bluuebunny/crossref_metadata_2025 huggingface dataset:
Myositis and Influenza
Authors: Buchta Richard M.
Published: December 2021

It was with personal, as well as intellectual, interest that I read the article, "Acute Myositis Associated With Influenza B Infection" (Pediatrics 57:255, February 1976).

In February 1976, both of my sons had an influenza-like illness associated with a transient myositis of about 48 to 72 hours' duration. I was aware of this phenomenon because of previous experience with similar cases. Mason1 described this mini-epidemic of myositis associated with influenza B.

My 11-year-old son, as well as my wife, developed symptoms of fever, malaise, and headache for three days' duration.
Hurler's Syndromes Without α-L-Iduronidase Deficiency
Authors: Orii Tadao , Sukegawa Kazuko , Minami Ryoji , Nakao Tooru
Published: December 2021

We read with great interest the article entitled "The Iduronidase-Deficient Mucopolysaccharidoses: Clinical and Roentgenographic Features" (Pediatrics 57:111, January 1976). Hurler's syndrome, Scheie's syndrome, and Hurler/Scheie compound are characterized by a profound deficiency of α-L-iduronidase. To our knowledge Hurler's syndrome without α-L-iduronidase deficiency has not been reported. We had an opportunity to study three boys in whom the clinical and laboratory findings were similar to those of Hurler's syndrome but which differed enzymatically in that α-L-iduronidase activity was not deficient in the leukocytes and liver tissues.1
A Modification of the Chest Transilluminator
Authors: Scanlon John W.
Published: December 2021

We have found the Mini-Light Illuminator (Medgeneral, Minneapolis, Minnesota) extremely useful in our neonatal intensive care unit for the early detection of pneumothorax, pneumomediastinum, and developing hydrocephalus; for defining some abdominal masses; and for following the removal of extrapulmonary air.

The initial article about the Mini-Light by Kuhns et al. (Pediatrics 56:355, September 1975) suggested the possibility of bacterial contamination. More recent correspondence (Pediatrics 57:975, June 1976) from them further noted a potential thermal hazard.
Don't Use Saline!
Authors: Cochran William D.
Published: December 2021

The article "Ophthalmia Neonatorum: A Chart Review" by Armstrong et al. (Pediatrics 57:884, June 1976) catches my eye. If one reads the Credé prophylaxis method of instilling silver nitrate into the eyes of newborns, one realizes that should anything be instilled into the eye afterwards to wash out the silver nitrate it should not be saline. The chloride reacts with the silver, forming silver chloride, which is ineffective as an antibacterial. Perhaps this is why they had as many as 43 cases of gonococcal conjunctivitis during their six-year review!
A Reply to the Commentary of Drs. Shuman and Oliver
Authors: Pape Karen E. , Armstrong Dawna L. , Fitzhardinge Pamela M.
Published: December 2021

As pointed out by Drs. Shuman and Oliver (Pediatrics 58:621, October 1976), we recognized in our article concerning CNS pathology associated with mask ventilation (Pediatrics 58:473, October 1976) that groups A and D were not homogeneous. For this reason, the "pure" mask and "pure" tube groups (A and B) with similar gestational age and age at death were compared with significant results in Table IV of the article. Although the mask group tended to be lighter in weight, the cerebellar hemorrhages did not show a specific predilection for the lowest-birth-weight infants (Table IV).
The International Children's Centre: An Experience in Teaching Social Pediatrics
Authors: Manciaux Michel , Berenberg Samuel R. , Masse Nathalie P.
Published: December 2021

The principal objective of preventive and social pediatrics is to seek solutions to the health problems of infants, children, and youth through programs that encompass and coordinate all aspects of child health and welfare. (The wording "preventive and social pediatrics" is unsatisfactory. It could lead to the misunderstanding that one is dealing with still another pediatric subspecialty. It is used in this article for the sake of convenience and should be understood in the sense of the preventive and social aspects of pediatrics as a whole.)

Since pediatricians are increasingly involved in problems that exist prior to pregnancy and during the prenatal and birth periods (genetic counseling, monitoring of fetal growth in coordination with obstetricians) and, much later, in the physical and psychosocial problems of adolescents, the teaching range of the social aspects of pediatrics must be broadened.

To be more precise, preventive pediatrics is concerned with the prevention of diseases and disabilities and with the preservation and supervision of the health of children, whereas social pediatrics deals mainly with children, both healthy and ill, in relation to their families, the community, the school, and the total environment. As far as these milieux are concerned, it is possible to identify the micromilieu: the child, dependent on the play of forces between inborn and acquired influences, in close contact with its restricted nuclear family; the mesomilieu: interrelationships between the child and the extended family, other children, crèches, preschool facilities, and schools; the macromilieu: the complex network of state and national policies, regulations, and legislation concerned with the health and development of children; the megamilieu: global problems such as poverty, overpopulation, malnutrition, pollution, violence, and wars, which primarily affect children.
RICHARD HAZELTINE DESCRIBED KOPLIK SPOTS BEFORE KOPLIK'S REPORT
Authors: C. T. E.
Published: December 2021

