bluuebunny/crossref_metadata_2025 huggingface dataset:
A NASOJEJUNAL TUBE FOR INFANT FEEDING
Authors: Rhea James W. , Kilby John O.
Published: December 2021

Nasojejunal feeding was used in 48 infants and found to be a practical and useful means of feeding premature and otherwise ill infants in whom conventional feeding was judged hazardous. A limp, polyvinyl tube with an outside diameter of 1.5 mm and a .9 mm bore was passed from the stomach through the pylorus. A tiny, reusable gold bead helped weight-direct the tip of the tube.

Full enteral infant feeding can be accomplished nonsurgically for a period of weeks with less regurgitation, aspiration, and gastric distention than seen with gastric tube, gavage, or gastrostomy feeding. In order to avoid the potential dangers inherent in bypassing the pylorus, the need for close attention to the amount, the type, and, especially, the osmolarity of the jejunal feeding is stressed.
Hereditary Adrenocortical Unresponsiveness to ACTH—Another Case
Authors: Monteleone James A. , Monteleone Patricia L.
Published: December 2021

We read with interest the excellent article on hereditary adrenocortical unresponsiveness to ACTH. (Pediatrics, 45:43, 1970) by Drs. Franks and Nance. We recently had a newborn infant with adrenocortical dysfunction, deficient cortisol production, and normal aldosterone production whom we feel fits the syndrome. In previous reports of this syndrome, the earliest age of diagnosis was 2 months. Those children who developed adrenal crisis shortly after delivery died before diagnosis or therapy could be initiated. Because of unusual hyperpigmentation and severe hypoglycemia, we were able to initiate studies necessary to make the diagnosis during the neonatal period.
STUDIES IN CYSTIC FIBROSIS
Authors: Shwachman Harry , Redmond Aileen , Khaw Kon-Taik
Published: December 2021

Early diagnosis and treatment can alter the morbidity and mortality of patients with cystic fibrosis (CF). This conclusion is based on a study of 130 patients in whom the diagnosis was made under the age of 3 months during the 20year period from 1949 to 1969. These patients were observed for a total of 912 patient-years.

The patients were segregated into three groups as follows: Group A (63) were diagnosed prior to the development of symptoms; Group B (13) had mild symptoms; Group C (54) were diagnosed during hospitalization. Immediately following the diagnosis all patients were started on a therapeutic program and followed at regular intervals. There were 29 deaths, 11 in Groups A and B, and 18 in Group C, 8 of which occurred under 1 year of age.

The present clinical status of the 101 surviving children is an follows: 14 are in excellent condition, 71 have mild disease or are in good health, and 12 are moderately or severely ill and have a poor prognosis. For all the 130 patients the calculated survival rate at age 20 is 77%.
ENTEROVIRUSES ASSOCIATED WITH THE HEMOLYTIC-UREMIC SYNDROME
Authors: Ray C. George , Tucker Virginia L. , Harris David J. , Cuppage Francis E. , Chin Tom D. Y.
Published: December 2021

Nine cases of the hemolytic-uremic syndrome and one case of purpura fulminans were studied clinically and virologically. All were thought to represent examples of varying degrees of intravascular coagulation.

Virological studies demonstrated a high frequency of infections with enteroviruses, particularly Coxsackie viruses. Evidence of such infections was found in 7 of the 10 subjects, and similar viral Infections were found among family contacts of 5 of the subjects.

Studies of the various subjects and the available family contacts demonstrated evidence of having recent enteroviral infection in the patient and/or the immediate family in 9 of the 10 subjects studied.

It is suggested that enteroviruses may have a role in initiating the sequence of events involved in the pathogenesis of these illnesses.
AMBULATORY TREATMENT OF LEAD POISONING: REPORT OF 1,155 CASES
Authors: Sachs Henrietta K. , Blanksma Lorry A. , Murray Edward F. , O'Connell Morgan J.
Published: December 2021

Subjects with lead concentrations greater than 50 µg per 100 ml whole blood were referred to a municipal lead poisoning clinic for evaluation. Chelating agents were administered when two blood lead levels were more than 50 µg, or calcium disodium edetate (EDTA) provocative test yielded over 1,000 µg/l of lead in the urine in the succeeding 8 hours. Therapy was on an ambulatory basis. Patients with moderate encephalopathy were hospitalized. Intramuscular EDTA, oral penicillamine, or the two drugs in sequence were given to 582 patients in 1967 and to 573 patients in 1968. Clinical evidence of lead intoxication was present in 103 or 8.9% of the 1,155 patients. Several drug reactions to penicillamine were observed, but none to EDTA, and mortality dropped due to early detection and detoxification of subclinical cases of lead poisoning.
ON A PECULIAR FORM OF INFANTILE CONVULSIONS (HYPSARRHYTHMIA) AS DESCRIBED IN HIS OWN INFANT SON BY DR. W. J. WEST IN 1841
Authors: C. T. E.
Published: December 2021

In a poignant letter to the Lancet in 1841 Dr. W. J. West clearly described infantile spasms and the accompanying mental subnormality. The patient was his own son and the letter below is an anguished appeal for possible help for West's son from readers of the Lancet.

TO the Editor of THE LANCET:-

Sir:-I beg, through your valuable Journal, to call the attention of the medical profession to a very rare and singular species of convulsion peculiar to young children.

As the only case I have witnessed is in my own child, I shall be very grateful to any member of the profession who can give me any information on the subject, either privately or through your excellent Publication.

