bluuebunny/crossref_metadata_2025 huggingface dataset:
GENETICS AND HUMAN CONGENITAL MALFORMATIONS
Authors: Neel James V.
Published: December 2021

A BRIEF SURVEY of the vast subject of "Genetics and Human Congenital Malformations" can scarcely be expected to be systematic. Accordingly, discussion of the subject will be limited to a series of more or less unrelated observations concerning genetics and the study of human teratology. The first portion of this discussion will be devoted to three general points concerning which there seems to be room for misunderstanding between the genetically and nongenetically oriented student of teratology. The latter portion of the discussion will be concerned with drawing attention to some general genetic approaches which may be profitable in specific areas. In approaching the material in this fashion, familiarity with the current status of work on human teratology is assumed. It is further assumed that the principal reason for this Conference on Teratology is to consider useful lines of attack on outstanding problems in this area.

It is important at the outset to establish the fact that, from the genetic point of view, human malformations are a very "mixed bag" indeed. At the one extreme there are malformations which have a clear-cut and relatively simple genetic basis. Many of the skeletal malformations, such as the relatively benign brachydactyly or polydactyly, or the more serious ectrodactyly (split hand) or acheiropodia, fall into this category. At the other extreme there are a few malformations, such as tracheo-esophageal fistula1 which thus far have not been demonstrated to show a noteworthy tendency to concentrate in particular families. The majority of congenital malformations fall into neither of these extremes, showing clearly statistical tendencies to occur in certain families, but in these tendencies not following any simple pattern.
THE ARTERIAL AND VENOUS GLUCOSE TOLERANCE TEST IN OBESE AND NONOBESE CHILDREN
Authors: Mostofi Abol G. , Sanford Heyworth N. , Bronstein I. Pat , Asrow Gertrude
Published: December 2021

The arteriovenous glucose tolerance was studied simultaneously in 8 obese and 10 nonobese children between the ages of 4 and 14 years. It was observed that the mean peak of the glycemia was slightly higher in the nonobese group. The concentration of sugar in the blood returned to fasting levels in 3 hours in 80% of the nonobese group. In only 25% of the obese group did the concentrations of sugar return to fasting levels in 3 hours. The difference between the concentrations of sugar in venous blood during fasting and 3 hours after ingestion of glucose was more conspicuous and statistically significant in the obese. The criteria for the interpretation of a normal glucose test for this age group are suggested.
PEDIATRICS AND ECONOMICS
Authors: SISSON WARREN R.
Published: December 2021

WHETHER we like it or not, we must admit that we are living and working in a period of basic changes in the economic aspects of the practice of medicine. There was a day when the physician could make his visits on a completely individual basis and charge as much for his services as he considered appropriate. His bills were entirely between himself and his patients.

But today an increasing number of physicians are finding themselves participants in one or another of the many medical care plans which are spreading rapidly throughout the country. A great variety of plans are being developed by public welfare agencies, health departments, non-profit organizations, medical societies, unions, cooperatives and other groups. Under the provisions of these plans the physician must abide by certain regulations directly affecting his practice and the fees he is entitled to collect.

The growth of the Blue Shield plans for voluntary medical care insurance has been phenomenal and is now so rapid that it is impossible to state accurately from day to day the number of their subscribers. A recent estimate indicates that there are 48 plans with more than 7,000,000 subscribers. In fact Blue Shield seems to be on the way to catching up with Blue Cross, which now has some 30,000,000 subscribers.

Other plans are testing different methods of providing service. One of the most notable of these is the Maryland Medical Care Program, which was established by legislation in 1945 providing that the State Department of Health should administer a program of medical services for indigent and medically indigent persons. Under the provisions of this plan county health officers have assumed administrative responsibility for this program of medical services; physicians are paid directly by the State Treasurer in accordance with a fixed fee schedule.
Panel Discussion
Authors: CLIFFORD STEWART H. , BAIN KATHERINE , HERBOLSHEIMER HENRIETTA , TISDALL FREDERICK F. , ALDRICH C. ANDERSON , WEGMAN MYRON E.
Published: December 2021

Well established principles for the care of premature infants include constant and competent nursing care, maintenance of satisfactory environment, prevention of infection and provision of proper nutrition.

Implementation of these principles is based on specific standards for care, which cover physical facilities, equipment, qualifications and duties of personnel.

There is need for community-wide integrated programs which will insure care that meets these standards, for every premature infant. Programs should include establishment of specialized centers to provide care meeting all standards, and facilities to train personnel both in and outside these centers; decentralized training and guidence in areas other than the centers; complete case-finding and provision for transportation; adequate follow-up; services of public health nurses and social workers. Cooperation, central planning and acceptance of responsibility by health departments, medical schools, private physicians and community agencies are all essential to success.
THE TREATMENT OF TETANUS
Authors: HARRIS RUTH C. , MCDERMOTT THOMAS F. , MONTREUIL FERNAND L.
Published: December 2021

The cases of two patients with tetanus have been presented in detail. One patient was severely ill and the other moderately so. Both were treated with large doses of antitoxin, curare, penicillin and sulfadiazine, tracheotomy and sedation. In the first case, sodium pentothal was used for continuous sedation for 15 days, supplemented with paraldehyde, chloral hydrate and sodium phenobarbital. In the second case sodium pentothal was needed only during the first three days of illness. Both patients recovered.

