bluuebunny/crossref_metadata_2025 huggingface dataset:
Arthritis Questioned
Authors: Athreya Balu H.
Published: December 2021

I read with interest the article on Yersinia enterocolitica infection in a child.1 Though I commend the physicians involved in the care of this child for identifying the organism, I question the diagnosis of "arthritis." Even though it is said in the article that the criteria developed by the American Rheumatism Association are satisfied, pain is a subjective criterion. In infants it is removed one step further since the symptom is crying on handling and this crying is interpreted as due to pain.
Drs. Blumberg and Young Reply
Authors: Young Stuart H. , Blumberg Michael Z.
Published: December 2021

Dr. Hamburger's letter raises several interesting points. Our statement that an IgE level of 200 IU/ml is "normal" is based on several studies"1-3 using a standardized radioimmunosorbant kit (Phadebas IgE test). These studies indicate that IgE levels in normal, "nonatopic," subjects can be as high as 700 IU/ml with the mean in these populations near 200 IU/ ml.

Dr. Hamburger questions the validity of concluding that our patient was a nonatopic individual. Atopy, as first used by Coca and Cooke in 1923,4 referred to individuals with a hereditary background and personal history of hay fever or asthma.
Prevention of Automobile-Associated Deaths
Authors: Tolby Blaine E.
Published: December 2021

Accidents are the leading cause of death in children from 1 to 14 years of age.1 The number of deaths resulting from accidents of all types exceed the combined fatalities resulting from pneumonia, meningitis, congenital malformations, and cancer.1

Among the various types of accidents in which children become involved, motor vehicle accidents rank as the leading cause of fatalities. They account for nearly 43% of the accident-caused fatalities.1 More than 75% of the children injured or killed in motor-vehicle-related accidents were occupants of a motor vehicle, while less than 25% were cyclists or pedestrians.2
Physical Therapy as a Determinant of Change in the Cerebral Palsied Infant
Authors: Scherzer Alfred L. , Mike Valerie , Ilson Jerome
Published: December 2021

Twenty-four children under 18 months of age with an initial diagnosis of cerebral palsy were observed for a minimum of six months on either experimental or control physical therapy programs using a double-blind study design. Medical and therapy evaluations indicated definite changes in motor, social, and management areas for those subjected to the experimental procedure and particularly among children expected to show higher intelligence. Change is found to be somewhat correlated with age at entry to the study and is more often associated with less actual treatment time. Findings suggest the need for additional treatment modalities for the youngest children who are most likely to have the greatest global involvement.
Acute Fluoride Poisoning
Authors: Yolken Robert , Konecny Philip , McCarthy Paul
Published: December 2021

Fluoride poisoning is a potentially severe environmental hazard for children. A case of fluoride poisoning is presented which was manifested by severe hypocalcemia, ventricular arrhythymias, and respiratory failure. Treatment of this poisoning, including peritoneal dialysis, is discussed. The kinetics of fluoride distribution as measured in this patient suggest a rapid binding of ingested fluoride to bone, followed by gradual release and excretion. Peritoneal dialysis resulted in no significamit fluoride removal.
Solitary Thyroid Nodules in Childhood: Is the Incidence of Thyroid Carcinoma Declining?
Authors: Scott Mary D. , Crawford John D.
Published: December 2021

Solitary thyroid nodules in childhood had a 40% to 70% incidence of malignancy in the era of low-dose therapeutic irradiation. In the last 15 years, 36 children have been evaluated for such nodules, with a final diagnosis of carcinoma in 17%, adenoma in 58%, and miscellaneous diagnoses in 26%. All patients with carcinoma were euthyroid and had no history of irradiation in infancy. Treatment included thyroidectomy and full-replacement thyroid therapy. Benign neoplasms were often "cold" by scan; all patients were euthyroid except one adolescent boy with T3 toxicosis. A majority proved to be follicular adenomas at surgery. Miscellaneous benign conditions outnumbered carcinoma and included variations in migration or embryologic development of the thyroid anlagen, thyroiditis, and a thyroid abcess. A 99mTc scan proved more valuable in diagnosis than thyroid function tests: a "hot" nodule usually suggested a developmental abnormality of the thyroid rather than a tumor. Our series of children, born since the dangers of irradiation have become common knowledge, suggests there may be a changing trend in the pathology encountered in solitary thyroid nodules.
Cephalexin Compared to Ampicillin Treatment of Otitis Media
Authors: Stechenberg Barbara W. , Anderson Donald , Chang Margan J. , Dunkle Lisa , Wong Michael , Van Reken David , Pickering Larry K. , Feigin Ralph D.
Published: December 2021

Cephalexin was compared to ampicillin for the treatment of otitis media in a randomized study. Bacteriologic diagnosis was sought by needle tympanocentesis in 179 children. No overall statistically significant differences were noted between the two groups; however, 20 patients who received cephalexin had a poor response to therapy whereas only five recipients of ampicillin responded poorly. A significant difference (P < .05) between the two regimens was noted when Hemophilus influenzae was recovered. Fifty per cent of the children with H. influenzae otitis media who were treated with cephalexin responded poorly; no patients receiving ampicillin had a poor response. Our data suggest that the use of cephalexin monohydrate is not warranted for treatment of otitis media due to H. influenzae even when the isolate proves sensitive to this drug in vitro. In selected patients with otitis media caused by Staphylococcus aureus which is resistant to penicillin, cephalexin may provide effective treatment.
The Bleeding Neonate
Authors: Glader Bertil E. , Buchanan George R.
Published: December 2021

