bluuebunny/crossref_metadata_2025 huggingface dataset:
Sodium Intake of Infants in the United States
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W. , Tomarelli Rudolph M. , Benson John D. , Purvis George A. , LiCari Jerome , Lockhart Haines B. , Saperstein Sidney , Taif Betty , White Philip L. , Egan Mary C. , Cheney Margaret , Pencharz Paul , Moore Melinda , Chopra Joginder , Brown Myrtle L. , Sarett Herbert P. , Fjellstedt Thorsten J. , Teply L. J. , Kennedy Eileen , Darby William J. , Lewy Peter
Published: December 2021

Since 1963 there has been public concern that prepared infant foods might be providing more sodium than was needed for normal infants.1

The suggestion that salt intake is an etiologic factor in the development of hypertension in adults rests largely on epidemiologic evidence and animal studies. Additional factors of genetic and nutritional origin play a role in its pathogenesis.2 The hypothesis that the sodium content of infant foods contributes toward hypertension in later life has not been confirmed in two areas. (1) Infant foods, even with salt added, have not been shown to contribute as much sodium to the diet as whole milk or table foods. (2) Studies of infants fed diets that were either high or low in sodium (9.25 mEq/100 kcal vs 1.93 mEq/100 kcal) from ages 3 to 8 months showed no correlation between salt intake during infancy and blood pressure at 1 and 8 years of age.3

The Subcommittee on Safety and Suitability of Monosodium Glutamate and Other Substances in Baby Foods, Food Protection Committee, Food and Nutrition Board, National Academy of Sciences,4 observed in 1970 that, between the fourth and 12th months of life, the introduction of supplemented foods and cow's milk increased the intake of sodium to approximately 5 mEq/100 kcal/day. Some of this sodium came from prepared infant foods. It was recommended that the manufacturers of infant foods add no more than 0.25% salt to foods requiring this in their formulation. This recommendation was implemented. The Committee on Nutrition observed in 1974 that this reduction in added salt had decreased the sodium intake only of infants less than 8 months old.2
Summarizing Remarks
Authors: Shih Vivian E.
Published: December 2021

The foregoing presentations have been most informative. Snodgrass, who has developed microassays of the urea cycle enzymes and has been instrumental in the study of a number of patients with urea cycle disorders, reviewed the biochemistry of the urea cycle in normal and in diseased states. He, as well as the others, has drawn our attention to acetylglutamate synthetase and its important role in the regulation of the urea cycle. Although the mechanism is not entirely clear, acetylglutamate synthesis seems to be a critical step in governing the entry of ammonia into the urea cycle. Perhaps it may also regulate the overall functioning of the urea cycle. The reason that patients with a defect of this enzyme have not been described is most likely due to our ignorance.

Another important message from Snodgrass is that at physiologic conditions, the urea cycle enzymes do not function at maximum rates and the ratio of enzyme activity as obtained by in vitro studies does not exist in vivo. Rather, the enzyme activities are limited in vivo by the availability of substrates that are present at Km levels. Therefore, small changes in concentration cause large changes in velocity.

Ornithine transcarbamylase (OTC) deficiency and argininosuccinate lyase deficiency are the two most common of the five urea cycle disorders. Enzyme studies have revealed several variants (or mutants) in each disorder including defects in altered enzyme kinetics and the absence of enzyme proteins. There has been no satisfactory explanation for the cause of hyperammonemia found in all five urea cycle disorders.
Letters to the Editor
Authors: Levin Solomon E.
Published: December 2021

The comments of Drs Riely, Rosenfield, and Cotlier are interesting, especially in relation to the abnormal eye findings and additional skeletal anomalies they have reported in cases of arteriohepatic dysplasia.1 Their contention that the syndrome is likely to be of genetic origin receives support from my own observations on two families seen subsequent to submission of our article for publication.2 In one family there were two siblings, a boy aged 5 years 3 months with significant pulmonary arterial stenosis documented at cardiac catheterization, and his younger sister, with clinical evidence of mild peripheral pulmonary stenosis.
Sinusitis
Authors: Deonna T. H.
Published: December 2021

In their article on complications of sinusitis (Pediatrics 66:568, 1980) Brook and colleagues have discussed the "proper management of subdural empyemas which require prompt surgical evacuation." We want to call to the attention of Brook and colleagues as well as your readers, our article on nonsurgical treatment of interhemispheric subdural empyemas in children (published in English), which discusses the changing outlook of intracranial suppurations given earlier diagnosis with CT scan (Helv Paediatr Acta 32:577, 1979).
Letters to the Editor
Authors: Brook Itzhak
Published: December 2021

There is ample evidence to indicate that administration of antimicrobial therapy alone to patients with intracranial abscess can result in neurologic deterioration1 and higher mortality.2

In our article entitled "Complications of Sinusitis in Children" we described the occurrence of intracranial complications following sinusitis.3 Surgical drainage accompanied by antimicrobial therapy resulted, eventually, in complete cure of all of our patients. However, three out of four of our patients with intracranial abscess initially did not respond to appropriate antimicrobial therapy directed against the organisms recovered from their abscesses.
Letters to the Editor
Authors: Glezen W. Paul
Published: December 2021

