bluuebunny/crossref_metadata_2025 huggingface dataset:
Computer-Based Information Retrieval and Decision Support for Birth Defects and Genetic Disorders
Authors: BUYSE MARY LOUISE
Published: December 2021

The increasing power and low price of the personal computer opens up many new possibilities for the management, storage, and retrieval of information in the convenience of your office. In addition to maintaining patient, accounting, and other vital records, the personal computer also gives the physician direct access to data and bibliographic sources formerly available only at large medical libraries. Furthermore, a number of other new online computer-based information services are also available. These information systems contain large databanks from which the physician makes requests. Unlike books and other printed publications that can become quickly outdated, central information banks are maintained to assure the most current data and research information.
A Pediatrician's Program for the Prevention of Dental Caries in the First Years of Life
Authors: HAGLER SUMNER
Published: December 2021

To the Editor.—

Inasmuch as infants and children usually do not visit a pedodontist or a dentist in the first few years of life, I have recently undertaken a dental prophylactic program.

The program consists of three approaches: (1) Fluoride supplementation is started in the first 2 weeks of life whenever the infant is ready to use formulas, or when well water with inadequate fluoride content is used. This consists of 0.25 mg of fluoride with the usual vitamin drops and later vitamin tablets with fluoride until the infant is seen by the family dentist.
Treatment of Disabled Infants
Authors: HARRISON HELEN
Published: December 2021

To the Editor.—

As the mother of a severely handicapped child, I was disappointed by the recent AAP Joint Policy Statement on the care of disabled infants.1 The Academy, whose members once argued so eloquently against the Baby Doe rule, now seems to have accepted one of its worst provisions—the insistence upon medical treatment "regardless of the nature and severity of the disability." Apparently this was done to placate the Reagan administration, an administration that shows it's true concern for the handicapped by constantly attempting to cut support programs for the disabled and their families.
Review of Research on the Factors Associated with Choice and Duration of Infant Feeding in Less-Developed Countries
Authors: Forman Michele R.
Published: December 2021

Research on factors associated with infant-feeding choice and duration has the following objectives: to describe the associated factors; to determine the degree of association; and to determine factors that are amenable to intervention in order to plan and implement infant nutrition programs. Underlying these objectives are a series of questions including: (1) What are the factors associated with the decision to breast-feed and/or bottle-feed at birth? (2) Among less-developed groups, in particular, what are the factors associated with use of prelacteal feeds before or in combination with breast-feeding or feeding by breast and bottle? (3) What are the factors associated with duration of exclusive breast-feeding, time of introduction of liquid breast milk substitutes, time of introduction of solids, and duration of partial breast-feeding? These questions are addressed in this review.

This review encompasses research from a variety of disciplines—anthropology, epidemiology, nutrition, economics, and demography, for example. This is because infant feeding can be considered a behavior, a perception, a nutritional pattern, and a risk factor in infant growth and development. When infant feeding is classified as a behavior, the objective is to describe the infant's actions as he/she feeds at the breast or from the container for the breast milk substitute. The focus is on measuring the sucking action; the ability of the infant to latch onto the breast; and the frequency of, interval between, and duration of feeds.

To examine a mother's perception of her infant-feeding practice requires answers to the following: Does the mother consider herself an exclusive breast-feeder, a breast-feeder and bottle-feeder, or an exclusive bottle-feeder? Does she feed on demand or on schedule? The focus of this research is on the mother's perception of her infant-feeding status rather than on the actual practice of infant feeding; the correlation between perception and practice may be examined but is commonly assumed.
Breast-Feeding, Birth Interval, and Infant Health
Authors: Anderson John E. , Marks James S. , Park Tai-Keun
Published: December 2021

In this section we consider the indirect effects of breast-feeding on infant health through its effect on birth intervals. First, we examine the evidence that breast-feeding is associated with longer intervals between births. Then we discuss studies that have attempted to show that short birth intervals are related to poorer infant health.

EFFECT OF BREAST-FEEDING ON INTERVALS BETWEEN BIRTHS

Breast-feeding is associated with a delay in the return of ovulation after a birth, with longer intervals between births, and with lower fertility rates occurring in populations where this practice is prolonged. In a recent issue of Population Reports,13 numerous studies that evaluate the contraceptive effect of breast-feeding were reviewed. Studies that link breast-feeding and fertility include clinical reports based on small numbers of women, larger prospective studies, and single-round demographic surveys which may be representative of national populations.

