bluuebunny/crossref_metadata_2025 huggingface dataset:
Neutrophils and Zinc in Infection-Prone Children with Sickle Cell Disease
Authors: Carpentieri Ugo , Smith Leigh , Daeschner Charles W. , Haggard Mary Ellen
Published: December 2021

Neutrophils can be distinguished as EA negative (EA-N) or EA positive (EA+N), according to rosette formation with sheep erythrocytes. EA- neutrophils show a bactericidal activity 50% to 70% lower than EA+ neutrophils. Thirty children with sickle cell disease were studied during steady state and crises/infections, together with matched control children. EA+ and EA- neutrophils, zinc levels in the body, and frequency of previous bacterial infection were evaluated. Sixty percent of the patients (18/30) had zinc deficiency (zinc < 8.5 µg/1010 RBC): of this group, more than three fourths (14/18) had a high frequency of infections (≥3/yr) and most of those (11/14) also had an increased percentage of EA- neutrophils (80% to 85% v 35% to 45% in control subjects). Only 4/18 of patients with zinc deficiency had a low frequency of infections, and only one of these four had a higher percentage of EA- neutrophils. In patients with normal zinc levels (12/30 or 40%), only three had frequent infections, but only one of these had an increased percentage of EA- neutrophils. The number of EA+ neutrophils increased after stimulation with epinephrine or during crises/infections. In six patients with more pronounced zinc deficiency and more severe crisis/infection, a delay in the increase of EA+ neutrophils occurred and was corrected by treatment. These findings suggest that a higher percentage of neutrophils with less bactericidal activity in many children with sickle cell disease and zinc deficiency may be a factor in the higher incidence of infections noted in these patients, and zinc might play a role in the formation, release, and activity of neutrophils.
Fatal Intracranial Hemorrhage in a Normal Infant Secondary to Vitamin K Deficiency
Authors: LANE PETER A. , HATHAWAY WILLIAM E. , GITHENS JOHN H. , KRUGMAN RICHARD D. , ROSENBERG DONNA A.
Published: December 2021

Since the initiation of routine vitamin K prophylaxis in newborns, the incidence of hemorrhagic disease of the newborn has been dramatically decreased. Recently there have been suggestions in the literature that prophylaxis may be unnecessary.1-4 We report here a fatal case of vitamin K deficiency in an otherwise healthy 1-month-old who did not receive prophylaxis. This case is illustrative because the child was initially thought to have suffered nonaccidental trauma. In addition, the correct diagnosis was confirmed, retrospectively, after vitamin K administration, with new assays for vitamin K-deficient prothrombin.

CASE REPORT

This 4-week-old male infant was seen at a community hospital emergency room with a one-day history of irritability, poor feeding, and decreased responsiveness without fever.
Maternal-Infant Bonding: A Joint Rebuttal
Authors: ANISFELD ELIZABETH , CURRY MARY ANN , HALES DEBORAH J. , KENNELL JOHN H. , KLAUS MARSHALL H. , LIPPER EVELYN , O'CONNOR SUSAN , SIEGEL EARL , SOSA ROBERT
Published: December 2021

Inaccuracies in Lamb's recent review1 of studies of maternal-infant bonding have resulted in considerable confusion and misunderstanding among those not well acquainted with the field. This rebuttal, prepared by the investigators whose works were sited, addresses these inaccuracies so that a fuller and more productive discussion of this area of study can occur in the future. Under the name of each investigator, Lamb's criticisms are quoted, after which the original researcher responds with corrected information.

Lamb in his criticism of the work of Hales et al2 notes that, "Many of the researchers have employed multiple measures and observed statistically significant differences on a small proportion of these.
Worms in Diaper
Authors: WEINBERG ARTHUR G.
Published: December 2021

To the Editor.—

In a recent letter,1 Ruttner called attention to the presence of housefly maggots in soiled diapers as a cause for parental misidentification of stool parasites. Recently, a mother brought a clean diaper with "worms" to our acute care clinic. The diaper contained more than 20 slender brown "worms," each 1.5 mm long, which moved in an undulating manner (Figs 1 and 2). Closer examination disclosed tiny caterpillars. Tim Friedlander, an entomologist at Texas A&M University, identified these as first-stage larvae of a pyralid moth, probably of the subfamily Pyraustidae, a harmless garden pest.
Efficacy of Penicillin Prophylaxis
Authors: HESS J. , HOLLOWAY Y. , DANKERT J.
Published: December 2021