Henry Koplik (1858-1927), an American pediatrician, is usually said to be the first to have noted and reported on Koplik spots, the buccal spots which are an important early diagnostic sign of measles (Arch Pediatr 13:918, 1896). However, nearly a century before Koplik described the spots which bear his name, Dr. Richard Hazeltine, a general practitioner in Berwick (Daughty's Falls) Maine, described these spots as follows:

I notice no phenomenon which I could call a precursor of the disease, except the early appearance of the eruption in the internal fauces might be called one. In almost every instance where the commencement of the disease came to my knowledge, this appearance was to be observed at least 36, and in some cases 48 hours before the eruption appeared externally. I suspect the coryza, raucedo [hoarseness] and tussis, which generally precede the cuticular eruption, and which constitute so important a trait in the diagnosis of the disease, are wholly attributable to this early eruption on the mucous membrane of the internal fauces, larynx, trachea, etc. I was informed by some persons, that they had pretty constantly observed a pale miliary eruption on the gums two to three days previous to the cuticular eruption; and I think I saw a case or two of this kind myself.
Discordant Correction of Hyperglycemia and Ketoacidosis With Low-Dose Insulin Infusion
Authors: Tamborlane William V. , Genel Myron
Published: December 2021

Since the appearance of several reports concerning the safety and efficacy of continuous low-dose infusion of insulin in the treatment of diabetic ketoacidosis,1-3 the method has received considerable acceptance. Several advantages have been cited. It provides a standardized insulin dosage. The short half-life of intravenously administered insulin allows for sufficient flexibility so that with proper monitoring, hypoglycemia can be avoided. The more physiologic levels of insulin achieved may decrease the risks of developing both hypokalemia and cerebral edema.4 Madison, however, after reviewing the evidence supporting this method, cautioned that the data available were too scanty to justify its general use by practicing physicians.5
Pneumatosis Intestinalis Associated With Fatal Childhood Dermatomyositis
Authors: Fischer Thomas J. , Cipel Louis , Stiehm E. Richard
Published: December 2021

Gastrointestinal complications are frequent in childhood dermatomyositis.1 Pneumatosis intestinalis has been reported only twice and both children had a benign course.2,3 We now report a boy in whom the appearance of pneumatosis intestinalis preceded colonic perforation, peritonitis, and death.

CASE REPORT

A boy 8½ years of age presented with a one-month history of muscle pain, weakness, dysphagia, and periorbital swelling. A diagnosis of dermatomyositis was established by elevated muscle enzyme levels and an abnormal electromyogram and muscle biopsy specimen. Despite prednisone therapy (60 mg/day), respiratory impairment developed and intravenous methotrexate (1 mg/kg/wk) was added, resulting in clinical improvement. During the next nine months the patient was hospitalized twice for respiratory weakness and a third time for abdominal pain, for which he underwent a third time for abdominal pain, for which he underwent a laparotomy with an incidental appendectomy.
Forgotten Children: Maltreated Children of Mentally Retarded Parents
Authors: Crain Lucy S. , Millor Georgia K.
Published: December 2021

It is estimated that at least 1 million developmentally disabled adults, half of whom are mentally retarded, now reside in communities throughout the United States.1,2 With recent emphasis on increased independence, normalization, and reaffirmation of the civil rights of mentally retarded persons, many are now experiencing nonsheltered adult lives and marriage. As emancipated adults, childbearing and childrearing may follow, but few if any communities have developed adequate supportive services for meeting the needs of these mentally retarded parents and their children.

Although there is a lack of data on the prevalence of parenting problems among mentally retarded adults,3 abuse and neglect have been repeatedly implicated as etiologic factors in mental retardation.
Pediatricians and The Education for All Handicapped Children Act of 1975 (public law 94-142)
Authors: Jacobs Francine H. , Walker Deborah Klein
Published: December 2021

In November 1975, Congress passed The Education for All Handicapped Children Act (public law 94-142) which became effective on October 1, 1977. This law requires that any state receiving funds through PL 94-142 provide a "free appropriate public education" for each resident handicapped child, and protect the procedural rights of parents and children in the receipt of these special education services. State and local educational agencies (school systems) must develop and implement plans to identify, locate, and evaluate these children, and place them into suitable programs, all toward the goal of "full educational opportunity" for each (sections 612 and 613).1
Dr. Reichelderfer Replies
Authors: Reichelderfer Thomas E.
Published: December 2021

We agree with Dr. Hall that better automotive restraint systems should be developed for intermediate children who weigh more than 22 kg and for early adolescents. A double air bag passive device has been perfected in Japan that appears to be effective for all children in head-on accidents. Until these newer devices are available, children weighing more than 22 kg should be placed on a firm cushion and strapped with the seat belt while sitting upright against the back of the seat.
Committee Report Needs Clarification
Authors: Kafka H. L.
Published: December 2021

McMillan et al. in their article "Iron Sufficiency in Breast-Fed Infants and the Availability of Iron From Human Milk" (Pediatrics 58:686, November 1976) made it clear that iron from breast milk is better absorbed than iron from any other source, and that it is therefore safe, at least from the point of view of iron deficiency, to breast feed an infant up to 18 months of age.