Clinical Studies

Because ovulation is difficult to measure, studies linking breast-feeding with ovulation have been limited to small numbers of clinic-based subjects.4,14,17 These studies have shown that women who breast-feed—and those who breast-feed for longer periods—tend to ovulate later following a birth than other women. This effect is believed to be related to the hormone prolactin, which is released through the stimulus caused by the infant's sucking. Prolactin promotes the production of breast milk and is believed to be related to the inhibition of ovulation. Levels of prolactin and the anovulatory effect are related to the frequency and intensity of nursing. Thus, women who breast-feed partially on infrequently, while giving supplementary food, are more likely to ovulate than those who breast-feed fully.
Sequential 22-Hour Profiles of Breathing Patterns and Heart Rate in 110 Full-Term Infants During Their First 6 Months of Life
Authors: Richards J. M. , Alexander J. R. , Shinebourne E. A. , de Swiet M. , Wilson A. J. , Southall D. P.
Published: December 2021

Sequential recordings (total number 365, mean duration 22 hours) of ECG and abdominal wall movement were obtained from 110 full-term infants up to 6 months of age. The longest pause in breathing movement per recording (maximum 21.6 seconds) decreased in duration over the first 2 weeks of life (P < .005). Pauses >18.0 seconds were not detected after seven days. The spread of values for pauses ≥3.6 seconds duration was widest during the first 2 weeks, and their number decreased with age (P < .001). Periodic breathing, detected in 69% to 80% of infants in all age groups, showed decreasing trends with age in total duration and maximum length of episode (P < .005 for both). The spread of values was widest during the first 2 weeks (range for total duration 0 to 4.7 hours) and decreased with age. The mean respiratory rate during regular breathing decreased after 4 weeks (P < .001). The spread of values was widest during the first 2 weeks and decreased with age. Birth weight was positively correlated with mean respiratory rate during the first three days of life (r = +.64, P < .001). The mean heart rate during regular breathing increased during the first 15 days (P < .001) and then decreased after 4 weeks (P < .001). Higher mean heart rates were found in male infants (P < .01).
Postnatal Growth Curve of the Infant with Extremely Low Birth Weight Who Was Fed Enterally
Authors: Brosius Keith K. , Ritter Dorothy A. , Kenny John D.
Published: December 2021

The primary objective of this study was the establishment of a postnatal growth curve for the very low-birth-weight infant. Only infants whose size was appropriate for gestational age and whose predominant form of nourishment was enteral were included in the study. Two growth curves were constructed: one for infants weighing less than 900 g (group A, birth weight 799 ± 79 [SD] g, mean gestational age 26.5 weeks), and one for infants weighing 901 to 1,100 g (group B, birth weight 1,023 ± 53 [SD] g, mean gestational age 28.5 weeks). Growth was followed over the first 50 postnatal days. Group A infants gained an average of 10.2 g/d overall during the first 50 postnatal days and group B infants gained an average of 17.1 g/d over the same period. Because the major objective of this study was construction of a growth curve for infants weighing less than 900 g, direct comparison is made with the Dancis grid (1948) as this is the only standard for this group. The growth rates of our infants were found to be more than twice that of the original prediction of Dancis.
Thoracic Trauma in Children
Authors: Meller Janet L. , Little Alex G. , Shermeta Dennis W.
Published: December 2021

A 20-year experience at The University of Chicago in dealing with chest injuries in pediatric patients has been reviewed. The clinical presentation, including results of diagnostic measures, and the initial and definitive management of thoracic trauma in children are discussed. The condition of the majority of patients was stable at time of presentation. The most frequent surgical intervention performed was intercostal tube placement. Thoracotomy was infrequently required and laparotomy for associated injuries was more common. Trends in the causes and epidemiology of thoracic trauma in an inner city environment over this 20-year period were noted: Blunt trauma, which is increasing in frequency, most commonly involves the younger age group and is usually related to automobile accidents. Penetrating injuries are generally seen in older patients within the pediatric age groups and are similar to those seen in the adult population.
Personal Experience
Authors: MILMAN DORIS H. , BENNETT ANGELA A.
Published: December 2021

To the Editor.—

The pediatric community is indebted to Dr Schwartz1 for sharing his personal experience with his own marijuana-using son and for using this experience to alert practitioners once again to the hazards of this drug. His remarkable personal restraint, combined with his thorough scientific documentation, underscore the pain that a family must endure as they witness the inexorable deterioration of their child, a pain made all the worse by the realization that the course of events might have been preventable.
Vomiting and Diarrhea
Authors: Book Linda S.
Published: December 2021

Vomiting and diarrhea are frequently encountered in pediatric patients. Dehydration, a serious consequence of both vomiting and diarrhea, results in the deaths of more than 700 children annually in the United States. With appropriate parent education, both morbidity and mortality can be reduced, and much of the anxiety about these problems can be alleviated. Parents must be educated to recognize the associated signs and symptoms that indicate serious disease and warrant notifying the physician. Fluid therapy should be individualized, and parents should be informed of the appropriate steps to take. Parents must make quantitative observations and keep records not only to enable the physician to assess adequate fluid balance but also to be able to demonstrate to themselves the effectiveness of the treatment. It is just as important for the physician to reassure parents, who will have concerns about long-term nutritional or growth consequences.
Drinking-Water-Induced Copper Intoxication in a Vermont Family
Authors: Spitalny Kenneth C. , Brondum Jack , Vogt Richard L. , Sargent Harold E. , Kappel Steven
Published: December 2021

