, and overall management. The academicians saw the patients at diagnosis and at regularly scheduled intervals but provided care for less than 30% of the outpatient visits. Factors examined included: (1) why the primary care physicians agreed to participate in the care of these patients, (2) how they thought their participation affected the patient and the patient's family, (3) how participation affected their personal and professional development, (4) how participation affected their practice, (5) what their perceptions were concerning the merits of traditional specialist management, and (6) their overall evaluation of the Iowa shared-management program. The initial agreement by primary care physicians to participate in shared management was related to their perception that it would improve the overall care of their patients. The physicians agreed that the program saved the family time and money, was of educational value, personally satisfying, and not economically detrimental to their practice. They did not identify areas where specialist management had clear advantages over shared management and none reported dissatisfaction with this management program.
Toxic Shock Syndrome— Scientific Uncertainty and the Public Media
Authors: Todd James K.
Published: December 2021

After languishing in relative obscurity since its description in 1978,1 toxic shock syndrome has recently been thrust into the public domain by its reported association with tampon use.2,3 The myths, partial truths, and gross misconceptions promulgated in the media, presumably with the intent of informing the public, must now be brought into the perspective of existing data, necessitating a reconsideration of the balance between the public's "right to know" and the evolutionary process of scientific knowledge.

Toxic shock syndrome is an acute febrile ifiness with mucocutaneous manifestations and multisystem involvement, the most severe manifestations being hypotension, renal failure, myocardial failure, and "shock lung syndrome."
Yellow Brains and Yellow Lungs
Authors: Doshi Nalini , Barmada M. A. , Klionsky Bernard
Published: December 2021

We read with interest the paper "Lack of Identifiable Risk Factors for Kernicterus" by Turkel and associates.1 In the last few years we have also noticed an increased incidence of kernicterus at Magee-Womens Hospital in the neonatal autopsy population. In a retrospective analysis of cases from 1976 to 1978, there were 35 cases of kernicterus among 284 neonates, a prevalence of 12%. This rose to almost 20% if we considered only the group of gestational age 25 to 32 weeks.
Treatment of Apnea and Excessive Periodic Breathing in the Full-Term Infant
Authors: Kelly Dorothy H. , Shannon Daniel C.
Published: December 2021

Twenty-two full-term infants, aged 0 to 6 weeks, with a history of unexplained apnea and respiratory abnormalities on pneumogram recordings, were treated with theophylline (average dose 7.5 mg/kg/day and average serum level 11 µg/ml). Subsequent recordings showed a significant decrease in the amount of periodic breathing (14.3% vs 0.7%) and apnea 10 to 14.9 seconds (12.8 vs 1.0/100 min) when compared to the initial pneumogram. It is concluded that theophylline therapy in this group of infants will result in a reduction of apnea and periodic breathing.
Neural Drive and Ventilatory Strategy of Breathing in Normal Children, and in Patients with Cystic Fibrosis and Asthma
Authors: Bureau Michel A. , Lupien Luc , Bégin Raymond , Labbé J. , Gagnon N.
Published: December 2021

The drive and performance of breathing during hypercapnia, isocapnic hypoxia, and transient hyperoxia were studied in 20 normal children (mean age 12.3 years), in ten children with asthma, and in ten children with cystic fibrosis (CF) matched by sex and age. These latter two groups of patients had had obstructive respiratory symptoms since infancy and their pulmonary disease was of moderate severity as documented by their pulmonary function studies. During hypercapnia, normal children had a linear increase in minute ventilation (ΔVE), in tidal volume (ΔVT) and in the inspiratory drive (VT/Ti). The drive of breathing was evaluated by the occlusion pressure (P0.1) at functional residual capacity. The P0.1 response to Paco2 was linear. Patients with asthma and CF showed a blunted ventilatory response (ΔVE, ΔVT, VT/Ti) to CO2 but a normal response in P0.1. In normal subjects, the test of isocarbic hypoxia demonstrated an exponential type of increase in ΔVE, ΔVT, and P0.1 as PAo2 decreased from 110 to 40 torr. With severe hypoxia (PAo2 <50 torr), children with CF (but not asthmatic patients) experienced a paradoxical decrease in ΔVE while the drive (P0.1) remained above normal in both groups of patients. Finally, the transient O2 inhalation test caused a decrease in VE of 26%, 21%, and 34%, respectively, in normal subjects, in asthmatic children, and in children with CF. It is concluded that the CO2 and O2 drive of normal children resembles that described for adults and that the CO2 and O2 command of breathing is normal in children with asthma and CF. However, the ventilatory response in children with chronic obstructive pulmonary disease is subnormal probably due to the impairment of the respiratory mechanics. Finally the respiratory depression induced by severe hypoxia in children with CF is unexplained, but it may reflect the high dependency of their respiratory muscle on oxygen supply.
Communication Between Physician and Physical and Occupational Therapists: A Neurodevelopmentally Based Prescription
Authors: Levine Michael S. , Kliebhan Linda
Published: December 2021