In the same issue (p. 765) the Committee on Nutrition recommends that "iron supplementation from one or more sources should start no later than 4 months of age in term infants and no later than 2 months of age in preterm infants . . ." and a few lines later that ". . . In breast-fed infants the best source [of iron] is iron-fortified cereal, two portions per day. . . ." Yet the Committee states that "the needs of breast-fed infants for supplemental iron require more investigation."
Encopresis, Enemas, and Gold Stars
Authors: Fleisher David R.
Published: December 2021

I was gratified to read the study of Levine and Bakow on childhood encopresis (Pediatrics 58:845, December 1976). Disorders of defecation cause great suffering to many children and their families. Pediatrics, as a clinical pursuit and scientific discipline, has too often side-stepped disorders of elimination.

The value of the authors' humane, caring attitude toward their patients cannot be overestimated. I would like to offer the following criticisms:

1. A pediatrician's ability to help a patient depends on his understanding of the symptom.
TECHNOLOGY
Authors: Avorn Jerry ,   Student
Published: December 2021

We must not assume, as we so often have, that any problem can be solved merely by the application of more technology, and more hardware. In the case of medicine, far-reaching cultural and economic changes will have to take place before we can develop an optional health care system—changes which need have nothing whatever to do with machines or automation. A computer, or a "patient's assistant," can improve the quality of care or render it mediocre; it can be a means of freeing medical talent for larger questions, or just larger incomes; it can increase the dignity of healing or it can cheapen and degrade the experience. These are outcomes that are relatively independent of the technology itself; as we have learned so often and so painfully, it is the social uses to which we put these capabilities that are crucial. If we don't allow a blind technological imperative to squeeze all that is human out of the healing process, if we don't let lust for maximized profit margins contaminate even more of medicine, these tools may play a role in ending the crisis of health care delivery we now face. But if we choose to approach these problems as we have approached so many others in this century, even pulling out all the plugs won't help.
Persistence of Antibody After Administration of Monovalent and Combined Live Attenuated Measles, Mumps, and Rubella Virus Vaccines
Authors: Weibel Robert E. , Buynak Eugene B. , McLean Arlene A. , Hilleman Maurice R.
Published: December 2021

Hemagglutination-inhibiting antibodies were retained in comparable levels eight years after vaccination with Enders' original Edmonston and more attenuated Moraten (Attenuvax) and Schwarz line measles vaccines. Neutralizing antibody persisted without substantial decline in titer for at least 9.5 years after administration of Jeryl Lynn mumps virus vaccine (Mumpsvax). Antibodies were retained without important decline in children and adults for at least 7.5 and 7 years, respectively, after administration of HPV-77 duck-modified rubella vaccine (Meruvax). The patterns of antibody persistence 7.5 years after administration of combined measles-mumps-rubella (M-M-R) and mumps-rubella (Biavax) vaccines, 6 years after administration of measles-rubella vaccine (M-R-VAX), and 4 years after administration of measles-mumps vaccine (M-M-VAX) were the same as for the monovalent vaccines, indicating no alteration in the retention of immunity. Subclinical reinfection evidenced by increase in homologous antibody titer was observed to follow vaccination the same as occurs after natural infection.
Myocardial Necrosis Following General Anesthesia in Hemoglobin SC Disease
Authors: Rockoff Alan S. , Christy Diane , Zeldis Norman , Tsai Ding-Joe , Kramer Robert A.
Published: December 2021

A 4-year-old girl with hemoglobin SC disease died following general anesthesia. Autopsy showed widespread intravascular sickling; staining with hematoxylin-basic fuchsin-picric acid demonstrated newly developed massive myocardial necrosis, a rarely documented finding. Anesthesia may produce conditions that provoke "crises" in patients with sickle hemoglobinopathies. Preoperative identification of sickle states and careful attention to hydration and oxygenation may minimize anesthetic risks in these patients.
SCREENING
Authors: McKeown T. , H. R. J.
Published: December 2021

In principle we should prefer in medicine never to use diagnostic or therapeutic measures whose value has not been established, but in clinical practice, where the patient seeks medical assistance, it is often necessary to do so. In screening, however, where investigation is initiated by the physician, unvalidated procedures should have no place.
Wegener's Granulomatosis in the Pediatric Age Group
Authors: Orlowski James P. , Clough John D. , Dyment Paul G.
Published: December 2021

Six cases of Wegener's granulomatosis (WG) occurring in patients younger than 21 years are described. Only 11 other cases in the pediatric age group have been reported, and all 17 of these patients had the onset of the disease during the second decade of life. Wegener's granulomatosis is a systemic disease characterized by a clinical triad of paranasal sinus and nasal mucosa involvement, pulmonary infiltration and cavitation, and renal disease with hematuria. The most common presenting symptoms are malaise and fever, sinusitis, epistaxis, and hematuria. Most patients have roentgenographic evidence of pulmonary and sinus disease and laboratory evidence of renal involvement on initial evaluation. The prognosis of WG was formerly dismal; more than 90% of patients died in less than two years, but with recent therapeutic regimens, more than 50% of these patients are surviving. The treatment we recommend consists of nitrogen mustard with adrenocorticotropic hormone or prednisone for the induction of remission, followed by cyclophosphamide and prednisone as maintenance drugs. This regimen has proved effective in inducing a remission in four of four patients.
Tetracycline Photo-onycholysis
Authors: Lasser Alan E. , Steiner Matthew M.
Published: December 2021