Three of four family members reported recurrent episodes of gastrointestinal illness while residing in a house in a small northwestern Vermont village. The father and two daughters repeatedly experienced episodes of emesis and abdominal pain after drinking water drawn from their kitchen faucet. One early-morning water sample taken from the family household contained a copper level of 7.8 mg/L, which is above the standard for drinking water (1.0 mg/L). Values for the second daughter's copper in hair analysis (1,200 µ/g) and copper in nail analysis (100 µ/g) were elevated (normal range 11 to 53 µ/g). The household was at the end of a ¾-in (19.05-mm) copper main, and it is suspected that copper levels increased in water when the water remained stagnant in the main. All symptoms of the family resolved when they stopped drinking water in their home. This is the first report of copper-induced gastrointestinal illness attributable to a public supply of drinking water.
Acute Pulmonary Edema Complicating Tonsillectomy and Adenoidectomy
Authors: FEINBERG ARTHUR N. , SHABINO CHARLES L.
Published: December 2021

In summary, we have presented two cases to illustrate the problem of postoperative pulmonary edema following tonsillectomy and adenoidectomy. Furthermore, we have discussed the difficulty in predicting those patients who will develop this complication. Because of the potential seriousness and unpredictability of acute pulmonary edema following tonsillectomy for chronic obstruction, it is important that medical personnel, including pediatricians caring for patients after tonsillectomy, be able to readily recognize this phenomenon of acute onset of congestive heart failure and treat it rapidly with diuretics, continuous positive airway pressure, and respiratory support as needed.
Clinical Estimation of Liver Size in Newborn Infants
Authors: BRION LUC , AVNI FREDDY E.
Published: December 2021

To the Editor.—

Measurement of liver size in the newborn frequently has been obtained only by palpation of the projection below the costal margin.1 It has been suggested2 that the measurement of the liver span obtained by percussion/palpation could be a more reliable estimation of the liver size. A study was designed to evaluate both methods.

A total of 317 newborns were examined: 287 were appropriate (in size) for gestational and 30 were small for gestational age, on the first and/or the fifth days of life.
Introduction to the Workshop on Current Issues in Feeding the Normal Infant
Authors: Gaull Gerald E.
Published: December 2021

Gestation and lactation form a biologic continuum during which nutrients, protective factors, and growth modulators are transferred from mother to offspring. Because placental transfer ceases at birth, these placental functions must be maintained by feeding. It has become accepted as axiomatic that breast-feeding by a healthy mother for some time after birth is the biologic norm for the healthy term infant. However, the apparent success of modern commercially prepared formulas in the Western world has raised questions in the minds of some pediatricians and infant nutritionists about this axiom. Certainly, it cannot be argued on teleological grounds alone that because a particular constituent is present in human milk that it is, therefore, needed by the infant. Scientific questions about human milk can be formulated, and the evidence should be subjected to the same scrutiny as any other such question.

During this first year of postnatal life, many biochemical adaptations are taking place. Those in the gastrointestinal tract and the immune system are especially important in bridging the transition between gestation and lactation, on the one hand, and independent postnatal life, on the other. In early infancy we must consider the role of human milk v formula and of whey-predominant v caseinpredominant formulas in the light of our newer knowledge of these adaptations. Both in the human and in animals, biochemical adaptations during the fetal and perinatal periods have been more extensively studied than those during the weaning period. Indeed, the data on which to make nutritional judgments during the later periods of infancy are scant.
Summary-Gastrointestinal and Immunologic Development
Authors: Kretchmer Norman
Published: December 2021

CARBOHYDRATE DIGESTION AND ABSORPTION

Whereas the first session of this meeting was concerned primarily with the nutritional content of infant feeds, the second focused on development of the organs that digest those feeds. Dr Richard Grand began the session with a review of various aspects of the development of the intestine from biochemical and physiologic standpoints, indicating that the absorption of various elements of food is dependent upon enzymatic activity and absorptive capability. He showed that, for unknown reasons, glucose from sucrose is absorbed at a much faster rate than glucose alone. In addition, in contrast to general opinion, the scientific data show that diand tripeptides are absorbed faster and by different mechanisms than the individual amino acids. Grand's talk then focused on the enzymes of the brush border, with particular emphasis on five enzyme groups that are involved in carbohydrate metabolism: (1) glucoamylase; (2) sucrase-isomaltase; (3) maltase; (4) lactase; and (5) trehalase. (The last enzyme is probably of minor importance in present day nutrition.) Grand also indicated that at one week of life, there is a decreased amount of digestibility derived from pancreatic enzymes, particularly amylase.

The relationship of these enzymes to nutrition was made quite evident by some studies conducted with the perfused fetal lamb, in which lactose was shown not to be a limiting substrate as there was a sufficient amount of lactase present in the intestine. In contrast, sucrose and maltose contributed little glucose to the general circulation of the lamb because sucrase and maltase were deficient in the intestine.
Stressful Life Events and Somatic Complaints in Adolescents
Authors: Greene John W. , Walker Lynn S. , Hickson Gerald , Thompson Juliette
Published: December 2021

Although life stress has often been associated with recurrent pain in children and adolescents, level of stress has not previously been found useful in differentiating patients with functional pain from those in whom other conditions are diagnosed. In this study, a standard measure of stressful life events was systematically administered to 172 adolescents seen for the first time at an outpatient adolescent clinic. Patients with recurrent pain for which no organic etiology could be identified reported significantly higher life stress than patients being seen for routine checkup, acute minor illness, stable chronic illness, or pain with clinically diagnosed organic cause. Furthermore, patients referred for behavior problems indicated significantly higher life stress than all other patient groups. It is suggested that a measure of stressful life events may be a useful adjunct to the clinical interview and is of particular value in identifying specific stressors and planning treatment to address them.
Prediction of Digoxin Treatment Failure in Infants with Supraventricular Tachycardia: Role of Transesophageal Pacing
Authors: Benson D. Woodrow , Dunnigan Ann , Benditt David G. , Thompson Theodore R. , Narayan Athi , Boros Stephen
Published: December 2021