Serious bleeding episodes in newborn infants can usually be diagnosed following careful clinical assessment and a few simple laboratory tests. Certain conditions are found almost exclusively in "sick" infants, whereas other coagulation abnormalities occur in otherwise "healthy" neonates. Successful management of hemorrhage necessitates a correct diagnosis which thereby dictates appropriate therapy. In some cases, such as in DIC, successful outcome ultimately depends on correction of the underlying pathophysiology which triggered the coagulation disturbance.
Hemolytic-Uremic Syndrome: Absence of Circulating Endotoxin
Authors: Van Wieringen P. M. V. , Monnens L. A. H. , Bakkeren J. A. J. M. , D. Biochem
Published: December 2021

In children with hemolytic-uremic syndrome endotoxin determinations were carried out in the peripheral circulation in order to get evidence for the hypothetical role of endotoxin in the pathogenesis of the disease. For this purpose the Limulus test was used to determine endotoxin activity in 16 patients with hemolytic-uremic syndrome. In the plasma of these patients no endotoxin could be detected above the lower detection limit of 100 pg/ml, although in all patients with septicemia due to gram-negative bacilli the test was positive.
The School Nurse Practitioner: Providing Improved Health Care to Children
Authors: Silver Henry K. , Igoe Judith Bellaire , Mcatee Patricia Rooney
Published: December 2021

School nurse practitioners have the competence to participate in providing a broad range of direct primary health care and services to the school-age child. Greater utilization of these specially prepared and highly qualified nurse practitioners as providers of health care in the school is a practical and effective method of adding to the quality, availability, and continuity of health care for the school-age child.
Incidence of Illness in Early Group and Family Day-Care
Authors: Doyle Anna-Beth
Published: December 2021

The frequency of reported illness in children enrolled in a day-care center was compared to frequency in home-reared children and in children in family day-care homes. Children ranged from 6 to 42 months of age (mean, 21 months). Data on seven categories of illness were collected by bimonthly telephone interviews with parents during two consecutive winters. In the first year of the study gastrointestinal and total illnesses were reported significantly more frequently in children enrolled in the day-care center, though major illnesses were not. In the second year of the study illnesses were significantly more frequently reported in center children though mainly at the younger ages, that is, prior to 2 years of age. The mean numbers of illnesses and symptoms reported per call over the 2 years of the study were 2.56, 1.36, and 1.35 for center, home-reared and family day-care children respectively.

Though it has been shown elsewhere that psychological health may be unaffected by early group care, the present findings imply that physical health may be somewhat reduced. It is unknown whether these children will be more resistant to infection at a later age.
Pyogenic Liver Abscess in Normal Children With Fever of Unknown Origin
Authors: Kaplan Sheldon L. , Feigin Ralph D.
Published: December 2021

Solitary pyogenic hepatic abscesses were identified as the cause of fever, abdominal pain, and hepatomegaly in two otherwise normal children who were seen at St. Louis Children's Hospital during the past year. Liver function tests were normal and blood cultures were negative in both patients. These cases illustrate that pyogenic liver abscess may occur in normal children and should be considered whenever fever of unknown origin is associated with abdominal complaints. Only in this way can we hope to improve upon the results cited previously, namely that the majority of liver abscesses remain undiagnosed during life.
Theophylline in asthma
Authors: Bierman C. Warren
Published: December 2021

In this issue of Pediatrics, Ellis et al.1 have a study of the pharmocokinetics of theophylline, a study which is 40 years overdue and which was technically feasible 25 years ago. They show that children are not "little adults" in that the dosage of theophylline and the dosing intervals in children cannot be based on adult studies. Their work shows that theophylline has a significantly shorter biologic half-life in children, and that intersubject variation is far greater, with a range of 1.4 to 7.8 hours. Thus, compared to adults, children tend to require relatively larger amounts of theophylline per kilogram of body weight per day, and the doses may have to be given at shorter intervals of time.
Savings and Adequate Care Questioned
Authors: Stein Ruth
Published: December 2021

Hoekelman's study on well-baby care1 is an example of a much-needed investigation to distinguish between ritualistic and functional components of infant care. Some of the data provided, however, raise questions about the validity of his statements that "the use of abbreviated visit schedules does not reduce the adequacy of care as measured by the endpoints used in this study" and "savings could be made." The data I refer to are those pertaining to the mean number of well-baby, immunization only, and illness visits in Table XIV.
Correction of Essential Fatty Acid Deficiency in Newborn Infants by Cutaneous Application of Sunflower-Seed Oil
Authors: Friedman Zvi , Shochat Stephen J. , Maisels M. Jeffrey , Marks Keith H. , Lamberth Edward L.
Published: December 2021

Two newborn infants receiving long-term, fat-free parenteral nutrition developed essential fatty acid (EFA) deficiency. Biochemical evidence of EFA deficiency was documented in plasma, red blood cells, and adipose tissue and included a decrease in arachidonic and linoleic acids, an increase in 5,8,11-eicosatrienoic acid, palmitoleic and oleic acids and a trienoic/tetraenoic ratio of more than 0.4. Cutaneous application of sunflower-seed oil, a source rich in the essential fat linoleic acid, rapidly reversed the clinical and biochemical manifestations of deficiency in plasma.
Transillumination of the Skull in Premature Infants
Authors: Swick Herbert M. , Cunningham M. Douglas , Shield Lloyd K.
Published: December 2021