The child is now near a year old; was a remarkably fine, healthy child when born, and continued to thrive till he was four months old. It was at this time that I first observed slight bobbings of the head forward, which I then regarded as a trick, but were, in fact, the first indications of disease; for these bobbings increased in frequency, and at length because so frequent and powerful, as to cause a complete heaving of the head forward towards his knees, and then immediately relaxing into the upright position, something similar to the attacks of emprosthotonos: these bowings and relaxings would be repeated alternately at intervals of a few seconds, and repeated from ten to twenty or more times at each attack, which attack would not continue more than two or three minutes; he sometimes has two, three, or more attacks in the day; they come on whether sitting or lying; just before they come on he is all alive and in motion, making a strange noise, and then all of a sudden down goes his head and upwards his knees; he then appears frightened and screams out: at one time he lost flesh, looked pale and exhausted, but latterly he has regained his good looks, and, independent of this affection, is a fine grown child, but he neither possesses theintellectual vivacity or the power of moving his limbs, of a child of his age; he never cries at the time of the attacks, or smiles or takes any notice, but looks placid and pitiful, yet his hearing and vision are good; he has no power of holding himself upright or using his limbs, and his head falls without support.
THE SIGNIFICANCE OF DEVELOPMENTAL DENTAL ENAMEL DEFECTS IN NEUROLOGICAL DIAGNOSIS
Authors: Cohen Herbert J. , Diner Harold
Published: December 2021

Dental enamel defects are definitive chronological markers of the probable time of insult to a developing fetus and infant. Enamel defects are easily recognized developmental malformations that reflect physiological changes that alter normal amelogenesis. When the prevalence of enamel defects in different populations was studied, enamel defects were observed to be significantly more common in clinic children with neurological deficits than in clinic children with negative neurological examinations or in nonclinic children from the same general socioeconomic group. Enamel defects were significantly less common in nonclinic children from middle to upper income families than in children from low income families. Enamel defects occurred with greatest frequency in low IQ groups where, as was expected, neurological defects were most common. Chronologically distributed enamel defects are a significant aid in neurological diagnosis since they occur most commonly in brain damaged children and, in addition, may indicate the time of insult to the developing fetus or infant even when the history is reportedly negative.
CARE OF THE CRITICALLY ILL CHILD: THE PROBLEM OF DISSEMINATED INTRAVASCULAR COAGULATION
Authors: Hathaway William E.
Published: December 2021

A critically ill child should be suspected of the complication of disseminated intravascular coagulation when evidence of the following signs and symptoms are present: (1) the potential of a triggering substance or event such as endotoxin, tissue thromboplastin (damaged tissue), endothelial damage, or proteolysis; (2) multiple system involvement producing coma, renal shutdown, respiratory disease, and shock; (3) a bleeding diathesis; and (4) a hemolytic anemia associated with fragmented and burred red cells. Laboratory confirmation should include evidence for depletion of coagulation factors consumed during clotting (i.e., platelets, fibrinogen, and factors II, V, and VIII). Treatment consists of heparinization, replacement of depleted factors if needed, and supportive care, which includes removal of the triggering event.
Infectious Mononucleosis and Reye's Syndrome: A Fatal Case with Studies for Epstein-Barr Virus
Authors: Rahal James J. , Henle Gertrude
Published: December 2021

A 6-year-old boy developed toxic encephalopathy and severe hepatitis following the onset of infectious mononucleosis. The disease was fatal and autopsy showed brain edema, fatty necrosis of the liver, and a mononuclear infiltration of the liver, spleen, lymph nodes, and gastrointestinal tract. Impression smears of these organs and inoculation of organ suspensions into tissue culture failed to demonstrate antigens of the Epstein-Barr virus or to yield cytopathic effect. The patient's serum contained a high titer of antibody to Epstein-Barr virus.
UTILIZATION OF A PEDIATRICIAN IN A COMMUNITY CHILD GUIDANCE CLINIC
Authors: Ackerly William
Published: December 2021

Today's symposium focuses on the use of the pediatrician in a community child guidance clinic. My discussion of that subject will be extended to include the broader subject of total comprehensive care for low-income families. The concept of such care seems to me the most important topic for discussion by physicians engaged in family medicine, whether as independent pediatricians, psychiatrists, general practitioners, or internists, or in neighborhood clinics. I would like to present certain philosophical notions as well as the hard facts in relation to this concept, particularly from my viewpoint as Director of a Community Child Guidance Clinic in a low-income area.

In the philosophical view, comprehensive care is a wish fulfillment and an ideal. In reality, as physicians we do not provide anywhere near the total care for most of the families that we see, particularly in a lowincome area. For example, a teen-ager in the average multiproblem family that comes to our clinic may be a school failure, intoxicated on drugs, consuming alcohol, truant, and delinquent. He probably has come in contact with school guidance counselors, police officers, settlement house workers, family doctors, and now our mental health team, not to mention the agencies which follow this family (e.g., welfare workers, family service, medical clinics, and, maybe, Alcoholics Anonymous). For this teen-ager and his family we must develop a model with both a philosophy and the resources to begin to approach the reality and the ideal of comprehensive care.