Photo-onycholysis is a rare complication of tetracycline therapy. Its occurrence is probably greater than the few reported cases indicate. It is hoped that this case report will alert physicians to its occurrence.
Airway Resistance in Infants After Various Treatments for Hyaline Membrane Disease: Special Emphasis on Prolonged High Levels of Inspired Oxygen
Authors: Stocks Janet , Godfrey S. , Reynolds E. O. R.
Published: December 2021

Thoracic gas volume, airway resistance (Raw), and dynamic lung compliance (CL) were measured in 48 infants surviving after hyaline membrane disease. Some infants were found to have a small reduction in CL after recovery from the acute phase of the illness but no other abnormalities were detected, irrespective of the type of treatment received. When studied again between the ages of 4 and 10 months, CL had returned to normal, but all infants who had been treated with intermittent positive pressure ventilation (IPPV) during the neonatal period were found to have developed a raised Raw. In contrast, all nonventilated infants, including those who had received up to five days of oxygen therapy in concentrations above 80%, had normal lung function. We conclude that IPPV, and not the increased inspired oxygen concentration, damaged the airways and interfered with their growth.
Effect of Phototherapy on Nitrogen and Electrolyte Levels and Water Balance in Jaundiced Preterm Infants
Authors: Wu Paul Y. K. , Moosa Amod
Published: December 2021

Twenty-four-hour metabolic balance studies were performed in ten jaundiced preterm infants, five light-treated (phototherapy) and five controls. Each of the light-treated infants was studied twice, once during phototherapy (period I) and once 48 hours after phototherapy (period II). Control infants were similarly studied during the corresponding days. Compared to period II and control infants, during period I the light-treated infants had less weight gain. Intestinal transit time was decreased by 50%. Fecal excretion of nitrogen, sodium, and potassium was increased. Stool water loss was increased twofold to threefold with a decrease in water balance. Unmeasured water loss was increased. These studies underscore the need for careful attention to fluid and caloric supplementation during phototherapy.
Sudden Death in Adolescence
Authors: Murphy Gordon K.
Published: December 2021

The majority of adolescent deaths are sudden and unexpected; of these, the great majority result from violence. These violent deaths largely accounted for the 25% increase in total adolescent mortality during the 1960s. Yet, sudden death in adolescence is not a distinct entity and receives little study from either pediatricians or pathologists.

Some cases of sudden death in adolescence are puzzling and difficult to classify. The pathologist must in each case obtain a detailed history, usually perform a complete autopsy, and obtain consultation when necessary. Only then will each case be adequately studied, and related medical questions and other problems be properly resolved.
Behavior Therapy and Withdrawal of Stimulant Medication in Hyperactive Children
Authors: O'Leary Susan G. , Pelham William E.
Published: December 2021

Psychopharmacological intervention has been the most frequent treatment for hyperactive children for two decades. Recent estimates suggest that approximately 2% of all U.S. elementary schoolchildren are receiving psychostimulant medication for hyperactivity.1 Dextroamphetamine sulfate (Dexedrine) and methylphenidate (Ritalin) hydrochloride are the most frequently administered psychostimulant medications. The efficacy of these drugs in changing teacher ratings of hyperactivity and improving sustained attention has been well established.2

Despite the consistency of salutary effects of stimulants on hyperactive children in school settings, the exclusive reliance on drug treatment has been questioned repeatedly.3-5 The concern stems from several sources. First, such treatment appears to have no long-term effect on academic achievement.6,7 Second, such treatment does not appear to be associated with long-term amelioration of social problems.7 Third, increases in heart rate and blood pressure have been observed,8 and decreases in the rate of height and weight gains have been found in some studies.4 Although the decrease in weight gain in probably reversible, the same may not be true of the decrease in height gains. Fourth, the child's attribution of his behavior change to the medication may have deleterious long-range effects. The child may learn that the only way to control his behavior is to take a pill.9 Fifth, because of the anorexic and insomnious effects of the stimulant medications, they are usually not administered in the late afternoon. Since the effects of the medication last only three to five hours, change in the children's behavior at home is often not observed.10 Thus, the parents whose children are given medication without psychological consultation are often faced with serious problems at home.
Down's Syndrome and Heart Surgery
Authors: Feingold Murray
Published: December 2021

The article by Greenwood and Nadas (Pediatrics 58:893, December 1976) may be misinterpreted. It states that the death rate in children with Down's syndrome and congenital heart disease is high. Although this is indeed true, the fact that the majority of these patients did not have corrective surgery must account for some of the high mortality. For example, of the ten patients with an isolated patent ductus arteriosus, six were not corrected. Also, 61 of the 66 patients with ventricular septal defect (VSD) did not have surgery.
Care of Infants With Near-Miss Sudden Infant Death Syndrome
Authors: Kelly Dorothy H. , O'Connell Kathleen
Published: December 2021

