bluuebunny/crossref_metadata_2025 huggingface dataset:
Myiasis
Authors: Pichanick A. M. E.
Published: December 2021

I would like to correct some of the impressions left by the report of a case of myiasis in the July 1979 issue of Pediatrics.1 In the first place, the authors' statement that there have been no recent reports is not altogether true, as a few minutes in the library soon turned some up,2,3 with a very clear account by Jeliffe,4 for example, and, indeed, in all the standard works on tropical medicine.5-8 Myiasis is, after all, common and widespread in the tropics and subtropics, and is well known to the natives and settlers in these areas, where it has a variety of local names such as Tumbu fly or Putsi fly in Africa, Warble fly, blow fly, flesh fly, bot fly, and screw worm in America.
Feingold Diet vs Allergic Tension Fatigue
Authors: Speer Frederic
Published: December 2021

Both sides involved in the controversy over the Feingold diet seem to overlook completely that behavior disorders have long been known to be caused by allergy to specific foods.1,2 In these cases, the child is ordinarily not only overactive but oversensitive to discipline, pain, light, noise, etc. Most patients also display manifestations of fatigue, such as weakness and torpor. These findings may occur in the absence of such well known allergic diseases as asthma.

In order to give this disorder proper recognition as an allergic clinical entity in its own right, the term allergic tension-fatigue syndrome was introduced in 1958.3
Lumbosacral Lipoma with Acute Deterioration during Infancy
Authors: Pasternak Joseph F. , Volpe Joseph J.
Published: December 2021

Recommendations concerning the timing of surgery for lumbosacral lipomas have been inconsistent. Proponents of delay of operation until 5 to 6 years of age in patients without neurologic deficits claim that the procedure is made technically easier by allowing growth and maturation of intraspinal structures.1,2 However, the frequency of eventual neurologic deficits in unoperated patients has led others to recommend prompt surgery, even in infancy.3,4 Because these deficits are usually insidious in onset, most clinicians are unaware that the patient with a lumbosacral lipoma can deteriorate acutely. We wish to report a patient with a lumbosacral lipoma who suffered two episodes of acute deterioration in early infancy, and is left with severe neurologic residua.
The Fetal Alcohol Syndrome and Neuroblastoma
Authors: Kinney Hannah , Faix Roger , Brazy Jane
Published: December 2021

In 1977 Hornstein et al1 reported the occurrence of adrenal carcinoma in a child with fetal alcohol syndrome. Recently Seeler et al2 noted a ganglioneuroblastoma in a child with fetal hydantoin-alcohol syndromes. The association of neural crest tumors with fetal hydantoin syndrome now appears established.2 The following case suggests an association with neoplasia may also exist for fetal alcohol syndrome.

CASE REPORT

Clinical Summary

T.E. was the 1,360 gm product of a 35-week gestation born to a 30-year old, black primigravida. At 11 days of age the patient was transferred to Duke Hospital for evaluation of multiple congenital anomalies and repair of a right-sided diaphragmatic hernia.
ON THE UPBRINGING OF CHILDREN BY JOHN PECHEY, WRITING IN 1697
Authors: C. T. E.
Published: December 2021

John Pechey (1655-1716), the last English writer on diseases of children in the seventeenth century, had this to say about the upbringing of children.1

Children if they are virtuous are great Blessings and a publick good. It is therefore the duty of Parents to inure them betimes to a Regular course of Life; nor ought Persons of the best Quality to think the guidance of their Children beneath them. For Cornelia the Mother of the Gracchi, and Aurelia the Mother of Augustus Caesar, were Governesses to Children, and Cato, tho' he kept a Tutor in his House, did himself frequently instruct his Son. So did Augustus his grand-children, and the great Theodosius wou'd often sit by the Tutor while he was instructing his Son. And certainly it is best and safest for Parents to have their Children under their own Eye and inspection. But above all, the Fathers Example is of greatest force to instruct the Son, and his Actions Authorise the same in the Child, nor can the Father chastize him for what himself is guilty.
Growth Disturbances in Hyperkinetic Children
Authors: Greenhill Laurence L. , Puig-Antich Joaquim , Halpern Frieda , Sachar Edward J. , Rubinstein Boris , Chambers William , Fiscina Bernadette , Florea John
Published: December 2021

Roche et al (Pediatrics 63:847, 1979) have provided a good clinical review of recent data on stimulant-induced growth disturbances in hyperkinetic children. They have clearly shown that substantial differences exist among published studies in methodology used, drug dosages employed, and measurement techniques cited. The clinician in the field needs this type of review to clarify the confusing reports on stimulant side effects.