Sodium pentothal was chosen because of its prompt action when given by vein, minimal toxicity to the liver, and noncumulative effect. Some degree of tolerance was noted and other sedatives were added to supplement its effect.

D-tubocurarine chloride (Squibb) in wax and peanut oil (1 cc. = 30 mg. or 175 units) was given intramuscularly daily to aid in diminishing peripheral irritability and to supplement the sedative effect. A clear-cut evaluation of its beneficial effect is impossible because of the small series of cases and the number of other agents hitherto untried in this disease.

Tracheotomy was used in these patients, prophylactically to prevent fatal laryngospasm, and therapeutically to provide an adequate airway and exit for accumulated thick gelatinous secretions. Few reports of its use in this disease have appeared in the literature. It was felt that it greatly benefitted these patients. Adequate, regular aspiration of the tracheotomy tubes was found to be mandatory while the patients were severely ill and while deep sedation was required. It was found that positive pressure oxygen could be administered through the tracheotomy tube for respiratory arrest while under curare and pentothal sedation. A simple apparatus for this purpose is presented.
POLIOMYELITIS IN FAMILIES ATTACKED BY THE DISEASE
Authors: WENNER HERBERT A. , TANNER WILLIAM A.
Published: December 2021

A study has been made concerning the presence, and persistence of neutralizing antibodies to poliomyelitis virus in six individuals. Five individuals had poliomyelitis; the remaining subject was a familial contact.

Neutralizing antibodies do appear in the serums of patients convalescent from poliomyelitis. In this study neutralizing antibodies, as a rule, appeared during the first ten days of illness. There is the suggestion that these antibodies appear rapidly, quickly reach their highest level, and that there is little if any fall in titer during the ensuing year.

The neutralizing antibody titer may not reach a high level in a considerable number of patients.
THE RELATIONSHIP OF FIBROCYSTIC DISEASE OF THE PANCREAS TO A DEFICIENCY OF SECRETIN
Authors: BAGGENSTOSS ARCHIE H. , POWER MARSCHELLE H. , GRINDLAY JOHN H.
Published: December 2021

The theoretic considerations which indicate that fibrocystic disease of the pancreas is the result of a congenital deficiency of secretin have been outlined. The varied clinical and pathologic manifestations of this disease can, in our opinion, be more nearly adequately explained by this hypothesis than by any of the other current theories. The absence of secretin (S1) in the upper part of the intestinal tract of a patient with fibrocystic disease of the pancreas lends support to this theory; which is to say, that the condition is the result of a congenital deficiency of secretin. It has been shown to be possible to extract secretin from the upper part of the intestinal tract of persons two months to 73 years old. The only consistent, failures occurred in work with patients in the neonatal period. Successful extraction of secretin from these patients in the neonatal period can be carried out, however, by combining the crude extracts obtained from a number of patients. The extraction of secretin is successful if it is done up to 15 hours postmortem. If the specimen is kept in a frozen state, extraction can be delayed without loss of activity as long as 39 days. Because this method of extraction is successful in individual cases at necropsy, it becomes possible to correlate the presence or absence of secretin with varying pathologic conditions. This, in turn, may open up a broad field for the investigation of many pancreatic and intestinal disturbances in addition to fibrocystic disease of the pancreas.
Round Table Discussion
Authors: BLATTNER RUSSELL J.
Published: December 2021

Chairman Blattner: During recent years, there has been increasing interest shown in diseases caused by filterable viruses, and significant work has been accomplished in this comparatively new and absorbing field of endeavor. With the advent of chemotherapeutic agents and antibiotics, the presence and action of these infectious agents has become more apparent. Viral diseases, therefore, have assumed increasing importance in medical literature in general and in pediatric literature in particular.

By way of review, it is well to bear in mind that viruses are filter-passing agents, obligate intracellular parasites, capable of reproducing themselves and of producing disease in plants and animals, including man. While these agents cannot be seen except by the most elaborate methods, their presence can be detected by their injurious effects.

The pathologic picture produced by viral agents is rather characteristic and can be recognized readily by experienced observers acquainted with tissue response. In some instances, inclusion bodies are produced which may be intranuclear or intracytoplasmic, and represent cytologic changes which are considered typical of the pathologic response to viral invasion. When inclusion bodies are present they may serve as sign posts for the recognition of the type of infectious agent.