Transesophageal atrial pacing was used to initiate and terminate tachycardia in 24 infants (seven female and 17 male, aged 1 to 34 days) with ECG documentation of supraventricular tachycardia. Six infants received no chronic treatment, and chronic oral digoxin prophylaxis was administered to 18 infants in an effort to prevent recurrences of tachycardia. In these 18 infants, the effectiveness of digoxin therapy in preventing the initiation of tachycardia by transesophageal pacing was compared with its ability to prevent spontaneous recurrences of supraventricular tachycardia. While receiving chronic oral digoxin therapy, tachycardia could be reinitiated in 15/18 (83%) infants. In these infants, the cycle length of tachycardia and the atrioventricular interval were the same before and during chronic digoxin treatment. Three infants in whom tachycardia could not be initiated during chronic digoxin therapy had no spontaneous recurrences during 6 months of follow-up, whereas 10/15 (67%) infants in whom tachycardia could be reinitiated had clinically significant recurrences in spite of chronic digoxin therapy. Six infants who received no chronic drug treatment had no documented recurrences during 6 months of follow-up. This study demonstrates that digoxin was effective in preventing significant spontaneous recurrences of supraventricular tachycardia in only 8/18 (44%) infants treated with digoxin. The ability to initiate supraventricular tachycardia with transesophageal pacing may be useful in determining which digoxin-treated infants are at risk for recurrence. Finally, not all infants with supraventricular tachycardia require chronic prophylaxis; six of the untreated infants had no documented recurrences.
A Study of Low Socioeconomic Status, Black Teenage Fathers and Their Nonfather Peers
Authors: Rivara Frederick P. , Sweeney Patrick J. , Henderson Brady F.
Published: December 2021

Demographic background, attitude and knowledge about pregnancy and contraception, and family characteristics and dynamics of 100 teenage fathers were studied and compared with those of 100 nonfather, age-matched peers. The subjects' age ranged from 14 to 19 years with a mean age of 17.5 years. Nearly all subjects were black and were from families of low socioeconomic status. There were no differences between the two groups for age at first sexual intercourse (mean 12.5 years) and frequency of intercourse in the last year. More control subjects than fathers perceived pregnancy as disruptive of their future plans for school, job, and marriage. Teenage fathers were more likely to have mothers who were teenage parents (77% v 53%, P = .0007). In both groups, one third of their brothers and 44% of their sisters were teenage parents. Both groups had poor knowledge about the risk of pregnancy and the effectiveness of contraceptives. In both groups, negative attitudes about contraceptives represent barriers to their use. Both groups of subjects became sexually active at young ages, had poor knowledge about pregnancy prevention, and often had unprotected intercourse. Although there were many similarities between the two groups, the teenage fathers, in particular, seemed to come from an environment in which teenage pregnancy was common, accepted, and perceived to be minimally disruptive of their lives now or in the future.
Subependymal Germinal Matrix Hemorrhage in Full-Term Neonates
Authors: Hayden C. Keith , Shattuck Karen E. , Richardson C. Joan , Ahrendt Deborah K. , House Ray , Swischuk Leonard E.
Published: December 2021

A population of healthy, full-term newborn infants was studied in order to obtain documentation of the prevalence of intracranial hemorrhage. Cerebral ultrasonography was performed within 72 hours of birth on 505 healthy newborn infants, 37 weeks of gestation or greater. Sonographic abnormalities were detected in 23 (4.6%) neonates. Bilateral subependymal germinal matrix hemorrhage occurred in 14 and unilateral hemorrhage in five infants. Other abnormalities detected included agenesis of the corpus callosum in two infants, a cyst involving the subependymal germinal matrix in one (presumably the result of a previous subependymal hemorrhage), and mild ventricular dilation of unknown etiology in one. Newborns with subependymal hemorrhage were compared with newborns without hemorrhage in order to determine whether any significant differences existed between the two populations. No significant differences existed between infants with and without subependymal hemorrhage with regard to gender, obstetrical presentation, use of forceps, birth trauma, Apgar scores, need for resuscitation, maternal age and parity, and neonatal clinical problems. Infants with subependymal hemorrhage were of significantly lower gestational age and birth weight; the overall difference in weight was attributable to lower weight in female infants with subependymal hemorrhage. Significantly more infants with subependymal hemorrhage were small for gestational age, vaginally delivered, and black.
Atrial Overdrive Pacing for Conversion of Atrial Flutter in Children
Authors: Campbell Robert M. , Dick Macdonald , Jenkins Janice M. , Spicer Robert L. , Crowley Dennis C. , Rocchini Albert P. , Snider A. Rebecca , Stern Aaron M. , Rosenthal Amnon
Published: December 2021