Transillumination of the Skull in Premature Infants Transillumination of the skull in infants is a simple technique which can be used to detect several major abnormalities of the central nervous system. The usefulness of transillumination has been limited, however, by the lack of standard techniques for its performance and by the absence of normal values, especially in premature infants. In healthy premature infants, there is a progressive increase in transillumination with increasing gestational age over three sites—the anterior fontanelle, the frontotemporal fossa, and the parieto-occipital eminence.
Respiratory Distress Syndrome of the Newborn and Complications of Pregnancy
Authors: Lee Kwang-sun , Eidelman Arthur I. , Tseng Po-I , Kandail Stephen R. , Gartner Lawrence M.
Published: December 2021

A group of 412 infants with birthweights between 501 and 2,500 gm and gestational ages of 36 weeks or less were studied for the influence of both prolonged rupture of amniotic membranes and maternal hypertension on the incidence of idiopathic respiratory distress syndrome (IRDS).

The occurrence of these complications was associated with a significant decrease in the incidence of IRDS only in infants with birthweights between 1,501 and 2,500 gm (37.4% in the no complications group versus 12.8% in the complications group; P < .01) or gestational ages of 33 to 36 weeks (35.2% in the no complications group versus 13.1% in the complications group; P < .01). In infants with birth weights of 1,500 gm or less or gestational ages of 32 weeks or less, the specific antecedent complications of pregnancy did not alter the incidence of IRDS. Rupture of the membranes for more than 72 hours had no greater effect on the incidence of IRDS than those lasting 24 to 72 hours.
Antibody to Varicella-Zoster Virus in Parturient Women and Their Offspring During the First Year of Life
Authors: Gershon Anne A. , Raker Richard , Steinberg Sharon , Topf-Olstein Barbara , Drusin Lewis M.
Published: December 2021

A nursery outbreak of varicella is reported. Serum from 200 parturient women and 131 of their offspring were studied for antibody to varicella-zoster (V-Z) virus to analyze their immunity to varicella. Antibody titers were measured by the sensitive fluorescent antibody to membrane antigen (FAMA) technique. It was found that approximately 5% to 16% of women of child-bearing age in New York City are susceptible to varicella. Women from Puerto Rico or other subtropical and tropical areas are more likely to be susceptible (16%) than others (5%).

Infants born to mothers with detectable V-Z FAMA titers almost always had detectable V-Z antibody at birth. In serial serum specimens obtained from 67 initially seropositive babies during the first year of life, it was found that by 6 months of age most infants were no longer passively protected against varicella. These observations may explain why varicella is not uncommonly observed in young babies.
Nutritional Supplementation of Disadvantaged Elementary-School Children
Authors: Paige David M. , Cordano Angel , Huang Shi-Shung
Published: December 2021

Nutritional reinforcement of disadvantaged elementary-school children is a recognized objective. Increased emphasis over the past few years has been placed on institutional feeding programs to upgrade the nutrition of children considered to be at risk.1,2

A traditional vehicle for attempting to improve the nutritional status of these youngsters is the "type A" school feeding program. This program represents one of the largest federal efforts in the field of public health, and is important in the nutrition of over 80% of the nation's children.3

Recent reports, however, indicate that the lunch program through the provision of one third of the daily requirements will not fully meet its objective of contributing to an improved nutritional profile in disadvantaged children, 4,5 It would, therefore, seem appropriate that in addition to providing lunch and an occasional breakfast in a conventional pattern, emphasis be placed on providing additional nutritional reinforcement through an acceptable, convenient, palatable, and nutritionally enriched supplement which would assist in improving the nutrition of children.6

It is the purpose of this paper to report on the provision of a nutritionally fortified supplement, containing low lactose levels, to disadvantaged elementary-school children and the changes, if any, in: (1) hematocrit; (2) height; (3) weight; and (4) absenteeism in the supplemented and nonsupplemented children studied.

METHODOLOGY

Population

The 177 children completely studied in the experimental school receiving the supplement represent all children in the first three grades remaining in school and participating in all elements of the study over the entire school year. The children ranged in age from 5.1 to 9.1 years.
Serum Enzyme Abnormalities in Juvenile Rheumatoid Arthritis
Authors: Rachelefsky Gary S. , Kar Nirmal C. , Coulson Anne , Sarkissian Edmund , Stiehm E. Richard , Paulus Harold E.
Published: December 2021

Elevated serum transaminases, particularly SGOT, as a result of acetylsalicylic acid (ASA) therapy have been reported in patients with juvenile rheumatoid arthritis (JRA). In order to evaluate the possibilities that these elevated transaminases may result from JRA itself or from concomitant muscle injury, we correlated liver function tests and a specific test for muscle damage, creatine phosphokinase (CPK), with ASA therapy in 37 patients. These JRA patients were evaluated serially; 20 took ASA continuously, 6 took it intermittently, and 11 were on no therapy. Thirty-five healthy children were also studied to establish normal control values for the serum enzyme tests.