The nature of a filterable virus is as yet unknown. Viruses may be a form of life similar to bacteria, but infinitely smaller in size. It is conceivable that viruses are enzymes capable of reproducing themselves and capable of producing cellular response. They may be non-living, crystallizable substances, such as the Stanley tobacco-mosaic virus; or a form of life, the definite nature of which is as yet unrecognized. Dr. Thomas M. Rivers has stated : "Viruses are a heterogeneous collection of diverse agents which happen to induce a state of broad similarity." He points out that the reaction of the tissues in general, and of the cells in particular, determines the nature of the pathologic process about as much as the infectious agent itself.
SPECIAL REVIEWS
Authors: JANEWAY CHARLES A.
Published: December 2021

This brief review of some of the recent accessions to our knowledge of the chemical structure, physiologic functions, and therapeutic applications of the plasma proteins serves to emphasize three important elements in medical progress—scientific curiosity, the humanitarian impulse, and effective social organization. We have had the privilege of summarizing the work of hundreds of investigators, whose studies are giving us new tools for the investigation and treatment of disease. Their work has only been possible because the magnificent response of a free people to the call for blood donors by a voluntary philanthropic agency, the American Red Cross, was coupled with a technical triumph, the development of practical methods for the large-scale separation of the plasma proteins, itself the culmination of highly theoretical and seemingly impractical investigations by protein chemists in various countries for many years.
Muscle Testing
Authors: MCCULLOCH HUGH
Published: December 2021

This book presents a technic for manual muscle examination and evaluation of muscle strength. It gives in detail information on muscle topography, muscle function, joint range, and nerve distribution by means of 349 line drawings made from photographs and diagrams. The work has been done with aid and supervision from the National Foundation for Infantile Paralysis. It includes the charts for muscle examination supplied by the National Foundation. The text is limited to notes for each drawing and diagram. Miss Daniels and Miss Williams are respectively Associate Professor and Assistant Professor of Physical Therapy, Stanford University. Miss Worthingham is Director of Professional Education, the National Foundation for Infantile Paralysis, Inc.,
THE ABSORPTION OF OILY AND AQUEOUS PREPARATIONS OF ESTER AND ALCOHOL VITAMIN A BY NORMAL CHILDREN AND CHILDREN WITH VARIOUS DISEASES
Authors: MCCOORD AUGUSTA B. , KATSAMPES CHRIS P. , LAVENDER C. FRED , MARTIN FREDERICK J. , ULSTROM ROBERT A. , TULLY ROBERT H. , KEENAN ALICE J.
Published: December 2021

A study was made of the absorption of aqueous and oily preparations of ester and alcohol vitamin A by normal subjects and by patients with various diseases. The oily preparations used were the Abbott product (containing 210,000 I. U. ester vitamin A/gm.) and the Borden product (210,000 I. U. alcohol vitamin A/gm). The aqueous preparations used were: "Vifort Special" (60,000 I. U. alcohol vitamin A/gm.); Vi-Syneral Vitamin Drops (7,000 I. U. alcohol vitamin A/gm.); "Zymadrops Special" (10,500 I. U. ester vitamin A/gm.).

When seven normal children ingested 14,000 I. U. vitamin A/kg. of body weight in the form of aqueous "Vifort Special" or the oily Borden or Abbott products, the maximum concentration of vitamin A in serum was found three to four hours after the ingestion of "Vifort Special" and four to five hours after the oily products. In most cases "Vifort Special" produced somewhat higher concentrations. The vitamin A in the serum tended to remain elevated longer after the oily products. We did not find the striking difference in the absorption of the oily and aqueous preparations of vitamin A in favor of the aqueous reported by other investigators. This seemed to be due to the fact that we used relatively concentrated oily vitamin A products containing 210,000 I. U./gm., while they used oleum percomorphum containing 60,000 I. U./gm.

Four hours after ingestion of 7,000 I. U. vitamin A/kg. body weight in the form of the oily Abbott ester product the mean I. U. vitamin A/100 ml. serum for 35 normal newborn infants, 13 older children and 12 adults was, respectively: 502, 1,569 and 1,300. After ingestion of the oily Borden alcohol product, the corresponding values were, respectively: 688, 817 and 1,273. The absorption of vitamin A by the newborn infants was very variable while the older subjects absorbed both products well.

After oral administration, 13 children with cystic fibrosis of the pancreas absorbed only small amounts of the Abbott ester product but absorbed the Borden alcohol product well, while seven children with celiac disease showed poor absorption of both products. Therefore a comparison of the absorption of concentrated oily preparations of ester and alcohol vitamin A is an aid in the differential diagnosis of these two diseases.

Since patients with cystic fibrosis of the pancreas, anemia, diarrhea, giardiasis, severe malnutrition and some acute conditions absorb alcohol vitamin A in oil much better than the ester in oil, it is suggested that the alcohol form of vitamin A in oil or in an aqueous dispersion or emulsified ester vitamin A would be effective sources of vitamin A in the proper nutrition of these patients.

Patients with celiac disease, intestinal ulcers and certain other diseases absorbed both oily and aqueous products poorly. Other patients showed excellent absorption of the various aqueous and oily products.
GALACTOSE STUDIES IN AN INFANT WITH IDIOPATHIC GALACTOSE INTOLERANCE
Authors: GREENMAN LAWRENCE , RATHBUN JOHN C.
Published: December 2021

Galactose metabolism has been studied in a group of convalescent children and in one patient with galactosuria, hepatomegaly and splenomegaly, and cataracts. The galactose tolerance of the convalescent infants studied following intravenous injection of the sugar was similar to that observed in healthy adults. Galactose intolerance as measured by test doses of the sugar, persisted in the infant with galactose intolerance despite clinical improvement on a galactose-free diet. Simultaneous administration of glucose or insulin with the galactose accelerated the rate of disposal of the latter partially, but not completely, toward normal. Alcohol did not alter the galactose tolerance of the patient.
PRIMARY PULMONARY HYPERTENSION
Authors: Rosenberg Harvey S. , McNamara Dan G.
Published: December 2021

A case is reported of a 4-month-old infant in which the outstanding clinical features were failure to gain weight, cough, and progressive dyspnea. There was marked accentuation of the second pulmonic sound and no significant murmur. The electrocardiogram was interpreted as showing right ventricular hypertrophy and roentgenographically, there was unusual clarity of peripheral lung fields and prominence of hilar vessels. Cardiac catheterization demonstrated pulmonary hypertension and revealed no left to right intracardiac shunt. Anatomically, there was right ventricular hypertrophy and prominence of the medial layer of the small pulmonary arteries.