Twenty-three successive patients with 27 different episodes of sustained atrial flutter were treated with atrial pacing for conversion of the tachyarrhythmia; 15 patients with 16 episodes of atrial flutter underwent intracardiac right atrial pacing and eight patients with 11 episodes of atrial flutter were treated with transesophageal atrial pacing. Ten of sixteen episodes (63%) and eight of 11 episodes (73%) were successfully converted using intracardiac and transesophageal techniques, respectively. Mean flutter cycle length for all 27 episodes was 219 ms (mean heart rate 274 beats per minute); successful pacing conversion cycle length (n = 15) was 72% of the flutter cycle length. Hemodynamic, electrophysiologic, and roentgenographic data were not predictive of conversion by either technique. Induction of localized atrial fibrillation or failure to meet critical pacing criteria may explain pacing failures. Based on this experience, a trial of transesophageal atrial pacing for acute conversion of any episode of atrial flutter in children prior to direct current cardioversion is recommended.
Indices of Protein Metabolism in Term Infants Fed Human Milk, Whey-Predominant Formula, or Cow's Milk Formula
Authors: Janas Lynn Marie , Picciano Mary Frances , Hatch Terry F.
Published: December 2021

Relationships between intakes of amino acids and total nitrogen, and blood indices of protein utilization were studied in 37 term infants fed either human milk, whey-predominant formula, or cow's milk formula as the sole nutritional source for 8 weeks. Biochemical analyses of two-hour fasting blood samples, and intakes calculated using three-day dietary records and direct analyses of milk samples were used to evaluate these relationships. Intakes of total nitrogen were positively correlated with plasma valine, leucine, isoleucine, phenylalanine, and serum urea nitrogen concentrations (r = .46 to .62, P < .01 to .001). Intakes of the four amino acids whose plasma concentrations were positively correlated with total nitrogen intakes plus four additional amino acids (threonine, tyrosine, histidine, and methionine) were correlated with their respective plasma concentrations (r = .41 to .74, P < .01 to .001). These relationships have not been previously described in term infants. Compared with values in infants fed human milk, plasma concentrations of valine, phenylalanine, methionine, and serum urea nitrogen were elevated with whey-predominant formula and cow's milk formula feeding. Values for four additional amino acids (threonine, lysine, leucine, and isoleucine) were elevated with whey-predominant formula feeding. Data indicate that altering the whey-to-casein ratio and, thus, the amino acid pattern of formulas will not achieve the desired blood indices characteristic of human milk feeding without a reduction in the total nitrogen content of formulas.
The Measure of Child
Authors: LEVINE MELVIN D.
Published: December 2021

To grow up in contemporary society is to be measured and judged. Schoolchildren are assessed repeatedly and evaluated for their adequacy to meet the expectations of peers, parents, and educational milieux. Report cards, achievement tests, and psychologic instrumentation are routine. Development and administration of evaluative tools is a major growth industry in North America. No constituency is more aware of this than are students with academic underachievement and/or associated behavior problems. In many communities, such youngsters are besieged by specialists compelled to test them. The results of these examinations often have substantial implications for the way affected children are perceived and served.
....Beginning to See the Light
Authors: MAISELS M. JEFFREY
Published: December 2021

In March 1952, Mollison and Walker1 reported the results of their prospective, randomized, controlled trial on the effect of exchange transfusion v simple transfusion in infants with severe erythroblastosis fetalis. They showed that exchange transfusion led to significantly lower mortality and a much lower incidence of fatal kernicterus. In the interim, numerous published studies have examined the relation between serum bilirubin levels in the neonatal period and the postmortem finding of kernicterus or the presence of later, clinical, bilirubin encephalopathy. With few exceptions, the design of these studies has made interpretation of their results hazardous, if not nugatory.2 We now have a study from the National Institute of Child Health and Human Development (NICHD)3 in which the population is sufficiently large and the study design sufficiently rigorous to permit actual, if tentative, conclusions concerning the effect of a different intervention (phototherapy) upon the immediate and later outcome of jaundiced newborn infants.
Neonatal Intensive Care: Cost-Benefit Analysis
Authors: BLACK LEHMAN E. , DAVID RICHARD J. , MCLONE DAVID G.
Published: December 2021

To the Editor.—

The article by Walker et al1 supports an idea that is becoming commonplace in the medical literature: preserving the lives of certain segments of the population (in this case very low-birth-weight babies) may not be worthwhile, not because we are inflicting pain and suffering on them by our treatments, but because they may constitute a net fiscal burden on society. These authors are even more explicit than most, using a cost-benefit analysis that compares the costs of neonatal intensive care and future medical and educational services to an infant's "expected lifetime earnings" to determine a baby's net worth.
Neonatal Intensive Care: Cost-Benefit Analysis
Authors: WALKER DONNA-JEAN B. , FELDMAN ALLAN , VOHR BETTY R. , OH WILLIAM
Published: December 2021

In Reply.—

In response to the comments on our paper1 dealing with the issue of cost-benefit analysis of health care delivery to the very low-birth-weight infants.