We wish to make two points. The authors might have stressed that the stimulant drugs available may have differential growth suppression effects.
Continuous Monitoring of Arterial Oxygen Tension in Infants: Four Years of Experience with an Intravascular Oxygen Electrode
Authors: Pollitzer Melanie J. , Soutter Linda P. , Reynolds E. Osmund R.
Published: December 2021

Two hundred eighty-two umbilical artery catheters with oxygen electrodes on their tips were passed into the aortas of 268 newborn infants with severe respiratory illnesses between 1974-1977; 254 (90%) of the electrodes recorded Pao2 satisfactorily for a mean of 66 hours; 212 (75%) electrodes were still functioning well when removed, because they were no longer clinically needed, after a mean of 87 hours. The 27 electrodes that failed to record Pao2 on insertion, 42 that failed later, and 25 that temporarily malfunctioned were examined after removal from the infants. A structural cause was found which accounted for the failure or malfunction of 43 electrodes. Problems with the remaining 51 electrodes were thought often to have been due to clotting over the tip of the electrode. The main complication of catheterization was temporary impairment of the circulation to the legs in 69 (26%) infants. Autopsies were done on 69 (85%) of the 81 infants who died; 22 (32%) infants were found to have thrombi in an iliac artery, which spread in ten (15%) to the aorta. It was concluded that the intravascular electrode usually functioned satisfactorily and that the incidence of complications was no higher than that reported with ordinary umbilical artery catheters. Improvements in the performance of the catheter-tip electrode would be expected if structural causes for failure were eliminated and if means to reduce the incidence of clot formation around the catheter and electrode could be found. It is believed that intravascular electrodes cannot be replaced by skin electrodes For the initial management of severe respiratory illnesses.
Hospital and Home Support during Infancy: Impact on Maternal Attachment, Child Abuse and Neglect, and Health Care Utilization
Authors: Siegel Earl , Bauman Karl E. , Schaefer Earl S. , Saunders Minta M. , Ingram Deborah D.
Published: December 2021

Effects of early and extended postpartum contact and paraprofessional home visits on maternal attachment, reports of child abuse and neglect, and health care utilization were determined by random assignment of 321 low-income women to intervention or control groups immediately after delivery. Observations of maternal attachment were made at four months and 12 months. Hospital, health and welfare agency records, and interviews were used to determine reports of child abuse and neglect and health care utilization. After establishing a control for maternal background variables, early and extended contact explained statistically significant but small amounts of variance in several of the attachment measures. There were no statistically significant effects of the home visit interventions on maternal attachment, and neither intervention was related to reports of child abuse and neglect and health care utilization. Although the study supported earlier findings that early and extended contact has a significant effect, additional interventions are needed to support mother-infant attachment.
SURVIVAL OF A ONE-POUND FEMALE INFANT BORN IN 1847
Authors: C. T. E.
Published: December 2021

After a thorough literature search of the survival rates of premature infants, I believe the infant described below was the smallest to survive until this century.1 I am mindful that the reported birth weights in the past may have been inaccurate because the weighing of newborn infants was not an accepted practice prior to this century. 2

Mrs. A. (aged 30) weaned her first child on the 17th of November 1846, a fortnight after which (1st December) she menstruated naturally. Two days after the catamenia disappeared (7th December), she conceived, having the same sensations post coitu which she felt at her previous conception. At four months she quickened. She was delivered (by a midwife) of her second child, a female, on the 14th of May 1847-on the hundred and fifty-eighth day of gestation. The child had only rudimentary nails, and almost no hair, except a little, of slightly reddish colour, at the lower part of the back of the head. It weighed one pound, and measured eleven inches. It was merely wrapped up at first, laid in a box about a foot long, used by the father (who is a slater) for carrying nails, and set on the kitchen fender, before the fire, to keep it warm. It came on very well, and was subsequently treated very much the same as other children, except perhaps, that it was a little more looked after than usual, being considered a curiosity. She is still of small make but is quite healthy, and takes her food well.
Tracheobronchial Foreign Bodies in Children: Back to the Bronchoscope and a Balloon
Authors: Kosloske Ann M.
Published: December 2021

Aspiration of a foreign body, a common pediatric accident, causes about 400 deaths per year in children under 4 years of age in the United States.1 Bronchoscopic extraction of the foreign body was the only standard treatment until 1972, when Burrington and Cotton2 introduced a controversial alternative. These authors reported that 80% of children treated by inhalation of a bronchodilator, followed by postural drainage and percussion, spontaneously coughed out the foreign body without need for bronchoscopy. They advocated continued use of the technique of inhalation-postural drainage for as long as four days before resorting to bronchoscopy for extraction of the foreign body.3
Letters to the Editors
Authors: Bergeson Paul S.
Published: December 2021

The Committee on Hospital Care is entirely in sympathy with the concerns expressed by Dr Van Gelder as they pertain to difficulty adjusting to any proposed new system. Such sentiments were expressed in the statement on SI.

Over the years we have become accustomed to a "non system" of units in medicine which, in reality, is nonsensical and chaotic. It developed piecemeal and with little overall planning or logic. As a result, a stupifying number of units must be memorized.
Control of Arthritis Associated with Congenital Agammaglobulinemia by High Doses of Exogenous Gamma Globulin
Authors: Prasad Rayasam V.S.K. , Kesarwala Hemant H. , Papageorgiou Photini S.
Published: December 2021

Reports about the response of arthritis associated with agammaglobulinemia to conventional amounts of exogenous γ-globulin have been controversial.1-3 It appears from some of these reports3 that more intensive therapy with exogenous γ-globulin is required for accomplishing remission of joint symptoms that is necessary for control of infections. Pabst and Gelpke (Pediatrics 61:306, 1978) suggested that a certain level of serum IgG should be achieved and maintained for remission. We report similar results in one of our patients with arthritis and congenital agammaglobulinemia.
Scopolamine Toxicity in a Newborn
Authors: Evens Ronald P. , Leopold John C.
Published: December 2021

Scopolamine, an alkaloid similar to atropine, is still widely used in combination with meperidine and barbiturates to induce sedation and amnesia during labor and delivery. William's Obstetrics,1 states that scopolamine produces neonatal depression when used with morphine during labor and delivery. The following case demonstrates the potential side effects of this drug.