This vascular change is indistinguishable from that seen in the normal newborn and certain varieties of secondary pulmonary hypertension. Although the clinical diagnosis can be suspected, the definitive anomaly can be determined only at post-mortem examination.
CHÉDIAK-HIGASHI SYNDROME
Authors: Donohue W. L. , Bain H. W.
Published: December 2021

An additional fatal case of Chédiak-Higashi's syndrome, occurring in the firstborn of a Canadian family, is reported.

The parents were not related and the mother has subsequently given birth to a normal healthy child.

The clinical features of the Canadian case were in all essential features similar to those reported by Chédiak and Higashi. The hematologic abnormalities were identical.

In addition to findings referable to the blood dyscrasia, the post-mortem examination disclosed a peculiar type of "encephalomyelitis," probably secondary to a chronic degenerative process.
CHRONIC MULTIPLE PERIPHERAL NEUROPATHY IN CHILDHOOD
Authors: Byers Randolph K. , Taft Lawrence T.
Published: December 2021

Attention is directed to the occurrence of chronic polyneuropathy in childhood. The difficulty of adequate sensory examination in children and the slow evolution of the disease tend to obscure the diagnosis and cause confusion with dystrophy or other diseases.

A review of the literature indicates that among chronic polyneuropathies of unknown etiology a number of different causes may lead to a common pathology, based on an increase in fibrous tissue and eventuating in hypertrophy. Histologic examination of nerves proves that the pathology of chronic interstitial polyneuritis may occur without palpable hypertrophy. Reference to the literature also suggests that the life span of affected individuals may be reasonably normal.

Early signs in childhood include disability in locomotion out of proportion to measurable weakness, later with frank sensory ataxia, deformities of the spine and feet and increase in the total protein in cerebrospinal fluid. The course is either progressive, or less frequently, remittent. Muscle and, less frequently, nerve biopsies are helpful diagnostically; the latter sometimes suggest the type of disease present.

In this series of patients no clear evidence of thiamine deficiency was detected by measurements of pyruvate in whole blood after administering a glucose load. No achlorhydria was found.

The possibility that continuing allergic factors are of importance was explored by treatment with cortisone. One child exhibited encouraging evidence of improvement on this regimen.
SUPPLEMENTS TO PEDIATRICS
Authors: MAY CHARLES D.
Published: December 2021

CERTAIN comprehensive investigations as well as considerations of some subjects justly require lengthy presentation. Such thoroughness on the part of authors deserves encouragement. The total pages of editorial text which can be made available to serve all authors and the diverse purposes of this type of medical journal is limited by many circumstances. Whenever manuscripts require more than 20 printed pages in Pediatrics, the right of other authors to prompt publication and a balanced assortment of material in the journal are threatened.

A substantial part of the cost of publishing this journal is borne by the subscribers. Regular publication of lengthy manuscripts from contributors would mean an increase in the price of the journal to subscribers, often for material which has unquestioned fundamental value but is of restricted interest.
NONTUBERCULOUS ACID-FAST BACILLI IN CERVICAL ADENITIS
Authors: Keith Haddow M. , Weed Lyle A. , Needham Gerald M.
Published: December 2021

THE TUBERCLE bacillus is the most common cause of lymphadenitis with caseous necrosis. Such a condition in the cervical region, while less frequent than in previous decades, still occurs occasionally. While other agents, for example, Coccidioides, Histoplasma, Brucella, Pasteurella and Miyagawanella, are known to produce a similar histopathologic reaction, they are not commonly associated with lesions in the cervical lymph nodes, especially in children. Therefore the finding of acid-fast bacilli in such lesions has generally been considered bona fide evidence of tuberculosis, although previous reports from this clinic indicate that such is not necessarily true. It is recognized that there are other acid-fast bacilli, such as the lepra and smegma bacilli, which may or may not cause disease. In 1944 Gellerstedt reported seven cases of tuberculoid skin lesions due to atypical acid-fast bacilli. He considered these to be due to exogenous infection with acid-fast bacilli differing from the organisms found in tuberculosis, and he considered them as possibly saprophytic organisms. In 1948 MacCallum and co-workers reported six cases of skin lesions due to acid-fast organisms that were not Mycobacterium tuberculosis. The lesions did not contain tubercle follicles, giant cells or caseous material. The name "Mycobacterium ulcerans" was applied to these organisms by Australian workers.