1. Neuspiel raised two issues. The first issue refers to placing a dollar value on human life. The final sentence of the abstract of our paper may be read by some to infer that care of infants weighing less than 900 g at birth is not economically beneficial; therefore, these infants should be restricted from receiving this care.
Glossoptosis-Apnea Syndrome in Infancy
Authors: Cozzi F. , Pierro A.
Published: December 2021

The clinical and physiologic features of 28 infants with Pierre Robin syndrome and those of 20 infants with various types of nasal obstruction were reviewed to determine whether different causes of upper airway obstructure may lead to a common syndrome. The patients had no significant differences in distribution of main clinical manifestations. Their features included cyanosis with respiratory distress, apneic spells, oropharyngeal dysphagia, vomiting, failure to thrive, cor pulmonale, brain damage, and sudden death during sleep. The common physiologic manifestation appeared to be an oropharyngeal obstruction caused by glossoptosis, which occured mainly during wakefulness. Upper airway obstruction led to hypoxemia, which, in many instances, was not associated with hypercapnia and was not relieved by oxygen administration. It is concluded that regardless of a specific cause, any airway obstruction that results in a decreased inspiratory pressure overcoming the airway maintaining genioglossus action causes a glossoptosis-apnea syndrome.
Phenothiazine-Induced Sleep Apneas in Normal Infants
Authors: Kahn Andrέ , Hasaerts Daniele , Blum Denise
Published: December 2021

A relationship between sudden infant death syndrome and the use of phenothiazine-containing medications is suspected. In order to investigate the influence of phenothiazines upon cardiorespiratory and sleep characteristics, four normal infants (mean age 15.8 weeks) had polygraphic recordings made for one night. The recordings were repeated three nights later, after the daily administration of a usual therapeutic dose of a standard phenothiazine syrup (promethazine, 1 mg/kg of body weight per day). The infants were monitored for six days after the first treatment. Findings from the first polygraphic recordings were normal for each infant. The second recordings disclosed an increase in sleep time, a reduction in the number and duration of awakenings, an increase in non-rapid eye movement (NREM) III sleep state, and a reduction in body movements. During the second night, each infant showed an increase in the number of central apneas, and each infant also had several episodes of obstructive apneas (median duration four seconds). It is concluded that promethazine depresses the arousal and respiratory mechanisms in normal infants during sleep. This observation reinforces the opinion that CNS depressants should be avoided in infants less than 1 year of age; CNS depressants could result in sudden death in apnea-prone infants.
Hypoxic and Hypercapneic Arousal Responses and Prediction of Subsequent Apnea in Apnea of Infancy
Authors: van der Hal Andre L. , Rodriguez Antonio M. , Sargent Charles W. , Platzker Arnold C. G. , Keens Thomas G.
Published: December 2021

Hypoxic and hypercapneic arousal responses from quiet sleep were tested in 56 infants with apnea of infancy (one or more episodes of cyanosis, limpness, and apnea requiring vigorous stimulation or resuscitation with no treatable cause; age 6.8 ± 1.1 [SEM] months). Responses were compared with those of nine control infants ranging from 1 to 25 months of age. To assess hypercapneic arousal, the inspired Pco2 was rapidly increased during quiet sleep to 60 mm Hg or until arousal (restlessness, agitation, eye opening) occurred. All control infants and those with apnea of infancy aroused to hypercapnea, but control infants aroused at a lower inspired Pco2 (inspired Pco2 40.1 ± 2.6 mm Hg) than those with apnea of infancy (inspired Pco2, 46.9 ± 1.5 mm Hg, P < .05). To assess hypoxic arousal, the inspired Po2 was rapidly decreased during quiet sleep to 80 mm Hg or until arousal occurred. All control infants aroused to hypoxia (inspired Po2, 78.3 ± 2.1 mm Hg). However, only 38% of those with apnea of infancy aroused (inspired Po2 78.1 ± 0.8 mm Hg), indicating an abnormality in recognition of hypoxia, or central brainstem response to hypoxia. During the 10.4 ± 1.2 months of follow-up, there was a high incidence of subsequent apneas (greater than 20 seconds) during sleep at home in 50 apneic infants. Infants with abnormal hypoxic arousal responses had more severe subsequent apneas than those with normal hypoxic arousal responses (P < .05).
Consequences of Cost-Sharing for Children's Health
Authors: Valdez R. Burciaga , Brook Robert H. , Rogers William H. , Ware John E. , Keeler Emmett B. , Sherbourne Cathy A. , Lohr Kathleen N. , Goldberg George A. , Camp Patricia , Newhouse Joseph P.
Published: December 2021

Do children whose families bear a percentage of their health care costs reduce their use of ambulatory care compared with those families who receive free care? If so, does the reduction affect their health? To answer these questions, 1,844 children aged 0 to 13 years were randomly assigned (for a period of 3 or 5 years) to one of 14 insurance plans. The plans differed in the percentage of their medical bills that families paid. One plan provided free care. The others required up to 95% coinsurance subject to a $1,000 maximum. Children whose families paid a percentage of costs reduced use by up to one third. For the typical child in the study, this reduction caused no significant difference in either parental perceptions of their child's health or in physiologic measures of health. Confidence intervals are sufficiently narrow for most measures to rule out the possibility that large true differences went undetected. Nor were statistically significant differences observed for children at risk of disease. Wider confidence intervals for these comparisons, however, mean that clinically meaningful differences, if present, could have been undetected in certain subgroups.
Nutritional Needs of Low-Birth-Weight Infants
Authors:   Committee on Nutrition
Published: December 2021

