bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional Balance Studies in Very Low-Birth-Weight Infants: Role of Soy Formula
Authors: Shenai Jayant P. , Jhaveri Banoo M. , Reynolds John W. , Huston Robert K. , Babson S. Gorham
Published: December 2021

Although a soy-based lactose-free infant formula is sometimes used for feeding very low-birth-weight infants, the nutritional adequacy of this diet has not been thoroughly investigated. This study used the metabolic balance technique to compare nutrient retention rates in 19 very low-birth-weight (<1,530 gm) infants fed either a soy-based formula or a conventional milk-based formula. Serum chemistries and anthropometric measurements were assessed serially. The soy isolate supplemented with methionine as the sole dietary protein appeared to be adequately utilized, and nitrogen retention rates comparable to fetal accretion rates could be achieved in soy-fed infants in the limited period of study. The absence of lactose in the diet of soy-fed infants did not interfere with calcium metabolism. However, phosphorus absorption was diminished with the feeding of soy formula, which resulted in relative hypophosphatemia. Although the soy-fed infants showed increased renal conservation of phosphorus during the study period, the lesser absorption may, over time, stress phosphorus homeostatic control mechanisms. It is concluded that routine use of soy formula without specific therapeutic indications is undesirable in feeding very low-birth-weight infants. Extended use of such a formulation needs to be monitored for potential adverse effects on skeletal mineralization.
Indomethacin Treatment for Symptomatic Patent Ductus Arteriosus: A Double-Blind Control Study
Authors: Yanagi Ruth M. , Wilson Allen , Newfeld Edgar A. , Aziz Kalim U. , Hunt Carl E.
Published: December 2021

A double-blind control study was designed to determine the efficacy and safety of indomethacin treatment of patients with symptomatic patent ductus arteriosus. Infants with severe respiratory distress syndrome and symptomatic patent ductus arteriosus were eligible for this prospective study if the ratio of left atrial/aortic root diameter remained ≥ 1.3:1 following a 24-hour period of medical management. Thirty-nine eligible infants were randomly assigned to the control or indomethacin group and given 0.2 mg/kg of enteral indomethacin or placebo in a double-blind manner. Second and third doses were administered at 24-hour intervals in phase 1 (17 patients), and at eight-hour intervals in phase 2 (22 patients). The 75% patent ductus arteriosus closure rate with indomethacin treatment in phase 1 was not statistically significant due to a 44% spontaneous closure rate in the control group. In phase 2, however, 85% of the indomethacin group demonstrated patent ductus arteriosus closure vs only 11% in the matched control group (P .01). Although no indomethacin side effects occurred in phase 1, in phase 2 indomethacin administration was associated with minimal, but statistically significant, transient impaired renal function and, in three infants (23%), mild upper gastrointestinal bleeding. In summary, enteral administration of three 0.2 mg/kg indomethacin doses at eight-hour intervals thus appears to be a safe and effective alternative to surgical closure.
Use of Groups in Well Child Care
Authors: Osborn Lucy M. , Woolley F. Ross
Published: December 2021

A controlled study was conducted to examine the use of groups for well child care in the office setting. Group visits were compared to traditional visits by assessing the efficiency, efficacy, content, and process of visits as well as patient satisfaction. The group method was efficient and required no more provider time per pair than individual visits. The group method effectively changed the process and content of the well child visits and was acceptable to the sample population. Few changes in health care utilization were found, but mothers in the experimental group completed more well child visits and sought less advice between visits than mothers in the control group. The group method offers an alternative method of care that is worthy of further investigation and implementation.
Effects of Brazelton Demonstrations for Mothers on the Development of Preterm Infants
Authors: Widmayer Susan M. , Field Tiffany M.
Published: December 2021

Thirty healthy preterm infants were rendomly assigned either to a control group or to one of two experimental groups. The mothers of the first experimental group were present during an administration of the Brazelton Neonatal Behavioral Assessment Scale and were asked to complete the Mother's Assessment of the Behavior of Her Infant Scale (MABI) at birth and weekly for four weeks after the discharge of their infants. The mothers of the second experimental group were not present during the administration of the Brazelton scale, but were asked to complete the MABI scale at birth and weekly for the first month after discharge. The mothers of the control infants did not observe administration of the Brazelton scale or complete the MABI scale, but were asked to complete a questionnaire on the developmental milestones of their infants. At 1, 4, and 12 months of age these infants were visited in their homes by teams of researchers blind to the hypothesis of the study and to the group assignment of the infants. The results at 1 month demonstrated that the experimental groups performed more optimally on the Brazelton scale interactive process items. These infants also received superior ratings on the video-taped feeding and face-to-face play sequences. At 4 months the experimental group infants showed better fine motor-adaptive abilities on the Denver Developmental Screening Test than did the control group. In addition, the face-to-face interaction ratings of the two experimental groups were significantly better than were those of the control group. The Bayley Scales of Infant Development were administered when the infants were 12 months corrected age. The infants of the experimental groups received significantly higher scores on the Mental Development Scale. This study suggests that teaching mothers the amazing skills of their newborns on the Brazelton and MABI scales may facilitate early interactions which, in turn, may contribute to early cognitive development.
Purchasing Infant Shoes: Attitudes of Parents, Pediatricians, and Store Managers
Authors: Weiss Jeffrey , De Jong Allan , Packer Edward , Bonanni Loretta
Published: December 2021