In his commentary entitled "Who Will Buy?" (Pediatrics 67:157, 1981) Hoekelman has presented a very limited viewpoint of the utilization of physician extenders, in general, and Child Health Associates, in particular. First, it should be pointed out that we, as pediatricians, are not "buying" but are the providers of health care. Extrapolating from the data which he presented on the increase of practicing pediatricians since 1966, I would guess that the numbers have doubled since that date.
Intractable Diarrhea: Value of the Small Intestinal Biopsy
Authors: Byrne William J. , Euler Arthur R.
Published: December 2021

In summarizing their article on intractable diarrhea of infancy Rossi et al1 stated, "a small bowel biopsy is useful in assessing the degree of injury present and guiding nutritional support." We concur that the small bowel biopsy is useful in assessing mucosal injury but has certain limitations. The authors used the Crosby-Krugler capsule, which obtains two small pieces of tissue, in close proximity. This limits the sensitivity of the technique as the specimens are not necessarily representative of the mucosal state of the entire small intestine nor do they allow exclusion of a patchy villous lesion.2
Letters to the Editor
Authors: Rossi Thomas M. , Lebenthal Emanuel
Published: December 2021

Our report1 clearly documents prolonged mucosal atrophy in infants with intractable diarrhea of infancy. We feel that this highlights the pathophysiology of the diarrhea and accounts for the malabsorptive state which leads to malnutrition in many infants.

In their letter, Drs Byrne and Euler focus on a tangential isue. We are aware of the limitations of the use of the small intestinal biopsy and recognize that disaccharidase activities are not absolute in predicting the clinical response of a given infant to a certain disaccharide-containing formula.
Exchange Transfusion in Treatment of Sepsis
Authors: Lemos L.
Published: December 2021

We read with interest the study of Vain and colleagues.1 Eight years ago we also observed a similar favorable effect of exchange transfusions upon the evolution of severe neonatal sepsis associated with sclerema neonatorum.2,3 We studied 27 newborns with this problem; eight of these survived. In all eight neonates exchange transfusions were repeated at 12- to 15-hour intervals, until clinical and hematologic improvement was noted. When exchange transfusion was not used in newborns with sepsis, none survived.
Unilateral Pulmonary Interstitial Emphysema: A Surgical Approach to Treatment
Authors: Levine David H. , Trump David S. , Waterkotte Glenn
Published: December 2021

Pulmonary interstitial emphysema is a condition that has become a significant problem chiefly as a complication of mechanical ventilation of the newborn. In its severe forms, it may compromise ventilation and restrict pulmonary blood flow to the degree that it becomes a significant cause of mortality. When its occurrence is unilateral, or predominantly so, it becomes more amenable to therapy. A number of different approaches have been described, especially for milder forms of the disease, but none has proved entirely satisfactory. A surgical approach has been used in four patients with severe unilateral pulmonary interstitial emphysema complicating ventilator therapy for hyaline membrane disease. The technique was successful in three of the four infants. An illustrative case is described, as well as the selective criteria for application of the technique.
Role of Antibody to Native Type III Polysaccharide of Group B Streptococcus in Infant Infection
Authors: Baker Carol J. , Edwards Morven S. , Kasper Dennis L.
Published: December 2021

The role of maternally acquired antibody to native type III polysacchande of group B Streptococcus as a determinant of susceptibility for infant systemic infection was investigated. Sera from 11 1 acutely ill infants with type III group B streptococcal bacteremia and/or meningitis and their mothers, and cord sera from 45 healthy neonates and their mothers who had type III group B streptococcal vaginal colonization at delivery were studied. Sera from each of 111 acutely ill infants contained very low levels ofantibody (sjlt 1.7 µg/ml, median 0.4 µg/ml), and a significant correlation with maternal levels was tested for early onset infection (median 0.6 µg/ml; r = .76; P sjlt .01). Women whose infants remained well had antibody levels sjgt 2 µg/ml in their sera (73%) more often than those whose infants developed symptomatic infection (17%) (P sjlt .001), and the median level in their sera (12.6 µg/ml) was considerably higher. Study of sera obtained during convalescence from 86 surviving infants indicated a poor antibody response to infection. In contrast, high levels of antibody were detected in sera from each of five convalescent women with postpartum bacteremia. These data extend earlier observations suggesting the correlation between low levels of type-specific antibody in serum and risk for systemic infection with type III strains of group B streptococci.
Children Killed in Falls from Motor Vehicles
Authors: Williams Allan F.
Published: December 2021

In 1978 in the United States, 38 children aged 5 years or younger were killed when they fell from the passenger compartments of moving motor vehicles not involved in crashes. Twenty-eight children (74%) were boys. Eighteen (47%) were 2 years old; 35 (92%) were aged 1 to 3 years. Thirty-six children fell out through doors, one fell out of a window, and one fell through a hole in the floor. Sixteen falls occurred when the driver was making a turn or going around a curve, nine when someone opened the door, seven when the driver was proceeding straight ahead, five when the driver was backing out of a driveway, and one when the driver was swerving. All 38 children killed in falls from vehicles were unrestrained. Use of seat belts or child restraint systems would prevent falls even if doors came open, as well as providing protection in crashes. A recent study has shown that pediatricians, by routinely counseling parents to restrain children in cars, can have some effect in increasing child restraint use. Pediatricians should also encourage parents to transport children in rear seats and to check at the start of trips to ensure that all doors are completely closed and locked.
Adoption of the Hard-to-Place Child
Authors: Sherry S. Norman , Riecke William C. , Sokoloff Burton , Sterne George G. , Wagner Virginia , Davis Joseph , Lewis Donald , Seidel Henry
Published: December 2021

The Committee on Adoption and Dependent Care reaffirms its position that adoption is a positive social process that provides a family for children whose parents cannot rear them. A permanent family is a primary need of all young children and the majority of older children. The handicapped child is also best served by a stable and secure placement which, in turn, offers ideal conditions for effective medical treatment of the child's particular condition.