The purpose of this study was to evaluate the effectiveness of home management of life-threatening apnea in infants with near-miss sudden infant death syndrome (SIDS). A total of 84 infants were monitored with apnea monitors for an average of seven months (range, 1 to 27). A group of 27 infants had episodes of apnea requiring resuscitation during home monitoring, all of whom were successfully resuscitated by their parents on at least one occasion using bag and mask resuscitation, and 17 infants required more than one resuscitation. Subsequent resuscitation was unsuccessful with four infants. Infants who experienced more than ten episodes of prolonged sleep apnea (apnea longer than 20 seconds) during home monitoring had a significantly increased risk of requiring resuscitation than other infants being studied. With the use of home monitoring of these infants and parents trained in cardiopulmonary resuscitation, the survival rate was 93.4%.
Survival of Transfused Normal Granulocytes in a Patient With Chronic Granulomatous Disease
Authors: Chusid Michael J. , Tomasulo Peter A.
Published: December 2021

A 5-year-old boy with chronic granulomatous disease (CGD) received four granulocyte transfusions from unrelated HLA-matched donors as part of therapy for a hepatic abscess. Survival studies of transfused granulocytes using the endotoxin-stimulated nitroblue tetrazolium (NBT) test on two occasions demonstrated 19.6% and 16.8% transfusion efficiency and a biphasic granulocyte disappearance curve. These curves were similar whether or not the patient had serum leukoagglutinins directed against donor granulocytes. Transfused granulocytes were present 24 hours after transfusion. Parallel studies demonstrated normal stimulated NBT activity of donor PMNs after overnight storage at 4 C. Kinetic studies of transfused granulocytes in the non-neutropenic recipient with CGD may be performed without radioactive labeling of grannlocytes because of the distinctive metabolic abnormality of their cells compared with normal donor granulocytes.
Arrhythmias and Stokes-Adams Attacks in Acute Rheumatic Fever
Authors: Lenox Cora C. , Zuberbuhler James R. , Park Sang C. , Neches William H. , Mathews Robert A. , Zoltun Richard
Published: December 2021

In spite of general complacency about first-degree heart block in acute rheumatic fever, abnormal conduction with dysrhythmias, occasional complete heart block, and, rarely, Stokes-Adams attacks are important early signs of acute rheumatic fever and may precede other signs. Every person with episodic fainting is entitled to an ECG, and frequent ECGs are imperative in any case of rheumatic fever with signs of arrhythmias. Changing atrioventricular block necessitates continuous monitoring for dysrhythmias. A 13-year-old boy who appeared with Stokes-Adams attacks secondary to acute rheumatic fever was successfully treated by temporary pacing.
Chromosomal Imbalance in the Aniridia-Wilms' Tumor Association: 11p Interstitial Deletion
Authors: Riccardi Vincent M. , Sujansky Eva , Smith Ann C. , Francke Uta
Published: December 2021

The triad of aniridia, ambiguous genitalia, and mental retardation (AGR triad) is the characteristic clinical feature of three unrelated patients with previously unreported chromosome 11 short arm interstitial deletions. A Wilms' tumor in one patient establishes one cause for the aniridia-Wilms' tumor association. The genetic heterogeneity of aniridia, the AGR triad, and Wilms' tumor are demonstrated, and Wilms' tumor is indicated to be a neoplastic birth defect which can result from a variety of embryologic insults, some of which may be chromosomal or heritable.
DR. WILLIAM BUCHAN ON THE INJURY DONE TO CHILDREN BY THE TOO EARLY AND UNNECESSARY USE OF MEDICINE—1804
Authors: C. T. E.
Published: December 2021

Dr. William Buchan (1729-1805), the author of Domestic Medicine or the Family Physician, the most popular work of its kind ever published, served as physician to the Foundling Hospital in Ackworth, Yorkshire, for a number of years.

Writing in 1804 in his Advice to Mothers, he described the sad fate of over-medicated infants:

About forty years ago when I undertook the charge of a large branch of the Foundling Hospital at Ackworth in Yorkshire, I found that the children at nurse had till then been attended by the country apothecaries, who, sure of being paid for their drugs, always took care to exhibit them with a liberal hand. Every cupboard and every shelf in the house was filled with phials and gallipots. Under such treatment, half the children died annually. As it was evident to me that this mortality could not be natural, I suggested to the governors, that the children had little or no occasion for medicines, and that with proper care they would thrive and do well. A new arrangement took place. The nurses were forbidden, at their peril, to give any medicine but what should he ordered by me; and were advised to rely more on the faithful discharge of their duty than on doses of physic. The consequence was, that the expense for drugs did not amount to a hundredth part of what it had been before, and that not above one in fifty of the children died annually. An opportunity of making experiments on so extensive a scale seldom occurs.
Stages in Pediatric Bone Marrow Transplantation
Authors: Pfefferbaum Betty , Lindamood M. Muriel , Wiley Frances M.
Published: December 2021