Children with neuromuscular handicaps require the coordinated services of physicians and physical and occupational therapists. Physicians must be familiar with at least one therapy framework along with its major treatment techniques in order to understand how therapy can help a specific child and to follow that child's progress. The physician can use that same framework to structure his or her own motor system observations. Physician-therapist coordination is formalized in a written referral communication (prescription) which must be logical and clear. It should include these six elements: diagnosis, family picture, description of observed movement abnormalities, functional goals, precautions, and intensity of therapy. The description of movement abnormalities can be based on neurodevelopmental treatment principles. Such a description will contain information on three focal areas: postural tone, movement patterns, and reflexes and reactions.
Chloramphenicol Study Questioned
Authors: Kauffman Ralph E. , Dajani Adnan S.
Published: December 2021

The article on chloramphenicol kinetics by Sack, Koup, and Smith1 contains several assumptions that raise serious questions regarding the validity of the calculated values for half-life, clearance, and volume of distribution of the drug.

The methods used to calculate T½, Vd, and clearance assume that chloramphenicol succinate is instantaneously and completely hydrolyzed following infusion. This has not been our experience. We found the succinate ester to persist in the serum for three hours in most patients and up to six hours in some patients.2
Letters to the Editor
Authors: Weston William L.
Published: December 2021

Dr Wiener's letter brings up several important issues. He believes that changes in patterns of diaper dermatitis may be related to technologic changes in the diaper itself. Many authorities agree with this concept; yet, convincing studies examining this hypothesis were not published until the study by Wiener. Wiener's report was a retrospective study in that a particular type of diaper was not assigned either in a random or nonrandom manner in the newborn nursery; then the results were evaluated at the one-month visit.
GALACTOSEMIA AND ITS RELATION TO LAENNEC'S CIRRHOSIS
Authors: TOWNSEND EDWARD H. , MASON HOWARD H. , STRONG PAUL S.
Published: December 2021

Five additional cases of galactosemia are added to the steadily increasing number of reports in the literature. A follow-up note is included regarding a sixth case in a patient now 18 years of age, previously reported from this hospital.

Two of these cases developed cirrhosis of the liver in a manner suggesting that galactosemia per se was the cause. Histologic examination of the liver in both cases confirmed the anatomic diagnosis.

A 10 year follow-up on Mason and Turner's reported Case 7 demonstrates that the illness is chronic but that with advancing years, demonstrable evidence of somatic damage is lacking. Mental retardation is a common complication of the disorder in the present investigators' experience. Cirrhosis of the liver accompanying galactosemia appears to be reversible, so far as can be determined.
New Haemophilus influenzae Type b Control Strategy: Premature Commitment to Prophylaxis?
Authors: Mann Jonathan M. , Hull Harry F.
Published: December 2021