The needs of the child have become the center of the adoption process; this replaces the earlier emphasis on meeting the needs of the childless couple. Today, candidates for adoption include children who are school-aged, of mixed or minority heritage, mentally, physically, or emotionally handicapped; or brothers and sisters who need to be placed together. Although many couples stifi want to adopt a newborn infant, many other couples are opening their homes to "hard to place" children.

The factors that will made the adoption of these "special" children a reality are as follows.

SUITABLE ADOPTIVE PARENTS

Families who adopt "special needs" children experience unusual demands on their parenting skills; they must extend themselves beyond the usual time and effort required of most parents. Often these families have had experience with handicaps. For example, parents who raise children with birth defects such as Down syndrome are increasingly choosing to adopt a child with a similar special need; this is proving beneficial to all concerned.

TRAINED SOCIAL WORKERS AND SPECIAL AGENCIES

In the last six or seven years, special agencies have been developed to care for the needs of the hard-to-place child.
Sucrose or Glucose for Diarrhea
Authors: Hughes-Davies T. H.
Published: December 2021

Water moves along osmotic gradients. Acute diarrhea is due to impaired solute absorption or to increased solute excretion. It seems reasonable, as well as traditional, to lower the osmolarity of the gut's contents in diarrhea by starvation and water.

Breast milk, when fully digested, has nearly twice the osmolarity of plasma, and giving it (or bread and butter1) as advocated in Dacca2 might prolong diarrhea. The 24-hour purging rate of the patients of Black et al on an unknown quantity of milk equalled that of the first eight hours, and diarrhea persisted for 60 hours.
Reading X-rays
Authors: Bowen A'Delbert
Published: December 2021

Mata and Rosengart1 believe that interobserver variability in interpreting radiographs may play a part in the disparate incidence of necrotizing enterocolitis (NEC) reported from various centers. Underlying their contention is the implication that the diagnosis of NEC rests upon abnormal radiographic findings. I do not dispute their observations, but let us examine the underlying premise.

Leonidas et al2 and Daneman et al3 analyzed the radiographic signs of NEC. Both groups found bowel dilation to correlate well with severity of the disease, but dilation is a highly subjective sign and is entirely nonspecific.4
On the Perceptual Distortion of Data: Early Intervention Programs Are Effective in Overcoming Environmental Deprivation
Authors: Lazar Irving
Published: December 2021

Your publication of a series of papers1-4 on early intervention with handicapped children is an important contribution to a critical area of theory and research, and your introductory caveat needs increased emphasis.

As a scientist with a more than passing knowledge of early intervention programs, I was astonished at the sweeping generalizations and selective use of the literature which characterized Ferry's contribution to this senes.4 By lumping together all forms of intervention and all kinds of conditions she ignores the considerable knowledge we do have, and, potentially, discourages fellow practitioners from the appropriate use of these techniques.
Letters to the Editor
Authors: Waskerwitz Steven , Christoffel Katherine K.
Published: December 2021

Since the publication of our article, "Hypersensitivity Vasculitis Presenting as Suspected Child Abuse: Case Report and Literature Review," we have received replies from physicians at several other centers relating other experiences with children misdiagnosed as being victims of abuse. These experiences confirm our speculation that this phenomenon is more common than the scanty reports in the medical literature would suggest.

Several correspondents have expressed concern that our paper may deter reporting of abuse cases and may be used to refute physicians' testimony if cases of suspected abuse are not subjected to exhaustive work-ups.
Letters to the Editor
Authors: Berry David D. , Brouhard Ben H. , Box Quellin T.
Published: December 2021

We appreciate Dr Liner's interest in our paper. We agree, as we stated in the paper, that lincomycin is not a first line drug and should be reserved for the patient population described in his letter.1 Furthermore, we certainly concur that the incidence of pseudomembranous colitis (PMC) following parenteral lincomycin is lese than 2%, in fact much less. If indeed the true incidence is 2%, then the probability of observing one or more cases of PMC in our series of 265 is 0.995, and thus the probability of observing no cases is 0.005.
A MEDIEVAL TEST FOR FERTILITY
Authors: C. T. E.
Published: December 2021

The curious fertility test quoted below comes from an eleventh century manuscript on gynecology attributed to Trotula of Salerno. This test can be traced back to Egyptian papyri; it was also mentioned by Galen.1