Questionnaires designed to collect data about the purchase of shoes for normal infants were completed by 104 parents in a university ambulatory unit, 127 practicing pediatricians, and 36 shoe store managers. Infants received their first pair of walking shoes at an average age of 8.1 months (range: 4 to 12 months) and at an average cost of $14.56 (range: $2 to $43). Most of these shoes had laces (95%), high tops (87%), hard soles (74%), and special arch supports (50%). Of the 104 children, 73 had shoes before they were walking (average cost: $13.21) and 35 wore walking shoes before they were even standing (average cost: $12.68). Parents obtained much more information about shoes from friends and relatives than from physicians. Those parents who obtained most of their information from salespersons spent the most for shoes. The average cost of shoes recommended by store managers was $18.74. Although 77% of pediatricians felt that inexpensive canvas sneakers are adequate, only 28% of the salespersons and 37% of the parents believed that wearing sneakers is healthy.
Development of Meningitis During Therapy with Cefamandole
Authors: Aronoff S. C. , Thomford W. , Bertino J. S. , Speck W. T.
Published: December 2021

Cefamandole nafate is a relatively new cephalosporin approved for use in pediatric patients. This compound offers certain advantages over previously approved cephalosporins including its in vitro antimicrobial activity against β-lactamase-producing Haemophilus influenzae. The purpose of this report is to describe a potential hazard associated with the use of this and closely related antimicrobial agents in life-threatening bacterial infections.

CASE REPORT

This was the first Rainbow Babies and Childrens Hospital admission for this 7-month-old boy with a ten-day history of fever and irritability. Seven days prior to admission he was seen by a local physician for fever. No source of infection was noted and the infant was treated with 300,000 units of intramuscular procaine penicillin.
Does the Early Application of Silver Nitrate Impair Maternal Attachment?
Authors: Butterfield Perry M. , Emde Robert N. , Svejda Marilyn J.
Published: December 2021

In a statement from the American Academy of Pediatrics (AAP) on "Prophylaxis and Treatment of Neonatal Gonococcal Infections" (Pediatrics 65: 1047, 1980), it was suggested that eye prophylaxis might be delayed up to one hour after birth in order to facilitate maternal attachment. Cited in the AAP statement was our 1977 study that demonstrated that silver nitrate administration in the delivery room decreases eye openness in the newborn and inhibits visual response within the first hour after birth.1

The eyes have been cited as central to the baby's ability to solicit affection.2-4 However, there has been little systematic information available to define the role of eye-to-eye contact in the attachment process.
Letters to the Editors
Authors: Hellerstein Stanley , Duggan Eileen
Published: December 2021

We want to respond to two of the issues raised in Dr Blackman's letter. The first is that the early introduction of solid foods would have prevented the occurrence of dietary chloride deficiency in the infants ingesting chloride-deficient Neo-Mull-Soy. The Table shows the age at which solid foods were introduced into the diet of 11 of the 12 infants described in our paper.1 Solid foods were introduced into the diets of seven of 11 of the infants prior to 5 months of age.
Multiple Carboxylase Deficiency: Clinical and Biochemical Improvement Following Neonatal Biotin Treatment
Authors: Wolf Barry , Hsia Y. Edward , Sweetman Lawrence , Feldman Gerald , Boychuk Rodney B. , Bart Robert D. , Crowell David H. , Di Mauro Robert M. , Nyhan William L.
Published: December 2021

Multiple carboxylase deficiency is characterized by deficient activities of three biotin-dependent enzymes, propionyl coenzyme A carboxylase, pyruvate carboxylase, and β-methylcrotonyl coenzyme A carboxylase. A newborn infant was seen with metabolic ketoacidosis, hyperammonemia, organic aciduria, seizures, and coma. Multiple carboxylase deficiency was subsequently confirmed by enzyme activity determinations in his peripheral blood beukocytes and cultured skin fibroblasts. The infant's neurologic and metabolic status improved markedly within a few days of administration of pharmacologic doses of oral biotin. His EEG, which was distinctly abnormal, became normal; his extensive computed tomography scan changes resolved, with the exception of ventricular dilation, over the next two months. After two weeks of biotin treatment the excretion of abnormal organic acid metabolites was reduced and his carboxylase activities increased to the normal range. However, the activities of these enzymes increased only to 30% to 55% of normal in fibroblasts incubated in supplemental biotin. This partial correction of enzyme activity differs from that observed in other individuals with multiple carboxylase deficiency and suggests biochemical heterogeneity in this disorder. Prompt diagnosis and intervention can avert some of the pathologic complications of this biotin-responsive condition.
Breast-feeding and Contraception
Authors: Segal Sydney , Pruitt Albert W. , Anyan Walter R. , Hill Reba M. , Kauffman Ralph E. , Mofenson Howard C. , Shinefield Henry R. , Singer Harvey S. , Weinberger Miles M. , Ballin John C. , Catz Charlotte , Farchione Louis , Freeman Martha M. , Frigoletto Fredric , Penna Richard P. , Licata Sam A. , Oakley Godfrey , Sawchuk Steven
Published: December 2021

Emphasis on the advantages of breast-feeding to the infant and to the nursing mother has been accompanied by resurgent interest in this practice. Although breast-feeding has many desirable features, the needs of the lactating mother and her nursing infant may not always be complementary. Possible competition between the mother's requirement for adequate contraception and the infant's nutrition or maturation is an important example. For this reason, the relationship between breast-feeding and various forms of contraception has been reviewed.