Case Report Baby B was a 7 lb 7 oz, female infant with an Apgar score of 10/10. She delivered spontaneously to a 24-year-old gravida 1, para 0, Latin-American woman without complications.
Thoughts on Vitamin E
Authors: Ozoylu Sinasi
Published: December 2021

I would like to add my short comments to the concise commentary of Phelps1 on vitamin E. In addition to the mentioned several conditions related to vitamin E metabolism, probable vitamin E deficiency in the pathogenesis of thrombocytosis in Caffey's disease2 should be remembered by the pediatricians. We have seen such a case recently.3 Improvement of erythrocyte survival in chronic hemolyzing G-6 PD and glutathione synthetase deficiency with high doses of vitamin E seems to be promising approach in the treatment of these patients.4
Effect of Vitamin E Therapy on Blood Coagulation Tests in Newborn Infants
Authors: Zipursky Alvin , Milner Ruth A. , Blanchette Victor S. , Johnston Marilyn A.
Published: December 2021

A double-blind randomized trial of vitamin E therapy was conducted in premature infants whose birth weight was less than 1,500 gm. Treated infants received 25 mg of Vitamin E daily by mouth for the first six weeks of life. Detailed studies of plasma coagulation factors were performed prior to therapy and at days 7 and 42. None of the factors differed significantly between the treated and control groups. Although vitamin E therapy has been reported to affect the blood levels of vitamin K dependent coagulation factors, no such effect was noted in this group of premature infants.
Development of Functional Response in Human Exocrine Pancreas
Authors: Lebenthal Emanuel , Lee P. C.
Published: December 2021

The ability of newborns to digest proteins, fats, and carbohydrates depends, to a large extent, on their level of exocrine pancreatic function. Building on the limited published data, we studied pancreatic enzyme activities in the duodenal fluid and the response of the exocrine pancreas to secretogogues in 15 premature and full-term infants at birth and at 30 days of age. We compared these findings to those obtained from identical studies of 17 children age 2 years and above. In addition, we measured the pancreatic exopeptidase, carboxypeptidase B, in relation to other pancreatic enzymes. The duodenal fluid of newborns and infants contained no amylase and negligible lipase. Carboxypeptidase B levels were also low compared to those in the older children. In contrast, chymotrypsin activity in infants was about 50% to 60% of level found in the older children. Trypsin activity, the highest of all enzymes measured, was about the same in both newborns and older children, with a transient increase at 30 days. Administration of pancreozymin had no effect on pancreatic enzymes in the duodenal fluid of newborns and a slight effect on 1-month-old infants. But by age 2 years, a full response of the pancreas to pancreozymin was evident. In infants and newborns, responses to secretin were poor. Thus, the secretory response of the human pancreas to secretogogues, absent or minimal at birth, is acquired during the postnatal period.
Renal Functions of Low Birth Weight Infants with Hyperglycemia and Glucosuria Produced by Glucose Infusions
Authors: Stonestreet Barbara S. , Rubin Loren , Pollak Arnold , Cowett Richard M. , Oh William
Published: December 2021

Hyperglycemia and glucosuria, which may lead to an osmotic diuresis, are often seen in low birth weight infants receiving glucose infusions during parenteral alimentation. This study was designed to examine the degree of glucose tolerance and the renal handling of glucose, solute, and water during intravenous glucose infusions in low birth weight infants. Twenty infants (mean birth weight, 1,170 gm; gestational age, 30 weeks) were studied between 1 and 20 days of age. At similar glucose infusion rates, 12 of 20 infants of lower gestational ages (29 ± 0.6 weeks, mean ± SEM) had higher plasma glucose concentrations and developed glucosuria while the remaining eight of 20 infants of higher gestations (31.4 ± 0.5 weeks, P < .05) did not. In the glucosuric infants, there were significant increments in the filtered glucose load on the basis of increased plasma glucose concentrations and slightly higher glomerular filtration rates, although the changes of the latter were not statistically significant. The percentage of tubular reabsorption of glucose decreased and urinary excretion of glucose increased significantly with increased plasma glucose. Although urine flow remained unchanged, significant increments occurred in osmolar and sodium excretions. Exogenous glucose infusions in low birth weight infants resulted in a greater degree of hyperglycemia in the less mature infants and produced significant changes in the renal handling of glucose and sodium associated with significant, although slight, increments in solute excretion. In this series of six-hour glucose infusions, untoward effects of an osmotic diuresis (significant urine loss) were not observed.
Postoperative Pericardial Effusion and Its Relation to Postpericardiotomy Syndrome
Authors: Clapp Sandra K. , Garson Arthur , Gutgesell Howard P. , Cooley Denton A. , McNamara Dan G.
Published: December 2021