Recent promulgation of an official policy on prevention of secondary cases of Haemophilus influenzae type b disease illustrates the challenges and frustrations inherent in the policy-making process. Despite evidence that H influenzae type b disease is "contagious" in households and probably also in day care centers and despite demonstration that rifampin eradicates nasopharyngeal H influenzae type b carriage, the single field study of rifampin use to prevent secondary cases of H influenzae type b disease remains unpublished and has yet to receive broad critical scrutiny. Promulgation of the rifampin strategy prior to publication of this critical study is unfortunate, as public and private providers are now committed to a policy that will be difficult to evaluate or alter. Now that the strategy has been issued, the central question regarding rifampin prophylaxis has changed from "Is this strategy effective?" to "Can this strategy be shown to be ineffective?" When policies are issued prior to publication of key supporting data, or when such studies are either missing or highly controversial, the policy-making committee might publish, along with its recommendations, explicit criteria for continuation, modification, or withdrawal of the new policy. This structured reassessment approach could accomodate the critical need to proceed with disease control recommendations—even though based on incomplete information—yet underscore the policy's tentative nature and provide direction for future assessment and study.
Home Monitoring and Its Role in the Sudden Infant Death Syndrome
Authors: SOUTHALL D. P.
Published: December 2021

Home monitoring has been increasingly adopted by pediatricians in an attempt to prevent sudden infant death syndrome (SIDS). Inasmuch as the basic mechanism or mechanisms behind this most frequent cause of post-perinatal infant mortality remain unknown, the only possible preventative measure that can be offered to parents is a monitor that allows the identification of a series of events known to be precursors of death. Recent studies, which show that a small proportion of infants die despite this surveillance (Table 1), introduce the following questions that require discussion. Are current monitoring systems likely to identify, in time for effective resuscitation, the final pathway or pathways to SIDS? Are there any harmful or even dangerous consequences of home monitoring?
Febrile Children
Authors: SOMAN MICHAEL P.
Published: December 2021

To the Editor.—

The attempts of McCarthy et al to understand quantitatively the clinical assessment of degree of illness in febrile children are fascinating, and their most recent publication in this area1 is a significant breakthrough. The task of understanding and characterizing clinical judgment to the point of testing its sensitivity, specificity, and predictive value is an enormous one, but the ramifications of decreased need for laboratory evaluation are great in terms of economics and emotional well-being (physician, patient, and parents).
Maternal Cigarette Smoking and Fetal Oxygen Transport: A Study of P50, 2,3-Diphosphoglycerate, Total Hemoglobin, Hematocrit, and Type F Hemoglobin in Fetal Blood
Authors: Bureau M. A. , Shapcott D. , Berthiaume Y. , Monette J. , Blouin D. , Blanchard P. , Begin R. , Gagnon N.
Published: December 2021

The current study was undertaken to determine whether the O2 carrying capacity of newborns born to mothers who smoke can accommodate to carbon monoxide poisoning to compensate for the potential tissue hypoxia induced by CO. From a cohort of 1,222 women and newborn infants the total hemoglobin concentration, hematocrit, and carboxyhemoglobin (HbCO) were measured and analyzed with regard to the maternal HbCO level and the number of cigarettes smoked per day. Also, for 100 pairs of mothers, of whom 50 were smokers and 50 nonsmokers, and their newborns, measurements were made of the intraerythrocyte concentration of 2,3-diphosphoglycerate (2,3-DPG), the hemoglobin concentration, and the affinity of hemoglobin for oxygen by determination of O2 tension for 50% of Hb-O2 saturation (P50). The results showed no significant relationship between smoking habits of mothers and their levels of hemoglobin, P50, and 2,3-DPG; only the hematocrit was slightly increased in smoking mothers. However, in fetal blood a significant correlation was found between the number of cigarettes smoked per day and levels of hemoglobin, hematocrit, and P50. The P50 decreased in relationship to the increase in maternal HbCO. The P50 change was brought about by an increase in hemoglobin F found in the fetuses of mothers who smoked. Although all these changes were statistically significant, these mechanisms of acclimatization to CO poisoning appeared trivial in magnitude. It is concluded that the human fetus does not have a biologic capacity to accommodate to maternal cigarette smoking, and therefore the fetus is particularly susceptible to the adverse effects of cigarette smoking.
Enhancing Infant Development and Parent-Practitioner Interaction with the Brazelton Neonatal Assessment Scale
Authors: Liptak Gregory S. , Keller Barbara B. , Feldman Andrea W. , Chamberlin Robert W.
Published: December 2021