LACTATIONAL AMENORRHEA

Nursing mothers experience lactational amenorrhea of longer duration than postpartum amenorrhea of women who do not breast-feed their infants.1-3 In addition to a decline in maternal estrogen levels following delivery, hyperprolactinemia— enhanced by suckling—facilitiates the onset of breast milk production.4,5 Depending to some extent on the frequency of breast-feeding, modestly raised prolactin levels may be maintained for several or many months post partum.4,6-8 Many studies suggest that prolactin exerts antagonistic effects on the secretion and actions of gonadotropins, and lactational amenorrhea seems to parallel the presence of hyperprolactinemia.7,8 As breast-feeding continues, the prolactin levels usually return to normal, with some episodic increases occurring in response to suckling. The contraceptive action provided by breast-feeding alone is well established. When breast-feeding is used exclusively and amenorrhea exists, ovulation usually does not occur before the end of the tenth postpartum week.3 However, this contraceptive effect is not universal; 5% to 10% of women with lactational amenorrhea become pregnant, and an even greater proportion of nursing mothers who have reinitiated menstruation become pregnant.2,9 These data indicate that women who want to breast-feed and also avoid pregnancy need to use contraception for complete protection, beginning about four to five weeks post partum when breast-feeding is firmly established.9
Age-Specific Risks of Varicella Complications
Authors: Preblud Stephen R.
Published: December 2021

Previous estimates of the age-specific risks of varicella-associated encephalitis and death (the only two varicella complications for which national data are available) have been based on age data for varicella cases from only three reporting areas. In an attempt to estimate more accurately the age-specific risks, 1978 age data for varicella cases were solicited from state epidemiologists. These age-specific data were compared to those from the three original reporting areas and from the National Center for Health Statistics Health Interview Survey (HIS) for the time period 1972 to 1978. The age distribution of state and HIS cases was then compared with that of encephalitis cases and deaths reported between 1972 and 1978 to the Centers for Disease Control and the National Center for Health Statistics, respectively. Despite differences in the number and distribution of varicella cases, both sources clearly identified those ≥20 years of age as having the greatest risk of varicella encephalitis or death. Young children also were at increased risk. A number of problems with the reliability and accuracy of the data indicate that more specific data are needed to delineate further the groups most at risk of varicella complications who might benefit most from vaccination, and to evaluate accurately the effects the vaccine might have.
Gastroesophageal Reflux-Associated Recurrent Pneumonia and Chronic Asthma in Children
Authors: Berquist William E. , Rachelefsky Gary S. , Kadden Mark , Siegel Sheldon C. , Katz Roger M. , Fonkalsrud Eric W. , Ament Marvin E.
Published: December 2021

Forty of 82 patients with recurrent pneumonias and/or clinical asthma were found to have gastroesophageal reflux (GER) by the criteria of two or more of five tests positive for GER. Of 36 patients with GER followed for response to therapy, 32 patients attempted medical therapy and four had fundoplications. Ten of 32 (31%) patients on medical therapy had improvement in symptoms but none became asymptomatic. Twenty patients who failed a trial of medical therapy also had fundoplications for a total of 24 patients surgically treated. Of these, 22 (92%) had improvement or became asymptomatic. All seven patients with diagnosed GER and recurrent pneumonias responded to medical antireflux management or fundoplication. GER is an important treatable cause of recurrent pneumonias and/or chronic asthma in children.
Apgar Scores as Predictors of Chronic Neurologic Disability
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: December 2021

Apgar scores were recorded at one and five minutes for approximately 49,000 infants, and at ten, 15, and 20 minutes for babies who did not achieve a score of 8 or higher at five minutes. These children were followed to the age of 7 years. Low Apgar scores were risk factors for cerebral palsy, but 55% of children with later cerebral palsy had Apgar scores of 7 to 10 at one minute, and 73% scored 7 to 10 at five minutes. Of 99 children who had Apgar scores of 0 to 3 at ten, 15, or 20 minutes and survived, 12 (12%) had later cerebral palsy; 11 of the 12 were also mentally retarded (in ten, IQ < 50) and half had seizure disorders. Eight children who survived after having very low late Apgar scores and who did not have cerebral palsy had lesser but significant disabilities. Of the children who had Apgar scores of 0 to 3 at ten minutes or later and survived, 80% were free of major handicap at early school age.
A PLEA TO GIVE WEAKLY CHILDREN A FAIR CHANCE BY WILLIAM FARR (1865)
Authors: C. T. E.
Published: December 2021

William Far (1807-1883) ranks with John Graunt (1620-1674) for his contributions to medical statistics. He was the first to express mathematically the rise and fall of epidemic disease by applying statistical methods to epidemiology. That he also had a deep concern for the frail and premature infant is evident in the following plea directed toward the medical audience.