In 1954 Linnell and Nordén described skin lesions that occurred in 80 boys and girls who used a certain swimming pool in a Swedish town. The etiologic organisms were acid fast, differed from those described by MacCallum and associates and were not lepra bacilli. Guinea pigs injected with these organisms presented no evidence of lesions after 7 weeks.
CLINICAL CONFERENCE
Authors: Grumbach Melvin M.
Published: December 2021

Dr. Grumbach: Barr and associates have demonstrated that in the human the majority of somatic cells of females contain a conspicuous, heterochromatic mass of chromatin in the resting nuclei. Their discovery of a sex-difference in intermitotic nuclei of a number of vertebrate species, including man, has provided a relatively simple method for assessing the sex-chromosome constitution. This chromatin mass is about 1 micron in diameter and often plano-convex in configuration. It is usually located against the inner surface of the nuclear membrane and contains desoxyribonucleic acid. In males, a comparable chromatin mass is rarely found, never in more than a few per cent of the nuclei. There is good evidence that this so-called "sexchromatin" represents the fusion of heterochromatic portions of two X-chromosomes.

The sex chromatin can be conveniently determined by examination of specimens of skin obtained by biopsy (Fig. 1). Recently, more practical methods for determining cytologic sex have been described employing smears from readily available tissues, such as the oral and vaginal mucosa (Fig. 2) and the blood. Davidson and Smith have shown that there is a sex difference in the morphology of polymorphonuclear neutrophils.

Cytologic examination of chromosomal sex has provided an important tool for the investigation of anomalies of sex development. Apart from its ancillary role in diagnosis, cytologic examination of sex chromatin has made a significant contribution to our understanding of the disordered development in these afflictions. However, the results of this determination should not be regarded as an especial indication of the psychosexual orientation of patients with such abnormalities, nor, in the case of infants, of the sex to which they should be assigned.
DIGITALIS INTOXICATION IN INFANCY AND CHILDHOOD
Authors: Joos Howard A. , Johnson John L.
Published: December 2021

Ten infants and children with digitalis intoxication, overdosage without symptoms, multiple intoxication with cardio-active drugs and other confusing associated circumstances are reported, including three fatalities.

Clinical and electrocardiographic manifestations were not related to the magnitude of the overdosage. Two examples of probable intoxication occurred in children who received digitalis not in excess of the maximum therapeutic doses commonly recommended.

The frequent occurrence of congestive heart failure as a manifestation of digitalis intoxication in early life emphasizes the need to consider this cause in the differential diagnosis of cardiac decompensation.

Dehydration is cited as a possible factor contributing to the occurrence of digitalis poisoning or if resulting from overdosage, aggravating the intoxication.

A wide variety of electrocardiographic disturbances in rhythm and conduction was demonstrated. First degree A-V block occurred in half of the cases. Disturbances in A-V conduction and supraventricular arrhythmias were much more common than abnormalities in ventricular conduction or rhythm. Ventricular arrhythmia was limited to the fatal cases, with one exception.

Digitalis therapy in infants and young children requires particular carefulness from all concerned. Whenever possible, the opportunity for error should be minimized by the use of standardized products, familiar to both physician and pharmacist.
Letters to the Editor
Authors: MCGUINNESS AIMS C.
Published: December 2021

I certainly agree with Dr. Dietrich that Asian influenza thus far has been a mild disease and not too serious a problem for the individual. Dr. Burney has pointed this out on a number of occasions, as, for example, in his remarks before the State and Territorial Health Officers on August 27. I agree, too, that the availability of antibiotics to deal with secondary bacterial infections should, to a great extent, minimize the severity of any epidemic in the United States.
NEWLY ISOLATED VIRUSES IN RESPIRATORY DISEASE
Authors: Parrott Robert H.
Published: December 2021

Adenoviruses are common agents often found in the respiratory tract in acute illness and from tonsils and adenoids removed at surgery.

These viruses are responsible for certain cases of respiratory infection in man, but a great deal of combined clinical, laboratory and epidemiologic study is necessary before a final picture can be drawn.

At the present time, there is good evidence that type 3 adenovirus causes pharyngo-conjunctival fever, an acute illness characterized by fever, pharyngitis, conjunctivitis and cervical lymphadenopathy. This illness may be considered clinically distinct only when most of the features are present or when an epidemic is occurring.

There is also accumulating good evidence that types 4 and 7 adenovinus cause acute febrile respiratory disease in military recruits. This is characterized by fever, chills, headache, generalized aches and pains, hoarseness and irritated throat; symptoms considered relatively specific by those dealing with military personnel.

Whether these observations can be borne out in children, on indeed whether types 4 and 7 adenovirus infections occur in children, is questionable.

Apparently types 1,2,3,4,5, and 7 adenoviruses may also cause nonbacterial pharyngitis, but sufficient cases have not been reported to allow a full description.
Shared Reading and Risk of Social-Emotional Problems
Authors: Martin Keith J. , Beck Andrew F. , Xu Yingying , Szumlas Gregory A. , Hutton John S. , Crosh Clare C. , Copeland Kristen A.
Published: December 2021

BACKGROUND AND OBJECTIVES

The American Academy of Pediatrics recommends literacy promotion as well as routine developmental surveillance during well-child visits to improve academic, relational, and health outcomes. In this study, we examined the possible association between shared reading and social-emotional problems among young children.

