bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperthyroidism in Juvenile Diabetes Mellitus
Authors: Hung Wellington , August Gilbert P. , Glasgow Allen M.
Published: December 2021

Three cases of hyperthyroidism occurring in juvenile patients with diabetes mellitus are presented. The presence of hyperthyroidism should be suspected in patients with diabetes mellitus when goiters develop and when there is unexplained weight loss, tachycardia, tremors, unexplained increases in insulin requirement, or instability of the diabetes with a tendency toward development of ketosis and/or ketoacidosis.
False alarms in the nursery
Authors: L. J. F.
Published: December 2021

British police no longer answer burglar-alarm calls with enthusiasm. Who can blame them? Statistics indicate that 98.8% of automatic burglar-alarm calls are false. It is estimated that false alarms are costing British taxpayers $36 million a year.1 What connection does this observation have with pediatrics? The article by Kelly et al. in this issue (p. 511) recommends home monitoring with apnea alarms to perhaps abort the sudden infant death syndrome (SIDS) in a group of infants judged to be at risk. I can't help but wonder about the "cost" of false alarms in this situation and in the intensive care nursery, where their use is universal.
Classes of Pediatric Care: Point-Counterpoint
Authors: Mebane William N.
Published: December 2021

Dr. Maurice Ross's commentary entitled "Classes of Pediatric Care" (Pediatrics 60:542, October 1977) suggests that medical care of children by family practitioners is second-class care. He extends his line of reasoning to suggest that pediatric care by pediatric nurse associates, pediatric nurse practitioners, physicians' assistants, or extenders is third-class care. Further extension of this reasoning might suggest that care by mothers is fourth-class care.

We are asked to acknowledge that there are different classes of pediatric care and that there are some children who receive little or no care.
Dr. Ross Replies
Authors: Ross Maurice
Published: December 2021

Credentials and even training or study do not make a competent, concerned, warm-hearted physician. As one of my respected mentors taught, we must always strive to develop empathy for all, in spite of personality differences, if we are to be good healers and counselors.

Dr. Mebane and I probably live and practice in different environments. Before my pediatric residency, I completed a rotating internship at a teaching hospital with a respected pediatric department. After my pediatric residency (also in a "prestigious" teaching hospital), I opened my office for the private practice of pediatrics in a small community where medicine was dominated by general practitioners.
Dr. Barness Replies
Authors: Barness Lewis A.
Published: December 2021

We thank Dr. Silverio for the nuances that he has expressed in his letter.
Immunity to Diphtheria in an Urban Population
Authors: Nelson Lois A. , Peri Barbara A. , Rieger Christian H. L. , Newcomb Richard W. , Rothberg Richard M.
Published: December 2021

Immunity against diphtheria is poorly understood since protection is the result of a complex interaction between host and environment, and technical problems with the present antitoxin assays exist. A radioimmunoassay which permits a reproducible estimation of antitoxin concentration and relative avidity was employed to characterize the immunological response to diphtheria of 195 healthy urban children. The antitoxin concentration in cord serum was equal to or greater than the concentration in maternal serum and decreased rapidly during the first two months of life. The first diphtheria-tetanus-pertussis inoculation was not immunogenic enough to initiate significant antitoxin production in infants without maternal antitoxin or in older children. A significant increase in antibody concentration and affinity was found after the second, third, and fourth toxoid administrations. More than four injections did not alter concentration, affinity, or duration of active immunity.

Correlation with recent epidemiologic studies suggested that a serum contained a "protective" concentration of antitoxin if it bound more than 100 ng of diphtheria toxin nitrogen per milliliter of serum (approximately 0.1 IU of antitoxin). By this criterion, among the study group only 74% of the healthy children who had received three immunizations and 84% of the children who had received four or more inoculations were "protected." Antitoxin concentrations observed in serum from children with chronic diseases who had received appropriate immunizations were lower than in serum from appropriately immunized healthy children. These observations suggest that the immunologic status of urban children against this disease is not optimal and should serve as a stimulus to improve both patient education and immunization practices.
HOW THE REVEREND JOHN BARNARD'S SCARLET FEVER WAS CURED BY ABSENT TREATMENT IN 1693
Authors: C. T. E.
Published: December 2021

The Rev. John Barnard of Marblehead, Massachusetts, an 18th century Puritan, is little known except to those who have read his autobiography. President Stiles of Yale wrote to Barnard on October 3, 1767: "with great pleasure I have read your life again and again. It has proved a feast to me."