Optimal nutrition is critical in the management of the ever-increasing number of surviving small premature infants. Although the most appropriate goal of nutrition of the low-birth-weight (LBW) infant is not definitively known, achieving a postnatal growth that approximates the in utero growth of a normal fetus at the same postconception age appears to be the most logical approach at present.1 In uncomplicated cases, growth will usually begin by the second week after birth, after the initial changes in body water distribution have taken place, and after the infant has accommodated in a nonstressful way to the provision of enteral feeds and parenteral supplements. The fetal standards of growth that will be considered here include not only weight and length, but also values for rate of retention of individual nutrients and minerals (Table 1).2 The quality of postnatal growth may differ from the quality of fetal growth, depending on the type of milk consumed, eg, ex utero weight gain of a premature infant given formula includes more fat gain than that of a fetus of the same maturity.3

CALORIC REQUIREMENT

Energy expenditure for maintenance and growth determines the caloric requirements of the infant. The energy expenditure for growth includes both the energy value of the new tissue and the energy cost of the tissue synthesis. The estimated "basal" or maintenance metabolic rate of LBW infants, including an irreducible amount of physical activity, is lower in the first week after birth than later, and in a thermoneutral environment is approximately 50 kcal/kg/d by 2 to 3 weeks of age.4,5
Blood Transfusions and Safety
Authors: MATTSON PHILIP D.
Published: December 2021

To the Editor.—

Transfusion practices in the neonate have become increasingly controversial with the recent reporting of AIDS (acquired immune deficiency syndrome). Many parents have requested the opportunity to provide directed donations with marginal success due to lack of storage apparatus and or staff refusal. The question of increased safety has been contested, especially when the infant requires multiple donors.

In some facilities, the Walking Donor Program has been resurrected. However, with heparinized syringes there is limited shelflife and inability to pack and irradiate (as done in some centers), and there are also contraints of donor availability.
Asthma and Pneumomediastinum
Authors: STURTZ GEORGE S.
Published: December 2021

In Reply.—

Zwerdling and Hen correctly point out the well-known association of pneumomediastinum and asthma. In most patients, pneumomediastinum occurs as a complication of asthma; in fact, a child reported by Knott in 1850 had been wheezing for 3 weeks!

My paper was intended to emphasize that severe anterior chest pain, precordial crunching, and the presence of subcutaneous air in the neck of a previously healthy adolescent should lead to the clinical diagnosis of spontaneous mediastinal emphysema. Thus, on clinical grounds alone, one can rapidly identify a benign illness in a seemingly critically ill patient.
Sudden Hearing Loss Following Infectious Mononucleosis: Possible Effect of Altered Immunoregulation
Authors: Williams Lowell L. , Lowery Howard W. , Glaser Ronald
Published: December 2021

Sudden, permanent hearing loss developed in three young patients. In an attempt to determine a viral etiology, their humoral and cell-mediated responses to a panel of seven viruses linked to deafness and altered immunity were measured. Although a specific viral cause was not determined, a mild Epstein-Barr virus infection was documented for each patient. It had preceded their hearing loss onset by 1 to 4 months. Evidence of altered cell-mediated responses to Epstein-Barr virus antigens was found in each patient. It is proposed that, in certain susceptible individuals, a temporary cellular immunosuppression, which accompanies normal recovery from Epstein-Barr virus infection, may provide an opportunity for a viral invasion of, or a latent viral reactivation in, the inner ear. This invasion or reactivation leads to deafness.
WHAT EVER HAPPENED TO `TRYING AGAIN'?
Authors: Student
Published: December 2021

. . . the replacement of grossly deformed infant hearts may be challenging and exciting, the procedure and the maintenance of a normal life thereafter . . . are such formidable calls on the resources in any country that their place in the responsible delivery of health care must be very seriously questioned. Surgeons, physicians, and parents should learn to accept that biology can go awry and that technical feats may not right it again; in the context of malformed hearts incompatible with prolonged survival, many parents are young enough to try again.
Parental Fever Phobia and Its Correlates
Authors: Kramer Michael S. , Naimark Lenora , Leduc Denis G.
Published: December 2021

Parents of 202 young febrile children were surveyed about their knowledge, attitudes, and fears concerning fever and its treatment. Forty-eight percent of the parents considered temperatures less than 38.0°C to be "fevers", 43% felt that temperatures less than 40.0°C could be dangerous to a child, 21% favored treatment for fevers less than 38.0°C, and 15% believed that, left untreated, temperature could rise to 42.0°C or higher. Fifty-three percent advocated waking a febrile child at night to administer antipyretic therapy. Young age of the child was associated with a preference for use of acetaminophen over aspirin and, unexpectedly, with a higher parental threshold for consideration of fever. The higher their child's temperature at the time they were questioned, the higher the minimum temperature that parents considered a cause for concern. Surprisingly, higher socioeconomic status was not associated with a lesser degree of fever phobia. In fact, parents of higher socioeconomic status were more concerned about the risks of brain damage or seizures as sequelae of fever than were parents of lower socioeconomic status. It is concluded that undue fear and overly aggressive treatment of fever are epidemic among parents of infants and young children, even among the highly educated and well-to-do. Considerable effort will be required on the part of pediatricians and other child health workers to reeducate these parents about the definition, consequences, and appropriate treatment of fever.
Total Population Estimate of Newborn Special-Care Bed Needs
Authors: Jung August L. , Streeter Nan Sherman
Published: December 2021