If the woman or the man be sterile you will ascertain it by this method: take two jars and into each put bran. Into one of them put the urine of the man and into the other put the urine of the woman and let the jars be left for nine or ten days. If the barrenness be from a defect of the woman you will find many worms and the bran foul in her jar. On the other hand you will have similar evidence from the other urine if the barrenness be through a defect of the man. But if you have observed such signs in neither urine, neither will be the cause of the barrenness and it is possible to help them to conceive by the use of medicines.
THE FIRST PRINTED BOOK DEALING EXCLUSIVELY WITH PEDIATRICS (1472)
Authors: C. T. E.
Published: December 2021

Paolo Bagellardo (?-1492), a native a Padua, was the author of the first printed book (incunabulum) dealing exclusively with pediatrics; it was entitled Libellus de Egritridinibus Infantium.1 This book was published in Padua on April 21, 1472, seven years after printing was introduced in Italy. It is also noteworthy that Bagellardo's book was the first medical treatise on any subject to make its original appearance in print.

See Images in the PDF File

The Figure is the first page of the opening chapter of Bagellardo's book; in translation the first 9 lines read:

When the infant at God's bidding is delivered, the midwife shall without haste or roughness, hold in her hand a linen cloth, not hard, but soft and old, and wrap the child in it and place it in her bosom, and then note whether the infant is alive or not, whether it shows any blemish, either black or white or ruddy color, and whether or not it is breathing.
Strategies for Reducing Prescription Costs
Authors: Chilton Lance
Published: December 2021

Much like all components of the cost of living, the US national drug bill has increased, although more slowly than the rest of the national health care bill—drugs in 1970 made up $8.5 billion or 12.9% of the $65.8 billion consumed by the health sector1; in 1976 the drug bill was $11.1 billion or 8% of a total of $139.3 billion.2 A higher proportion of the cost of outpatient care is drug related; in the internal medicine clinic at our institution, 54% of the cost of a visit is for prescriptions. The corresponding figure for pediatric clinic is 21% (W. B. Applegate, M. B. Bennett, L. A. Chilton, et al, unpublished data, 1980). Inasmuch as many third-party payers do not cover outpatient prescription costs, savings in this area often go directly to the patient.

The savings on the cost of prescription drugs can be effected through judicious prescribing for some patients. There are three categories of available methods to help patients save on prescriptions: one sure (taking advantage of "quantity discounts"), one controversial (generic prescribing), and one difficult (prescribing nothing when nothing is needed).

In order to determine cost benefits that might accrue to the patient from generic prescribing and from seeking a quantity discount, I have surveyed Albuquerque pharmacies to determine their pricing procedures and their practices when they are given prescriptions written with the generic names of ten drugs.

METHODS

A questionnaire (available from the author upon request) was distributed to all pharmacies in the northwest and northeast quadrants of Albuquerque.
Theophylline and Diet
Authors: Koren Gideon
Published: December 2021

Regarding the article by Feldman et al1 concerning the interaction between diet and theophylline metabolism, we found ourselves wondering about the validity of one of their basic assumptions.

The authors assumed that the bioavailability of the drug is "absolute," regardless of the various diets. This assumption is based on a study2 that compared two different sources of theophylline and found their bioavailability to be almost 100%. But in this study2 the drugs were taken by adults, as a single test dose, after a night's fast, with two hours of fasting after taking the drug.
Letters to the Editor
Authors: Feldman Charles H. , Hutchinson Vincent E. , Pippenger Charles E. , Blumenfeld Thomas A. , Feldman Bernard R. , Davis William J.
Published: December 2021

Bioavailability is defined as the measurement of both the relative amount of an administered dose that reaches the general circulation and the rate at which this occurs. The most satisfactory method for measurement of bioavailability of a drug is by comparing the plasma level following oral administration of the drug in a given dosage to that following intravenous administration of the same dosage.1

As Koren correctly observes, most bioavailability studies have involved adults receiving a single oral test dose of theophylline following an overnight fast and then continuing with two to four more hours of fasting.2-6
Letters to the Editor
Authors: Yogev Ram
Published: December 2021

We appreciate Dr Kauffman's comments regarding our paper. His initial point correct. For simplification we adopted the open one-compartment model, which in reality is inadequate to describe the pharmacokinetics of a drug that must be hydrolyzed to the active form. As a result, the rate of "elimination" will reflect the net result of two mechanisms: (1) decay of the plasma levels, and (2) continued prodution of active drug from the nonhydrolyzed form. Because this is true for drugs administered intravenously as well as orally, we assumed that although the model is not perfect it could be used to measure relative differences between the two routes of administration.
Neonatal Leukocytosis Associated with Prenatal Administration of Dexamethasone
Authors: Otero Lewis , Conlon Charles , Reynolds Patrick , Duval-Arnould Bertrand , Golden Stephen M.
Published: December 2021

Prophylactic induction of fetal surfactant through maternal steroid administration in early premature labor is becoming accepted clinical practice. This article describes an 840-gm, 27 weeks' gestation male infant, who had a profound, apparently benign, leukocytosis persisting throughout the first week of life following maternal dexamethasone administration.
Waning Effectiveness of Mailed Reminders on Reducing Broken Appointments
Authors: Morse Dale L. , Coulter Molly P. , Nazarian Lawrence F. , Napodano Rudolph J.
Published: December 2021