Mean SGOT and SGPT in the 11 untreated subjects were significantly (P < .001) higher than normal controls while CPK and alkaline phosphatase (AP) were not elevated. Mean SGOT and SGPT were also significantly (P < .001) elevated in 20 children receiving ASA continuously; CPK was normal and AP less (P < .05) than normal. CPK was elevated in 13 patients. Elevation of enzymes was sporadic and there was no correlation with serum salicylate, sex, age, disease duration, type, or activity.

We conclude that mild abnormalities of SGOT and SGPT in JRA patients are common, but that they occur sporadically and elevated values appear to be unrelated to ASA therapy.
Iron Supplementation for Infants
Authors:   Committee on Nutrition
Published: December 2021

Iron deficiency remains the most common cause of anemia in infants and children despite the increasing availability of iron-fortified foods during the past three decades. The Committee on Nutrition published a review in 1969 of the iron requirements for infants, along with recommendations for several ways of meeting these.1 In 1971, the Committee issued another statement recommending the use of iron-fortified formulas until at least 12 months of age.2 Developments since that time indicate that there are various means for fulfilling iron needs and that a broader set of recommendations is warranted.

The risk of iron deficiency is greatest when neonatal iron stores have been depleted, after about two months in small, preterm infants and after four to six months in term infants.3 Previous Committee statements have made no distinction between socioeconomic groups, but recent surveys among infants and children4-6 indicate that the highest incidence of anemia, which is a late manifestation of iron deficiency, is found in lower socioeconomic populations. Possibly this reflects poor compliance with recommended feeding practices and overdependence on fresh cow's milk in the diet. Most children in middle-income families have little or no anemia.5,6 Infants of low birthweight are more likely to develop iron deficiency regardless of economic status.1 Thus, recommendations for iron supplementation in infancy must be flexible and should emphasize the needs of low-birthweight infants and of normal-birthweight infants in lower socioeconomic populations.

Although there is no evidence that iron deficiency without anemia has a permanent effect on human infant growth and development, animal studies indicate that iron deficiency anemia early in postnatal development results in biochemical abnormalities of some organs (e.g., the brain) that persist long after anemia has been corrected.7
What's Cheaper Than Pediatric Care?
Authors: Narkewicz Richard M.
Published: December 2021

In these days of rising health care costs, the finger has been pointed at physicians as the cause of these increases. Because of these charges each physician should look critically at his own fee structure and try to compare it with other commodities in today's budgets. I have done just that. In totaling the cost of complete well-child care for a child and continuing care through the age of 20 years, I was surprised to find that in the present fee structure it costs a family $464.25.
What Is "Adequate Well-Baby Care"?
Authors: Chamberlin Robert W.
Published: December 2021

In reference to Hoekelman's study on "What Constitutes Adequate Well-Baby Care," I have concerns about how the study will be interpreted and would like to raise some issues I don't think were adequately covered in the article. My major concern is that people who read this may jump to the conclusion that three well-child visits during the first year are all that are necessary to provide "adequate well-baby care." My own feeling is that Hoekelman's measures do not, in fact, identify important aspects of "adequate well-baby care."
Serum T3 and T4 Levels in Sick Children
Authors: Carter J. N. , Corcoran J. M. , Eastman C. J. , Lazarus L. , O'Halloran M.
Published: December 2021

We have reported that most adults with severe, chronic, nonthyroidal illnesses (i.e., sick euthyroid patients) have significantly decreased circulating levels of triiodothyronine (T3) and thyroxine (T4), whilst the thyrotropin (TSH) levels are not elevated.1 The T3 levels are usually reduced into the hypothyroid range, whilst the T4 levels generally remain within the normal range. The patients in that study were aged from 21 to 84 years.

We have recently concluded a study of circulating thyroid hormone levels in children of various ages and have found that the mean levels of both T3 and T4 are higher than in adults.
PEDIATRIC NEPHROLOGY (Major Problems in Clinical Pediatrics, Vol. XI). Edited by Pierre Royer, et al. Philadelphia, WB Saunders Co, $19.00; 454 pp
Authors: Heymann Walter
Published: December 2021

This book has been written by four leading French pediatric nephrobogists (Pierre Royer, Renee Habib, Henri Mathieu, and Michel Broyer) in collaboration with nine contributors. It reflects the experience of an outstanding nephrology quartet. The material on which the critical evaluaation is based is impressive. It represents not only material that the city of Paris offered but that the whole of France referred to this group of nephrologists connected with the University Necker of Paris in the Hospital Necker.
A CHILD'S PARENT DIES. Edited by Eerna Furman. New Haven, Connecticut, Yale University Press, 1974, $15.00; 316 pp
Authors: Wright Alice L.
Published: December 2021

This book evolved as 14 child analysts from the Cleveland Center for Research in Child Development met weekly to study the problems of the bereaved child. Careful observations were made on the status and treatment of 23 children who lost a parent at various ages between 10 months and 13 years; only one presented to the analyst because of the death of a parent.