METHODS

We conducted a retrospective review of longitudinal records for children aged 30 to 66 months presenting for visits to an academic pediatric primary care center between July 1, 2013, and February 1, 2019. The outcome was evidence of social-emotional problems, defined by an Ages and Stages: Social Emotional Questionnaire (ASQ:SE) score above the established cutoff. The predictor was caregiver-reported frequency of shared reading (most = 5–7 days per week, some = 2–4 days per week, rarely = 0–1 days per week) at a previous visit. Generalized linear models with generalized estimating equations were used to assess the association between the longitudinal outcome and predictor, adjusting for child demographics and needs reported on routine social history questionnaires.

RESULTS

Analyses included 5693 children who completed at least 1 ASQ:SE (total of 7302 assessments) and had shared reading frequency documented before each ASQ:SE assessment. Children were predominantly Black (75%) and publicly insured (80%). Sixteen percent of ASQ:SE scores were suggestive of social-emotional concerns; 6% of caregivers reported sharing reading rarely. Children with rare shared reading had a higher risk of an ASQ:SE above cutoff compared with those with shared reading on most days (adjusted risk ratio, 1.62; 95% confidence interval, 1.35–1.92).

CONCLUSIONS

Less-frequent caregiver-reported shared reading was associated with higher risk of social-emotional problems in young children presenting for primary care. This highlights potential relational and social-emotional benefits of shared reading.
Frequency and Consequences of Routine Temperature Measurement at Well-Child Visits
Authors: Dang Rebecca , Patel Anisha I. , Marlow Julia , Weng Yingjie , Wang Marie E. , Schroeder Alan R.
Published: December 2021

OBJECTIVES

To determine the (1) frequency and visit characteristics of routine temperature measurement and (2) rates of interventions by temperature measurement practice and the probability of incidental fever detection.

METHODS

In this retrospective cohort study, we analyzed well-child visits between 2014–2019. We performed multivariable regression to characterize visits associated with routine temperature measurement and conducted generalized estimating equations regression to determine adjusted rates of interventions (antibiotic prescription, and diagnostic testing) and vaccine deferral by temperature measurement and fever status, clustered by clinic and patient. Through dual independent chart review, fever (≥100.4°F) was categorized as probable, possible, or unlikely to be incidentally detected.

RESULTS

Temperature measurement occurred at 155 527 of 274 351 (58.9%) well-child visits. Of 24 clinics, 16 measured temperature at >90% of visits (“routine measurement clinics”) and 8 at <20% of visits (“occasional measurement clinics”). After adjusting for age, ethnicity, race, and insurance, antibiotic prescription was more common (adjusted odds ratio: 1.21; 95% CI 1.13–1.29), whereas diagnostic testing was less common (adjusted odds ratio: 0.76; 95% CI 0.71–0.82) at routine measurement clinics. Fever was detected at 270 of 155 527 (0.2%) routine measurement clinic visits, 47 (17.4%) of which were classified as probable incidental fever. Antibiotic prescription and diagnostic testing were more common at visits with probable incidental fever than without fever (7.4% vs 1.7%; 14.8% vs 1.2%; P < .001), and vaccines were deferred at 50% such visits.

CONCLUSIONS

Temperature measurement occurs at more than one-half of well-child visits and is a clinic-driven practice. Given the impact on subsequent interventions and vaccine deferral, the harm–benefit profile of this practice warrants consideration.
RESPONSE OF THE YOUNG INFANT TO POLIOMYELITIS VACCINE GIVEN SEPARATELY AND COMBINED WITH OTHER ANTIGENS
Authors: Batson Randolph , Christie Amos , Mazur Bertha , Barrick Jewell H.
Published: December 2021

Two groups of infants received poliomyelitis immunizations beginning at the age of 6 weeks and completing the series by the age of 10 months. One group was given the vaccine as a separate injection while the other received the vaccine mixed in the same syringe with pertussis or diphtheriapertussis-tetanus vaccine. The responses of these infants to poliomyelitis vaccine were analyzed and the following general conclusions were reached:

Poliomyelitis vaccine administered to infants as young as 6 weeks, and given according to the usually recommended schedule results in a satisfactory antibody response.

The response to poliomyelitis vaccine mixed with pertussis and DPT vaccines and given as one injection is satisfactory.

The combination of antigens gave no practical interference to development of antibodies to diphtheria and pertussis.

There were no apparent hazards or adverse reactions associated with combined poliomyelitis-pertussis or poliomyelitis-DPT vaccines.

There were no differences in poliomyelitis antibody responses following immunizations with separate and combined vaccine injection.

The existence of maternal antibodies at the time of poliomyelitis immunization had no apparent influence on the production or persistence of active antibodies.