Great qualities of soul are often hidden in the frail child. One Christmas day a premature posthumous son was born in England of such an extremely diminutive size, and apparently of so perishable a frame, that two women who were sent to Lady Pakenham at North Witham, to bring some medicine to strengthen him, did not expect to find him alive on their return. He would inevitably have been consigned to the caverns of Taygetus if the two women had carried him to Spartan tryers. As it was, the frail boy grew up into Newton, lived more than four-score years, and revealed to mankind the laws of the universe. If he had perished, England would not have been what it is in the world. In Paris one evening a puny child in a neat little basket was picked up: he had been left at the church door, the commissary of police was about to carry him to the foundling hospital, when a glazier's wife exclaimed: "You will kill the child in your hospital, give him to me; I have no children, I will take care of him."

She cherished her boy, poor as she was, until some one, perhaps his father, settled a small annuity on his life, with which he was educated at the Mazarin College, where he displayed the early genius of a Pascal: it was D'Alembert, to whom we are indebted for a new calculus, for the grand introduction to the Cyclopaedia, and for innumerable physical discoveries.
Mechanical Vibration in Neonatal Transport
Authors: Shenai Jayant P. , Johnson Glen E. , Varney R. Victor
Published: December 2021

Mechanical vibration encountered in land transports was assessed objectively through measurement of vertical acceleration experienced by neonates in transit. Vibration was most predominant in the hazardous low frequency range of 3 to 18 Hz. The peak acceleration amplitudes (intermittent thrusts) ranged from 5 to 13 m/sq sec. The root mean square acceleration (averaged vibration) ranged from 2 to 6 m/sq sec. These vibration levels are high when compared with adult vibration tolerance limits, and may jeopardize the safety of the transported infants, particularly in long-distance transports. Further research is needed to understand the possible effects of mechanical vibration in neonates and to define safe vibration thresholds in all modes of transport. Careful evaluation of vibratory stress and its attenuation in newer designs of transport equipment may be desirable to enhance the safety of the transported infants.
Aspergillus Endocarditis in Childen: Case Report and Review of the Literature
Authors: Barst Robyn J. , Prince Alice S. , Neu Harold C.
Published: December 2021

Aspergillus fumigatus endocarditis developed in a 2½-year-old girl after repair of tetralogy of Fallot. There have been 14 other cases of Aspergillus endocarditis in children described in the literature. Fever and embolic phenomenon, particularly to the CNS, were the most common presenting manifestations. Consumptive coagulopathy developed in this patient as it has in other children and should suggest the diagnosis of Aspergillus endocarditis inasmuch as blood cultures are uniformly negative. Antemortem diagnosis was made in four of 15 patients. Only one patient survived the infection. Environmental surveillance is crucial when a case is encountered. Survival of the infected patient occurs only with early diagnosis and surgical removal of the infected tissue.
Infant Pneumonitis Associated with Cytomegalovirus, Chlamydia, Pneumocystis, and Ureaplasma: A Prospective Study
Authors: Stagno Sergio , Brasfield Dana M. , Brown Mary B. , Cassell Gail H. , Pifer Linda L. , Whitley Richard J. , Tiller Ralph E.
Published: December 2021

In a prospective study of 104 infants between 1 and 3 months of age hospitalized with pneumonitis, 65 (63%) had evidence of infection with one or more potential respiratory pathogens. Single infections were noted in 48 (74%) whereas mixed infections occurred in 17 (26%) of 65 infected infants. The four most common infections were Chlamydia trachomatis (15/59, 25%), Ureaplasma urealyticum (8/38, 21%), cytomegalovirus (21/104, 20%), and Pneumocystis carinii (19/104, 18%). In sharp contrast, the incidence of these infections in control infants was 0% (0/25), 4% (2/49), 3% (3/97), and 0% (0/64), respectively. The clinical, radiologic, and laboratory characteristics of the pneumonitis syndrome associated with Chlamydia, cytomegalovirus, and Pneumocystis were indistinguishable from each other. Patients with mixed infections had a more severe pneumonitis as measured by the occurrence of apnea and the need of oxygen therapy and mechanical ventilation. The patients enrolled in this study are being followed-up to determine the longitudinal course of these infections.
Teaching Self-Management Skills to Asthmatic Children and Their Parents in an Ambulatory Care Setting
Authors: Fireman Philip , Friday Gilbert A. , Gira Cathy , Vierthaler Wanda A. , Michaels Lois
Published: December 2021