While, in passing, the author comments on other losses a child may sustain, such as that of a sibling or of a parent or parent surrogate throught some means other than death, the focus on the book is on the effect on the child of the death of a parent.
Intralipid–Its rational use in parenteral nutrition of the newborn
Authors: Bryan Heather , Shennan Andrew , Griffin Elizabeth , Angel Aubie
Published: December 2021

The recent release of Intralipid by the FDA has made available a calorie-dense and nutritious supplement to parenteral feeding regimens. Since it was first developed and introduced in 1961 by Wretlind and co-workers in Sweden, a large and successful experience has accrued in Europe and Canada in patients with burns, severe malnutrition, gastrointestinal disorders, and anomalies. It has not, however, been widely used in newborn infants. In general, complications are rare and anaphylactic reactions experienced with the use of earlier intravenous fat emulsions are not seen.1 Intralipid is a 10% emulsion of soybean oil stabilized with 1.2% egg phospholipid with a particle size less than 1 mµ and metabolic fate similar to naturally occurring chylomicrons.
Is Continuous Transpulmonary Pressure Better Than Conventional Respiratory Management of Hyaline Membrane Disease? A Controlled Study
Authors: Belenky David A. , Orr Rosemary J. , Woodrum David E. , Hodson W. Alan
Published: December 2021

The influence of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) on mortality and complication rates in severe hyaline membrane disease (HMD) was evaluated in a randomized, prospective study. Patients were admitted to the study if the PO2 was ≤ 50 mm Hg with FiO2 ≥ 0.6. Twenty-four patients in each of three weight groups were equally divided between treatment and control groups. The treatment regimen included CPAP (6 to 14 cm H2O) for spontaneously breathing patients and PEEP for patients requiring mechanical ventilation for apnea or hypercapnia (PCO2 ≥ 65 mm Hg). Control patients received oxygen and were mechanically ventilated if they had apnea, hypercapnia, or PO2 ≤ 50 mm Hg with FiO2 ≥ 0.8. Oxygenation improved after the start of CPAP or PEEP; however, PCO2 rose after CPAP was initiated. There was no significant difference between treatment and control groups in mortality, requirement for mechanical ventilation, or incidence of pulmonary sequelae. The incidence of pulmonary air-leak was increased with PEEP. The findings suggest that CPAP and PEEP have not significantly altered the outcome of HMD.
Home Management of Bronchopulmonary Dysplasia
Authors: Pinney Margo A. , Cotton Ernest K.
Published: December 2021

Home oxygen was utilized in six infants with BPD with no complications. This program allowed for early discharge of the infants, resulting in a mean financial savings of $18,000 per infant and a more normal family environment for the babies.
Tension Pneumothorax: A Teaching Model
Authors: Henderson Richard , Alden Errol , Jennings Paul , Hofmann John
Published: December 2021

A TPT induced in a small rabbit is an excellent teaching model for the treatment of a TPT in the small human neonate. Pediatric housestaff, neonatal nurses, and others have utilized this model to gain confidence and expertise in the diagnosis and treatment of TPT. The rabbit model is inexpensive, readily available, and recreates the clinical condition of a TPT in an educational environment.
Hemophilus influenzae Type b Sepsis in Infant and Mother
Authors: Marston Gail , Wald Ellen R.
Published: December 2021

Hemophilus influenzae type b is an uncommon cause of neonatal sepsis. Fifteen detailed case reports of neonatal H. influenzae infection appear in the literature1-5; approximately one half of these are type b. Where information was available on the mother, only local cultures of genitourinary tract and/or pharynx were positive in mothers of infants with H. influenzae disease. Puerperal sepsis caused by this organism has not been previously reported. We wish to report a case of generalized sepsis in mother and newborn caused by H. influenzae type b.

CASE REPORT

A 4,972-gm boy was born to a 17-year-old gravida 0, para 0, Caucasian, afebrile mother.
Drs. Cashore and Usher Reply
Authors: Cashore William J. , Usher Robert H.
Published: December 2021

We are indeed interested to learn that Higgs et al.1 have achieved early growth rates comparable to those in our study with the use of intravenous fat emulsion in small premature infants. Further information on the metabolic complications and autopsy findings encountered in their study would provide important additional evidence concerning the effectiveness and potential hazards of using intravenous fat emulsions in sick newborns.

There was a difference between the two studies in the method of infusing the fat emulsion.
The Sleep State Characteristics of Apnea During Infancy
Authors: Gould Jeffrey B. , Lee Austin F. S. , James Ophelia , Sander Louis , Teager Herbert , Fineberg Naomi
Published: December 2021

The sleep state characteristics of infant sleep apnea were studied in 36 twins examined by polygraphy at 40, 44, and 52 weeks after conception. The definition of sleep apnea is dependent upon the length of apnea, sleep state, and post-conceptional age.

None of the infants had apnea longer than 20 seconds and apnea of 10 seconds or longer was uncommon. The attack rates for apneas 2 to 4.9 seconds long were highest in REM and lowest in quiet sleep. The attack rates for apneas 5 to 9.9 seconds long were equal in REM and indeterminate and lowest in quiet sleep. The percentage of infants with apnea of 10 seconds or longer at 40 weeks was highest in REM (27%) and indeterminate sleep (42%) and lowest in quiet sleep (12%). At 52 weeks, apnea 10 seconds or longer during REM decreased to 0%.