Studies performed in low socioeconomic populations have shown that the demonstration of a newborn's developmental capacity to his mother during the first few days post partum enhances subsequent mother-infant interactions. This study was undertaken to determine whether demonstrating the Brazelton Neonatal Assessment Scale to white middle-class mothers would result in similar outcomes. Mothers of 75 neonates were randomly assigned to either an experimental group or to one of two control groups. Direct observation, subjective assessment of mother-infant interactions, and maternal questionnaires were used 1 and 3 months later to assess outcomes on several dimensions. Mothers in the experimental group spent more time playing with, talking to, and looking at their infants than did those in either control group, and were less likely to use feeding as a method of interacting with their infants. Experimental group mothers also were more likely to ask developmentally related questions. However, no differences were found in most indices of maternal-infant interaction used. The results of this study and a review of the literature indicate that the recommendation that such a demonstration be performed with all neonates must be weighed against the other methods available for enhancing infant development and healthy parent-child interaction.
Biostatistical Trends in Pediatrics: Implications for the Future
Authors: Hayden Gregory F.
Published: December 2021

All physicians face the challenge of keeping abreast with a body of medical knowledge that is growing at an exponential rate. On this account, physicians often spend countless hours each month reading journals to "keep current" with recently described techniques of diagnosis and therapy. To gain maximal benefit from their reading, physicians must be able to assess the scientific merit of published research. They must evaluate the various claims and conclusions and then decide which are valid and applicable to their own clinic settings. This type of critical insight requires familiarity with basic principles of good study design and with biostatistical logic and procedures. Unfortunately, recent studies have demonstrated that physicians' concepts regarding statistics are often inaccurate, and even more disturbing, that readers are often willing to draw conclusions unsupported by the available data.1,2 Some authorities have therefore recommended remedial statistical training for physicians by means of increased attention to statistical issues in biomedical journals. The question of exactly which statistical concepts and techniques need to be mastered, however, remains largely unanswered. On this account, I reviewed several volumes of Pediatrics to determine which statistical techniques have appeared regularly, and whether the frequency and intensity of statistical analysis have recently changed enough that a familiarity with biostatistics that was adequate a few years ago may no longer be sufficient. I surveyed the scientific reports in volumes 9 (1952),29 (1962), 49(1972), and 69 (1982). I excluded editorials, book reviews, correspondence, and the like, and I classified remaining articles as review articles, case reports, or research reports.
Undetected Episodes of Prolonged Apnea and Severe Bradycardia in Preterm Infants
Authors: Southall D. P. , Levitt G. A. , Richards J. M. , Jones R. A. K. , Kong C. , Farndon P. A. , Alexander J. R. , Wilson A. J.
Published: December 2021

Twenty-four-hour tape recordings of ECG and breathing movement were made on 14 preterm infants with prolonged apneic episodes. Despite apnea monitoring systems, 136/203 (67%) apneic episodes ≥20 seconds in duration, including 19 episodes ≥50 seconds in duration, were not recorded by nursing staff. Of 120 apneic episodes ≥30 seconds, 100 (89%) were accompanied by bradycardia ≤100 beats per minute. Episodes of more marked bradycardia (≤80 beats per minute and up to seven minutes in duration) occurred without cessation of breathing movement in 10/14 infants studied. Treatment with theophylline or aminophylline was associated with a reduction in the number of episodes of apnea ≥20 seconds accompanied by bradycardia ≤80 beats per minute (P < .001). Many prolonged episodes of apnea and bradycardia are going unnoticed in neonatal intensive care units. Further studies are required to investigate and overcome the causes of these failures.
Full and Limited Medicaid Participation Among Pediatricians
Authors: Davidson Stephen M. , Perloff Janet D. , Kletke Phillip R. , Schiff Donald W. , Connelly John P.
Published: December 2021

Participation in Medicaid by pediatricians is an important element in the access of low income children to health care. Factors that influence whether participating pediatricians choose to participate fully in the program or to limit their acceptance of Medicaid patients are identified and analyzed. Data were derived from interviews conducted with 814 pediatricians in 13 states. A multivariate analysis examining physician, practice, service area, and Medicaid policy characteristics indicates that policy factors are most influential in the physician's decision whether to participate fully in medicaid programs. Factors found to foster the willingness of pediatricians to participate fully in state Medicaid programs included more competitive levels of reimbursement, minimal delays in reimbursement, and eligibility and benefit policies that minimize interference with the exercise of medical judgment.
Icosaphobia
Authors: HART WILLIAM E.
Published: December 2021