A program designed to teach self-management skills to asthmatic children and their parents was performed by a nurse-educator utilizing health education techniques. Goals included: (1) reduce frequency and severity of asthma; (2) reduce emergency room visits and hospitalizations; (3) reduce school absenteeism; (4) develop positive family self-help attitudes; and (5) incorporate patient-parent education in an office. After informed consent was obtained, 26 asthmatic children, aged 2 to 14 years, were selected and evaluated. Appropriate asthma management including avoidance, medications, and immunotherapy, if indicated, was initiated for both a study group (13 patients) and a comparison group (13 patients). Symptom and medication diaries were kept for six to 18 months. Educational intervention by a nurse-educator, including four hours of individual instruction, group classes, telephone access, and monitoring for the study patients, resulted in fewer hospitalizations and emergency room visits as compared to control patients, tenfold less school absenteeism, and fewer asthma attacks. Estimated hospital and emergency room costs were much less in the educated group. These results were accomplished by improving comprehension of and compliance with the medical management program by the study patients and their families; more medications were used and therapy for asthma was initiated earlier.
Water Intoxication in Normal Infants: Role of Antidiuretic Hormone in Pathogenesis
Authors: David Ronald , Ellis Demetrius , Gartner J. Carlton
Published: December 2021

Eight infants, 2 to 5 months of age, who were seen with somnolence or irritability, seizures, and hypothermia are described. The symptoms developed following the ingestion of dilute formula. All infants were hyponatremic. Three patients were identified by the symptom complex and were evaluated prior to any therapeutic intervention. Plasma arginine vasopressin concentration and urinary osmolality were either normal or increased despite hyponatremia and decreased serum osmolality. These data, coupled with rapid biochemical and clinical improvement following fluid restriction and/or administration of 3% NaCl, strongly implicate the excessive release of arginine vasopressin in the pathogenesis of this syndrome of water intoxication.
Naturopaths and Childhood Immunizations: Heterodoxy Among the Unorthodox
Authors: Halper Jonathan , Berger Lawrence R.
Published: December 2021

Many families at a community clinic in Seattle reported that they were choosing not to immunize their children at the advice of practitioners of naturopathy. To learn more about this alternate form of health care, a review of the available literature on naturopathy was undertaken and interviews were conducted with individual naturopaths in the state of Washington. Naturopaths vary widely in their training, practices, and philosophy of healing. Many are opposed to routine immunization because they view immunization programs as unnatural, unnecessary, and elitist. Other practitioners, however, did not actively discourage parents from immunizing their children. Pediatricians must be aware of the growing popularity of naturopathic medicine in their care of families, and in their role as advocates for children.
Dental Caries Potential of Liquid Medications
Authors: Feigal Robert J. , Jensen Mark E. , Mensing Candace A.
Published: December 2021

Cariogenicity of seven commonly prescribed liquid medications was studied. Sucrose content of the medications ranged from 0 to 70 gm/100 ml. Initial pH and buffering capacity were measured and found to vary widely among the medications. Intraoral microbial plaque pH changes were determined at intervals for 30 minutes following an oral rinse with each medication. These data were compared with plaque pH changes caused by rinsing with an established cariogenic challenge, 10% sucrose solution. Decreased plaque pH was caused by each medication tested. The extent and duration of the pH drop varied among the medications. Patterns of the pH curves are discussed in relation to sucrose content, endogenous pH, and buffering capacity of the medications. Intraoral pH response to several medications equaled or exceeded that seen when sucrose rinses alone were given. The findings are discussed in relation to dental caries-producing potential of long-term therapy with liquid medications, and two cases are presented that implicate liquid medications as a major etiologic factor leading to rampant dental decay.

It is concluded that health practitioners should be aware of the sucrose content of pediatric medications. Patient education to ensure adequate oral clearance following each dose of medication is an essential first step in minimizing the risk of dental decay posed by long-term therapy with liquid medications.
Nutrition and Lactation
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W.
Published: December 2021

Lactation is a continuation of intrauterine gestation. In both processes, maternal diet plays an active role in the provision of nutrients, maternal nutritional stores and endocrine adaptations serve to buffer the short-term variations in maternal nutritional intake, blood flow plays an overriding role in nutrient transfer to the fetus and newborn infant, and the nutrient demands of the recipient are the highest of any stage in human development.

Human milk is remarkable in its variability. Recent data suggest that the variability often improves the nutrient composition as part of a complex adaptation to the infant's specific needs. A comprehensive survey of the literature on lactation and human milk is provided in two review articles.1,2

NUTRIENTS

Lipids

Milk lipids provide the major fraction of calories in human milk, yet they are the most variable constituent.3 Preceding a nursing, the fluid phase of milk stored within the gland resembles skimmed milk. During the course of a nursing, the contraction of smooth muscle launches the fat droplets. This draught reflex is essential for caloric adequacy for the breast-fed infant.2

Women living under unfavorable socioeconomic conditions have reduced total milk lipid.4-6 There is evidence that supplementing the diets of these women leads to increased milk fat. Under controlled metabolic ward conditions, a high-caloric, high-fat diet can be demonstrated to increase milk fat production.7 The distribution of the spectrum of fatty acids in human milk also is responsive to dietary changes.7-13