The effect of maturation on apnea varies with sleep state. Over the period from 40 to 52 weeks, quiet sleep apnea was unchanged and indeterminate sleep apnea decreased only between 40 and 44 weeks. Although REM apnea 2 to 4.9 seconds long was unchanged, REM apnea 5 to 9.9 seconds long decreased between 40 and 44 weeks, and REM apnea of 10 seconds or longer decreased from 27% at 40 weeks to 0% at 52 weeks. This suggests that semi-independent apnea turn-on and turn-off mechanisms operate during REM sleep. A correlation between brief apneas and the longer apneas was seen only during REM sleep. For all sleep states, there was no correlation between the levels of apnea of 5 seconds or longer at 40, 44, and 52 weeks.
HUMANKIND AND DISEASE
Authors: McNeill W. H. ,   Student
Published: December 2021

It is not absurd to class the ecological role of humankind in its relationship to other life forms as a disease. Ever since language allowed human cultural evolution to impinge upon age-old processes of biological evolution, humankind has been in a position to upset older balances of nature in quite the same fashion that disease upsets the natural balance within a host's body. Time and again, a temporary approach to stabilization of new relationships ocurred as natural limits to the ravages of humankind upon other life forms manifested themselves. Yet sooner or later, and always within a span of time that remained minuscule in comparison with the standards of biological evolution, humanity discovered new techniques allowing fresh exploitation of hitherto inaccessible resources, thereby renewing or intensifying damage to other forms of life. Looked at from the point of view of other organisms, humankind therefore resembles an acute epidemic disease, whose occasional lapses into less virulent forms of behavior have never yet sufficed to permit any really stable, chronic relationship to establish itself.
Tracheal Extubation of the Neonate at 2 to 3 cm H2O Continuous Positive Airway Pressure
Authors: Fox William W. , Berman Lawrence S. , Dinwiddie Robert , Shaffer Thomas H.
Published: December 2021

To investigate the efficacy of extubation at higher levels of continuous positive airway pressure (CPAP), 49 newborns (0.95 to 4.0 kg) were extubated at 2 to 3 cm H2O following 1 to 47 days of CPAP therapy. Pre- and post-extubation measurements of PO2, PCO2, pH, FiO2, and CPAP were made in all infants. No significant differences (P < .05) were found between pre- and post-extubation arterial blood gas values for all patients. Comparison of pre- and post-extubation blood gas data with respect to birthweight (< 2.0 kg vs. > 2.0 kg) and intubation time (< 8 days vs. > 8 days) also indicated no statistical differences. Mean alveolar-arterial oxygen differences and FiO2 for 41 infants showed progressive decreases following extubation. Six of the 49 infants required reintubation within 72 hours following extubation. The results of this study indicate that newborns with respiratory disease requiring CPAP may be extubated at 2 to 3 cm H2O with no significant changes in arterial blood gas values, thus preventing prolonged intubation associated with weaning to 0 cm H2O CPAP.
KNOWLEDGE AND WISDOM
Authors: Cowper William
Published: December 2021

Knowledge and Wisdom, far from being one.

Have oft-times no connexion. Knowledge dwells

In heads replete with thoughts of other men;

Wisdom in minds attentive to their own.

Knowledge is proud that he has learned so much;

Wisdom is humble that he knows no more.
Sudden Death in an Infant From Methemoglobinemia After Administration of "Sweet Spirits of Nitre"
Authors: Chilcote Robert R. , Williams Bruce , Wolff Lawrence J. , Baehner Robert L.
Published: December 2021

The administration of "sweet spirits of nitre" (4% ethyl nitrite CH3CH2ONO in 70% ethyl alcohol) was followed by acute methemoglobinemia and severe anoxic metabolic acidosis in infant twins. Methylene blue administration reversed methemoglobinemia in both, but one twin died from the consequences of hypoxemia. Hemoglobin electrophoresis and methemoglobin reductase determinations were normal for age. This medicine is available without prescription and contains the potent oxidant ethyl nitrite. In infants with sudden death or onset of cyanosis, appropriate toxicological and historical information should be obtained.
Relief of Chronic Upper Airway Obstruction Using a Dental Prosthesis: A Nonsurgical Approach
Authors: Eavey Roland D. , Casagrande Angelo , Blasberg Bruce , Stool Sylvan E.
Published: December 2021

The spectrum of symptoms of chronic upper airway obstruction ranges widely from merely annoying "noisy respirations" to death from heart failure secondary to cor pulmonale.1 The latter condition occurs because airway obstruction can lead to alveolar hypoventilation which results in hypoxia, hypercapnia, and acidosis which, in turn, produce pulmonary arteriolar construction.2

Chronic upper airway obstruction can also be a management problem for the pediatrician. Depending on the etiology and degree of symptoms, three treatment choices are usually considered: medical management, corrective surgery to recreate an airway; or tracheotomy to bypass the obstruction. We recently have seen a patient who demostrated chronic respiratory difficulty and ECG evidence of early right heart failure who benefited greatly by the use of a simple dental appliance.
Foreign Body of the Right Nostril and Left Bronchus
Authors: Hawkins Donald B. , Kahlstrom Emily J. , MacLaughlin Eithne F. , Margetis Monique F.
Published: December 2021

Foreign bodies in the airway often present problems for physicians who treat children. The following case report illustrates some of these problems.

CASE REPORT

A 6-year-old boy was admitted to the Pediatric Respiratory Disease Service of the Los Angeles County-University of Southern California Medical Center with a complaint of persistent nonproductive cough since awakening the morning of the previous day. He also had a history of discharge from his right nostril for eight months, at times foul-smelling. During this time, he had seen doctors on three occasions; twice antibiotics had been prescribed for sinus infection.