Mr. Barnard's fascinating description of how he was cured of scarlet fever follows:

. . . In June, 1693, in my twelfth year, Sir Francis Wheeler, with his fleet, which had in vain made an attempt upon Martinico, came to Boston, and brought with him a violent and malignant distemper, called the scarlet fever, by which he lost many hundreds of his men. The distemper soon spread in Boston, of which many persons died, and that within two or three days of their being taken ill. It pleased God I was seized with it, and through the rampancy of the fever, and a violent pain at my heart, which rendered every breath I drew to be as though a sword had pierced me, I was so bad that life was despaired of. On the third night, (I think) it seemed to me that a certain woman, wife of a doctor, who used to supply my father's family with plasters upon occasion, came and brought me some small dark colored pills, and directed me to put one in my mouth, and hold it there till it grew mellow, then squeeze it flat betwixt my thumb and finger and apply it to my right nipple; it would soak in and before I had used them all so, I should be well.
Medical Management of Serous Otitis in Children
Authors: Bierman C. Warren , Furukawa Clifton T.
Published: December 2021

Though pediatricians have long been concerned with the problem of fluid in the middle ear as it pertains to infection or temporary conductive hearing loss, it is only recently that they have begun to be aware of the long-term consequences of middle ear fluid. Brannon and Murray,1 for instance, studied language skills in children with hearing impairments and found deficits in five specific areas including total words, words per sentence, total errors, words per corrected sentence, and syntax score. Nation2 studied children of normal intelligence with cleft palate. Even with the exclusion of children with a hearing loss of 30 dB or greater, he found a significant deficiency of vocabulary comprehension and usage in the children with cleft palates, suggesting that even a mild hearing loss may affect vocabulary development. Holm and Kunze3 studied children with fluctuating hearing loss from chronic otitis media. They found problems of deficient vocabulary, articulation skills, ability to receive and express ideas through spoken language, use of grammar, syntax, and auditory memory skills. Since resolution of serous otitis restores normal hearing, early diagnosis is essenhal to prevent persisting long-term behavioral, social, and educational handicaps. In this article we will focus on changes within the ear, Eustachian tube, and nose which predispose to serous otitis, on methods of diagnosing serous otitis, and on options in management.

Serous and Secretory Otitis Media

When nonsanguinous middle ear effusions are cultured, approximately one fourth to one third will be sterile4 and will not respond to antibiotic therapy. The pediatrician diagnoses this condition as serous otitis media.
Islet Cell Tumor in a Neonate: Diagnosis by Selective Angiography and Histological Findings
Authors: Kirkland John , Ben-Menachem Yoram , Akhtar Mohammad , Marshall Robert , Dudrick Stanley
Published: December 2021

Congenital islet cell adenomas of the pancreas are rare. Fewer than 20 cases have been documented.1,2 The purpose of this article is to present what we believe is the first case in which a preoperative diagnosis of an insulinoma was established by selective angiography in a neonate and to describe the histological findings.

CASE REPORT

A girl weighing 2,759 gm was the product of a normal 38-week pregnancy with an uncomplicated labor and delivery. The one- and five-minute Apgar scores were 8 and 9. At 19 hours of age she was observed to be cold, pale, and diaphoretic. A sepsis evaluation was initiated.
New Canadian Institute of Child Health
Authors: Law John T.
Published: December 2021

On July 1, 1977, the Canadian Institute of Child Health (Institut canadien de la santé infantile) began operation in Ottawa. The mission of this new institute is to be an effective and useful force to improve the health and, therefore, the quality of life of Canadian children. Health is defined as complete physical, mental, and social well-being, and the target population will be all children from conception to 18 years of age, or approximately 8 million Canadians.

In June 1975, The Hospital for Sick Children Foundation commissioned Shirley E. Post to examine the need for an institute of child health and to prepare a report for the Foundation.
Home Care for Children Dying of Cancer
Authors: Martinson Ida M. , Armstrong Gordon D. , Geis Dorothy P. , Anglim Mary Ann , Gronseth Evangeline C. , Maclnnis Helen , Kersey John H. , Nesbit Mark E.
Published: December 2021

Hospitals have traditionally provided the setting for the treatment of children with cancer, including those in the terminal stage of their illness. However, when treatment that requires hospitalization has been discontinued and the child's cancer is still not under control, then the wisdom of continued hospitalization is questionable.

If the care that is required by the patient could be provided as effectively by the parents and by nurses at home, then it would be reasonable to make a home care option available to the families who desired it. The possible advantages of such home care would be improved satisfaction of the child, better adjustment to the situation by the family, and reduced cost. It is more comforting to the child to be in familiar surroundings with the parents at hand during the terminal stages of his or her illness. Most of the specialized and expensive sive facilities provided by the hospital are no longer needed by the child.

The preliminary findings from a research project dealing with home care of children with cancer are reported in this article. The feasibility and desirability of the home as an alternative to the hospital for children whose death from cancer was impending were examined. Administration of the home nursing service was at the time of the study separate from existing nursing services. Home care nurses were hired on an hourly basis and were recruited from hospitals and public health agencies. Two project staff nurses oriented the home care nurses to the special functions that they would serve, and also provided consultation and some of the actual home care.
A CASE OF CHOLERA INFANTUM CURED BY LUNAR CAUSTIC IN 1829
Authors: C. T. E.
Published: December 2021

Cholera infantum was the name Benjamin Rush gave to the so-called summer diarrhea of infants and children. This disease was also known as "the vomiting and purging of children" or "the disease of the season" because of its regularity in appearing during the summer months.1 The mortality from this malady during the early 19th century was appalling and its treatment unscientific as this case history by Dr. Joseph Skinner of North Carolina of his daughter's illness will show.