In 1977, 7% of the 38,855 infants born in Utah were estimated to have required a total of 27,439 special-care hospital days. About half (53%) were mildly ill; their average length of stay was 4.6 days, or 24% of the total hospital-days. Another 20% of the infants had intermediate illness, with a 12-day average stay, or 23% of the total hospital-days. The remaining 27% of the infants required intensive care and used 53% of the total hospital-days; their average length of stay was 20 days. As a total population, the state's 38,855 births generated a need for two beds per 1,000 annual live births in special-care facilities. The estimated bed need was: mild illness (Level I), 0.5 beds per 1,000 annual live births; intermediate illness (Level II), 0.5 beds per 1,000 annual live births; and intense illness (Level III), one bed per 1,000 annual live births. Results are based on the assumption that nonstudy births, 30% of the total, have needs proportionate to study births. The following considerations are necessary to extrapolate these bed needs to other populations: (1) convalescence of intensely ill babies may require that up to 50% of their bed needs may be shifted to intermediate care; (2) compliance with criteria for transport to the next level of care may not be 100% as assumed in the study, thus redistributing bed needs; (3) census characteristically fluctuates in special-care nurseries (study results are reported for an unchanging daily census); and (4) the low birth rate of a population is intimately related to the bed needs.
Cardiovocal Syndrome in Infancy
Authors: Condon Lawrence M. , Katkov Harold , Singh Amarjit , Helseth Hovald K.
Published: December 2021

Chronic hoarseness is a rare presenting or accompanying sign of congestive heart failure in infancy. Two infants had a paralyzed left vocal cord, secondary to traction on their left recurrent laryngeal nerve. Both had significant underlying congenital heart disease (type 2 aortopulmonary window, ventricular septal defect, patent ductus arteriosus; large ventricular septal defect). After surgical repair of their congenital heart defect, both infants had normal vocal cord function. Direct laryngoscopy is necessary to diagnose the cause of persistent hoarseness in infancy. If a paralyzed left vocal cord is found, a comprehensive cardiovascular diagnostic workup is warranted.
Acoustic Reflectometry in the Detection of Middle Ear Effusion
Authors: Lampe Richard M. , Weir Michael R. , Spier James , Rhodes Miller F.
Published: December 2021

Acoustic reflectometry, a new technique for detecting middle ear effusion, was compared with results from tympanocentesis or myringotomy in 75 patients (141 ears). There was a highly significant association (P < .0001) for ears having middle ear effusion with high reflectivity (5 through 9 units) and for ears having no middle ear effusion with low reflectivity (0 through 4 units). In a pediatric population with middle ear effusion present in 98 of 141 ears and using reflectivity readings greater than 4 to indicate middle ear effusion, the sensitivity of this technique was 86.7% and the specificity was 69.8%. False-positive errors usually occurred in ears with thick tympanic membranes, or in ears in which reflectivity was determined prior to the induction of anesthesia. False-negative errors usually occurred in ears with both air and fluid. This technique was validated by direct comparison with tympanocentesis or myringotomy and can be used with pneumatic otoscopy and impedance tympanometry to follow children with middle ear effusion.
Rhabdomyolysis and Myoglobinemia in Neonates
Authors: Kasik J. W. , Leuschen M. P. , Bolam D. L. , Nelson R. M.
Published: December 2021

Serial myoglobin determinations were made in 20 neonates during the first week of life to determine whether birth asphyxia results in ischemic damage to muscle with the subsequent pathologic release of myoglobin. Serum myoglobin values were significantly elevated in asphyxiated infants compared with control infants. High myoglobin values correlated with a longer duration of oliguria in the neonatal intensive care unit population. The value of urine dipstick testing for myoglobinuria screening was also evaluated. Infants with elevated myoglobin values were more likely to have a strongly positive urine dipstick for occult blood in the first 48 hours of life. These data suggest that ischemic damage to muscle with pathologic release of myoglobin occurs in the neonatal period and that urine dipstick testing provides a reasonable screening examination for myoglobinuria.
Meningomyelocele and Hirschprung Disease: Theoretical and Clinical Significance
Authors: MERKLER RICHARD G. , SOLISH SHARYN B. , SCHERZER ALFRED L.
Published: December 2021

Evidence to support a unifying theory to explain the embryogenesis of numerous midline anomalies, including neural tube defects, has been widely sought.1,2 The impetus for this search has been the finding of certain combinations of these anomalies at incidence rates higher than those predictable by chance,1,2 such as the occurrence of oral clefts with neural tube defects,1 or Hirschprung disease with neuroblastoma.2

To further document the possible midline developmental relationship, we present the first reported case of Hirschprung disease occurring in a patient with meningomyelocele and hydrocephalus.

CASE REPORT