To the Editor.—

In coining a new word, one should attempt to maintain consistency in the use of the root language. Thus eikosaphobia, or icosaphobia, from the Greek: eikosi (twenty), is preferable to vigintiphobia1 since the latter is a hybrid. That a hybrid is established in common usage, eg, claustrophobia, does not justify a repetition.
Effect of Peer Counselors on Adolescent Compliance in Use of Oral Contraceptives
Authors: Jay M. Susan , DuRant Robert H. , Shoffitt Tamsen , Linder Charles W. , Litt Iris F.
Published: December 2021

Poor compliance with contraceptive regimens has been shown to be an important antecedent of adolescent pregnancy. The purpose of this study was to test prospectively the effect of a peer v nurse counseling program on adolescent compliance with the use of oral contraceptives. Fifty-seven females aged 14 to 19 years from a lower socioeconomic background were randomly assigned to a peer (n = 26) or nurse (n = 31) group. At the initial visit and at 1-, 2-, and 4-month follow-up visits, subjects received Ortho-Novum 1/35 combined with a tablet marker and were counseled by a nurse or peer. Noncompliance was measured using a Guttman scale consisting of: (1) avoidance of pregnancy, (2) appointment adherence, (3) pill count, and (4) urinary fluorescence for riboflavin. At the first and second follow-ups, the adolescents counseled by a peer had a significantly (P ≤.038) lower noncompliance level than the nurse-counseled group. Adolescents with more frequent sexual activity (P ≤.027), with one sexual partner (P <.04), and who worried that they might become pregnant (P ≤.01) had significantly lower levels of noncompliance when counseled by a peer than by a nurse. At the fourth month follow-up, adolescents who expressed feelings of hopelessness about the future had significantly (P ≤.036) higher levels of noncompliance when counseled by a nurse than when counseled by a peer. These results suggest that incorporating a peer counselor into the health care team may be an effective method of increasing adolescent compliance.
Ventricular Dilation Following Periventricular-Intraventricular Hemorrhage: Outcome at Age 1 Year
Authors: Allan Walter C. , Dransfield Douglas A. , Tito Alison M.
Published: December 2021

Ventricular dilation following periventricular-intraventricular hemorrhage can be managed without ventriculoperitoneal shunting in most cases. Twenty-six patients who had periventricular-intraventricular hemorrhage with subsequent ventricular dilation were examined at 1 year of age for neurodevelopmental outcome and hydrocephalus. As previously reported, ventricular dilation may be divided into two groups: ventriculomegaly and posthemorrhagic hydrocephalus. Fourteen patients with ventriculomegaly were followed up with serial ultrasound observations only, and 12 patients with posthemorrhagic hydrocephalus had temporary drainage of ventricular fluid. Only three patients with posthemorrhagic hydrocephalus required ventriculoperitoneal shunting in the neonatal period. Neurodevelopmental abnormalities were found in eight infants who had posthemorrhagic hydrocephalus and two who had ventriculomegaly. Six of these infants had intraparenchymal injury demonstrated by ultrasound, five as a result of the original hemorrhage and 1 by infection. A single infant with posthemorrhagic hydrocephalus, discharged from the hospital with stable ventricular size, developed hydrocephalus and neurodevelopmental delay after the neonatal period. This reversed with ventriculopenitoneal shunting at 1 year of age. It is suggested that even in patients developing ventricular dilation following periventricular-intraventricular hemorrhage, it is the primary intraparenchymal injury that is responsible for subsequent morbidity. Thus, provided serial reevaluations are possible, an expectant management of ventricular dilation is justified.
Toxic-Shock Syndrome Associated with Nasal Packing: Analogy to Tampon-Associated Illness
Authors: Barbour Stephen D. , Shlaes David M. , Guertin Stephen R.
Published: December 2021

A pure culture of migmatoxin-producing Staphylococcus aureus was isolated from the purulent nasal packing removed from a 13-year-old premenarchal girl with toxic-shock syndrome after rhinoplasty. The similarities between this case and the tampon-associated illness are examined. An increased awareness of these similarities and the identification of predisposing factors may lead to earlier detection and treatment of toxic-shock syndrome.
Parental Response to Repeat Testing of Infants with `False-Positive' Results in a Newborn Screening Program
Authors: Sorenson James R. , Levy Harvey L. , Mangione Thomas W. , Sepe Stephen J.
Published: December 2021