My daughter Cornelia, aged seventeen months, was attacked about the middle of June, 1829, with the usual symptoms of cholera infantum, . . . occasional vomiting, particularly when any fluid was taken in the stomach; the matter ejected was sometimes tinctured with bile, but more commonly it was merely the fluid taken in the stomach; the bowels were exceedingly irritable, the evacuations copious, frequent, and very offensive; sometimes of a clay colour, at other times resembling coagulated milk; fever of a remittent form; skin hot and dry, &c. . . .On examination of the mouth, I found the gums tumefied and four molares [sic] making their way through, which was believed to be the exciting cause of the train of symptoms which I have described.

In the treatment of the case my first object was to remove all sources of irritation; accordingly the gums were freely scarified, and the bowels were purged with calomel and calcined magnesia and injections of common salt and warm water. This practice was steadily adhered to for several days, but failing to produce the desired effect, the symptoms of prostration fast approaching, the pulse indicating a great degree of debility, and the fever assuming a more decided remittent type, indicating the influence of miasmata,.
Impedance Audiometry: It Is Useful!
Authors: de C. Magian V.
Published: December 2021

Dr. Mortimer's commentary "Impedance Audiometry: Is It a Wise Investment?" (Pediatrics 58:151, August 1976) certainly expresses concerns which might appear valid. However, I cannot agree with his statement deploring the widespread use of impedance screening of school-age children until such time as we can prove that serous otitis causes learning impairment or that the condition can be treated favorably.

One of the concerns is with cost. Cooper et al.,1 taking into account salaries, equipment, and its maintenance and life expectancy, have shown that impedance screening is less expensive than traditional pure tone screening, once the number of children screened per year exceeds 1,239.
Letter To The Editor
Authors: Mortimer Edward A.
Published: December 2021

Perhaps the best way to clarify my position for Dr. Magian is to consider the benefit/cost ratio of impedance audiometry for routine screening of children. (As a research tool I support its use strongly.) Let us first consider the benefit of routine screening and how firmly established this benefit is.

The major benefit claimed is that tympanometry identifies eustachian tube dysfunction with greater sensitivity than other techniques. To quantitate this benefit one needs to know the proportion of children identified by this, but not by other, techniques.
It Doesn't Work!
Authors: Thompson Hugh C.
Published: December 2021

In the April 1977 issue of Pediatrics (59:636, 1977), Dr. Cunningham recommends that the patient's medical record be given to the family to keep. He urges that the Committee on Standards of Child Health Care consider this subject.

For at least 20 years the American Academy of Pediatrics has published for this very purpose, a "Child Health Record." This is publication HE-4 of the Academy and was last revised in 1968. The central office of the Academy tells me that, at the present time, between 50,000 and 100,000 of these are sold annually to physicians for the distribution that Dr. Cunningham recommends.
DR. J. QUIER DESCRIBES KOPLIK'S SPOTS 122 YEARS BEFORE KOPLIK
Authors: C. T. E.
Published: December 2021

On June 28, 1774, Dr. J. Quier wrote a letter to Dr. Donald Monro of Edinburgh in which he gives an account of an epidemic of measles in Jamaica. His description of "Koplik's spots" equals that of Koplik himself.1

The usual symptoms, (of cough, inflamed eyes and throat, anxiety and restlessness,) were observed here in a very great degree. But the most certain diagnostic of the disease in its beginning, (and which I do not remember to have found mentioned by any author that I have met with,) was the appearance of the white aphthous specks about the gums; which were always visible several days before the eruption, and not unfrequently before the fever began. By this symptom, I discovered several to be affected with the measles, before they were themselves sensible of any indisposition.2
Segmental Colonic Gangrene: A Surgical Emergency in the Hemolytic-Uremic Syndrome
Authors: Schwartz David L. , Becker Jerrold M. , So Henry B. , Schneider Keith M.
Published: December 2021

A 2½-year-old girl had rectal bleeding, an abdominal mass, and diffuse peritonitis. A segment of gangrenous colon was removed. Following surgery she developed the hemolytic-uremic syndrome (HUS), which is characterized by renal failure, hemolytic anemia, and thrombocytopenia. The intestinal manifestations associated with the HUS are stressed. This case demonstrates that gangrenous bowel can occur in these patients, and that their survival may depend on resectional surgery.
Fatal Graft-Versus-Host Disease After a Small Leukocyte Transfusion in a Patient With Lymphoma and Varicella
Authors: Betzhold James , Hong Richard
Published: December 2021

A child with a poorly differentiated lymphoma developed varicella while being treated with maintenance chemotherapeutic agents. He received a transfusion of nonirradiated leukocytes from 1 unit of whole blood donated by a healthy volunteer who had recently recovered from varicella The clinical course of varicella was aborted, but a classic graft-versus-host reaction developed and ultimately proved fatal. The host may have presented a large population of antigen-bearing cells to an infusion of presensitized immunocompetent donor cells, leading to an overwhelming aggressor lymphocyte reaction. We speculate that a modified approach using irradiated donor cells could be of benefit in the treatment of varicella infections in the immunosuppressed host.
Research Involving Children: Recommendations of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research
Authors: Jonsen Albert R.
Published: December 2021