Postpericardiotomy syndrome often delays recovery from cardiac operation. Pericardial effusion is an important sequela of postpericardiotomy syndrome. To define the relationship between postpericardiotomy syndrome and pericardial effusion, we performed four to seven serial echocardiograms (echoes) between postoperative day 0 and postoperative day 10 in 40 children who had operation requiring pericardiotomy. We also performed daily physical examination on each patient for clinical evidence of postpericardiotomy syndrome. Echocardiographic signs of pericardial effusion developed in 21/40 patients (53%). The effusion was present by postoperative day 5 in 19/21 patients. Clinical signs of postpericardiotomy syndrome occurred in 18/40 patients (45%). Among the 18 patients with postpericardiotomy syndrome, 16 had echocardiographic evidence of pericardial effusion. Thus the sensitivity of the echocardiogram was 89%. The pericardial effusion always developed prior to and persisted through clinical symptoms. We conclude that (1) pericardial effusion is present in over 50% of the patients following cardiac surgery, (2) it develops early in the postoperative period, and (3) once present, the effusion is persistent and frequently followed by clinical evidence of postpericardiotomy syndrome.
Common Wisdom and New Findings in Sinusitis
Authors: Fulginiti Vincent A.
Published: December 2021

Common wisdom often guides us in pediatric practice; sometimes it's an excellent guide, sometimes not. In this issue Brook and colleagues (p 568) challenge established dogma in infectious diseases and otolaryngological practice in pediatrics. They report a predominance of anerobic bacteria as causative agents for acute and chronic sinusitis in a selected series of patients. They fail to isolate aerobic, pyogenic organisms (staphylococci, hemolytic streptococci, pneumoniae and Haemophilus influenzae) from their patients, except in one instance, irrespective of prior antibiotic therapy. In contrast, common wisdom plus previous investigative efforts have specically identified these organisms as predominant in sinusitis; indeed, antibiotic recommendations by age are predicated upon such prevalence.1-7
Cimetidine Toxicity
Authors: Lilly John R. , Murr Peter , Pau Christine
Published: December 2021

In the recent report by Chhattriwalla and colleagues (The use of cimetidine in the newborn. Pediatrics 65:301, 1980) no toxic side effects were observed in three infants during cimetidine treatment. The authors referenced several reports of cimetidine toxicity in adults but did not discuss previously reported studies in children. Two reports from our institution noted both hepatic and cerebral toxicity in young subjects during cimetidine therapy.1,2 First, cholestasis, as manifested by striking elevations of serum bile acids, occurred in five consecutive children from 1 to 14 years old.
Controlled Trial of Prenatal Nutrition Supplementation Defended
Authors: Rush David , Stein Zena , Susser Mervyn
Published: December 2021

The three commentaries on our recent paper1 by Drs Barness,2 Jacobson,3 and Hegsted4 pose thoughtful questions, which require serious consideration and reply.

The study was complicated, of long duration, and it was costly in money, time, and energy. The National Institute of Child Health and Development scrupulously sought to protect its investment; we were site-visited by scientific peers no fewer than seven times. Indeed, both Drs Jacobson and Hegsted served twice on site visit committees.
Diagnosis and Follow-up of Intraventricular and Intracerebral Hemorrhages by Ultrasound Studies of Infant's Brain Through the Fontanelles and Sutures
Authors: Bejar Raul , Curbelo Violeta , Coen Ronald W. , Leopold George , James Hector , Gluck Louis
Published: December 2021

A technique to diagnose subependymal hemorrhage (SEH), intraventricular hemorrhage (IVH), intracerebral hemorrhage, and posthemorrhage hydrocephalus in tiny infants, using real time ultrasound studies of the brain ventricular system, is described. This is a bedside technique that visualizes the brain through the fontanelles and the sutures, in three planes: coronal, sagittal, and horizontal. Excellent visualization of the ventricular system, caudate nuclei, the thalamus, the choroid plexus, the corpus callosum, and the foramen of Monro is obtained. This method has good definition using high frequency transducers since there is no bone interference. The ultrasound diagnosis correlated well with computed tomography (CT) and with direct pathologic studies. This technique was more sensitive in diagnosing small IVH/SEH and organized clots than were CT studies. IVH/SEH were found in 90% of 113 infants ≤34 weeks of gestation; 49% of the hemorrhages were large and 41% were small. Most hemorrhages were found in the first scan, usually shortly after birth. Twenty-one premature infants who never had perinatal asphyxia or respiratory distress syndrome had IVH/SEH. The hemorrhages were followed until disappearance, usually in one to three months in cases of large hemorrhages.
Ultrasound Detection of Changing Ventricular Size in Posthemorrhagic Hydrocephalus
Authors: Horbar Jeffrey D. , Walters Carrie L. , Philip Alistair G. S. , Lucey Jerold F.
Published: December 2021

Real time ultrasonography has been used to follow sequentially the changing size of the cerebral ventricles in an infant with posthemorrhagic hydrocephalus. A method for quantitating ventricular size is presented and the rapidity with which ventricular size decreases following removal of cerebrospinal fluid is demonstrated.
Neo-Mull-Soy Metabolic Alkalosis: A Model of Bartter's Syndrome?
Authors: Reznik Vivian M. , Griswold William R. , Mendoza Stanley A. , McNeal Richard M.
Published: December 2021