At the present time, we only scratch the surface in providing the leadership, coordination, and service necessary to implement what any of us would consider to be true comprehensive care–a myth only approximated even in the wealthier communities.
Hereditary Hydrometrocolpos with Polydactyly in Infancy
Authors: Dungy Claibourne I. , Aptekar Robert G. , Cann Howard M.
Published: December 2021

An infant with hydrometrocolpos, secondary to vaginal atresia, and bilateral polydactyly, the product of unaffected first cousin parents, is presented. Autosomal recessive inheritance for hydrometrocolpos secondary to vaginal atresia is suggested by this case and by a previous report of two sibships each with affected sisters and each issuing from consanguineous parents. A review of the literature reveals the association of hydrometrocolpos, secondary to vaginal atresia, with polydactyly in four additional cases. Early diagnosis and treatment of hydrometrocolpos is emphasized.
Acute Airway Obstruction in Infectious Mononucleosis
Authors: Gutgesell Howard P.
Published: December 2021

Sudden and complete airway obstruction occurred in a 16-year-old boy with tonsillar hypertrophy and pharyngeal exudate secondary to infectious mononucleosis. Clinicians caring for children should be aware of this possibility in the patient with dysphagia, drooling, a muffled voice, and dyspnea, even though objective signs of respiratory difficulty may be absent.
THE MANAGEMENT OF AGENESIS OF THE PHALLUS
Authors: Young Hugh H. , Cockett A. T.K. , Stoller Robert , Ashley Franklin L. , Goodwin Willard E.
Published: December 2021

Personal experience with four cases of complete agenesis of the phallus are recorded. The principal question is whether to raise the newborn infant as a boy or a girl. The answer was deduced from the major psychological and social problems encountered in raising two of these patients as boys. In one of these cases multiple, previous attempts at plastic construction of a phallus had been complete cosmetic failures, and the patient suffered from extreme psychological trauma. A cosmetic and psychological improvement was obtained by covering the existing pedicle flap with scrotal skin.

Both the psychological and surgical considerations have led us to raise two newborn infants with agenesis of the phallus as girls. The testicles were placed in the inguinal region so that the endocrine relationships of childhood were not disturbed. The scrotum was preserved for later use in construction of a vagina. From an unusual case of transexualism, we found that it is possible to obtain a completely normal female appearance by giving estrogens to a normal male at puberty. Feminization will be achieved in a similar manner in these patients with agenesis of the phallus. Following construction of a vagina, these children will be completely normal, female sexual partners, except that they will not be able to reproduce. Furthermore, these children will go through childhood and adolescence with a more acceptable appearance as a girl than they could as a boy.

We place great emphasis on a rapid decision on sex assignment within a day or so after the child's birth. After that the legal problems of sex change and the social problems of ambiguity among relatives and friends are compounded.
INFANT FEEDING IN THE NINETEEN SEVENTIES
Authors: Filer L. J.
Published: December 2021

We are now obviously in what the microbiologist would call a log phase of growth in nutritional knowledge, following a long incubation. In the last two decades infant feeding in the hospital and home has changed drastically, but as yet the changes are largely similar to those observed for other food purchases and use by hospitals and housewives. Prepared formulas have essentially replaced the hospital formula room and the daily home preparation of an infant formula from evaporated milk with added carbohydrate. This is similar in principle to the hospital purchase of pre-prepared foods or meals or the housewife's use of cake mixes.
THE CLINICAL AND BIOCHEMICAL EFFECTS OF EXCESS MAGNESIUM IN THE NEWBORN
Authors: Lipsitz Philip J.
Published: December 2021

The effect of two regimens of magnesium sulfate therapy in the toxemic mother and her newborn is reviewed. When magnesium sulfate is given intramuscularly to the mother, the newborn is usually not compromised by excess magnesium but may be affected. If continuous intravenous infusion of magnesium sulfate is used and especially if given for more than 24 hours, one can anticipate a newborn manifesting all the signs of hypermagnesemia.

Serum levels in the cord blood and serial samples of the newborn do not necessarily correlate with the clinical picture and may be of little diagnostic value.

In contrast to the adult, the newborn does not excrete a magnesium load satisfactorily.

Magnesium toxicity should be recognized and treated as outlined in the infant of a toxemic mother who has received a large dose or prolonged magnesium sulfate therapy.
Pseudomonas Osteomyelitis Following Puncture Wounds of the Foot
Authors: Minnefor Anthony B. , Olson Mary I. , Carver David H.
Published: December 2021

This paper reports three cases of pseudomonas osteomyelitis complicating puncture wounds of the foot. The clinical features which serve to differentiate this entity from hematogenous osteomyelitis are presented along with the therapeutic considerations.
GROWTH STANDARDS IN THE FIRST TWO YEARS OF LIFE BASED ON MEASUREMENTS OF WHITE AND BLACK CHILDREN IN A PREPAID HEALTH CARE PROGRAM
Authors: Wingerd John , Schoen Edgar J. , Solomon Irene L.
Published: December 2021

Measurements of height, weight, and head circumference in the first 2 years of life were obtained on more than 15,000 California children born between 1959 and 1967. The children were from a middle-class, multiracial (66% white, 23% black) population enrolled in a prepaid medical care program; black and white children lived under comparable economic circumstances. The growth curves for height, weight, and head circumference were similar in the two racial groups. The data for the white children agreed more closely with the recent British standards of Tanner than with the widely used older United States standards of Stuart and Meredith.
BICYCLE OWNERSHIP, USE, AND INJURY PATTERNS AMONG ELEMENTARY SCHOOL CHILDREN
Authors: Waller Julian A.
Published: December 2021