He was in no distress, and demonstrated no respiratory difficulty.
Computerized Tomography: A Perspective in the Pediatric Patient
Authors: Harwood-Nash Derek , Grossman Herman , Felman Alvin , Kirkpatrick John , Swischuk Leonard
Published: December 2021

Computerized tomography (CT), a technique conceptualized by Oldendorf in 19611 and developed by Hounsfield2 of EMI-Tronics Inc. (EMI) Central Research Laboratories, has proven to be a successful innovation in neuroradiology. Reviews by Ambrose3 in England and by Baker et al.4 and by New et al.5 in the United States have clearly demonstrated the value of this new modality in neuroradiological diagnosis. In 1975 Houser et al.6 and Harwood-Nash et al.7 provided the initial clinical and radiological data about CT in infants and children.

More recently this technique has been extended to the study of tissues and organs in the body other than those in the head. This has been accomplished by modification of the original machine into a whole-body CT system. Early reviews by Ledley et al.8 and by Alfidi et al.9 suggest a significant potential for diagnosis of lesions in the abdomen, pelvis, and thorax.

The advantages of CT are that it is less invasive than standard special diagnostic radiological procedures and that for the first time it provides in vivo information regarding the content and the characteristics of tissue composing organs and masses.

DESCRIPTION OF EQUIPMENT

In conventional radiography an image is made on radiographic film by an attenuated X-ray beam. In passing through a core of tissue, each ray of the beam is attenuated as it is absorbed and scattered by the tissue in its path. The intensity of the transmitted ray depends on the sum total of X-ray attenuation by all the different soft tissues in its path.
Primary care: We need all the help we can get!
Authors: Hoekelman Robert A.
Published: December 2021

Primary care has finally been defined to the satisfaction of almost everyone and educational programs to prepare physicians to provide primary care to children have emerged in response to reason, demand, and dictum.1-3 Questions now arise as to who should provide the bulk of that care and how it can best be organized to ensure that the health care needs of all of our children are met. The politics of primary pediatric care begin then to occupy more of our thought and discussion.

Dodds has reviewed the politics involved at all levels of pediatric care but speaks mostly to the conflicts that exist between general practitioners and pediatricians in the delivery of primary care.4
Transient Tricuspid Insufficiency of the Newborn: A Form of Myocardial Dysfunction in Stressed Newborns
Authors: Bucciarelli R. L. , Nelson R. M. , Egan E. A. , Eitzman D. V. , Gessner I. H.
Published: December 2021

Fourteen term newborn infants have been recognized as having transient tricuspid insufficiency associated with significant perinatal stress. Five of these infants underwent cardiac catheterization for presumed congenital heart disease, but had only massive tricuspid valve insufficiency. The other nine infants were diagnosed on the basis of a murmur characteristic of tricuspid valve insufficiency and on other clinical grounds. All had a history of significant perinatal stress in the form of asphyxia with or without hypoglycemia. Frequently, congestive heart failure, persistent cyanosis, and ECG evidence of myocardial ischemia were present. Twelve of the 14 survived, and in each of them all cardiac signs and symptoms, including the murmur, spontaneously resolved. The two patients who died had histopathologic evidence of necrosis in the anterior papillary muscle of the tricuspid valve.

The constant features of perinatal stress, ST-T wave abnormalities on the ECG, and spontaneous resolution of the transient tricuspid insufficiency strongly suggest that this syndrome is secondary to a reversible form of myocardial dysfunction, perhaps by affecting papillary muscle specifically. We believe that hypoxia with or without hypoglycemia precipitates the events leading to this clinical syndrome which is distinguishable from other cardiac abnormalities in the newborn by the history, distinctive murmur, and the ECG abnormalities.
Milk Protein Quantity and Quality in Low-Birth-Weight Infants: II. Effects on Selected Aliphatic Amino Acids in Plasma and Urine
Authors: Rassin David K. , Gaull Gerald E. , Heinonen Kirsti , Räihäa Niels C. R.
Published: December 2021

The optimal quantity and quality of protein for low-birth-weight infants is undefined. In this study, 106 well, appropriate-for-gestational-age, low-birth-weight infants weighing 2,100 gm or less were divided into three gestational age groups and assigned randomly within each age group to one of five feeding regimens: pooled human milk; formula 1 (protein content, 1.5 gm/100 ml, 60 parts bovine whey proteins to 40 parts bovine caseins); formula 2 (3.0 gm/100 ml, 60:40); formula 3 (1.5 gm/100 ml, 18:82); and formula 4 (3.0 gm/100 ml, 18:82). The concentrations of the free amino acids in the plasma and urine of these infants were determined. The plasma concentrations of free amino acids were generally far greater in the infants fed the 3.0-gm/100 ml protein diets than they were in the infants fed pooled human milk. The plasma concentrations of free amino acids of the infants fed the 1.5-gm/100 ml protein diets were intermediate. In general, the concentrations of the free amino acids in the plasma of the infants fed the 3.0-gm/100 ml caseinpredominant formula (F4) were furthest from those fed pooled human milk. Glutamate showed the highest plasma amino acid concentrations in infants fed both the high- and low-protein casein-predominant formulas. This was true despite the fact that the intake of glutamate on the high-protein, whey-predominant formula was twice that on the low-protein, casein-predominant formula. The differences between groups in the essential amino acids in plasma were generally greater than those of the nonessential amino acids. The concentrations of amino acids in the urine tended to parallel those of the plasma.
Lymphocyte Subpopulations in Human Malnutrition: Cytotoxic and Suppressor Cells
Authors: Chandra R. K.
Published: December 2021