Broken appointments are a major problem in many health facilities. Many studies have shown that broken appointments can be significantly reduced by mailing out appointment reminder cards. One of the first such studies was done at the Anthony L. Jordan Health Center in 1972 and showed that use of such reminders resulted in kept-appointment rates of 64% compared with 48% for control studies. Subsequently, routine use of such reminders was instituted. In March 1980, a follow-up study was conducted at the same health center to determine whether mailed reminders were still effective in reducing broken appointments. A 20% systematic random sample of 766 scheduled March appointments had their reminder cards held; the remaining 80% were mailed reminders as usual. Results showed no significant differences in "keep rates" between the two groups: 64% in those with reminders compared with 62% for those without. These findings suggest that effectiveness of mailed appointment reminders on reducing broken appointments may decrease with time.
The Bowel Cocktail
Authors: Euler Arthur R. , Byrne William J.
Published: December 2021

In a recent issue of Pediatrics, a commentary by Bowie, Mann, and Hill1 addressed the subject of the treatment of persistent diarrhea with a "bowel cocktail." As commentaries such as this one in a refereed journal are widely read and the recommendations put forth are frequently adopted by physicians in practice, we believe a number of points must be emphasized. First and foremost is that this commentary appears to be based on uncontrolled observations. Second, no mention was made as to how many infants had bacterial or parasitic infections, cases in which the bowel cocktail may have been effective. Third, the definition of persistent is unclear.
Letters to the Editor
Authors: Bowie M. D. , Mann M. D. , Hill I. D.
Published: December 2021

The commentary was not a report on a controlled study but an outline of our management of severe infantile gastroenteritis. We define this as acute diarrheal disease in children less than 1 year of age of such severity that there is clinical evidence of dehydration and intravenous fluids are required to restore hydration to normal. These infants require admission to a hospital and are at least 5% dehydrated. We classify the diarrhea as persistent if it is still present seven days after admission and the infant still requires intravenous fluids to maintain hydration.
Decisions on Death and Dying
Authors: McLaughlin John F.
Published: December 2021

Caring for the newborn who is critically ill or has a major birth defect is a difficult problem with an irreducible core of grief and tragedy. Despite scholarly discussions, Duff1 and Fost2 fail to clarify several issues including alternatives to aggressive care, the criteria on which a decision should hinge, and the role of parents.

All infants deserve supportive treatment which consists of warmth, air, human contact, oral feeding as tolerated, and freedom from pain.
Letters to the Editor
Authors: Bartholome William G.
Published: December 2021

There is bitter irony in the fact that in this the International Year of Disabled Persons the official journal of the Academy selected an article by Raymond Duff as the lead article in its March issue.1 Dr Duff claims to be speaking for "80% of pediatricians" in his impassioned plea that we put a stop to our "medical Vietnam" and stop burdening our "defective" patients (especially newborns) with medical treatment. Even though I may be part of a minority, I would like to point out a few serious and dangerous flaws in the argument he presents.
Near Fatal Hyperkalemia from a Dangerous Treatment for Colic
Authors: Oseas Ronald S. , Phelps Dale L. , Kaplan Solomon A.
Published: December 2021

Life-threatening hyperkalemia is usually the result of renal or adrenal disorders although on some occasions it is an iatrogenic mishap. An alternate etiology of hyperkalemia is an unusual dietary regimen followed by the patient which may or may not be known to his physician. The present case occurred when the parents of a newborn infant followed the advice given for treatment of colic in the popular nutrition book, Let's Have Healthy Children.1

CASE REPORT

This 27-day-old boy weighed 4.36 kg at birth, born to a healthy white gravida 2, para 0, abortus 1 by cesarean section for face presentation.
New Section on Uses of Computers in Pediatrics
Authors: Lucey Jerold F.
Published: December 2021

You may not have noticed but we are in the midst of a revolution as important as the industrial revolution. Computers, microprocessors, and word processors have appeared on the pediatric scene. Your children may know more about them than you do! They can no longer be ignored. Many pediatricians are using these devices in their offices. Hospital physicians and researchers are surrounded by them—on the wards, in clinical laboratories, pharmacies, and intensive care nurseries. This is just the beginning. It is probably inevitable that before long a new pediatric society with its own journal will spring up to satisfy this need.
Letters to the Editor
Authors: Lipper Evelyn , Lee Kwang-sun , Gartner Lawrence M. , Grellong Bruce
Published: December 2021

All of the infants entered into the study were low-birth-weight infants (<2,500 gm). The majority of infants had a gestational age less than 37 completed weeks, and, of these, some were also small for gestational age. Sixteen infants had a gestational age of ≥37 weeks but were included in the study because their birth weight was below the tenth percentile for their gestational age.