A case of Neo-Mull-Soy-induced metabolic alkalosis occurred in an 8-month-old child. This child had hypochloremic hypokalemic alkalosis as well as hyperreninemia. Initially, a diagnosis of Bartter's syndrome was made and treatment consisted of KCl replacement, indomethacin, and aspirin. In retrospect, the diagnosis of Neo-Mull-Soy induced metabolic alkalosis could have been suspected on the basis of the low chloride concentration in his urine. Proposed mechanisms for the etiology of Bartter's syndrome are reviewed. Neo-Mull-Soy induced metabolic alkalosis simulates Bartter's syndrome and supports the concept that the primary abnormality in Bartter's syndrome is chloride deficiency. The chloride deficiency in Bartter's syndrome results from a defect in active chloride transport in the thick ascending limb of the loop of Henle.
Artificial Surfactant to Prevent and Treat Neonatal Respiratory Distress Syndrome
Authors: Enhorning Goran
Published: December 2021

Twenty years ago we were first presented with evidence that infants dying from hyaline membrane disease suffer from a pulmonary surfactant deficiency.1 This observation has been substantiated with numerous reports from several countries. It offers a logical explanation to the physiology and pathology characterizing the condition, and has clearly influenced preventive and therapeutic measures. The obstetrician tries to avoid delivery until surfactant synthesis has become adequate through a naturally occurring process of maturation, or through one stimulated with glucocorticoids, and the pediatrician counteracts the tendency for atelectasis to develop by applying an airway pressure which is continuously distending.

Delivery quite often occurs so early in gestation that surfactant synthesis is still inadequate and there has not been sufficient time to stimulate it.
Rules for Breast-feeding
Authors: Isenberg Howard
Published: December 2021

The Committee on Nutrition of the American Academy of Pediatrics has stated, "Breast-feeding is strongly recommended for full-term infants."1 Although breast-feeding is increasing, especially among higher income groups, the failure rate among nursing mothers remains high.2 Even highly motivated and educated mothers are often forced to stop nursing earlier than they had wished.2 It has been shown that successful nursing is highly correlated with possession of correct information concerning nursing.3 In order to help our nursing mothers, I made the following handout entitled "The Six Essentials of Successful Nursing" based on various articles about breast-feeding.1, 4-6
Urine Screening After Discharge from Hospital
Authors: Nadler Henry L.
Published: December 2021

Experience gained during the past decade has clearly documented the value of neonatal screening for the early diagnosis of a number of disorders. Many "screening" approaches for the detection of inborn errors of metabolism in the neonate have been utilized, including cord blood sampling, dried blood collected on filter paper during the first week of life, and dried blood or urine collected on filter paper between the second and fourth weeks of life. Despite the fact that interesting and potentially important information has been obtained, the Committee on Genetics of the American Academy of Pediatrics has recommended routine screening, preferably during the first week of life, for only two conditions, phenylketonuria and hypothyroidism.1,2
Valproate in the Treatment of Seizures Associated with Propionic Acidemia
Authors: Wolf Barry , Paulsen Elsa P. , Dreifuss F. E.
Published: December 2021

MacDermont et al1 (Pediatrics 65:624, 1980) have described the uncomplicated efficacy of valproate in treating the seizures of two patients with nonketotic hyperglycinemia even though valproate elevates urinary and serum glycine concentrations in individuals with convulsive disorders.2,3 Recent observations of increased urinary propionate excretion as a metabolic consequence of valproate therapy in two patients with seizures seem to contraindicate its use in children with disorders of propionate metabolism.4 However, we have successfully and safely used valproate to control seizures in a patient with propionyl coenzyme A carboxylase (PCC) deficiency, a disorder characterized by both hyperglycinemia and propionic acidemia.
Comment on Teenage Pregnancy Statement
Authors: Reiss G. Russell
Published: December 2021

Thanks for the "Letters to the Editor" section of Pediatrics. In the June 1980 issue we are treated to Dr Eugene Diamond's sound and reasonable philosophy of medical practice in his comments on the American Academy of Pediatrics' policy statement on teenage pregnancy (Pediatrics 65:1192, 1980). One has to read and search through many lines of medical literature to find such clear thinking as expressed here by Dr Diamond.

The committee's policy statement is one that has to be made to accommodate the various viewpoints held by the members of the Academy–so we are told.
Recrudescence and Relapse in Bacterial Meningitis of Childhood
Authors: Schaad Urs B. , Nelson John D. , McCracken George H.
Published: December 2021

Antibiotic therapy of bacterial meningitis in children may be complicated by reappearance of bacteria in cerebrospinal fluid during therapy (recrudescence) or within three weeks after therapy is stopped (relapse). Clinical and laboratory features of six children with recrudescence and of 21 children with relapse were reviewed. These complications occurred mainly in infants less than 2 years of age and comprised less than 1% of all cases of bacterial meningitis. Neither the initial nor the follow-up CSF findings were predictive of recrudescence or relapse. Prolonged or secondary fever was unrelated to these complications. Recrudescence was usually caused by inappropriate therapy whereas relapse after adequate therapy of bacterial meningitis was usually ascribed to persistence of infection in meningeal or parameningeal foci. Relapse did not become manifest until three or more days after discontinuation of therapy. It is concluded that routine examination of CSF at the end of adequate antimicrobial therapy is not necessary or useful when the patient has exhibited a satisfactory clinical response. Furthermore, the commonly recommended observation period of 48 hours in the hospital after discontinuation of therapy is not justified for a patient who has had an uneventful course.
Fatal Graft Versus Host Disease Following a Blood Transfusion in a Child with Neuroblastoma
Authors: Woods William G. , Lubin Bertram H.
Published: December 2021