These findings indicate that poliomyelitis immunization procedures can very easily be integrated into routine pediatric immunization programs, thereby affording the earliest possible protection.
MODIFIED METHOD OF PREPARING CONCENTRATED SMEARS OF BONE MARROW
Authors: McGovern J. J. , Duane M. , Hebert R.
Published: December 2021

THE FOLLOWING brief communication concerns a method of obtaining bone marrow smears which are practically devoid of dilution with cells from the peripheral blood. In the authors' experience bone marrow particles are not usually obtained from small infants and children. Therefore it has not been possible to make use of the standard technique of aspiration of the bone marrow into a heparinized syringe, placing the aspirate on a watchglass, and then selecting a particle of bone marrow for smear or imprint. Neither has the alternative method of centrifuging heparinized marrow in Wintrobe hematocrit tubes proved satisfactory, because the small quantity of marrow generally taken from infants is insufficient to fill a Wintrobe tube. Another difficulty is in separating the buffy coat from the erythrocyte layer in the Wintrobe tube. [SEE FIG. 1 IN SOURCE PDF]

METHOD

The present method consists of expelling two or three small drops of bone marrow from the aspirating syringe on to a glass slide; this is transferred by means of capillary attraction into a micro-hematocrit tube. The micro-hematocrit tube is heat-sealed as in the determination of the micro-hematocrit of peripheral blood. The tube is centrifuged for 5 minutes at high speed, and then broken at the interface of the erythrocytes and buffy coat. This is accomplished by the use of an ordinary metal file such as is used for cutting glass vials. The buffy coat with the supernatant plasma is expelled on to a coverslip, smeared and stained in the usual manner (Fig.1).

This method has proved useful in providing a concentrated preparation of marrow cells and in yielding a more informative picture of the activity of the bone marrow than has been available with the use of ordinary smears.
Pediatric Cardiology
Authors: LURIE PAUL R.
Published: December 2021

Many books on rheumatic fever, congenital heart disease, laboratory diagnosis of heart diseases, and lengthy sections on cardiologic subjects in pediatric textbooks have been written but until now there is no comprehensive textbook in the field of pediatric cardiology. It is fortunate that the first book to appear to fill this real need is an excellent one. Dr. Nadas, of the Children's Medical Center in Boston and Harvard Medical School, is a recognized authority in the field of cardiology and has contributed much to its recent rapid development.
A COMPARISON OF THE EFFECTS OF WHOLE BLOOD AND SEDIMENTED ERYTHROCYTES IN EXCHANGE TRANSFUSION
Authors: Sisson Thomas R. C. , Whalen Lorraine E. , Telek Amalia
Published: December 2021

The relative efficiency of whole blood compared with sedimented erythrocytes in exchange transfusion was studied in regard to the correction of anemia. Two groups of infants with hemolytic disease of the newborn due to maternal-fetal Rh incompatibility were transfused with one or the other type of blood. Determinations of concentration of hemoglobin; packed cell volume; plasma, erythrocyte, and total blood volumes; and total circulating hemoglobin mass were made and compared.

It was concluded that the use of sedimented erythrocytes does not lead to a deficit of erythrocyte volume and circulating hemoglobin mass as does the use of whole blood.

Analysis of data from 47 infants, 23 of whom received whole blood, and 24 of whom received sedimented erythrocytes, indicates that a significant difference in concentration of bilirubin occurs. The increase in concentration of bilirubin subsequent to exchange transfusion was lower and less rapid in most infants of the group receiving sedimented erythrocytes.

For these reasons the use of sedimented rather than whole blood is suggested in exchange transfusion for hemolytic disease of the newborn.
INFANT FEEDING
Authors: MAY CHARLES D.
Published: December 2021

IN THIS ISSUE of Pediatrics (p. 288) is the report of a survey of the types of preparations used routinely in feeding newborn infants during their stay in hospital nurseries. As the author states, the information obtained is of "historic" interest. He points out judiciously that the formula selected for routine use in a hospital, for the sake of simplicity, is apt to convey a subtle implication to parents, residents in training, and other physicians that this one must be the best food for infants.

Thus the choice of a preparation for routine use imposes a responsibility on the attending physician to make the selection on a sound nutritional basis.
RESPIRATORY ILLNESS IN SIX INFANTS INFECTED WITH A NEWLY RECOGNIZED ECHO VIRUS
Authors: Cramblett Henry G. , Rosen Leon , Parrott Robert H. , Bell Joseph A. , Huebner Robert J. , McCullough Norman B.
Published: December 2021

A close association has been established between onset of infection with an ECHO virus (JV-1) and the onset of a mild clinical respiratory illness in six infants 5 months to 14 months of age. The illnesses were characterized by coryza, pharyngitis, and fever of short duration. Other manifestations included abnormal stools, erythema of the ear drums, and mild conjunctival congestion.

Examination of paired acute and convalescent sera from the infants demonstrated a rise in titer of both neutralizing and complement-fixing antibodies against the prototype JV-1 virus. Conversely, tests of sera taken from the same time period of the illnesses did not, with one exception, reveal rising antibodies against adenoviruses, Coxsackie A viruses, ECHO type 8 virus, and influenza A, B, and C viruses.
AORTIC STENOSIS IN INFANTS AND CHILDREN
Authors: Ongley Patrick A. , Nadas Alexander S. , Paul Milton H. , Rudolph Abraham M. , Starkey George W. B.
Published: December 2021

Aortic stenosis is a relatively common lesion in childhood. In severity, it may vary from extreme mildness to cases terminating in sudden death. The prognosis is worse in the presence of left ventricular strain as shown by the electrocardiogram.