Patterns of bicycle ownership and injury were studied over a 4-month period among over 6,000 school children. Two-thirds of the bikes owned were standard style and one-third high rise. Boys more often had high rise bikes. Slightly over 2% of bike owners are injured annually, but no differences were found according to bike style either in injury rate or severity. Bike borrowing and riding double were common factors in the injury events. Injury from spokes and loss of control because of loose handlebars were identified as problems resulting from product design.
GENETICS OF THE MECKEL SYNDROME (DYSENCEPHALIA SPLANCHNOCYSTICA)
Authors: Hsia Y. E. , Bratu M. , Herbordt A.
Published: December 2021

Seven cases in two families are reported of the Meckel syndrome; two sets of male identical twins in one family, and three affected siblings in another. The key features of this syndrome are occipital encephalocele, cleft lip and palate, polydactyly, and polycystic kidneys. Additional malformations frequently found include microcephaly, micrognathia, absence of the olfactory lobes, microphthalmia, absent pituitary with consequent thyroid hypoplasia and suprarenal agenesis, short-limbed dwarfism, microgenitalia or ambiguous genitalia, and accessory spleen. No chromosomal abnormality has been found in this syndrome, although it is otherwise remarkably similar to the trisomy D1 syndrome.

More than 50 cases have been described in the literature that are recognizable as having the Meckel syndrome. Almost half of these were familial, being clustered in sibships. Eight cases tested have all had normal chromosomes. The concordant involvement of identicial twins, and consanguinity of some parents provide further evidence strongly supporting the hypothesis that the Meckel syndrome is a recessively inherited condition which is determined by homozygous expression of a single autosomal gene.

Recognition of this syndrome is important for proper genetic counseling of parents having this risk.

This mutant gene may disrupt normal fetal development by affecting an embryonic organizer system.
"SUICIDE" AS SEEN IN POISON CONTROL CENTERS
Authors: McIntire Matilda S. , Angle Carol R.
Published: December 2021

Of 1,103 cases of poisoning, ages 6 to 18, admitted to 50 poison control centers during 1 year, 13% were considered unintentional, 13% "trips," 26% suicide attempts, and 48% suicide gestures or affect reactions. The youngest age group, 6 to 10, is 63% male, 40% Negro, and about one-half give a history of precipitating stress or current or prior referral for behavior problems. The abrupt increase in self-poisoning in girls at age 12 peaks at age 16, while male paisonings continue to increase with age. An admittedly immature concept of death was retained by 16% of the 17 to 18-year-olds. In the five deaths (mortality 1: 220 hospitalized self-poisonings), lethality of intent was presumed low with death the result of a toxicologic mishap.

The estimate of about 115,000 self-poisonings annually in the United States, ages 6 to 18, defines a mental health problem of the first magnitude, but open to epidemiologic analysis by relatively simple techniques.
HYPERAMMONEMIA DUE TO A DEFECT IN HEPATIC ORNITHINE TRANSCARBAMYLASE
Authors: Sunshine Philip , Lindenbaum Jeffrey E. , Levy Harvey L. , Freeman John M.
Published: December 2021

A 9-year-old girl with vomiting, changes in behavior, coma, and evidence of hepatic dysfunction at 3½ years of age was found to have hyperammonemia and decreased activity of liver ornithine transcarbamylase. When her dietary protein was reduced, she had improvement in her clinical condition and a return to normal of all hepatic function indices. Despite a defect in an enzyme of ornithine metabolism, she did not have hyperaminoacidemia, specifically hyperornithinemia, even when she had hyperammonemia. When she ingested a large amount of ornithine (300 mg/kg) she developed hyperornithinemia and hyperornithinuria. She also had orotic aciduria despite having normal activities of red cell orotidylic decarboxylase and pyrophosphorylase. Treatment with a low protein diet and citric acid supplements has been successful in preventing hyperammonemia and promoting growth and development.
MORBIDITY AND MORTALITY OF INFANTS WEIGHING LESS THAN 1,000 GRAMS IN AN INTENSIVE CARE NURSERY
Authors: Alden Errol R. , Mandelkorn Ted , Woodrum David E. , Wennberg Richard P. , Parks Colby R. , Hodson W. Alan
Published: December 2021

A 5-year experience with 161 infants with birth weights less than 1,000 gm was evaluated to ascertain predictive factors for mortality, cause of morbidity, and status of survivors. There was an overall mortality of 87% which was worse if the initial hematocrit was less than 40%, the blood pressure was less than 40 cm H2O, the Apgar score was low, or if hyaline membrane disease (HMD) was present or assisted ventilation was required. The survival rate was improved by two- to threefold if the Apgar score was greater than 6 and if the infant required no resuscitation. The survival rate was 2 to 3 times normal if rupture of the amniotic membranes preceded labor and if the infant was able to maintain his core temperature. Respiratory difficulties accounted for the highest incidence of morbidity-apnea 84%, HMD 66%. Only two infants of the twenty surviving had definitely abnormal developmental quotients. Intensive care does not appear to have affected survival but may be responsible for an improved outlook for survivors.
UMBILICAL ARTERY CATHETERIZATION: DEMONSTRATION OF ARTERIAL THROMBOSIS BY AORTOGRAPHY
Authors: Neal William A. , Reynolds John W. , Jarvis Charles W. , Williams Hugh J.
Published: December 2021

One hundred consecutive admissions to a neonatal intensive care unit were included in a prospective study designed to ascertain the frequency of clinically silent thrombosis among infants with umbilical artery catheters.