A 2-year-old boy who was receiving intensive chemotherapy for advanced neuroblastoma developed fatal graft versus host disease following administration of a unit of packed red blood cells from an unrelated donor. Graft versus host disease was documented by demonstrating human leukocyte antigen identity between the transfusion donor and the patient's peripheral circulating lymphocytes. Nonirradiated packed red blood cells contain viable lymphocytes and pose a risk to the immunosuppressed cancer patient.
Left Ventricular Hypertrophy in Adolescents with Elevated Blood Pressure: Assessment by Chest Roentgenography, Electrocardiography, and Echocardiography
Authors: Laird W. Pennock , Fixler David E.
Published: December 2021

The purpose of this study was to assess the prevalence of left ventricular hypertrophy in adolescents with persistently elevated blood pressures. Chest roentgenograms, electrocardiograms, and echocardiograms were performed on 50 adolescents with elevated blood pressure and 50 matched normotensive control subjects. No subject in either group demonstrated cardiomegaly on x-ray. Interpretation of the electrocardiograms indicated that similar numbers of both hypertensive (7/50) and control subjects (8/50) had ECG evidence of left ventricular hypertrophy. The echocardiograms showed that the mean left ventricular wall thickness (LVWT) in the hypertensive adolescents was 7.8 mm ± 0.1 (SE), compared with 6.5 ± 0.1 in the control subjects (P < .001). When the measurements were indexed to body surface area, the difference remained highly significant. Indexed left ventricular mass (LVM)/body surface area (BSA) was also significantly greater (P < .001) in the hypertensive (84.2 gm/sq m ± 2.1) than in the control subjects (72.0 ± 2.1). Using data from the normotensive control subjects, we defined the 95th percentile for both LVWT/BSA and LVM/BSA. Among hypertensive adolescents, 9/50 had LVWT/BSA and 8/50 had LVM/BSA above this level. For control subjects, only 1/50 had elevated LVWT/BSA values and 2/50 elevated LVM/BSA values. This study demonstrates that hypertensive adolescents have an increased prevalence of left ventricular hypertrophy and that echocardiography is the most useful noninvasive method to detect these changes.
Depressed Neutrophil Chemotaxis in Infants with Cow's Milk and/or Soy Protein Intolerance
Authors: Butler Helen L. , Byrne William J. , Marmer Daniel J. , Euler Arthur R. , Steele Russell W.
Published: December 2021

Neutrophil chemotaxis and random migration were studied in 11 infants with active cow's milk and/or soy protein intolerance and in an additional four infants following clinical recovery. Results were compared to 15 age-matched control subjects. Infants with active intolerance exhibited depressed chemotaxis and enhanced random migration. The four recovered infants had values similar to those of control subjects.
Chronic Protracted Diarrhea: Intolerance to Dietary Glucose Polymers
Authors: Fisher Stanley E. , Leone Guy , Kelly Robert H.
Published: December 2021

The use of "elemental" diets has received widespread acceptance in the treatment of chronic protracted diarrhea of infancy1,2 and other gastrointestinal disorders.3,4 Two frequently used commercial "elemental" formulations are Vivonex (Norwich- Eaton Pharmaceuticals, Norwich, NY) and Pregestimil (Mead Johnson and Co, Evansville, IN), both of which utilize glucose polymers as the major source of carbohydrate. Prior to the fall of 1978, Pregestimil contained simple glucose, instead of polymers, but was changed in order to decrease the formula osmolality. We report an infant recovering from chronic protracted diarrhea who was unable to tolerate glucose polymers, but thrived on the "old" glucose-containing Pregestimil formulation.
Vascular Etiology of Disruptive Structural Defects in Monozygotic Twins
Authors: Hoyme H. Eugene , Higginbottom Marilyn C. , Jones Kenneth L.
Published: December 2021

Two infants with structural defects previously undescribed in the survivor of a monozygotic twin pair are reported. One infant had hydranencephaly and a spinal cord transection, with an associated dead monozygotic co-twin of 24 weeks gestation; the other child had complete atresia of the colon and a horseshoe kidney, with a deceased co-twin of approximately six weeks gestation. These defects are presumed to be the result of in utero disruption of previously normally formed structures. They occur secondary to vascular exchange from a dead to a living monozygotic twin through placental vascular anastomoses. As illustrated by the two children described, the nature of the vascular defects seen in the survivor of a monozygotic twin pair depends on the time during gestation at which the co-twin dies. Recognition of the disruptive vascular etiology of the structural defects outlined in this report will allow for appropriate counseling with respect to the negligible recurrence risk for similar vascular accidents.
Letters to the Editor
Authors: Grim Clarence E.
Published: December 2021

The comments by Dr Walson raise some worthwhile points.