Women who are malnourished also produce an excess of 12:0 and 14:0 fatty acids.14
Child Health Associate Programs
Authors: Jones M. Douglas
Published: December 2021

Dr Hoekelman's comment (Pediatrics 67:157, 1981) on the paper by Silver et al. (Pediatrics 67:47, 1981) describing the Child Health Associate (CHA) program at Colorado makes an important point: Similar programs have not been started elsewhere. He then speculates. One of his major points is that a pediatrician, with 11 years of training, is not anxious to give patients to a CHA, with five. I think what he says is unfortunately true. Many pediatricians fear the worst from CHAs.
Fat Digestion in Very Low-Birth-Weight Infants: Effect of Addition of Human Milk to Low-Birth-Weight Formula
Authors: Alemi Behjat , Hamosh Margit , Scanlon John W. , Salzman-Mann Carol , Hamosh Paul
Published: December 2021

The possible compensatory role of human milk lipase in the digestion of dietary fat was examined in a group of very low-birth-weight infants. Fat excretion was studied in 15 preterm infants of gestational age 26 to 33 weeks and birth weight 660 to 1,695 gm. The amount and composition of fecal fat were determined in stools collected for 72 hours. Eight infants were fed Similac 24 LBW exclusively and seven infants were fed a mixture of fresh human milk (40%) and formula (60%). Fat excretion was lower in infants fed a mixture of human milk and formula than in infants fed formula only (4.7% ± 0.50% vs 11.9% ± 1.4% of intake, respectively). Excretion of calcium soaps, when expressed as percent of total fat, was higher in the group fed the human milk-containing diet (18.9% ± 13.5%), than in the group fed formula only (6.8% ± 2.5%); however, the absolute amounts excreted were similar in both groups (65 ± 46 and 45 ± 17 mg/kg/day, respectively). The lower fat excretion in infants fed a mixture of fresh human milk and formula could be related to the lipase present in human milk. These data suggest that human milk lipase probably contributes to the digestion and absorption of dietary fat in the "tiny premature" infant.
Significance of Transient Postnatal Hypothyroxinemia in Premature Infants With and Without Respiratory Distress Syndrome
Authors: Hadeed Anthony J. , Asay Lyal D. , Klein Alan H. , Fisher Delbert A.
Published: December 2021

The significance of relatively low thyroxine (T4) levels in preterm infants with and without respiratory distress syndrome (RDS) was assessed by evaluating the free T4 level, the thyrotropin (TSH) response to thyrotropin releasing hormone (TRH), and intellectual development in infants ≤35 weeks with cord blood T4 concentrations sjlt 6.5 µg/100 ml. Fifty-four (19 well, 28 with RDS, and seven without RDS and sick) of 215 premature infants (25%) and 27 of 8,831 term infants (0.3%) had cord T4 levels sjlt 6.5 µg/100 ml. Serum T4 levels were measured in 39 surviving preterm infants (20 RDS and 19 well) during the first 5 days of life and at 2, 4, 24, and 52 weeks postnatally. Serum total T4 level during the first week was 4.5 ± 0.3 µg/100 ml (mean ± SEM). Free T4 levels ranged from 1.1 to 2.2 ng/100 ml (normal adult range 0.8 to 2.3 ng/100 ml). Administration of TRH resulted in a clear increase in both TSH and T4 levels in all infants. T4 levels increased significantly (r = .70, P sjlt .01) with increasing postnatal age, reaching stable levels by 6 to 7 weeks. Developmental quotients obtained in the infants with low T4 levels were no different from those found in a matched control population at 12 months of age. The low T4, free T4, and TSH concentrations and normal TSH responses to TRH found in these infants are characteristic of hypothalamic (tertiary) hypothyroidism, but differ from classic tertiary hypothyroidism in that the disorder was transient. The normal intellectual development at 12 months of age and the spontaneous increase in T4 levels that occurs over the first six weeks of life suggest that the low T4 levels in these infants reflect a benign relative delay in maturation of hypothalamic-pituitary-thyroid control.
Utility of M-Mode Echocardiography for Early Identification of Infants with Persistent Pulmonary Hypertension of the Newborn
Authors: Valdes-Cruz Lilliam M. , Dudell Golde C. , Ferrara Angelo , Nickles Barbara J.
Published: December 2021

The clinical syndrome of persistent pulmonary hypertension of the newborn (PPHN) still carries high mortality in spite of improved neonatal care. The purpose of this prospective study was to assess the utility of M-mode echocardiography for the early identification of infants with PPHN prior to clinical deterioration. Echocardiograms of 51 infants who needed fractional inspiratory oxygen (FIO2) ≥0.25 to maintain adequate Pao2 within 36 hours of life were compared to those of 115 healthy full-term and preterm newborns. Of the 51 infants, ten had elevated systolic time interval ratios of both ventricles simultaneously (ventricular pre-ejection period to ventricular ejection time [RPEP/RVET ≤0.50, LPEP/LVET ≤0.38J]). All of these newbrns had PPHN that was manifest clinically by 11 to 30 hours of age. The echocardiographic findings preceded clinical deterioration by at least one to five hours in all cases. The other 41 infants had clinical courses consistent with uncomplicated pulmonary disease. These data indicate that systolic time interval ratios, although not accurate measures of pulmonary arterial pressure and/or pulmonary vascular resistance, permit early identification of infants with PPHN and separation from others with uncomplicated pulmonary disease.
ADOLESCENT BLUES
Authors: Anderson Lori
Published: December 2021

A smile

A frown

A laugh

A cry

I'm so mixed up

I wonder why?