Eighteen of 19 infants (95%) had distinct arterial thrombus formation demonstrated by hand injection of contrast media at the time of catheter removal. In addition, 7 of the 12 patients (58%) who died were found to have clots present by necropsy.

Only one patient had clinical evidence of vascular occlusion prior to the pullout aortogram, though a second infant became symptomatic 4 hours after the study and subsequently died.

Careful selection of patients in whom umbilical artery catheters are inserted is emphasized because of the unexpectedly high incidence of arterial thrombosis associated with this procedure.
URINARY TRACT INFECTIONS IN CHILDREN I. FEMALES AGED 2 THROUGH 14, FIRST TWO INFECTIONS
Authors: Cohen Matthew
Published: December 2021

In January of 1964 a 20-year prospective study of urinary tract infections was begun at the Southern California Permanente Medical Group in Panorama City, California. This paper is concerned with 368 females, aged 2 through 14 years, who had their first infection diagnosed between January 1964 and August 31, 1969.

No benefit could be demonstrated to Sulfisoxazole therapy exceeding 2 weeks for the first infection and 6 weeks for the second infection nor to treating with ampicillin instead of sulfisoxazole.

A higher recurrence rate was found in those patients who, at the time of the first infection, had minimal abnormalities on urinalysis, infection with an organism other than E. coli, fever, or no symptoms.

Recurrences of 40% and 60% were diagnosed after the first two infections respectively. Usually the patients with a recurrent infection were asymptomatic. It is therefore felt that the physician must take an active part in informing the patient of the need to return and contacting her if she fails to do so. The follow-up period should extend for at least 6 years after the last infection.
PROLONGED GIANT CELL EXCRETION IN SEVERE AFRICAN MEASLES
Authors: Scheifele D. W. , Forbes C. E.
Published: December 2021

This study reviews 54 Kenyan children with measles of varying severity. Children with severe measles and extensive staining of the skin had prolonged excretion of giant cells (presumably virus-containing) from their nasopharyngeal mucosa, ranging from 8 to 28 days after start of rash. Children with mild measles excreted giant cells for three days or less, conforming to the North American pattern of illness. Prolonged excretion of giant cells suggests an impaired cellular immune response in these children, which may be a function of their seriously impaired nutrition.
HYPERGLYCINEMIA WITH KETOSIS DUE TO A DEFECT IN ISOLEUCINE METABOLISM: A PRELIMINARY REPORT
Authors: Keating James P. , Feigin Ralph D. , Tenenbaum Stanley M. , Hillman Richard E.
Published: December 2021

A new metabolic defect, clinically mimicking pyloric stenosis, propionic acidemia, and methylmalonic acidemia is described. Although the specific enzymatic defect has not been identified, the infant's response to protein restriction has been excellent. Unfortunately, some evidences of developmental delay persist. Earlier recognition and institution of therapy may, as in allied disorders, be associated with normal physical and intellectual development.
THE GASTROINTESTINAL COMPLICATIONS OF NEONATAL UMBILICAL VENOUS EXCHANGE TRANSFUSION: A CLINICAL AND EXPERIMENTAL STUDY
Authors: Touloukian Robert J. , Kadar Andrew , Spencer Richard P.
Published: December 2021

Two newborn infants having umbilical venous exchange transfusion for Rh incompatibility developed serious gastrointestinal complications preceded by abdominal distention, bilious vomiting, and blood-streaked meconium stools; 21 other infants with similar findings are reviewed. The clinical material suggests that a vascular mechanism, possibly related to hemodynamic alterations accompanying exchange transfusion may be responsible for the gastrointestinal lesions observed. Significant increase in portal venous pressure (0.8 ± 0.3 to 4.5 ± 0.4 mm Hg) during the injection phase of exchange occurred during experimental exchange transfusion via the umbilical vein of newborn piglets. The authors advise roentgen verification of the umbilical vein catheter within the inferior vena cava prior to undertaking exchange transfusion, eliminating the potential risk of portal venous congestion.
USE OF d-AMPHETAMINE AND RELATED CENTRAL NERVOUS SYSTEM STIMULANTS IN CHILDREN
Authors: Yaffe Sumner J. , Bierman Charles W. , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo , Weiss Charles F. , Chudzik Gregory , Shirkey Harry C. , Soyka Lester F. , Ballin John C. , Done Alan K. , Farchione Louis , Leger Jacques , Lockhart Jean D. , Sawchuk Steven , Simopoulos Artemis P.
Published: December 2021

The abuse of amphetamines has become a problem of international significance. Japan was the first country to recognize this problem, and by 1954 there were an estimated 500,000 to 600,000 abusers in Japan. More than ten years ago Japan banned the use of amphetamines. The United Kingdom restricted distribution of amphetamines to hospital pharmacies in 1968. Sweden categorized amphetamine as a narcotic in 1944 because of abuse; and in 1965 phenmetrazine (Preludin) and in 1968 methylphenidate (Ritalin) were removed from the market. Patients now requiring amphetamines are registered with the government. Sweden has about 10,000 drug addicts (almost all between 15 and 30 years of age) using central stimulants intravenously; this is about the same percentage of their population as the estimated percentage of heroin addicts in New York City.1 In contrast, the number of heroin and opiate addicts in Sweden is estimated to be less than 500.

In 1970, the Food and Drug Administration (FDA) responded to the problem of amphetamine abuse in the United States by limiting the package insert labeling for amphetamines to three indications: narcolepsy, hyperkinesis in children, and the short-term treatment of obesity. Currently, the latter indication is being reviewed and may no longer be valid.