Throughout history, children have been subjects of research. A legendary Persian prince is said to have isolated newborn babies from all human speech in hopes of discovering whether language was natural and spontaneous. Queen Caroline of England recruited children from a foundling hospital in order to test Jenner's vaccination on them before it was applied to her own royal progeny. The modern controversy over research with children and the retarded can be traced to events at Willowbrook State Hospital for the Mentally Retarded where, during the 1950s and 1960s, healthy mentally retarded children were infected with mild hepatitis in order to study the natural history of the disease. That research aroused great public controversy and its merits and faults are debated even today. It initiated a discussion within and without the medical profession over whether any invasion or manipulation of the body or person of a nonconsenting subject could ever be ethically justified, apart from expectation of benefit to that subjct.1

The prevailing codes of ethics governing the use of human subjects for experimentation are curiously ambivalent about children. The progenitor of these codes, The Code of Nuremberg, if taken literally, would exclude children as subjects, for it requires the voluntary consent of the subject "as absolutely essential," without any provision for proxy consent.1 The World Medical Association's Declaration of Helsinki, on the other hand, states that for nontherapeutic research involving legally incompetent subjects, "the consent of the legal guardian should be procured."3(p277) This position has been adopted by the American Medical Association:
Mesmerism, magic, and medicine
Authors: Schowalter John E.
Published: December 2021

The appearance of Olness and Gardner's article, "Some Guidelines for Uses of Hypnotherapy in Pediatrics" (p. 228), must strike many readers as something far out, while for some others there is relief that Pediatrics has finally recognized a phenomenon that is a fact of everyday life.

Hypnosis is not easy to define. It need not produce a trance, but is a state in which the subject is extremely suggestible to the wishes of the hypnotist and in which there is a heightening of the powers of concentration.

The use of the hypnotic state dates back to early in the history of the individual and of medicine.
Abuse of the child abuse law
Authors: Bergman Abraham B.
Published: December 2021

In the belief that public officials potentially can affect health more than physicians, for the past 15 years I have engaged in the part-time practice of "political medicine." When I started as a starry-eyed rookie, I viewed successful passage of some legislation as a big deal. As a scarred, and perhaps burned-out, veteran I now know that getting a law enacted by Congress is simple compared to seeing that it is implemented in the manner intended by its original sponsors. The reason is as much due to the fraility of human nature as to the constitutional separation of powers among the three branches of government.
Potentially Toxic Theophylline Dose Recommendations
Authors: Hendeles Leslie , Wyatt Richard , Weinberger Miles
Published: December 2021

We are alarmed by the theophylline dosage recommendation published in a recent Quibron advertisement in Pediatrics (61:A8-A9, April 1978) and labeled as "New Pediatric Dosage" on the outside of sample packages of Quibron Elixir that are mailed to pediatricians. These recommendations, in some cases, approach the excessive doses that produced seizures and death in children during the 1950s.1

Some patients who are rapid metabolizers may require the larger doses recommended in the Quibron advertisement in order to achieve peak serum concentrations in the therapeutic range of 10 to 20 µg/ml.
Neonatal Neurobehavior in the First 48 Hours of Life: Effect of the Administration of Meperidine With and Without Naloxone in the Mother
Authors: Hodgkinson Robert , Bhatt M. , Grewal G. , Marx G. F.
Published: December 2021

The early neonatal neurobehavioral scale ‘was administered to three groups of newborns at 2, 4, and 24 hours of age. Group 1 consisted of 28 babies whose mothers had received no narcotics during labor, group 2 of 33 babies whose mothers had received meperidine hydrochloride alone during labor, and group 3 of 40 babies whose mothers had received meperidine followed by 0.4 mg of naloxone hydrochloride intravenously approximately 15 minutes before delivery. Babies who were not exposed to meperidine showed a statistically significantly greater percentage of high scores than those exposed to meperidine alone for all items on the neurobehavioral scale at 2 and 4 hours and for all items except tone and Moro response at 24 hours. Similarly, babies whose mothers had received meperidine and naloxone showed a significantly greater percentage of high scores than those whose mothers had received meperidine alone at 2 hours of age. At 4 hours a difference was found for tone and rooting and at 24 hours for overall score, placing, and total decrement score. It is concluded that naloxone given intravenously to the mother reverses the effect of meperidine on neonatal neurobehavior for approximately two hours after birth. At 4 and 24 hours, however, the neurobehavior of neonates exposed to meperidine and naloxone is depressed almost as much as that of babies exposed to meperidine alone.
Early-Onset Haemophilus Sepsis in Newborn Infants: Clinical, Roentgenographic, and Pathologic Features
Authors: Lilien Lawrence D. , Yeh Tsu F. , Novak Gertrude M. , Jacobs Norman M.
Published: December 2021