The level of serum potassium in each patient was measured on nine separate days. In only one patient (the youngest) was a single potassium level of less than 3.6 mEq/liter obtained. Thus, in 26 of 27 measurements, potassium was normal (96% of the time). In contrast, plasma renin activity (PRA) was always less than 0.5 ng of angiotensin I (AI) per ml per 3 hr in 17 of 17 samples collected (100%) on each patient.
Psychologic Functioning of Siblings of Disabled Children
Authors: Breslau Naomi , Weitzman Michael , Messenger Katherine
Published: December 2021

This paper reports findings from a comprehensive study of families of pediatric patients with cystic fibrosis, cerebral palsy, myelodysplasia, and multiple handicaps receiving care in clinics of two teaching hospitals in Cleveland. In 239 families with normal siblings 6 to 18 years old, mothers completed the Psychiatric Screening Inventory for a randomly selected sibling in this age group. Results were compared to data on 1,034 randomly selected children from a cross-section of Manhattan households. The proportion of siblings with serious impairment was not significantly different from the Manhattan sample. Although on the total inventory siblings did not score significantly higher than the comparison sample, they did score significantly higher on the mentation problems, fighting, and delinquency subscales. The diagnostic categories of the disabled children had no significant effect on siblings' scores, nor did level of disabiity. Neither siblings' sex nor age bore any relationship to their psychologic functioning. A sibling's birth order in relation to the disabled child had a significant interaction effect with sex on psychiatric impairment. Little relationship was found between a mother's perceived effects of caring for a disabled child on attention to siblings and siblings' disorder.
Should Linen in Newborn Intensive Care Units Be Autoclaved?
Authors: Meyer Christopher L. , Eitzen Harold E. , Schreiner Richard L. , Gfell Mary A. , Moye Lemuel , Kleiman Martin B.
Published: December 2021

The American Academy of Pediatrics' standards and Recommendations for Hospital Care of New-born Infants recommends that linen in newborn intensive care, intermediate care, continuing care and admission observation areas be autoclaved. Questionnaires sent to 269 directors of newborn intensive care units (69% returned) showed that 74% of the respondents do not autoclave linen used in their newborn intensive care unit. There were 284 linen cultures performed in our newborn intensive care unit where linen is not autoclaved; 68% of the cultures were positive, but only 2.5% had a colony count greater than 20 colonies per plate. The most common organisms obtained were Staphylococcus epidermidis, diphtheroids, and Micrococcus species. Two cultures grew Staphylococcus aureus, one colony and two colonies per plate. Three-factor analysis of variance showed that the location of the linen in the top of the pile exerted a statistically significant effect on the bacterial contamination rate. The fact that three fourths of neonatal intensive care centers in this country do not autoclave nursery linen, the lack of reports in the literature relating linen contamination to nosocomial infections, and the microbiologic results of this study suggest that the recommendations of the American Academy of Pediatrics merit further study and reevaluation.
Why Not Use Naloxone?
Authors: Goodlin Robert C.
Published: December 2021

Since narcotic antagonists have long been used in the second stage of labor1 and naloxone has been shown to have no detrimental effects on the normal fetus,2 I wonder why the Committee on Drugs3 recommends that naloxone not be used to reverse the fetal and neonatal effects of maternally administered narcotic analgesics?
Intracranial Hemorrhage in Children with Idiopathic Thrombocytopenic Purpura
Authors: Woerner Sarah Joan , Abildgaard Charles F. , French Barry N.
Published: December 2021

Intracranial hemorrhage is a rare but lifethreatening complication of childhood idiopathic thrombocytopenic purpura. We present three cases of this complication encountered at our institution, in addition to a tabulation of 15 previously reported cases. Prevention, diagnosis, and management of intracranial hemorrhage in idiopathic thrombocytopenic purpura are discussed. The importance of avoidance of antiplatelet drugs as well as the significance of the location of the intracranial hemorrhage are emphasized. Posterior fossa hemorrhages are especially dangerous because of the possibility of rapid cerebellar herniation and brainstem compression. Management of intracranial hemorrhage should be prompt and aggressive, and splenectomy should always be performed prior to any neurosurgical procedure. It is encouraging that 11 of 18 patients had a favorable outcome.
Paraplegia Due to Peripheral Venous Air Embolus in a Neonate: A Case Report
Authors: Willis John , Duncan Caroline , Gottschalk Sheila
Published: December 2021

A term male infant with pneumonia was receiving fluid and antibiotics through an intravenous line in the scalp. Air was accidentally infused in this line. Subsequently, discoloration of the skin, a flaccid paraplegia, hematuria, and gastrointestinal bleeding occurred as the presumed effect of venous air entering the systemic arteries. The umbilical vessels were never catheterized. Absence of any apparent cerebral air embolism is interpreted as being due to the infant's position (head down) at the time of air infusion. The pathogeneis and prevention of this tragic complication are discussed.
Primary Care of Previously Institutionalized Retarded Children
Authors: Schor Edward L. , Smalky Kathleen A. , Neff John M.
Published: December 2021