Among the related agents there is some specificity in labeling, e.g., methylphenidate is approved for use in adults with mild depression, narcolepsy at any age, and children with minimal brain dysfunction but not obesity; phenmetrazine for use only in obesity, etc. However, in the broad view there is a similarity in the pharmacologic properties, side effects, and abuse liability of dextro-amphetamine, methamphetamine, methylphenidate, and phenmetrazine.
STAPHYLOCOCCAL DISEASE RELATED TO HOSPITAL NURSERY BATHING PRACTICES—A NATIONWIDE EPIDEMIOLOGIC INVESTIGATION
Authors: Kaslow Richard A. , Dixon Richard E. , Martin Stanley M. , Mallison George F. , Goldmann Donald A. , Lindsey James D. , Rhame Frank S. , Bennett John V.
Published: December 2021

After the FDA bulletin recommending curtailed use of hexachlorophene (HCP), medical epidemiologists performed a retrospective survey of records for recent nursery staphylococcal disease in over 200 randomly selected United States hospitals. A group of nurseries discontinuing prophylactic infant bathing with 0.10 to 3.0% emulsions of HCP was found to have experienced a significant rise in incidence of staphylococcal disease from approximately one case to more than five cases per 1,000 admissions when compared to a group of hospitals continuing infant bathing with HCP. Rates of serious staphylococcal disease also increased approximately five-fold in the group discontinuing HCP bathing, but not in the group continuing it. In a group of hospitals not bathing infants with HCP, the difference between the higher rate of infection noted following the bulletin and the previous rate was not significant. Changes in handwashing policy, in infant bathing procedure per se, or in rates of culturing did not seem to account for the observed increases in disease rate; influences of other specific factors were not evaluated.
SERUM CONCENTRATIONS OF AMPICILLIN IN NEWBORN INFANTS AFTER ORAL ADMINISTRATION
Authors: Silverio John , Poole John W.
Published: December 2021

Previous studies have shown that antimicrobial agents as well as other agents differ in their absorption, metabolism, and excretion in the newborn compared to older children and adults. Earlier work with the natural penicillin, penicillin G, and the monobasic semisynthetic penicillin, nafcillin, showed that the administration of these products in newborn infants resulted in a significantly altered serum level time curve compared to that obtained after administration to adults. The present study shows that this same relationship holds for the amphoteric penicillin, ampicillin. The differences noted between the infants and adults are probably due to a difference in the excretory ability of the neonatal kidney compared to the more mature kidney. In addition, it was shown that the newborn was similar to the adult in utilizing more efficiently the more soluble anhydrous ampicillin, as compared with the trihydrate.
NURSERY EPIDEMIC CAUSED BY A NONTYPABLE GRAY COLONY VARIANT OF STAPHYLOCOCCUS AUREUS
Authors: Ramamurthy Rajam S. , Pildes Rosita S. , Gorbach Sherwood L.
Published: December 2021

A nursery epidemic caused by coagulase-positive Staphylococcus aureus and involving 32 infants is reported. The epidemic occurred between March 16, 1971, and May 3, 1971, in spite of hexachlorophene bathing. No breaks in technique could be identified. The causative pathogen was sensitive to hexachlorophene in a 1:10,000 dilution and its morphological characteristics were unique. The colonies, on human blood agar, were intensely hemolytic and had a grayish white color. These characteristics proved useful markers for identification of the carriers.

The epidemic was brought under control by several measures. Reinforcement of nursery techniques was ineffective. Nasal antibiotics decreased the number of cases but the persistent carriers required prolonged treatment. Cohort system was effective, but complete eradication of the pathogenic organism occurred, only after the carriers were removed from the nursery.

The emergence of a virulent strain of S. aureus was considered an important factor in this epidemic. The maintenance of a low colonization rate may, by itself, be inadequate in the prevention of epidemics caused by a virulent strain.
A LONGITUDINAL STUDY OF THE GROWTH OF LOW BIRTH WEIGHT INFANTS
Authors: Cruise Mary O.
Published: December 2021

Physicians may need to consider the growth of children–especially those of unusual size for age–from two different viewpoints. Most pediatricians are used to thinking of what may be called distance growth: how "normal" is a child's actual length at 2 years? The other aspect, velocity growth, expresses the rate or speed at which the child has grown. This may be equal for children of corresponding ages, whereas their distance growth may vary greatly. Failure of growth at a normal rate in one child should be investigated whereas another child with horizontal growth measurement outside ± 2 SD, but with normal velocity growth may require no investigation.

Data from this study provide not only mean measurements for weight, length, and head circumference of low birth weight infants who are grouped by sex and gestational age, but also provide velocity growth from birth through 3 years of age. Preterm infants (gestational age < 37 weeks) had greater velocity growth rates than small-for-date infants (full-term, low birth weight). At 1, 2, and 3 years the SFD infants had the smallest mean measurements of all the study groups of low birth weight infants. Comparative full-term infants were larger than low birth weight infants from birth through 3 years of age.
TWO CURRENT POISONINGS: TRICYCLIC DRUGS AND METHADONE
Authors: Arena Jay M.
Published: December 2021

One of the most serious types of poisoning, occurring with increasing frequency in children as well as in adults in the United States, arises from the wide usage and increased accessibility of antidepressant drugs, specifically the tricyclic compounds. These include imipramine (Tofranil), desipramine (Norpramin, Pertofrane), amitriptyline (Elavil), nortriptyline (Aventyl), protriptyline (Vivactyl), trimipramine (Surmontil), and opipramol. Doxepin hydrochloride, a dibenzoxepin compound, is structured similarly to amitriptyline except for the replacement of one carbon atom by an oxygen atom in the tncyclic ring.