Maybe it's just

adolescent blues

I'm not really sad,

just kinda confused!
Daytime Television Viewing by Hospitalized Children
Authors: Guttentag Deborah N. Waldner , Albritton William L. , Kettner Ruth B.
Published: December 2021

To determine whether hospitalized pediatric patients may be inadvertently exposed to excessive amounts of commercial television, a survey of the quantity and quality of daytime television viewing by patients was conducted at the Winnipeg Children's Centre. Television viewing patterns were recorded for 845 patients, each of whom was observed at half-hour intervals between 9 am and 5 pm. The results indicated that the percentage of children viewing television throughout the day ranged from 21% fo 75% with a mean daily weekday viewing time of 3.9 hours per eight-hour survey day. The data indicate that daytime viewing is substantially higher for hospitalized than nonhospitalized children and includes much programming that is directed toward adults. Hospital television viewing was characterized as indiscriminate and excessive, indicating the need to increase staff awareness of the influence of television and, if possible, provide patients with commercial-free, alternative programming.
Childhood Mental Disorders in Primary Health Care: Results of Observations in Four Developing Countries
Authors: Giel R. , de Arango M. V. , Climent C. E. , Harding T. W. , Ibrahim H. H. A. , Ladrido-Ignacio L. , Murthy R. Srinivasa , Salazar M. C. , Wig N. N. , Younis V. O. A.
Published: December 2021

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Colombia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to that encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The results have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.
Use of Intravenous Fat Emulsions in Pediatric Patients
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collip Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W. , Heird William C. , Tomarelli Rudolph M. , Benson John D. , Purvis George A. , LiCari Jerome , Lockhart Haines B. , Saperstein Sidney , Taif Betty , White Philip L. , Egan Mary C. , Cheney Margaret , Pencharz Paul , Moore Melinda , Chopra Joginder , Brown Myrtle L. , Fjellstedt Thorsten J. , Teply L. J. , Kennedy Eileen , Darby William J. , Lewy Peter
Published: December 2021

Intravenous fat preparations are used in the nutrition of those requiring parenteral alimentation. Although parenteral nutrition is recognized as a limited substitute for oral alimentation, and should be used for as short a time as possible, widespread use has resulted in some adverse effects.

Fat has the highest caloric density of any nutrient. In addition, intravenously infused fat emulsions exert negligible osmotic effects. Thus, for a number of years, the possibility of providing calories by the intravenous administration of fat emulsions has been an attractive one. In fact, one of the first attempts at intravenous nutrition was infusion of various nonemulsified oils.1 Approximately 30 years ago, a fat emulsion suitable for intravenous use was developed and used extensively. Although it was efficacious as an intravenous calorie source, it was unstable and the serious, short-term effects of this instability resulted in its withdrawal from the market in the late 1960s.

Subsequently, advances in manufacturing technology allowed preparation of stable fat emulsions, and several such preparations are available today. All currently available emulsions are efficacious calorie sources; moreover, they appear to be extremely stable and have been associated with relatively few adverse effects.2-5 All allow delivery of lipid to patients requiring parenteral nutrition. In fact, they may make it possible to deliver adequate nutrients solely by peripheral vein, thus avoiding in many patients the use of central vein catheters and their associated complications.6 This possibility, plus the possibility of providing linoleic acid and thereby preventing essential fatty acid deficiency, which occurs with fat-free total parenteral nutrition,7,8 has generated considerable enthusiasm for these products.
Adoptive Children in a Dysmorphology Clinic: Implications for Evaluation of Children Before Adoption
Authors: Frank Deborah A. , Graham John M. , Smith David W.
Published: December 2021

Your committee statement on "Adoption and the Right to Know"1 suggests that "the pediatrician should encourage the adoptive parents to obtain as much medical and background history of the birth parents as possible at the time of the adoption." Our ten-year (1967-1977) review of 1,824 records of children referred to the Dysmorphology Unit of the University of Washington provides data to support this recommendation and enhance the pediatric assessment of adoptive children outlined in the AAP manual.2
Hypertrichosis Pinnae in Babies of Diabetic Mothers
Authors: Rafaat Massoud
Published: December 2021

Congenital hypertrichosis of external ears is commonly seen among some populace of Pacific Islands and babies with XYY syndrome. However, we have observed this condition among most of our babies born of diabetic mothers (Figure).