Lymphocytes in the peripheral blood of young children with protein-calorie undernutrition were evalutated for surface markers and function. Thymus-dependent lymphocytes were reduced and the immunoglobulin-bearing B lymphocytes were unchanged. The relative proportion of the remaining "null" lymphoid cells was increased. Null cells and, to a lesser extent, B lymphocytes showed cytotoxic activity against xenogeneic target cells and suppressed phytohemagglutinin-induced DNA synthesis by normal T lymphocytes. It is suggested that these alterations in lymphoid subpopulations contribute to depressed cell-mediated immunity in malnutrition.
Therapy of Familial Hypercholesterolemia in Childhood: Diet and Cholestyramine Resin for 24 to 36 Months
Authors: Glueck C. J. , Tsang R. C. , Fallat R. W. , Mellies M.
Published: December 2021

In 16 children heterozygous for familial hypercholesterolemia, two- to three-year therapy with diet and cholestyramine resin (16 gm/day) was assessed in terms of effectiveness, practicality, and safety. All 16 children had previously taken a low-cholesterol (< 300 mg/day), polyunsaturate-rich (P/S ratio, 1.5:1) diet and cholestyramine resin (12 gm/day) for 12 months. In this study, the cholestyramine resin dose was increased to 16 gm/day, and follow-up was maintained through months 13 through 18, 19 through 24, 25 through 30, and 31 through 36. Eleven children had good drug adherence (four packs of cholestyramine per day) and five children had fair adherence (two to three packs per day). Plasma total cholesterol and low-density lipoprotein (LDL) cholesterol levels were not significantly lowered on the drug-plus-diet regimen as compared to diet alone in five children with fair drug adherence. For children with good drug adherence. mean plasma cholesterol level was lowered below levels achieved on diet alone by 13% (months 13 through 18), 12% (months 19 through 24), 12% (months 25 through 30), and 11% (months 31 through 36) (P < .05). Reduction in plasma cholesterol level was no greater with 16 than with 12 gm of cholestyramine per day. There were no group changes in mean plasma triglyceride levels. Cholestyramine resin, when added to diet and maintained for two to three years, effects a significant reduction in total and LDL cholesterol levels in about 60% of children heterozygous for familial hypercholesterolemia. Continued reinforcelnent of both diet and drug adherence is necessary in the face of gradual increments in plasma cholesterol level with time.
LIMITATIONS
Authors: McDonald C. J.
Published: December 2021

Implicit in currently available remedies for medical errors is the belief that man is perfectable and his errors can be eliminated by training or coercion. Postgraduate training and recertification can eliminate errors caused by ignorance. Professional Standards Review Organization (PSRO) length-of-stay reviews, malpractice suits and tissue committees can eliminate errors caused by wrong intent. However, man is not perfectable. There are limits to man's capabilities as an information processor that assure the occurrence of random errors in his activities . . . . many medical errors are due to the physician's intrinsic limits rather than to remediable flaws in his fund of knowledge. . .

If this hypothesis is correct, all practice errors cannot be attributed to the human causes of ignorance and avarice. Some are intrinsic to the limitations of the human mind.
Hexachlorophene Storage in a Burn Patient Associated With Encephalopathy
Authors: Chilcote Robert , Curley August , Loughlin Howard H. , Jupin John A.
Published: December 2021

Hexachlorophene (HCP), a chlorinated phenolic hydrocarbon with bacteriostatic properties against Staphylococcus, is used in a number of topical products. Absorption through normal and damaged human skin has been appreciated and neurologic changes have been described in experimental animals, but instances of human toxicity have been reported infrequently. A 10-year-old boy who sustained a 25% burn did well initially but died in the second week of convalescence with hyperthermia, lower-extremity weakness, and cerebral edema. His treatment had included frequent applications of HCP. Analysis of post-mortem tissue revealed the presence of toxic levels of HCP in the blood (2.2µg/gm) and brain (2.2µg/gm), with storage in skin (25µg/gm). liver (4.4µg/gm), and fat (6.0µg/gm). This case suggests that topical applications of HCP in man may result in an extensive absorption with fat storage and may cause fatal encephalopathy.
Health Needs of the Child in Foster Family Care
Authors:   Committee on Adoption and Dependent Care
Published: December 2021

The health needs of the child will depend upon the type of foster care being offered to him, as the needs for an emergency short-term placement of a healthy child are very different from those of a long-term placement of a handicapped child. When a tentative decision is reached that placement is necessary, arrangements should be made for a medical examination by a physician trained in the care of children. Psychological testing and psychiatric examination may occasionally be necessary to arrive at an understanding of the nature and severity of personality problems.

The adequate provision for safeguarding and promoting the health of children in routine foster care should include periodic health supervision examinations, appropriate medical care for the ill child or child with special health problems, and dental care. Foster families having access to adequate, continuing medical care for themselves and other siblings should incorporate their foster child into their family health care system. By aligning the health services needed by the foster child with the provider of health services utilized by the foster family, the child would not be singled out for differential treatment, hence becoming a more integral part of the family life. When this is not possible, basic medical services should be provided through the agency or other resources whose services are coordinated with a total plan for the child, thus providing for continuity of medical care.

Health services should include preplacement examinations and periodic medical examinations for appraisal of the child's physical growth, development, health status, and the effect of emotional and social factors upon the child's physical well being.