There have been a number of serious cardiac arrhythmias, conduction disturbances, and heart blocks associated with intoxications from tricyclic antidepressant tranquilizers.

The most commonly seen disturbances of cardiac function from overdoses of these drugs are supraventricular tachycardia, widening of the QRS complexes, depression of the S-T segments, and abnormal T waves. Disturbances of rhythm and conduction which have been reported include atrial and ventricular tachycardias, flutters, and fibrillations, wandering pacemaker, multifocal extrasystoles (ectopic beats), complete or partial atrioventricular and intraventricular blocks, and cardiac arrest.

In addition to the cardiac disturbances, intoxication with tricyclic antidepressants also produces the peripheral signs of atropinism and symptoms of vomiting, thirst, drowsiness or dizziness, and signs of mydriasis, nystagmus, agitation or stupor, bowel and bladder paralysis, muscle rigidity, tremors, hyperreflexia, athetoid or clonic movements, convulsions, hypertension or hypotension, depressed respiration, cyanosis, hyperthermia or hypothermia, and coma. The most serious phase appears to be the first 12 hours, but during recovery a deep lethargy may alternate with tremors, agitation, delirium, hallucinations, mental confusion, and persistent insomnia.
Letters to the Editor
Authors: Baden Melvin , Stern Leo
Published: December 2021

Drs. Farrell and Zachman have presented a very lucid explanation of how the corticosteroids might act as an enzyme inducer in the therapy of RDS. Nevertheless, before one could recommend such usage in the postnatal period on a wholesale basis, data indicative of its efficacy are required and they have indeed wisely pointed out the need for such confirmation in their letter.

With respect to their interpretation of the findings in our paper,1 we should like to reiterate the following which are worthy of careful consideration by any prospective user.
SYSTEMIC HYPERTENSION FOLLOWING OCULAR ADMINISTRATION OF 10% PHENYLEPHRINE IN THE NEONATE
Authors: Borromeo-McGrail Virginia , Bordiuk Joseph , Keitel Hans
Published: December 2021

The effect of ophthalmic instillation of 10% phenylephrine on systemic blood pressure in the neonate has not been previously evaluated, despite reports of adverse reactions. The effect of 10% and 2½% phenylephrine eye drops in healthy low birth weight neonates was compared in a double-blind study. Blood pressure showed a rise of 12 to 16 mm Hg in systole and 10 to 14 mm Hg in diastole following administration of 10% phenylephrine. Blood pressure remained stable in infants receiving 2½% phenylephrine.

Consistent, although more variable, increases in blood pressure were noted in eight low birth weight infants given 10% phenylephrine eye drops in a nonblind study. Complete mydriasis was achieved with 2½% phenylephrine as well as with 10%.

Neither concentration had an effect on pulse or respiratory rates. Cutaneous administration of either 10% or 2½% phenylephrine to abdominal skin produced local blanching but no systemic effect.

To avoid potentially dangerous sequelae from iatrogenic hypertension, it is recommended that not more than one drop of 2½% phenylephrine in each eye be administered to neonates for mydriasis.
PLASMA GLUCOSE AND INSULIN RESPONSES TO ORAL GLUCOSE WITH CHRONIC DIPHENYLHYDANTOIN THERAPY
Authors: Cummings Nancy P. , Rosenbloom Arlan L. , Kohler William C. , Wilder B. J.
Published: December 2021

The hyperglycemic effect of massive doses of diphenylhydantoin (DPH) was noted in rabbits in 1965.1 The following year Klein2 described a patient with DPH-induced hyperglycemia: a child of 20 months who had ingested 800 mg of the drug during 24 hours. The peak plasma glucose level was 726 mg/100 ml and returned to normal a few days after the cessation of DPH. Later, a dose of 100 mg of DPH was shown not to affect oral glucose tolerance in this child. Dahl3 described a 47-yearold-man who increased his own anticonvulsant dose of DPH to 700 mg daily; he had a blood glucose level of 230 mg/100 ml two hours after eating. Two days after reduction of the dose to 200 mg daily, the blood glucose was normal and while he was taking 300 mg daily he had a normal oral glucose tolerance test and no side effects. A 26-month-old retarded child receiving 300 mg DPH daily was the next to be reported to have hyperglycemia.1 Two fatal instances of hyperosmolar coma related to DPH induced hyperglycemia were described in seriously ill elderly patients given large amounts of DPH intravenously.5 Peters and Samaan6 observed relative hypoinsulinism and abnormal oral glucose tolerance four days after stopping DPH (500 to 700 mg daily) in a 17-year-old girl with lethargy, headache, and nystagmus. Her plasma DPH level at the time of glucose tolerance testing was 65µg/ml.