Nine infants with early-onset Haemophilus sepsis were seen between January 1973 and July 1977. Of the five isolated strains that were typed, only one was type B. All infants had respiratory distress, metabolic acidosis, and large alveolar-arterial oxygen tension difference gradients. Eight infants weighed less than 1,500 gm and died; one infant weighed 1,701 gm and survived. Roentgenograms in six of eight showed hyaline membrane disease. Pulmonary pathologic specimens in eight infants revealed hyaline membranes in six and polymorphonuclear leukocytes in the alveolar spaces in four. In two infants, small Gram-negative bacilli were noted within proteinaceous exudates in alveolar ducts. The route and time of infection in these infants with early-onset Haemophilus sepsis are unclear. However, the possibility that the infection occurs before birth and that these infants represent septically aborted prematures is suggested by the high incidence of prematurity in infants with early-onset Haemophilus sepsis and early detection of bacteremia in three infants.
Physiological Basis of Hyperkinesis Treated With Methylphenidate
Authors: Shouse Margaret N. , Lubar Joel F.
Published: December 2021

The study attempted to determine the primacy of physiological arousal or motor activation levels in predicting the number of developmental problems, current symptoms, and response to methylphenidate in 12 hyperkinetic children when compared with 12 unmedicated normal controls. Auditory evoked responses (EVC) and galvanic skin conductance (GSR) gauged physiological arousal level, while the sensorimotor EEG rhythm (SMR) and electromyogram (EMG) indexed both arousal and motor activation. Before medication, hyperkinetic children differed from normal control children in showing more severe developmental amid current symptom profiles and reduced SMR. The dearth of SMR is consistent with the rhythm's association with immobility in lower aninials. Although physiological measures failed to distinguish hyperkinetic children in general, four children consistently revealed hypoaroused physiological patterns relative to other hyperkinetic and normal control children. Low arousal characteristics included higher amplitude EVC as well as reduced GSR conductance, EMG, and SMR. Low arousal subjects also showed a history of poor sensorimotor development with the most severe current symptomatologies and benefited most from methyiphenidate. A concurrent trend toward a normalization of all physiological measures with medication is consistent with the arousal hypothesis. However, initial SMR incidence alone accurately predicted the severity of pretreatment motor symptoms and individual response to medication, suggesting a basis for these findings in motor functions.
BUREAUCRATIC LEARNING
Authors: Nisbet Robert
Published: December 2021

Through the application of science, human beings in America and other parts of the world have been liberated from plagues, pestilences, threats of famine, hardship and torment that once seemed an unalterable part of the human condition.

And until recently, all of this was rewarded by public and governmental respect.

In the past few years, however, disenchantment has set in, with the public concluding that the post-war promises of learning were inflated and misleading.

Much of science and scholarship has become obsessed with what it likes to think is a public-policy role, with the individual scholar only too happy to serve as policy maker. Unhappily, as the policy maker advances, the man of learning recedes.

Bureaucratic learning has also become commercial. The large grant, the entrepreneurially established institute have come to wield great power. Thus a substantial amount of research that does not really require great amounts of money and complex organizations, that is indeed retarded in inspiration by them, demands them anyhow. Grantsmanship, at first a wry joke among academics, is by now a publicly recognized source of banality, trivialization and pretentiousness.

Bureaucratic learning has lost its sense of proportion and of the true roots of knowledge.
Social Policy Issues in Improving Child Health Services: A Child Advocate's View
Authors: Schorr Lisbeth Bamberger
Published: December 2021

Child advocates share many goals with pediatricians. All of us, regardless of the perspective from which we approach the familiar issues, are dedicated to finding ways of improving the life and health of children. While the rhythm of the advocate's rhetoric and the cycle of our daily activities may differ from that of the health professional who works with and for children, most of us share a vision of a better world. Our efforts are informed and enriched by exposure to each other's views. None of us can afford to be doctrinaire; all of us must remain ready to look, case by case, issue by issue, at what is best for children and families.

The Children's Defense Fund is a child advocacy organization that grew out of the civil rights movement, the poor people's campaign of the 1960s, and a variety of efforts undertaken during that period to narrow the gap between federal promise and performance as it affected less fortunate people in our society.

By the early 1970s, there was increasing evidence that the problems faced by the poor and the Blacks were not as isolated as they had seemed. Marian Wright Edelman, who heads the Children's Defense Fund, and had been organizing through the South during the mid-Sixties, said at the time that "the problems that I thought were Mississippi poor and Black, turn out to be problems of children in Maine, Iowa and Beverly Hills."

The Children's Defense Fund was created to provide long-range, systematic advocacy for all children in the fields of health, education, juvenile justice, the handicapped, foster care, day care and child development.
An Epidemiologic Approach to School Absenteeism
Authors: Berganza Carlos E. , Anders Thomas F.
Published: December 2021

For pediatricians and family physicians who examine children with multiple physical complaints associated with school absenteeism, there are few guidelines to aid in proper diagnosis and management. Clusters of demographic and psychosocial variables associated with patterns of absenteeism might differentiate subgroups of school avoidance, which would enhance diagnosis and disposition. In this study, we analyze the absentee rates of 1,088 seventh graders in the Palo Alto Unified School District. A high absentee group and a low absentee group are identified and traced backward to the first grade and forward to the eighth grade. Absentee patterns are analyzed. A methodology is applied which subdivides the groups into further potential categories of risk.
Neonatal Mortality
Authors: Talbot Yves
Published: December 2021

I was very interested by Dr. Wegman's article on vital statistics (Pediatrics 58:793, December 1976). Nevertheless, I would like to share some reservations that I have concerning the inference he made regarding the decrease in neonatal mortality: "The steady decline in the neonatal mortality rate, almost as rapid as that of the post-neonatal rate, does imply that care of the neonate has improved."