Bone marrow transplantation is a relatively new and aggressive procedure that is being used in the treatment of leukemia and aplastic anemia. We observed approximately 30 children and their families at the UCLA Medical Center throughout the procedure. Various psychological responses during the treatment are outlined. Eleven stages are identified, including the patient's and family's first awareness of this procedure, the preadmission evaluation and psychosocial assessment, the introduction into isolation, the donor's hospitalization, the transplantation itself, and the various reactions atid interactions of the patient, family, and staff throughout these stages.
Long-Term Results of Renal Transplantation in Children
Authors: Fine Richard N. , Malekzadeh Mohammad H. , Pennisi Alfred J. , Ettenger Robert B. , Uittenbogaart Christel H. , Negrete Vida F. , Korsch Barbara M.
Published: December 2021

During the past decade, as hemodialysis and renal transplantation have become more available, the outlook for children with irreversible renal insufficiency has changed dramatically. Prior to that time, no programs were devoted exclusively to the treatment of children with end-stage renal disease (ESRD), and a limited number of children received treatment in adult facilities. In light of very limited experience there were those who claimed1,2 that the rigors of the treatment program were so catastrophic for both child and family, and the outlook so dismal, that dialysis and transplantation should not be offered to children.

Despite these warnings a program was initiated in 1967 at Childrens Hospital of Los Angeles (CHLA) to provide dialysis and transplantation for children with ESRD. The program was designed to include a component for long-term medical and psychosocial evaluation.

Subsequently, other programs were developed in the United States, Canada, and western Europe. The latest report on Regular Dialysis and Transplantation of Children in Europe, 1975,3 of the European Dialysis and Transplant Association Registry included 1,111 children who were less than 15 years of age at the initiation of therapy, and the last report of the ACS/NIH Transplant Registry4 included data on 987 children, 0 to 15 years of age. In addition, numerous articles5-25 describing experience with transplantation in children attest to the increasing acceptance of this therapeutic modality for children. However, there are few reports of children surviving with a functioning graft for more than five years.13,14,21-23-25 Only the reports of DeShazo et al.21 and Weil et al.25 include data on the long-term results of renal transplantation in a large number of pediatric patients.
Esophageal Foreign Body: An Uncommon Cause of Stridor
Authors: Tauscher John W.
Published: December 2021

Esophageal foreign bodies do not commonly cause inspiratory stridor. Esophageal foreign bodies are considered in the child who presents with anorexia, dysphagia, and drooling. This diagnosis is not so readily apparent when the child has the symptom of stridor only.1 The diagnosis must be made early and appropriate treatment initiated. Undue delay can lead to complications such as esophageal ulcerations, stenosis, perforation, mediastinitis or aspiration pneumonia. The otolaryngological and radiological literature has placed more emphasis on inhaled and ingested foreign bodies than has the pediatric literature.
But who shall monitor the monitor?
Authors: Nenson Nicholas M.
Published: December 2021

Three circumstances may (thinly) be argued to qualify the present writer as an "expert" commentator on the article by Kelly et al. in this issue of Pediatrics (p. 511): first (and nearly 20 years ago), that most humbling of all experiences for the pediatrician, the dismissal from one's office of an apparently healthy 2-month-old infant with a minor upper respiratory tract infection who is brought dead on arrival to one's own hospital not three hours later, the unavailability of any autopsy data (difficult to obtain from unsubsidized pathologists in small suburban hospitals ruled by the coroner system of forensic medicine) forcing the diagnosis of sudden infant death syndrome (SIDS) on bewildered parents and shaken physician; last, participation in a recent task force assembled by the American Academy of Pediatrics in an attempt to generate an omniscient statement to cover the optimal management of a dreaded condition ("near-miss SIDS") whose identification is by definition uncertain and concerning which a minimal base of factual knowledge is only now beginning to accrue.
Drs. Schmickel and Chu Reply
Authors: Schmickel Roy D. , Chu E. H. Y.
Published: December 2021

Although the patient described by Robbins et al.1 has both xeroderma pigmentosum and Cockayne syndrome, the report cited by Dupuy and Lafforet would not permit us to reach this conclusion. The coexistence of xeroderma pigmentosum and Cockayne syndrome in a single patient is an intriguing situation. Although the two diseases both show an increased cellular sensitivity to ultraviolet (UV) light, the molecular defect(s) in these diseases remain unknown. Speculation about this coincidence is, therefore, conjectural.
Prognosis in Children With Febrile Seizures
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: December 2021

Febrile seizures occurred in 3.5% of white and 4.2% of black children who were followed up in a large prospectively defined cohort. The frequency of adverse outcomes was examined in this population and risk factors were identified. Among 1,706 children with febrile seizures, no deaths or persistent motor deficits occurred as sequelae of seizures. Todd's paresis occurred in 0.4%. Risk factors identified for epilepsy after febrile seizures were family history of afebrile seizures, preexisting neurological abnormality, and complicated initial seizure. Of the 60% of children with febrile seizures who had none of these factors, 1% developed epilepsy by age 7 years. A single risk factor was present in 34%, of whom 2% developed epilepsy. Of the 6% with two or more of these factors, 10% developed epilepsy.

After an initial brief febrile seizure, 1.4% experienced a subsequent attack which lasted 30 minutes or longer; none of these children had an afebrile seizure by the age of 7 years.