We agree with Drs Knobloch and Malone's comment about the interrelationship of all three figures: as gastation advances, birth weight and head circumference increase.
Encephalopathy of Reye's Syndrome: A Review of Pathogenetic Hypotheses
Authors: DeLong G. Robert , Glick Thomas H.
Published: December 2021

The pathogenesis of Reye's syndrome encephalopathy was analyzed in terms of uniform criteria designed to clarify and assist evaluation of the leading hypotheses. Three of these hypotheses derive from known metabolic sequelae of hepatic mitochondrial dysfunction and the severe systemic catabolism of protein, fats, and carbohydrates that characterize the syndrome biochemically: hyperammonemia, hyperfattyacidemia, and hyperlactatemia. In addition, there is a fourth hypothesis of generalized mitochondrial insult affecting brain, muscle, and other organs as well as liver. The weight of evidence favors hyperammonemia as a sufficient factor while recognizing important interrelationships with the other observed biochemical derangements. How the catabolism and hepatic mitochondrial dysfunction are produced by the triggering viral infection remains unknown. Therapeutic efforts have thus far not succeeded in definitive metabolic intervention. Such reversal of the clinical syndrome would lead to confirmation of the necessary pathogenetic factors; this type of intervention remains the chief goal of metabolic research in Reye's syndrome.
SIMON DE VALLAMBERT ON THE TREATMENT OF DIARRHEA IN INFANTS (1565)
Authors: C. T. E.
Published: December 2021

Little is known of Simon de Vallambert (fl. 1555-1565) the author of the first printed work on pediatrics in French. His book, Cinq Livres de la Manière de Nourrir et Gouverner les Enfans des Leur Naissance, was published in 1565 at Poictiers [Poitiers]. It is a single volume of 379 pages measuring about six by nine inches.

Like a few of his predecessors, his book was written as much for nurses and midwives as for physicians. Simon de Vallambert, although greatly influenced by ancient writers, has a mind of his own, and a common sense far in advance of most of the medical writers of the sixteenth century.1

His treatment of infants suffering from diarrhea was as follows2:

As soon as one sees that the flux of the stomach persists too long, that is to say, that the infant is weakened by it, it is time to restrain it, but with discretion: for if it is green and yellow and the child big, it should first be given, if it is possible, a little powdered rhubarb with syrup of dried roses and on the next day a clyster of a decoction of barley and plantain with a very little roast honey, then another of starch and the juice or decoction of plantain, or of other astringent things, with roast oil and quince oil or the like: cover the stomach with linen moistened with distified water, or a decoction of myrrh, of roses, or of plantain: then a plaster of sandol, roses, Armenian bole and the like, incorporate an astringent oil with a piece of wax: or a cataplasm of spelt (?) or of rye, cooked in vinegar and sprinkled with the said oil: give starch to eat in the form of broth and lettuce cooked in vinegar and water: make them drink at meals and between of the syrup of grenadine, or of quince or of dried roses with chalybeate water .... For drink, goats' milk to which one has added steel, or of water prepared the same, alone or with syrup of quince, or of dried roses and sometimes of service berries: the same syrup may be drunk between meals if there is thirst, with syrup of mint and iron water ....
NITROUS OXIDE—OXYGEN SEDATION FOR MINOR SURGERY?
Authors: Marcuse Edgar K.
Published: December 2021

Nitrous oxide-oxygen inhalation sedation is a helpful method of calming children and adults when suturing and other painful minor surgical procedures are needed. It is within the scope of family physicians, pediatricians and emergency department physicians, and other medical doctors and our data1 indicate that it is quite safe when proper equipment and a thorough understanding of the technique are used....

In our opinion, of the different modalities available for sedation, nitrous oxideoxygen inhalation sedation is one of the safest, when properly used. This is especially so because its effects can be reversed rapidly with a few deep breaths. Certainly, it is much safer than the frequently used injectible cocktail mixtures of a sedative, tranquilizer and narcotic.

Editorial Comment.2 Griffin and colleagues ... report no recognizable problem. Their report is understandably enthusiastic; they admit to no "controls," and they do not attempt to quantify the resultant relief achieved....Will their committment to careful selection in carrying out their technique be replicated by others? ... Regardless of these concerns, the work of Griffin and colleagues cannot be disregarded out of hand; a comparable technique has been used in dentistry and while it is found objectionable by many anesthesiologists, largely on a hypothetical basis, its use has been deemed beneficial. Certainly replication of the current study should proceed: the outcome remains "not proved."
Severe Cardiac and Ophthalmologic Malformations in an Infant Exposed to Diphenylhydantoin in Utero
Authors: Bartoshesky Louis E. , Bhan Ina , Nagpaul Kanta , Pashayan Hermine
Published: December 2021

A newborn male infant with multiple congenital malformations including lethal cardiac malformations and severe ophthalmic malformations is described. The infant was exposed in utero to hydantoin. There is no other identifiable cause for the malformations apparent in the infant's or his family's history.
Neonatal Effects of Maternal Clomipramine Treatment
Authors: Østergaard G. Zahle , Pedersen S. E.
Published: December 2021

This paper calls attention to a relatively unnoticed problem, ie, morbidity in neonates caused by treatment of pregnant women with the tricyclic antidepressant clomipramine (Anafranil). Recently we have seen identical clinical pictures in two neonates born to mothers treated throughout pregnancy with clomipramine because of an endogenous depression (200 mg daily in case 1 and 100 mg daily in case 2). Both babies were delivered without complications at term after otherwise uneventful pregnancies.