Forty-five percent of the parents of 60 infants being retested in a newborn screening program for metabolic disorders understood that their infant was undergoing retesting because the first test result was abnormal. Fifty-five percent had incorrect or incomplete information, believing that retesting was routine, or that mistakes had been made in the original testing procedure, or they report being told nothing specific about the testing. Parents who were aware that the initial test was abnormal were no more anxious or depressed while waiting for the repeat test results than other parents. At a second interview after learning the normal results of the repeat test, both those parents informed of the initial abnormal result as well as those not informed were less anxious and depressed. However, 36% of the parents of these normal infants reported concern about the health of their infant because of the repeat testing. This concern was not related to a parent's knowledge that the initial test result was abnormal, but was greater in parents reporting that they had not received sufficient information about the screening/testing process and its significance for the health of their infant.
Patient Tampering with Electronic Intravenous Fluid Regulators
Authors: OKSTEIN CHARLES J.
Published: December 2021

Intravenous (IV) fluid controllers and pumps have generally made administration of parenteral fluids and medications safer and more reliable. In addition, they have permitted more effective utilization of nursing services to pediatric patients, because less time is required to monitor the progress of IV fluid infusions.

These devices may be classified as either volumetric infusion controllers or volumetric infusion pumps. In the former type, the force of gravity provides the fluid flow through the IV tubing, and an electronic controller limits the flow of solution to a rate that the operator has preset on an indicator. Such infusion controllers are useful for the delivery of most parenteral fluid therapy when moderate flow rates are needed.
Protest Views of Singer
Authors: CALLIE ALBERT S.
Published: December 2021

To the Editor.—

Singer, in his article "Sanctity of Life or Quality of Life?" (Pediatrics 1983;72:128-129) has rejected the "sanctity-of-life view"—as he defines it. He calls it "the obsolete and erroneous notion of the sanctity of all human life." He states that "the philosophical foundations of this view have been knocked asunder." He adds "We can no longer base our ethics on the idea that human beings are a special form of creation made in the image of God."
Prolonged Effects of Maternal Alcohol Ingestion on the Neonatal Electroencephalogram
Authors: Ioffe S. , Childiaeva R. , Chernick V.
Published: December 2021

Newborn infants of mothers who drink heavily (> 2 oz alcohol per day) during pregnancy have been shown to have hypersynchrony of the EEG. The possibility that hypersynchrony is related to acute alcohol withdrawal was tested. Eleven preterm infants of mothers who drank heavily ("alcoholic") were studued at a postnatal age of 4 to 6 weeks using power spectral analysis of EEG signals. This group was compared with a control group with similar racial and socioeconomic status. In addition, a group of ten "healthy" preterm infants was compared with a carefully matched control group. Total power of the EEG during quiet, indeterminate and rapid eye movement (REM) sleep was 162%, 183%, and 188%, respectively, in the infants whose mothers were alcoholic when compared with their control infants or with the healthy preterm infants and their control infants. It is concluded that ingestion of alcohol during pregnancy may result in potentially serious prolonged effects on brain function of the offspring, even in the absence of dysmorphology.
Infant Size at 8 Months of Age: Relationship to Maternal Use of Alcohol, Nicotine, and Caffeine During Pregnancy
Authors: Barr Helen M. , Streissguth Ann Pytkowicz , Martin Donald C. , Herman Cynthia S.
Published: December 2021