Progression of signs of left ventricular "strain" by electrocardiogram should be studied by catheterization of the left side of the heart prior to deciding upon aortic valvotomy.
CONCENTRATION OF PENICILLIN IN THE SERUM FOLLOWING INTRAMUSCULAR ADMINISTRATION OF BENZATHINE PENICILLIN G TO CHILDREN WITH INACTIVE RHEUMATIC FEVER
Authors: Lade Roswith I. , Diehl Antoni M. , Snyder Irvin , Hamilton Tom R.
Published: December 2021

Ninety-six children between the ages of 4 and 20 years with inactive rheumatic fever received 1,200,000 units of benzathine penicillin G every 28 days by intramuscular injection and were studied from the standpoint of effective and consistent concentrations of penicillin in the serum. The concentrations of penicillin in the serum could be determined with certainty in 81% of the specimens; concentrations ranged from 0.002 to 0.125 unit/ml.

The mean concentration of penicillin reached in the serum of females was three times higher than in males. The concentration of penicillin in the serum of females increased with age and weight from the tenth to the seventeenth years. No such increase was observed in the sera of males in relation to age and weight.

The differences in concentration of penicillin reached in the sera of the two sexes from 12 through 17 years of age were statistically significant (p less than 0.01). No significant difference in concentration of penicillin in the serum was found in comparing obese and thin girls of 10 through 15 years of age. The explanation for the differences between the two sexes is not apparent.

During the period of the study, 491 swabs from the nose and throat yielded only one positive culture for beta hemolytic streptococcus of group A; this organism could not be typed and was not associated with an increase in the titer of antistreptolysin O. One other patient had a significant rise in antibody titer, but there was no antecedent positive culture for streptococcus. There were no recurrences of rheumatic fever.
CONGENITAL DEFECTS IN THE BIOSYNTHESIS OF THYROID HORMONE
Authors: Mosier H. David , Blizzard Robert M. , Wilkins Lawson
Published: December 2021

Two patients with goitrous cretinism were studied by use of I-131 and chromatographic analyses of the thyroid gland, plasma and urine.

These studies showed normal mechanisms existed to carry iodine through the steps of organic binding of iodide and deiodination of free iodotyrosines.

There was nearly complete failure to form iodothyronine derivatives (e.g., thyroxine and tri-iodothyronine). The nature of this reaction in the normal thyroid is not known and the nature of a defect at this stage can only be the subject of speculation.

The possible mechanisms involved are discussed in the light of current concepts of thyroidal metabolism of iodine.
PROTEINS IN THE CEREBROSPINAL FLUID IN THE NEWBORN
Authors: Arnhold Rainer G. , Zetterström Rolf
Published: December 2021

The fractions of protein in cerebrospinal fluid of 10 infants with hemolytic disease of the newborn, and 12 newborn infants with other illnesses, have been analyzed by paper electrophoresis.

Relative concentrations have been found to be almost constant, despite wide individual variations in total concentration of protein—except in inflammatory disease with involvement of the central nervous system.

Relative concentrations of gamma globulin are higher in serum than in cerebrospinal fluid, while concentrations of beta globulin are greater in cerebrospinal fluid.

It is suggested that the total concentration of protein in cerebrospinal fluid in newborn infants may reflect the degree of functional maturity of the blood-brain barrier system.
CHONDROECTODERMAL DYSPLASIA (ELLIS-VAN CREVELD SYNDROME)
Authors: Smith Harris L. , Hand Albert M.
Published: December 2021

Two cases of chondroectodermal dysplasia (Ellis-van Creveld syndrome) in infants are reported. The four major features of the syndrome (chondrodysplasia, ectodermal dysplasia, polydactylism, and congenital defect of the heart) were present in each of the infants. One of the cases (Case 1) is believed to be the first published instance of this syndrome in the Negro race. The clinical course of both infants was marked by progressive dyspnea and cyanosis, leading rapidly to death in the newborn period.

Detailed gross and microscopic pathologic findings are included. The cardiac malformation in one case was cor triloculare and in the other was cor biloculare with transposition of the great vessels. The thoracic cage of each infant was extremely narrowed anteriorly and flared inferiorly. Chondro-osseous junctions of ribs were in the anterior axillary line. Death was attributed to the congenital malformation of the heart, pulmonary hypoplasia, and diminished capacity of the thorax due to chondro-osseous dysplasia. The severe chest deformities together with serious congenital cardiac lesions distinguish these cases.

The literature is briefly reviewed, and the clinical and radiographic features of the syndrome are discussed.
Salmonella Osteomyelitis and Abnormal Hemoglobin Disease
Authors: SILVER HENRY K.
Published: December 2021

In reply to Dr. Hammond's letter (Pediatrics, 21:162, January 1958) regarding our article on "Salmonella Osteomyelitis and Abnormal Hemoglobin Disease" may we point out that one of the authors (J.L.S.) not only saw the patient under discussion but took care of her during her hospitalization. She was discussed by Dr. Hammond at Grand Rounds at the University of California Hospital and at that time it was concluded that she probably had hemoglobin C-D disease. Subsequently, when the patient's chart was abstracted (September, 1956) there was nothing to indicate that this conclusion had been altered. Therefore, we used the data as then available.