CASE REPORTS

Case 1

Physical examination of the neonate at birth revealed the following: birth weight, 3,550 gm; height, 52 cm; and head circumference, 34.6 cm. Apgar scores were 9 at one minute and 10 at five minutes.
It's a Muddled Debate
Authors: Ruedisueli Glennard S.
Published: December 2021

Like many others, I was somewhat dismayed upon learning of the American Academy of Pediatrics' decision not to endorse the WHO Code of Marketing Breastmilk Substitutes. After reading the commentaries by May,1 Barness,2 and the Ambulatory Pediatric Association Board of Directors,3 I found the matter no less muddled. As long as the can of worms is open, I feel that a few of the statements made deserve additional comment.

As the issue was recently discussed at our hospital's Pediatric Department meeting, I would be interested in having May and Starfield elaborate on their apparently contradictory interpretations of the Montreal study on the effects of distribution of free formula samples.4
Letters to the Editor
Authors: May Charles D.
Published: December 2021

At the conclusion of the commentary on the "infant formula controversy"1 a plea was made to focus on the single issue of concern: the assumption behind the WHO Code that practices in marketing of prepared infant foods had been a substantial cause of the decline in breast-feeding in some Third World countries. Because this assumption could not be supported by sound evidence, a rational approach to development of an international health policy was displaced by emotional and political clamor.
Letters to the Editor
Authors: Ernhart Claire B. , Landa Beth , Schell Norman B.
Published: December 2021

Our report1 details very clearly the reasons behind our conclusions that intellectual and behavioral effects, if any, of low levels of lead burden, appear to be minimal and nonpersistent. Poor science is characterized by failure to give due weight to limitations in results and to methodologic weaknesss and by inability to recognize a pattern of results that is not consistent with one's hypotheses or with one's own previous conclusions.

The reservations expressed in the conclusions of our report are not the result of modesty but rather of adherence to stringent standards of scientific reasoning.
Are Bacterial Screening Programs in the Hospital Worthwhile?
Authors: Weber Andy , Marks M. I.
Published: December 2021

The article by White et al1 requires some comment. This is so because the authors' appear to recommend discontinuation of bacterial and antibiotic surveillance programs for newborn nurseries. Instead, I believe they meant to emphasize the lack of relationship between bacterial colonization and outbreaks of sepsis. This is partly supported by the data presented. These observations have been noted in relation to staphylococcal colonization as well.

Some of the other conclusions that appear in the text are not warranted by the design of the study or the results.
Persistent Pseudohypoaldosteronism in a 7-Year-Old Boy
Authors: Satayaviboon Sataya , Dawgert Francis , Monteleone Patricia L. , Monteleone James A.
Published: December 2021

Pseudohypoaldosteronism has been described as a syndrome presenting early in life with profound salt wastage, failure to thrive, and lethargy. The mechanism of sodium loss is renal, not related to aldosterone production. Previous cases have been transient, responding to supplemental salt therapy which was discontinued after one to two years. A child whose pseudohypoaldosteronism was first diagnosed in infancy and whose salt loss persisted to 7 years of age is described.
Complications Associated with Digoxin Therapy in Low-Birth Weight Infants
Authors: Johnson Gregory L. , Desai Nirmala S. , Pauly Thomas H. , Cunningham M. Douglas
Published: December 2021

Eighteen infants, each weighing less than 1,500 gm, were treated with low dose digoxin therapy for patent ductus arteriosus and signs of circulatory congestion. Nine of the 18 developed one or more signs of clinical deterioration felt to be related to digoxin therapy: eight infants experienced frequent episodes of bradycardia, six had cardiac arrhythmias, and six experienced feeding difficulties. All signs disappeared when digoxin therapy was discontinued. Digoxin, even in relatively low dosages, can have deleterious complications in seriously ill low-birth-weight infants. Alternatives to digoxin in this patient population should be considered before institution of digoxin therapy.
Evaluation of a Commercial Latex Particle Agglutination Test for Rapid Diagnosis of Haemophilus influenzae Type b Infection
Authors: Daum Robert S. , Siber George R. , Kamon Jill S. , Russell Rebecca R.
Published: December 2021

The effectiveness of a commercially available latex particle agglutination test (Bactogen) in the diagnosis of invasive Haemophilus influenzae type b infection was evaluated. Bactogen correctly diagnosed all 27 patients with bacteriologically proven H influenzae type b infection (sensitivity 100%). Two of 39 patients with proven, non-H influenzae type b infections had false-postive tests (specificity 95%). One of 103 sera and 0 of 55 urine specimens from hospitalized adults contained detectable H influenzae type b antigen. Bactogen is a sensitive, specific, commercially available test for rapid diagnosis of H influenzae type b infection.
Incensed by Alleged Avarice
Authors: Berger David
Published: December 2021

Ross's commentary, "Stretching a Minute"1 exemplifies much that is wrong with the health care delivery system as it exists today. Ross accurately described many of the different types of anticipatory guidance that are available to providers. He should have ended his commentary at that point. However, he chose to continue by pointing out the ugly truth that much of the reason for the lack of time devoted to preventive health care and anticipatory guidance is sheer avarice on the part of the physician.
Letters to the Editor
Authors: Arbus Gerald S. , Bacheyie Godfrey S.
Published: December 2021

Inadvertently we did not reference three articles from 1978—the two mentioned by Leumann and our own abstract.1 Both of Leumann's references confirmed that in children, as in adults with progressive renal failue, a straight-line relationship exists when plotting the reciprocal of the serum creatinine (SC) level or, occasionally, the logarithm vs time. They also examined the rate of change in SC for various disease categories in children, which was also previously investigated in adults.2,3

On the other hand, our recent paper4 considered whether we could have predicted early in the child's illness when he would reach his already known SC value just before dialysis was instituted.
Does ‘Hype’ Work?
Authors: Raskin Valerie D. , Grandola Carl D.
Published: December 2021

In his June1 commentary Todd discusses mass media "hype" of scientific information. In August 1981 we randomly surveyed women of menstrual age at our rural health center to assess whether knowledge of toxic shock syndrome (TSS) altered menstrual practices (Table 1).