I would like to review the definition of neonatal mortality, enumerate some of the factors influencing it, and cite examples of the importance of those factors.
Hemorrhagic Retinopathy in a Patient With Cystic Fibrosis
Authors: Rimsza Mary E. , Hernried Lucy S. , Kaplan Allen M.
Published: December 2021

There is an error on the cover of the September issue of Pediatrics. The article "Hemorrhagic Retinopathy in a Patient With Cystic Fibrosis" by Rimsza et al, begins on page 336, not page 366.
Group B Streptococcal and Pneumococcal Sepsis in Newborn Infants: The Role of Pneumococcal Antibody
Authors: Fischer Gerald W. , Bass James W. , Lowell George H. , Crumrine Martin H.
Published: December 2021

The article by Bortolussi et al. on pneumococcal septicemia and meningitis in the neonat (Pediatrics 60:352, September 1977) was of great interest to us, since we have been analyzing the effect of antibody directed against Streptococcus pneumoniae on group B Streptococcus type III. We have recently shown (unpublished data) that antibody directed against S. pneumoniae type 14 precipitates the hot hydrochloric acid-extracted polysaccharide antigen of group B Streptococcus type III. Further studies have shown that this antibody is opsonic for group B Streptococcus type III in an in vitro bactericidal assay and protective in a suckling rat model of group B Streptococcus type III sepsis.1
JUVENILE JUSTICE SYSTEM
Authors: Harris L.
Published: December 2021

Today, when some critics of our juvenile-justice system are complaining that the system is incompetent in dealing with violent young criminals, other critics are complaining that it is showing amazing efficiency in locking up—often for long periods—troubled young people who have not been charged with committing any crime, violent or otherwise. Such young people, they point out, represent approximately forty per cent of the hundred thousand-odd children who will be sent to jail this year for at least twenty-four hours and of the twelve thousand who will be placed in juvenile-detention centers every day. These children, who are variously labelled Persons in Need of Supervision (PINS), Children in Need of Supervision (CINS), Juveniles in Need of Supervision (JINS), or Wayward Minors, depending on the state they live in, will be guilty of nothing more serious than being a burden or a nuisance. They are not juvenile criminals—they have committed no act for which an adult could be prosecuted. Mainly, they are children who are truant from school, who have run away from home, or whose parents (the majority of them poor) find them too difficult to manage. Under one name or another, the PINS judicial category is written into the laws of forty-one states, and children who are assigned to it occupy, according to one estimate, as much as forty-one per cent of the case load of juvenile courts....

Underlying all the state statutes [is] the doctrine of parens patriae drawn from English chancery law—that the court could act to resolve the problems of troubled children as if it were a parent.
Dietary Fluoride Supplementation for the Prevention of Caries
Authors: Newbrun Ernest
Published: December 2021

Fluoride supplements are effective in preventing dental caries if conscientiously taken on a daily basis from birth until at least 12 to 14 years of age. The optimal dose depends on the child's age and the existing fluoride concentration in the water supply. A dosage schedule is recommended that decreases the dose of fluoride in infancy and that is inversely related to the concentration of fluoride in the drinking water.
Pulmonary Function Abnormalities in Asymptomatic Children After Hydrocarbon Pneumonitis
Authors: Gurwitz Dennis , Kattan Meyer , Levison Henry , Culham J. A.G.
Published: December 2021

To assess the effect of hydrocarbon pneumonitis on the developing lung, we studied the pulmonary function of 17 asymptomatic children, 8 to 14 years after the initial insult. Fourteen of the 17 subjects (82%) had one or more pulmonary function abnormalities, the most frequent being a high volume of isoflow. Volume of isoflow, ratio of residual volume to total lung capacity, slope of phase III, flow rates at 50% and 25% of vital capacity and 60% of the total lung capacity, one-second forced expiratory volume, and maximum midexpiratory flow rate differed significantly (P < .05) from values in control groups. Closing volume and closing capacity were not significantly different. Residual abnormalities present in children after hydrocarbon pneumonitis can be explained on the basis of small airway obstruction and/or loss of elastic recoil. These children may be at risk for the development of chronic lung disease as adults when they are exposed to exogenous factors such as air pollution or smoking.
Complete Heart Block in Epstein-Barr Myocarditis
Authors: Reitman Milton J. , Zirin Heddu J. , DeAngelis Charles J.
Published: December 2021

The clinician must recognize that the Epstein-Barr virus can affect the conduction system of the heart. Therefore, children with infectious mononucleosis who develop bradycardia or hypotension deserve careful cardiac evaluation, including serial ECGs. Pacemaker therapy may be necessary in the treatment of life-threatening bradyarrhymias.
Immunization Data Tracking
Authors: Laws Harry F.
Published: December 2021

Because the number of unimmunized children seems to be rising, the American Academy of Pediatrics has called upon physicians caring for children to develop their own best method to insure completion of immunizations at the recommended time (News and Comment 28:7, October 1977). Follow-up, they say, is the clear responsibility of any physician or institution that undertakes the care of children.