Several studies have shown the dose dependency of the hyperglycemic and hypoinsulinemic effect of DPH. In a 42-year-old woman blood glucose was elevated on 400 mg/day.7
AN AUTOMATED "WELL-BABY" QUESTIONNAIRE
Authors: Pearlman Mark H. , Hammond Edward , Thompson Howard K.
Published: December 2021

An on-line, computer-based, self-administered questionnaire has been tested using patients 1 to 27 months of age (majority, < 8 months), randomly selected from a public well-baby clinic. The questionnaire covers areas of past health, development, immunizations, feeding history, present health, and parental attitudes. It was administered via a video terminal to 71 mothers of about 10th to 12th grade educational levels and was satisfactorily completed by all in an average time of 17.8 minutes (range, 9 to 40 minutes, with two > 25 minutes). Computer printouts provided to clinic physicians included mother's responses to questions and pinpointed certain identifiable problem areas (e.g., check cardiac status, check renal status, tell parent not to prop bottle while feeding, talk with parent about burping, mother has some questions she wants to ask you). Results indicate acceptance of the questionnaire by 95% of the mothers and substantial agreement between the findings recorded in the printouts and those recorded independently by the clinic physicians. Discrepancies were noted where the computer picked up information not recorded by the clinic physicians (e.g., mother's complaints, type of formula, how mixed, amounts given and how often, parental attitudes).
THE THIRTEEN-YEAR-OLD LOUISA MAY ALCOTT WRITES OF HER WISH FOR A ROOM OF HER OWN
Authors: C. T. E.
Published: December 2021

One of Louisa Alcott's (1832-1888) strongest desires as a young adolescent was for a room of her own. The following is taken from her Journal and was written when she was 13 years old.

Fruitlands

March, 1846,–I have at last got the little room I have wanted so long, and am very happy about it. It does me good to be alone, and mother has made it very pretty and neat for me. My workbasket and desk are by the window, and my closet is full of dried herbs that smell very nice. The door that opens into the garden will be very pretty in summer, and I can run off to the woods when I like.

I have made a plan for my life, as I am in my teens, and no more a child. I am old for my age, and don't care much for girl's things. People think I'm wild and queer; but mother understands and helps me. I have not told any one about my plan; but I'm going to be good. I've made so many resolutions, and written sad notes, and cried over my sins, and it does n't (sic) seem to do any good! Now I'm going to work really, for I feel a true desire to improve, and be a help and comfort, not a care and sorrow, to my dear mother.1
SAFETY AND ANTIGENICITY OF TEMPERATURE SENSITIVE (TS) MUTANT RESPIRATORY SYNCYTIAL VIRUS (RSV) IN INFANTS AND CHILDREN
Authors: Kim Hyun Wha , Arrobio Julita O. , Brandt Carl D. , Wright Peter , Hodes David , Chanock Robert M. , Parrott Robert H.
Published: December 2021

In attempts to stimulate local respiratory tract immunity to respiratory syncytial virus (RSV), a temperature-sensitive mutant of RSV strain A2 (ts-1 mutant) was administered to 32 infants and children. Evidence of infection was demonstrated in all and no illness accompanied infection in children who had prior experience with RSV. Mild rhinitis occurred in seven infants without prior RSV experience and otitis occurred in one of these individuals. Also, genetically altered virus was recovered from some children but this type of virus represented less than 0.1% of virus recovered from the respiratory tract. An ideal RSV mutant would infect without undergoing such reversion or other genetic change and without producing clinical findings such as otitis which would not be acceptable for a vaccine designed for widespread use.
PRIVATE PEDIATRIC PRACTICE: PERFORMANCE AND PROBLEMS
Authors: Starfield Barbara , Seidel Henry , Carter Gertrude , Garvin William , Seddon Johanna
Published: December 2021

All 96 physicians in pediatric practice in the Baltimore area were invited to join in a study assessing the quality of health management. The 15 practitioners who participated helped to set the criteria which were modifications of the standards set by the American Academy of Pediatrics. Medical records of 5-year-olds were audited for recording of preventive procedures, throat cultures for suspected pharyngitis, and urine cultures for suspected urinary tract infection. Some procedures were uniformly well performed; the performance of others varied widely. None of the practices had high rates of recording for all procedures. Existing records proved inadequate to assess the sequence of performance of activities and the relationships between problems, diagnostic procedures, responses, and follow-up. Data from questionnaires sent to all 96 physicians indicated that the performance of the 15 participants was probably higher than that which would be obtained if all the practitioners in the area had participated. This study has implications for the way in which peer review activities are organized and carried out.
PSYCHOLOGICAL AND EDUCATIONAL SEQUELAE OF PREMATURITY
Authors: Rubin Rosalyn A. , Rosenblatt Cynthia , Balow Bruce
Published: December 2021

Psychological and educational correlates of prematurity were assessed in a prospective longitudinal study of 241 infants classified by birth weight, gestational age, and sex. Eighty per cent of the 78 low birth weight (LBW) infants weighed between 2,001 and 2,500 gm; three weighed less than 1,500 gm.

It was found that (1) LBW was associated with a number of indicators of abnormal conditions during the neonatal period; (2) birth weight rather than gestational age was the major correlate of psychological and educational impairment; (3) LBW males and small-for-date (SFD) subjects of both sexes had a significantly higher incidence of school problems warranting special school placement and special school services than did full birth weight (FBW) full-term control subjects; (4) LBW subjects scored lower than FBW subjects on all measures of mental development, language development, school readiness, and academic achievement through 7 years of age; (5) while there were no sex differences among LBW subjects on objective measures of psychological development and academic achievement, males had a higher incidence of school identified problems than did females; and (6) LBW and preterm infants did not differ significantly from control subjects on socioeconomic status.

It was concluded that low birth weight preterm males and small-for-date subjects of both sexes constitute a "high risk" population in terms of eventual impairment of school functioning.