Medical care of retarded children is a responsibility of pediatricians that is seldom discussed. Past practices of isolating these children in institutions and caring for them in special multidisciplinary clinics are fading. The medical experience with 48 retarded children, the problems that they present, and the system of care that was developed to meet their special needs are described. Previous medical care was often found to be lacking or inappropriate. The spectrum of morbidity resembles that of a general pediatric population although chronic conditions are much more prevalent. Utilization of primary care and consultative services is much higher than for a nonretarded population. Much time is required for their care; a great deal of time is devoted to advising caretakers and schools and to coordinating health services. A prepaid system of care using a health associate as the primary provider was developed, and has been an effective means of providing health care to these children.
Critique of the Final Report of the Graduate Medical Education National Advisory Committee
Authors: Hughes James G. , Budetti Peter P. , Chapman Daniel D. , Cramblett Henry G. , Mathies Allen W. , Meyer Bruce P. , Seidel Henry , Slungaard Rolv K. , Connelly John P. , Bornstein Suzanne L.
Published: December 2021

I. INTRODUCTION: THE GMENAC REPORT

In 1976, the federal government took two major steps that were to have a major impact on public attitudes and policies toward the health professions. (1) Congress passed the Health Professions Educational Assistance Act of 1976, formally declaring an end to the notion that there was an overall shortage of physicians in the United States, and emphasizing geographic and primary care shortages instead. (2) Earlier, in April of the same year, the Department of Health, Education and Welfare (DHEW), now the Department of Health and Human Services (DHHS), established the Graduate Medical Education National Advisory Committee (GMENAC) to advise the Secretary of DHEW on a set of issues related to the health professions. The formal charge to GMENAC included five specific questions: (a) What number of physicians is required to meet the health care needs of the nation? (b) What is the most appropriate specialty distribution of these physicians? (c) How can a more favorable geographic distribution of physicians be achieved? (d) What are the appropriate ways to finance the graduate medical education of physicians? (e) What strategies can achieve the recommendations formulated by the Committee?

After 4½ years of meetings, analysis, and developing and applying a complex methodology, GMENAC has now completed its work. Its recently published conclusions and recommendations are the subject of this policy statement.

II. GMENAC's APPROACH

GMENAC chose a ten-year span for its analysis, producing separate estimates for supply of and requirements for health professionals in 1990. Decisions on whether there would be a "shortage" or a "surplus" in a given field were based on a comparison of estimated supply with estimated requirements; the Panel's recommendations were, in turn, based on those decisions.
Controlled Evaluation of Muscle Relaxation in the Ventilated Neonate
Authors: Finer N. N. , Tomney P. M.
Published: December 2021

To assess the effects of muscle relaxation on the critically ill ventilated neonate, pancuronium bromide was administered for a 12-hour period to ten low-birth-weight neonates (960 to 2,000 gm) of 26 to 34 weeks gestation, all of whom required mechanical ventilation and were studied within 48 hours of birth (six to 39 hours). The infants were also studied for a 12-hour period during which no pancuronium bromide was administered. During both study periods, the order of which was randomized, heart rate, blood pressure, Po2, and intracranial pressure were continuously measured. The amounts of handling during the pancuronium and control periods were similar. The results revealed a significantly greater duration of hypoxia (P02 < 50 torr) (56.1 vs 23.6 minutes, P < .001) and hyperoxia (Po2 > 70 torr) during the control period (92.5 vs 13 minutes, P < .001). Durations of intracranial pressure elevation 10 cm H2O above the infant's baseline were significantly less during paralysis (6.7 vs 58.8 minutes, P < .001) as were spikes of intracranial pressure to greater than 25 cm H2O (1.6 vs 24.4, P < .05). There was no significant improvement in blood gas values, fractional inspiratory oxygen, or ventilator settings during muscle relaxation. Pancuronium reduced periods of nonoptimal oxygenation and elevated intracranial pressure and may therefore help to decrease adverse sequelae for the low-birth-weight, ventilated neonate.
Pharmacokinetic Comparison of Intravenous and Oral Chloramphenicol in Patients with Haemophilus in fluenzae Meningitis
Authors: Yogev Ram , Kolling William M. , Williams Tommy
Published: December 2021

The pharmacokinetics of chloramphenicol following intravenous and oral administration were studied in 14 infants with Haemophilus influenzae meningitis. Following five days of treatment with intravenous chloramphenicol (100 mg/kg/day every six hours), oral chloramphenicol was substituted at the same dose. Multiple serum levels of chloramphenicol were determined after an intravenous dose on day 4 and after an oral dose on day 10. CSF levels were measured six hours after intravenous or oral chloramphenicol dose on those days (CSF trough). Following intravenous administration, the mean peak serum level of 15.0 µ/g ml was reached at 45 minutes. In comparison, after oral chloramphenicol in the same dosage, the mean peak serum level of 18.5 µg ml was achieved at two to three hours. The mean serum half-life of the drug (6.5 hours) was significantly longer after oral administration than after intravenous chloramphenicol (4.0 hours) (P .001). The increased serum half-life following orally administered chloramphenicol was occasionally associated with drug accumulation. In addition, mean trough CSF levels were somewhat higher when the patient received oral medication (6.6 µg/ml) compared to intravenous administration (4.2 µ/ml) (P .001). For any treatment regimen for H influenzae meningitis that includes a period of oral chloramphenicol therapy the patient should be hospitalized to ensure compliance. Because of the wide range of individual variation in serum half-life that may result in accumulation, periodic monitoring of serum chloramphenicol levels is also recommended.