Because of our relatively closed military community at Ellsworth Air Force Base, we have been able to develop the following workable system for tracking childhood immunizations.
Routine Chest X-ray Examination?
Authors: Baker David H. , Berdon Walter E.
Published: December 2021

In reference to the article by Sane et al. entitled "Value of Preoperative Chest X-ray Examinations in Children"

(Pediatrics 60:669, November 1977), we would like to know if the authors broke down the abnormalities by age group—for instance, five-year segments. If so, did a preponderance of abnormalities of any variety occur at any particular age? We believe that should be stated, as it would strengthen their thesis if there was no difference between 0 and 19 years of age.
Letter To The Editor
Authors: Burch P. R. J.
Published: December 2021

Dr. Garn and his colleagues have found a crudely linear "dose-response" relation between maternal smoking and various measures of newborn size and prematurity. I regret I cannot agree with them that their findings stretch a constitutional explanation to the uttermost. We can distinguish at least two types of smoker: the so-called social or nonconstitutional smoker and the habituated or constitutional smoker. At low levels of smoking the former type will predominate, but at high levels the latter will.
Letter To The Editor
Authors: Speck William T.
Published: December 2021

We are pleased to respond to the questions raised by Dr. Herrera regarding our article. Dr. Herrera sites three references to support his statement, "We know of the effectiveness of triple dye in controlling staphylococcal colonization and infection." Our interpretation of these articles is somewhat different than that of Dr. Herrera. The first two references are morbidity and mortality reports commenting on the use of hexachlorophene and nursery staphylococcal disease.1,2 No reference is made in these articles to triple dye.
McATEE WINS HENRY K. SILVER AWARD
Authors: H. R. J.
Published: December 2021

Patricia Rooney McAtee, Ph.D., was the recipient of the Henry K. Silver Award of the National Association of Pediatric Nurse Associates and Practitioners. The award, presented on October 22, 1978, was given for significant contributions to child health care and for the furtherance of the nurse practitioner movement's goals and objectives.

Dr. McAtee has been a member of the faculty of the School of Nursing and the School of Medicine of the University of Colorado. She was one of the co-developers of the school nurse practitioner program, and is president of the National Board of Nurse Practitioners and Associates, which she was instrumental in developing.

Patricia McAtee has been widely recognized for her contributions in the field of child health care. She was one of the first nurses to be elected to the Institute of Medicine of the National Academy of Sciences and served on its committee to develop manpower policy for primary health care. She has been selected as a member of Who's Who of American Women and of Who's Who in America. She is a member of the Editorial Board of Pediatric Nursing and is the author of numerous articles which have appeared in nursing, medical, and school health journals.

Dr. McAtee has been a pioneer in the development of the role of the Pediatric Nurse Practitioner/Associate in the delivery of primary child health care. She has been a major contributor to the concept of team delivery service and has been instrumental in promoting collaboration between medicine and nursing to provide more comprehensive child health care.
Corticosteroids and Respiratory Distress Syndrome: Status 1979
Authors: Ballard Philip L. , Ballard Roberta A.
Published: December 2021

The pioneering report of Liggins and Howie1 on the use of antepartum glucocorticoid treatment to prevent respiratory distress syndrome (RDS) appeared in this journal just over six years ago. Their article stimulated a number of subsequent investigations regarding the efficacy, safety, and mechanism of this prophylactic treatment. Publication of the articles by Papageorgiou et al2 and by Taeusch et al3 in this issue of Pediatrics, along with the recent report of Block et al,4 now provides three additional prospective, controlled trials with synthetic glucocorticoid, all of which confirm the observations of Liggins and Howie.1.5 In addition, a number of retrospective, nonblind studies also support the usefulness of prenatal steroid therapy.6-10
International Year of the Child—1979
Authors: H. R. J.
Published: December 2021

The following two commentaries were solicited to acquaint pediatricians with plans in the United States (Aldrich) and in Europe (Wagner) for implementing The International Year of The Child—1979 (IYC-79). Plans were not solicited from other areas of the world, not because of lack of activity—for I have heard that several other areas of the world have extensive plans—but because I did not know whom to contact. As is evident from Aldrich's commentary, the United States is just now starting, and its activity is, to date, largely a series of meetings of agencies. In contrast, Europe has a variety of interesting projects already in action.
The United States and the International Year of the Child
Authors: Aldrich Robert A.
Published: December 2021