News of TSS had reached most women; six (9.4%) of 64 surveyed had never heard of TSS. Among those who had used tampons within two years, 14 of 36 (38.9%) had changed menstrual practices due to knowledge of TSS.
Meat Tenderizer and Stings
Authors: Lanier Bob
Published: December 2021

In a recent letter1 a reader commented on the therapeutic application of a meat tenderizer solution in hymenoptera envenomization. May I inject a note of skepticism.

Since time immemorial the natives of the Polynesian Islands have used the papaya leaf to treat the injuries produced by the jellyfish. Even today when scuba divers meet they usually share one thing in common among their tackle: meat tenderizer.

Both papaya leaves and most forms of meat tenderizer contain the enzyme papain.
Lymphoid Polyps (Focal Lymphoid Hyperplasia) of the Colon in Children
Authors: Byrne William J. , Jimenez Jorge F. , Euler Arthur R. , Golladay Eustes S.
Published: December 2021

Lymphoid polyps (focal lymphoid hyperplasia) of the colon are rare in children. These lesions are benign, but must be differentiated from malignant lymphomas. Grasp biopsies of the lesion are inadequate for this purpose and the polyp should be submitted in toto for pathologic examination. No treatment other than local excision is warranted. Two cases are presented and the literature is reviewed.
Blood Pressure in Low-Birth-Weight Infants
Authors: Feldman Rochelle C.
Published: December 2021

I would like to commend Versmold et al1 for their recent attempt to establish more accurate "normal" values for arterial pressure in infants with birth weights less than 1,000 gm. I too had been struck by the potential problems in extrapolating values from the parabolic curves established for aortic blood pressures in infants with birth weights < 1,000 gm and had measured mean arterial pressure in 34 low-birth-weight infants of 440 to 1,000 gm.2 Although the measurements in my study were in centimeters of water, an easy calculation converts them into millimeters of mercury for comparison with the results of Versmold et al.
Letters to the Editor
Authors: Graham John M. , Frank Deborah A.
Published: December 2021

The comments by Wilkie are of great potential interest to those of us who see and follow troubled families. Our study pointed out that 6/45 (13%) of the adoptive children referred to our dysmorphology clinic had fetal alcohol syndrome. An additional 2/45 (4%) had a sex chromosome anomaly.1 The phenotypic manifestations of fetal alcohol effects and sex chromosome abnormalities may be difficult to recognize during childhood. Both these conditions may be associated with hyperkinetic behavior disorders and learning disabilities.
Uses for Adolescents
Authors: DiTraglia John
Published: December 2021

I was very stimulated by Eisenberg's article "Social Context of Child Development" (Pediatrics 68:705, 1981) and am sure my letter joins a huge response. But I am curious specifically about two excellent suggestions in the second to last paragraph: "Day care centers and nurseries can and should be situated adjacent to intermediate and secondary schools. Adolescents can not only provide irreplaceable person power but can gain direct experience in parenting as they contribute to the development of the young."
Letters to the Editor
Authors: Eisenberg Leon
Published: December 2021

Whatever the legal questions that concern DiTraglia, they have not prevented the implementation of either of the programs I referred to in my paper (education for parenthood and intermittent schooling).

As to the first, the Education Development Center (55 Chapel Street, Newton, MA 02160) has developed excellent curriculum materials entitled: "Exploring Childhood" for just such purposes. EDC reports that the curriculum has been field tested successfully in more than 500 classrooms across the country. I urge pediatricians to become familiar with it in order to promote similar educational activities in their own communities.
Comment on Social Context of Child Development
Authors: Mittleman Richard
Published: December 2021

I would like to comment on Eisenberg's article, "Social Context of Child Development" (Pediatrics 68:705, 1981), and in particular his attitude toward abortion, which he sums up by saying, "Every pediatrician, committed to the goal of this Academy to foster healthy growth and development, must become an advocate of women's fundamental right to reproductive freedom."

To us common folks that translates into: All members of the American Academy of Pediatrics must aid and abet women who want to murder their unborn children.
Mongolian Spots, Day Care Centers, and Child Abuse
Authors: Dungy Claibourne I.
Published: December 2021

Physicians caring for infants and children are familiar with mongolian spots. Most physicians inform the child's family of the benign nature of this condition. However, more and more infants are being cared for by care providers other than their parents. Many infants are cared for in day care centers. It is important that these caretakers also be informed and aware of mongolian spots. Two recent cases seen at the University of California, Irvine Medical Center underscore this need.