Febrile seizures were associated with an increased risk of intellectual deficit only among children with preexisting neurological or developmental abnormality, and in those who developed subsequent afebrile seizures. A third of the children with febrile seizures had a recurrence, and 9% had three or more recurrences. The major predictor of recurrence was early age at onset.
Behavior Disturbance, Phenobarbital, and Febrile Seizures
Authors: Wolf Sheldon M. , Forsythe Alan
Published: December 2021

Of 109 children treated daily with phenobarbital following the first febrile convulsion, 42% developed a behavior disorder, usually hyperactivity. Daily phenobarbital therapy was prematurely discontinued in 54% of the children with behavior abnormality (20% of those treated). The behavior disturbance usually appeared within several months, was not correlated with high blood barbiturate levels, disappeared in 73%, and improved in all children when barbiturate therapy was discontinued. No characteristics of the child, the initial febrile seizure, or recurrence of febrile seizures were significantly correlated with the occurrence of the behavior disorder except for behavioral abnormality preceding the initial febrile convulsion.

Eighteen percent of the children who received no phenobarbital developed behavior disorder, most often hyperactivity. The behavior disturbance spontaneously disappeared in 52%. Among these children not given phenobarbital, the group with normal behavior had a greater frequency of family history of seizures, especially febrile convulsions, and a lower frequency of preseizure behavior disturbance; abnormalities of pregnancy, labor, delivery, and neonatal period; delayed milestones; long seizures; abnormal results of neurological examination; abnormal EEC; and recurrent febrile seizures.
Evaluation of the Expanded Newborn Screening Program in New York City
Authors: Grover Ranjeet , Wethers Doris , Shahidi Syad , Grossi Margaret , Goldberg Doris , Davidow Bernard
Published: December 2021

Since September 1974, New York State public health law has mandated that all newborn infants be tested for phenylketonuria, maple syrup urine disease, homocystinuria, histidinemia, galactosemia, adenosine deaminase deficiency, and sickle cell anemia in accordance with regulations of the state commissioner of health. During the period from May 1, 1975, to April 30, 1976, a total of 110,180 babies born in New York City were tested for these seven conditions. One year's experience with the screening program demonstrated a paucity of technological problems, low observed rate of both false-negatives and -positives, and the expected incidence of the conditions of highest prevalence, incidentally found during screening: i.e., sickle cell traits, AS and AC. What is equally apparent in reviewing this first year's experience is the extent to which the New York State law, its structure, and implementation have fallen short of the ultimate objective. The major reason for this failure is lack of hinds and facilities in the areas of education, case retrieval, continuing medical care, and counseling. This report is presented with the hope that it will benefit all involved in genetic screening and especially those concerned with establishing similar programs.
Turn down the water temperature and win a prize
Authors: Bergman Abraham B.
Published: December 2021

Certain signs of a publication with an ailing circulation are the appearance of stories about unidentified flying objects, techniques of sexual rejuvenation, life after death, and the sponsorship of contests. The circulation of Pediatrics is doing well, thank you, but we still announce what we think is the first-ever competition promulgated by a medical journal. (The Lancet's quizzes are too esoteric and they don't give prizes.) It's a grand chance for readers to get their competitive juices flowing while bathing in moral rectitude.

Here's the pitch: Elsewhere in this issue (page 1) Feldman and colleagues make a compelling case that if the temperature of hot water heaters were regulated so as not to exceed 52°C(125°F), the incidence of scald burns would be reduced, and our patriotic duty to conserve energy would be furthered.
Pulmonary Lesions in Atypical Measles
Authors: Laptook Abbot , Wind Edward , Nussbaum Michael , Shenker I. Ronald
Published: December 2021

Atypical measles is a well-described entity which has a high frequency of pulmonary involvement. Resolution and shrinkage of the pneumonic infiltrates into nodular mass-like lesions have been cited only once before. Three cases of atypical measles pneumonia are described which demonstrate these pulmonary nodular sequelae. In one of the cases examined a nodular residuum has now persisted for five months. Atypical measles pneumonia should be considered as a diagnostic possibility before invasive investigations are performed in a patient who has a pulmonary nodule.
Microbiology of the Vagina in Children: Normal and Potentially Pathogenic Organisms
Authors: Hammerschlag Margaret R. , Alpert Susan , Rosner Ingrid , Thurston Pauline , Semine Deborah , McComb Dorothy , McCormack William M.
Published: December 2021

Vaginal cultures from 100 healthy girls, 2 months to 15 years of age, were examined for the presence of normal and potentially pathogenic microorganisms. Corynebacterium vaginale, yeast species, and genital mycoplasmas were isolated from vaginal cultures from 13.5%, 28%, and 28% of the girls examined, respectively. Colonization with these organisms was not associated with signs or symptoms of vaginitis. Neisseria gonorrhoeae was isolated from a 4-year-old with purulent vaginitis. Trichomonas naginalis was recovered from two 13-year-olds, both of whom had an abnormal vaginal discharge. Vaginal antibody to Chlamydia trachoinatis was found in two girls, 4 and 13 years of age. In neither girl was the organism recovered from the vaginal culture. Chlamydia trachoniatis was recovered from the vaginal culture of another 4-year-old who had no abnormal findings on examination. Cultures from 59 of the girls were examined for aerobic and facultatively anaerobic bacteria. Diphtheroids and Staphylococcus epidermidis were the most frequently isolated organisms. Lactobacilli were isolated most frequently from the older girls, whereas enteric organisms were isolated most frequently from the younger girls.
BECOMING HUMAN
Authors: Jenks Christopher
Published: December 2021

Opponents of abortion sometimes argue that a fetus "wants" to grow up into a real person. But every egg and sperm also "want" to become a person in this sense. And if that is the case, how can one defend either contraception or celibacy, both of which deny life to millions of eggs and sperms that "want" to become people, and both of which also involve repression of "natural" impulses?