Readers of Pediatrics are among the most effective advocates for children; as pediatricians, our primary focus is on children's health. It is evident that many of the forces that shape children's health are to be found throughout society and frequently are beyond the control of individual children or their families. The advancement of child health in the United States increasingly demands both individual effort by health professionals in the diagnosis and treatment of illness, and community activities focused on health problems, such as the prevention of vehicular accidents, that depend more on the design and function of cities than on biology and medicine.
Environmental Contamination of Continuous Drip Feedings
Authors: Schreiner Richard L. , Eitzen Harold , GfelI Mary A. , Kress Sharon , Gresham Edwin L. , French Morris , Moye Lemuel
Published: December 2021

Continuous gastric and transpyloric feeding techniques have been advocated for low birth weight infants, but bacterial surveillance studies of these systems have not been reported. A preliminary investigation in our nursery showed that 176(33%) of 576 formula samples obtained from the drip chaimber were contaminated. Using the same feeding system with a broth of Escherichia coil simulating the infant's stomach, none of 83 specimens of formula was contaminated, thereby eliminating the ascending route as the bacterial source. Five of 142 bottles of formula that were opened and exposed to room air for eight hours grew positive cultures. A prospective study of 115 infants showed that 354 (36%) of 976 cultures grown from material taken from formula drip chambers were positive; the presence of a vacuum flutter valve in the reservoir and the number of times formula was added to the chamber did not significantly affect the incidence of positive cultures. Milk reservoirs changed every 24 hours did not have a significantly different contamination rate from those changed every 12 hours. Results of cultures grown from organisms taken from the hands of nurses on the intensive care unit showed a high incidence of organisms that were similar to those cultured from the feeding chambers. This study demonstrates a very high rate of bacterial contamination of infant formulas administered by continuous drip and emphasizes the need for meticulous care in formula-handling techniques.
A New Device for Diagnosis and Treatment of Neonatal Pneumothorax
Authors: Shutack John G. , Wagaman Marcia J. , Moomjian Ara S. , Eavey Ronald D. , Shaffer Thomas H. , Fox William W.
Published: December 2021

A new closed-system device for the diagnosis and treatment of pneumothorax was evaluated in ten New Zealand white rabbits and compared with an open-system needle. The closed-system device proved to be safe for diagnostic thoracentesis. There were no pneumothoraces as a result of the procedure with the closed-system device as confirmed by chest roentgenograms and pleural pressure measurements. In contrast, 70% of the diagnostic thoracenteses with the open-system needle were associated with pneumothorax documented by x-ray films and a significant increase in mean pleural pressure. The new apparatus was more efficacious for evacuation of pneumothoraces because complete air removal occurred in 90% of the rabbits as compared with 60% of trials with the open-system needle. If the efficacy of the new closed-system device proves to be good in human infants, the pediatrician encountering a tension pneumothorax in the newborn can use a completely assembled system that is safe for diagnosing and treating this acute life-threatening condition.
Tropical Pyomyositis: A Case Report and Review
Authors: Goldberg Joel S. , London William L. , Nagel Denise M.
Published: December 2021

Tropical pyomyositis is a disease of skeletal muscle characterized by single or multiple abscesses. The infective organism is most often penicillin-resistant Staphylococcus aureus. Only recently have case reports appeared in the literature from temperate zones; however, this disease is common in the tropics. This report reviews the literature and describes a child from rural North Carolina in whom tropical pyomyositis developed after incision and drainage of a furuncle.
Febrile Seizures
Authors: Majer Lani Smith , Charney Evan , Roberts Kenneth
Published: December 2021

We read and thoroughly discussed the report by Wolf et al (Pediatrics 59:378, March 1977) and wish to commend these authors for their well-planned study and the wealth of data that it generated. However, there are several serious limitations in the usefulness of their results.

While the authors identify the "major influence on pediatric practice" that has resulted from Livingston's recommendation1 to distinguish a simple febrile seizure from a seizure with fever, they fail to make this distinction when analyzing their data.
Varicella Vaccine
Authors: Zaia John A. , Levin Myron J.
Published: December 2021

Kempe and Gershon in a commentary on the varicella vaccine (Pediatrics 60:930, December 1977) enumerate the factors that might influence the development of such a vaccine. They state that zoster immune globulin (ZIG), which can modify chickenpox in susceptible immunosuppressed children exposed to the varicella-zoster virus, is often not available. However, we wish to point out that varicella-zoster immune globulin (VZIG) has now been prepared from selected outdated normal blood in quantities that could meet the needs of these children in the foreseeable future.1
Letter To The Editor
Authors: Kempe C. Henry , Gershon Anne A.
Published: December 2021

The studies of Zaia et al demonstrating a practical method for preparation of hyperimmune globulin, varicella-zoster immune globulin (VZIG), for passive immunization against varicella are encouraging. Consequently, in the future, it should be possible to obtain VZIG for high-risk children who have known exposures to varicella-zoster virus.

However, we believe that history has demonstrated that passive immunization is rarely a substitute for active immunization, and varicella is no exception to this rule. Passive immunization will be of no value if (1) persons are unaware that they were exposed or (2) they wait too long after exposure before notifying their physician.