To examine the relationship of maternal alcohol consumption, caffeine use, and smoking to infant size at 8 months of age, a follow-up cohort of 453 infants was examined at birth and again at their 8-month birthday. Even after adjustment for other relevant variables, maternal alcohol use during early pregnancy (average ounces of absolute alcohol by self-report) was significantly related to infant weight and length at 8 months of age but not as strongly related to head circumference. Maternal smoking and caffeine use during pregnancy were not significantly related to infant size at 8 months, although nicotine use had been highly related to the birth size in this sample. Maternal use of marijuana was significantly and negatively related to infant length at 8 months of age, but not to weight or head circumference. The magnitude of the growth retardation is smaller at 8 months than at birth in this sample of infants whose mothers are primarily white, married, and well-educated, and who report a variety of alcohol use patterns. Significance was tested using multiple regression analyses that adjusted for the effects of nicotine use, caffeine use, birth order, maternal height, and gestational age as well as sex and age of infant at examination.
Heparinization of Alimentation Solutions Administered Through Peripheral Veins in Premature Infants: A Controlled Study
Authors: Alpan Gad , Eyal Fabian , Springer Chaim , Glick Benjamin , Goder Kami , Armon Jacob
Published: December 2021

A randomized controlled study was done to determine whether the addition of heparin (1 U/mL) to peripheral intravenous alimentation solutions would affect the incidence of phlebitis and duration of patency of intravenous catheters in premature infants. Twenty-two-gauge Teflon catheters were uniformly used. One hundred five catheters infused with heparin were placed in 13 infants, and 122 catheters were placed in the control group of 13 infants. The time, nature, and incidence of complications were noted for each infusion site. Infusion of heparin was found to double the duration of patency of intravenous catheters and to reduce significantly the incidence of phlebitis. No complications related to the administration of heparin were noted. Heparinization of intravenous alimentation solutions should therefore be considered in premature infants as a means of reducing the work load and incidence of complications associated with peripheral lines.
An Investigation into the Benefits of Resiting Nasoenteric Feeding Tubes
Authors: van Someren V. , Linnett S. J. , Stothers J. K. , Sullivan P. G.
Published: December 2021

Partial nasal obstruction in preterm infants increases the airway resistance. In spite of this, nasal feeding tubes are often used, if only because oral tubes are difficult to secure. A palatal appliance has been devised that maintains the position of oroenteric feeding tube(s) and is not associated with local complications. In order to assess the effects of resiting feeding tubes, two related studies were carried out. The first study, a trial, included respiratory monitoring of 29 infants on the third and/or seventh day after either the appliance and oroenteric tubes had been inserted, or, in the control group, after the nasoenteric tubes had been passed. After seven days, the infants using the palatal appliance had significantly less periodic breathing, central apnea, and movement than the control group. The second study showed that the removal of feeding tubes that had been in situ for several days reduced apnea rates and produced a significant increase in transcutaneous Po2.
Effect of Father's Death or Departure on Growth of Poor Children in Peru
Authors: Graham George G. , Adrianzén Blanca , Rabold Judith , Mellits E. David
Published: December 2021

Between 1966 and 1976, heights and weights were determined yearly on all available children from 163 families who had had at least one child successfully treated for malnutrition between 1961 and 1971 and from eight families who had adopted such a child. Between 1959 and 1976, a total of 72 fathers departed from these families: 12 died, 47 deserted, six were jailed, and seven left to look for work elsewhere. Heights and weights as Z scores and the weight age/height age ratios were analyzed, when available, during four periods around the date of the event: 6 to 18 months before (period 1B), 0 to 6 months before (period 2B), 0 to 6 months after (period 3A), and 6 to 18 months after (period 4A). Mean Z scores for all children measured in the period were already low (-0.26 ± 0.93 and -0.25 ± 0.95) during period 1B, were higher during period 2B, (-0.15 and 0.04), lower during period 3A (-0.39 and -0.46), and similar to original levels during period 4A (-0.37 and -0.27). Mean weight age/height age was low (0.93 ± 0.17) only during period 3A for children 2 to 18 years of age. In paired comparisons for children measured during any two periods there were significant increases in Z height and Z weight from periods lB to 2B and from periods lB to 4A in children < 2 years of age and a significant decrease in the weight age/height age ratio from periods lB to 3A in those 2 to 18 years of age. Loss of father had little or no further impact on the already poor growth of these children.
Sacral Meningocele with Conotruncal Heart Defects: A Possible Autosomal Recessive Trait
Authors: Kousseff Boris G.
Published: December 2021