In Reply.—

Studies evaluating the efficacy of antibiotic prophylaxis for bacterial endocarditis in patients undergoing dental extractions are numerous, but studies dealing with the association between the peak serum concentrations achieved by the antibiotic used and the occurrence of postextraction bacteremia are lacking. It is questionable whether higher dosages than the dosages used in our study would have prevented the occurrence of postextraction bacteremia, because no relationship was found betwen the occurrence of postextraction bacteremia and postextraction serum penicillin concentrations.
Incidence of Breast-Feeding in a Low Socioeconomic Group of Mothers in the United States: Ethnic Patterns
Authors: Rassin David K. , Richardson C. Joan , Baranowski Tom , Nader Philip R. , Guenther Nancy , Bee David E. , Brown Judy P.
Published: December 2021

Breast-feeding has been shown to have increased in incidence during recent years in the United States. However, this increase is not particularly evident in lower socioeconomic groups. Factors associated with the decision to breast-feed or not were investigated in a population of 379 mothers. Self-completed questionnaires were obtained from 94.5% of these mothers. Data with respect to demographics, reproductive history, prenatal care, and education were collected. Only 27.2% of the study population indicated that they intended to breastfeed. Using the x2 test for equality of proportions, marital status, head of household, maternal and paternal ethnicity, maternal education, income, and number of pregnancy were found to be the most important variables associated with breast-feeding. The effect of ethnicity predominated over that of the other demographic variables when they were examined jointly within ethnic groups. The effect of ethnicity was apparent when the number of each ethnic group in the study population was compared with the percent of that group that intended to breast-feed: 145 Anglo-Americans, 43.5% breast-feeding; 131 black Americans, 9.2%; 62 Mexican Americans, 22.6%; 19 others, 42.1%. The importance of ethnicity in the decision to breast-feed has probably been underestimated. Efforts to increase breast-feeding in the United States ought to be designed with full consideration of this factor.
Systemic Candidiasis in Very Low-Birth-Weight Infants (<1,500 Grams)
Authors: Johnson Dana E. , Thompson Theodore R. , Green Thomas P. , Ferrieri Patricia
Published: December 2021

Previous reports in the literature have documented that systemic infection with Candida albicans in very premature infants is frequently fatal (54%) or associated with significant morbidity in survivors (25%). Five patients with a mean birth weight of 829 g had a diagnosis of systemic candidiasis during their stay in a newborn intensive care unit. All infants survived with minimal sequelae following aggressive early treatment with amphotericin B and 5-flucytosine. A review of these five extremely premature infants and 26 previously reported patients suggests the following: (1) disseminated candidiasis is common in the absence of positive findings in blood, CSF, and/or urine cultures; (2) transient candidemia rarely resolves without therapy; (3) meningitis and osteoarthritis occur more frequently than in older patients with disseminated disease; and (4) premature infants tolerate amphotericin B and 5-flucytosine well. Infants who are found to have systemic cultures positive for candidiasis should be treated by (1) removing all factors that predispose to systemic candidiasis (eg, indwelling catheters, broad-spectrum antibiotics); (2) early initiation of systemic antifungal therapy with amphotericin B and 5-flucytosine; and (3) searching for additional foci of disease. After the disease is recognized and treatment is prompt and aggressive, outcome can be substantially improved.
Comparison of Radiography and Radionuclide Bone Scanning in the Detection of Child Abuse
Authors: Jaudes Paula Kienberger
Published: December 2021