The question of whether abortion is morally wrong depends on when we become "human." Unfortunately, this does not happen all at once, as in medieval fantasies of the soul's entering the body. It happens bit by bit. We must therefore make some arbitrary decision about when to confer the "right to life." Because nature offers no clear guidance about where this line should be drawn, the most humane solution is to draw it so as to minimize human suffering. I doubt, however, that opponents of abortion will accept this approach, for once you accept it, you will almost inevitably be led to precisely the same "liberal" conclusion the Supreme Court reached five years ago in Roe v. Wade.
Hypercholesterolemia in the Newborn: Occurrence After Antepartum Treatment With Betamethasone Phenobarbital-Ritodrine for the Prevention of the Respiratory Distress Syndrome
Authors: Andersen Gunnar E. , Friis-Hansen Bent
Published: December 2021

Cord serum lipid and lipoprotein values were measured in 117 normal full-term newborns, in 42 full-term newborns who had received antepartum phenobarbital therapy and in 19 full-term newborns who had received antepartum betamethasone-phenobarbital-ritodrine therapy. The values were the same in untreated and phenobarbital treated newborns, whereas a marked hypercholesterolemia with an increase primarily in very-low-density lipoprotein/low-density lipoprotein cholesterol was found in betamethasone-phenobarbital-ritodrine-treated newborns, compared with untreated infants.

Furthermore, cord serum lipid and lipoprotein values were compared in 15 untreated and 10 betamethasone- phenobarbital-ritodrine-treated premature newborns. Again, hypercholesterolemia was seen in the treated newborns with an increase primarily in high-density lipoprotein cholesterol. No difference was found in the cord serum lipid and lipoprotein levels of 31 untreated and 11 betamethasone-phenobarbital-ritodrine-treated small-for-gestational-age infants.

The hypercholesterolemia seen in appropriate-for-gestational-age infants after this triple drug treatment is probably caused by betamethasone. This is a cause of hypercholesterolemia in the newborn that has not been described earlier.
Reye's Syndrome in Infancy
Authors: Huttenlocher Peter R. , Trauner Doris A.
Published: December 2021

Reye's syndrome in infancy is not a well-defined entity and is infrequently diagnosed. Eight infants 6 months of age or younger had a prodromal viral illness followed by the rapid onset of lethargy, seizures, and coma, resulting in the diagnosis of Reye's syndrome. All had abnormal results of liver function tests including elevations of blood ammonia level. Three patients had pathological studies that confirmed fatty visceral infiltration.

The data on these patients, as well as a review of the literature, indicate that the most prominent clinical findings in Reye's syndrome in infancy include marked respiratory abnormalities with tachypnea and apneic episodes; frequent occurrence of seizures in the early stages of the illness; and hypoglycemia in most cases.

A strong socioeconomic bias was noted in these patients, with the infants coming primarily from lower socioeconomic urban environments, while older children with Reye's syndrome have been observed to be predominantly middleclass and from suburban or rural areas.
Cerebral White Matter Lesions in Sudden Infant Death Syndrome
Authors: Takashima S. , Armstrong D. , Becker L. E. , Hubert J.
Published: December 2021

In 21.6% of infants who died of sudden infant death syndrome, the cerebral white matter showed areas of leukomalacia. Of those infants with congenital heart disease, 24.8% had lesions, whereas 4.4% of infants who died from known acute causes had lesions. The sites of the cerebral white matter lesions, subcortical or periventricular, seem to be related to the age of the infant.
Grief Response of Parents to Neonatal Death and Parent Participation in Deciding Care
Authors: Benfield D. Gary , Leib Susan A. , Vollman John H.
Published: December 2021

We determined the grief response to neonatal death of 50 mother-father pairs by administering a queastionnaire and conducting a semistructured interview during the infant postmortem review. As measured by a parent grief score, maternal grief significantly exceeded paternal grief (t = 5.89, P .0001). Parent grief was not significantly related to birth weight, duration of life, extent of parentinfant contact, previous perinatal loss, parent age, or distance from the hospital of birth to the regional center (Pearson product-moment correlation coefficients). However, the attitudes and behavior of family, friends, and health care personnel in the hospital of birth often adversely influenced parent grieving.

Of 39 mother-father pairs whose infants required respirator support, 18 participated in a group decision with their physician to withdraw respirator support when the prospects of infant survival seemed hopeless (limited respirator care group). No significant differences in parent grief scores were found (t tests) when the limited respirator care group was compared to those parents of infants who died despite uninterrupted respirator care. Our data suggest that informed parents can participate as partners with their physician in difficult infant care decisions, even when death results, and adjust to their loss with healthy grieving.