Three of four siblings had sacral meningocele with subsequent development of hydrocephaly; two died during the neonatal period due to conotruncal heart defects (transposition of the great vessels and truncus arteriosus type I, respectively). An in utero diagnosis of open neural tube defect was made on the third sibling; persistent slightly elevated α-fetoprotein levels in amniotic fluid and increased number of rapidly adhering cells in short term amniotic cell culture were found. The unique combination of sacral meningocele and conotruncal malformations in this sibship suggests a new autosomal recessive condition. It also emphasizes the heterogeneity of both the open neural tube defects and congenital heart defects. Awareness of this variant is necessary in regard to the 25% recurrence risk instead of the 3% to 5% recurrence risk given for both congenital heart defects and open neural tube defects as isolated anomalies. The difficult prenatal diagnosis for the small neural tube defect should be appreciated.
Progressive Diaphyseal Dysplasia: Genetics and Clinical and Radiologic Manifestations
Authors: Naveh Yehezkel , Kaftori Joseph K. , Alon Uri , Ben-David Jacob , Berant Moshe
Published: December 2021

Progressive diaphyseal dysplasia was found in a three-generation family including 13 affected individuals, the largest family reported to date. Our study confirms that progressive diaphyseal dysplasia, also known as Engelmann's or Camurati-Engelmann disease, is an autosomal dominant disorder with variable osseous and muscular manifestations. Disease distribution among patients, within a given patient, or even in individual bones is unpredictable. The femur is the most commonly and severely affected bone and hence most useful for radiographic screening of possible patients. Radiographs provide a meaningful assessment of disease activity and extent. The severity of symptoms is generally proportionate to severity of involvement shown by roentgenography. Exophthalmos due to osteosclerotic dysplasia of the skull occurred in more than half of the patients with progressive diaphyseal dysplasia. Twelve-year follow-up of this family, with affected individuals ranging in age from 6 months to 12 years, indicates that progressive diaphyseal dysplasia may progress or become quiescent and be remarkably inactive despite advanced osteosclerosis and structural deformity.
Ethical Issues in the Prenatal Diagnosis of Phenylketonuria
Authors: Holtzman Neil A.
Published: December 2021

Clinicians often view ethical dilemmas in terms of individual patients: would couple X, who have a normal 2-year-old child with phenylketonuria (PKU) (due to early treatment), want prenatal diagnosis with subsequent pregnancies? Eventually, the question will be posed on that level, but not yet. At this stage, we are still dealing with a new, unproven technology; a more generic analysis is needed. We must consider whether the technology is ready to be disseminated, and if so, how. Until recently these questions were seldom asked. As a result, modern medicine is replete with examples of technologies—drugs, surgical operations, laboratory tests—whose lack of effectiveness became evident, sometimes at great cost, only after they became part of routine medical practice.1 Lack of "effectiveness" of prenatal diagnosis for PKU could mean the abortion of fetuses unaffected with the disorder, and the unwanted birth of affected infants. The technology introduces a new ethical issue as well: the appropriateness of abortion for treatable conditions.

Three issues should be addressed before new technologies are disseminated: validation, acceptance, and proliferation. I will use prenatal diagnosis for PKU to illustrate them. Several items to be discussed under "acceptance" also apply at the personal level. I pose them because they are important in deciding if and how the new technology should be made available, which is a matter of public policy. Lest one think these decisions have all been made for prenatal diagnosis for PKU, consider the following: (1) Research funding must continue to discover other restriction endonuclease sites, develop better probes, and simplify the techniques.
Multiple Congenital Malformations Associated with Maternal Isotretinoin Therapy
Authors: DE LA CRUZ ELIZABETH , SUN SHYAN , VANGVANICHYAKORN KAMTORN , DESPOSITO FRANKIN
Published: December 2021

Isotretinoin (Accutane), an oral synthetic vitamin A derivative, introduced in September 1982 by Roche Laboratories has been widely used in the treatment of recalcitrant cystic acne. Although there is extensive information regarding the teratogenic effects of excessive vitamin A in experimental animals,1 there are few data available on its possible effects in humans. We report a case of a preterm infant with microcephaly, microphthalmia, rudimentary pinnae, cardiac anomaly, and hepatocellular derangement born to a mother on isotretinoin therapy. This constellation of abnormalities mimicks the type of malformations seen in the animal models and is strongly suggestive of the teratogenicity of this drug to the human fetus.