In all of the textbooks of pediatrics and endocrinology, the physical characteristics of these infants are described as follows: "Large and plump babies with increased body

See Images in the PDF File

fat and enlarged viscera with puffy, plethoric facies resembling those of patients who have been receiving corticotropin or a corticosteroid (cushingoid or tomato facies)."
Salicylates and Reye's Syndrome
Authors: Tonsgard James H. , Huttenlocher Peter R.
Published: December 2021

The recent article by Starko et al1 on aspirin in Reye's syndrome prompted us to review this issue in 43 consecutive patients seen at the University of Chicago since January 1975. Salicylate levels or toxicology screens that included measurement of salicylates were performed at the time of hospital admission in 37 of the 43 patients. In 15 patients no salicylates were detected in the urine or blood. In ten of these patients, whereas the salicylate level was zero, there was some recent exposure to aspirin by history, although in some instances aspirin therapy was begun after the onset of vomiting or encephalopathy, or was given only once or twice.
Questions Value of Name Change: RLF/ROP and IF
Authors: Day Richard L.
Published: December 2021

I wish to disagree with the Second International Retrolental Fibroplasia Conference. They wish, as they have written in a recent issue of Pediatrics (67:751, 1981), to "dislodge the established misnomer, RLF." They wish to substitute two names, ROP and IF. I refrain from mentioning what ROP and IF, abominable acronyms, stand for, and go on to what is more important.

The purpose of a name is to describe something so that, in one brief word, a future scholar, investigator, or bookworm can quickly grasp what the writer has in mind.
Annual Summary of Vital Statistics—1980
Authors: Wegman Myron E.
Published: December 2021

Data for this article, as in previous reports,1 are drawn principally from the Monthly Vital Statistics Report,2-5 published by the National Center for Health Statistics. The international data come from the Demographic Yearbook6 and the quarterly Population and Vital Statistics Report,7 both published by the Statistical Office of the United Nations, which has also been kind enough to provide directly more recent data. Except for mortality data by cause and age, which are based on a 10% sample, all the United States data for 1980 are estimates by place of occurrence based upon a count of certificates received in state offices between two dates, one month apart, regardless of when the event occurred. Experience has shown that for the country as a whole the estimate is very close to the subsequent final figures. There are, however, considerable variations in a few of the states, particularly in comparing data by place of occurrence with data by place of residence. State information should be interpreted cautiously.
Racial and Environmental Influences on Fetal Lung Maturation
Authors: Ross Samuel , Naeye Richard L.
Published: December 2021

Claims that fetal lung maturation is more rapid in blacks than in whites were investigated. Histologic measurements of lung maturation and the frequency of hyaline membrane disease were compared in four groups of neonates: 490 South African blacks, 841 Ethiopians, 767 US blacks, and 560 US whites. Lungs matured much more rapidly in the Ethiopian and more slowly in the South African than in the US fetuses. The rate of maturation was about the same in US blacks and whites. Hyaline membrane disease was more frequent in the South Africans and less frequent in the Ethiopians than in either US group. Environmental factors in the mother may explain some of these differences. Lungs matured more rapidly in the fetuses of cigarette smokers than in fetuses of nonsmokers. Half of the US mothers but almost none of the South African mothers smoked during pregnancy. The rate of lung maturation had an inverse correlation with maternal body weights. The South African women were heavier and the Ethiopians lighter than women in the United States.
Long-Term Effect of Phenobarbital on Cognitive Function in Children with Febrile Convulsions
Authors: Wolf Sheldon M. , Forsythe Alan , Stunden Alastair A. , Friedman Robert , Diamond Harriet
Published: December 2021

Psychometric tests were performed on 50 children with a history of febrile convulsions. Twenty-five of these had received daily phenobarbital for a mean of 35 months; 25 had received no phenobarbital. The two groups were matched for sex, age at the time of testing, race, and socioeconomic status. The tests used were the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), the Matching Familiar Figures Test, and the Children's Embedded Figures Test. There were no significant differences in test results between the two groups.
Conceptions of Illness in Young Adolescents
Authors: Millstein Susan G. , Adler Nancy E. , Irwin Charles E.
Published: December 2021

This study examined conceptions of illness in young adolescents. A group of 77 urban junior high school students aged 11 to 15 years were asked for their definitions of illness. Themes occurring in definitions of illness were identified and coded according to a previously developed coding scheme. Evidence in support of a developmental process underlying conceptions of illness was found by examining adolescents' definitions and comparing them with child and adult norms established in prior research. Results for adolescents showed the frequency of use of specific themes to fall between child and adult norms. The strongest evidence in support of a developmental trend was seen in definitions of illness pertaining to changes in daily activities. However, the relative frequency of adolescents' definitions was more like that of children than adults, indicating that whereas adolescents used a greater frequency of adult-like themes, they did so within a framework more descriptive of children. Qualitative aspects of definitions of illness showed age-linked differences with adolescents generating more adult-like, conceptually sophisticated definitions than children. In addition to developmental differences, similarities in definitions of illness were also found; among all age groups the most common delineators of illness were physical symptoms. Psychosocial themes were less frequently mentioned. Clinicians who discuss with their adolescent patients the ways in which illness affects social interaction may be communicating more effectively than practitioners who focus solely on signs and symptoms of physical disease.