The battered child syndrome consists of a constellation of signs that may be either apparent or covert. Radiographic documentation of unexplained or difficult-to-detect fractures is an important means of establishing a basis for legal intervention in child abuse. One hundred ten children were evaluated with either radiographic surveys or bone scans, and 50 children had both roentgenograms and bone scans. In 40% of the children there was at least one fracture whereas 20% had between two and seven fractures. Among the children who received both skeletal surveys and bone scans, 41 fractures were detected: skeletal survey detected 52% and bone scan detected 88% of those fractures. Children with fractures were more likely to be placed in foster homes than to be returned to the original environment. The presence of single v multiple fractures did not alter the probability of foster placement. It was concluded that fracture documentation is important in determining whether to place abused children in foster homes. Both skeletal surveys and radionuclide bone scanning had high false-negative values. When either test is initially negative and blatant signs of physical abuse are present, both tests should be performed to ensure the greatest probability of fracture detection.
A Cluster of Neonatal Herpes Simplex Infections Without Mucocutaneous Manifestations
Authors: Amortegui Antonio J. , Macpherson Trevor A. , Harger James H.
Published: December 2021

Three cases of neonatal disseminated herpes simplex virus (HSV) infection are reported. They were all due to different strains of HSV-1, according to restriction endonuclease studies, and they represent the first cluster of neonatal HSV infection at Magee-Womens Hospital. The neonatal symptoms occurred early, suggesting intrauterine infection. None of the babies had mucocutaneous lesions, and the mothers were asymptomatic and had no history of previous genital HSV infection.
Localized Bowel Distension in the Newborn: A Review of the Plain Film Analysis and Differential Diagnosis
Authors: Johnson J. Fred , Robinson Lawrence H.
Published: December 2021

Neonatal abdominal plain films were prospectively analyzed over a 41-month period in order to generate a differential diagnosis for focal bowel distension during the first 6 weeks of life. A total of 31 examples of locally distended bowel were collected. The study discredits the concept that asymmetrically distended bowel in the newborn is usually caused by necrotizing enterocolitis (only 9/31 cases) and indicates that distended bowel in the lower abdomen or left upper quadrant is often caused by air trapping in normal but redundant rectosigmoid (11 cases) or in distal transverse colon (three cases). Five other pathologic conditions not normally specified in differential diagnoses of focally distended bowel included inguinal hernia (three cases), small bowel atresia (two cases), midgut volvulus (one case), Hirschsprung's disease (one case), and small left colon (one case). The study emphasizes the value of sequential supine and prone filming for distinguishing normal from pathologic dilated loops of bowel.
Determination of Anterior Displacement of the Anus in Newborn Infants and Children
Authors: Reisner Salomon H. , Sivan Yaakov , Nitzan Menachem , Merlob Paul
Published: December 2021

Anterior displacement of the anus is a common cause of constipation in infancy and early childhood. However, normal values are not available for defining anal displacement. Using a simple technique, an anal position index of less than 0.34 in girls and less than 0.46 in boys was indicative of anterior displacement. The diagnosis can be made in the neonatal period.
Intestinal Lesions Containing Coronavirus-like Particles in Neonatal Necrotizing Enterocolitis: An Ultrastructural Analysis
Authors: Rousset S. , Moscovici O. , Lebon P. , Barbet J. P. , Helardot P. , Macé B. , Bargy F. , Vinh Le Tan , Chany C.
Published: December 2021

Since the outbreaks of neonatal necrotizing enterocolitis occurring in maternity hospitals of Paris and suburbs in 1979-1980, it has been possible to examine by light and electron microscopy gut specimens from ten newborns with this illness. Coronavirus-like particles, enclosed in intracytoplasmic vesicles of damaged epithelial cells of the intestinal mucosa, were observed in the small intestine, appendix, and colon. The ultrastructural study, supported by bacteriologic findings, suggests the role of coronavirus-like particles in the appearance of the lesions. Secondary proliferation of mainly anaerobic bacteria, probably responsible for pneumatosis, may aggravate the disease.
Aerosol Bag for Administration of Bronchodilators to Young Asthmatic Children
Authors: Lee Haesoon , Evans Hugh E.
Published: December 2021

An aerosol rebreathing bag was developed by modifying an ordinary freezer bag of 1-qt size. A mouthpiece was inserted in a corner of the bag, and the aerosol canister was actuated inside the bag while an asthmatic child breathed in and out of the bag. Its feasibility was tested in 20 child-parent pairs. Children less than age 7 years easily learned to inhale aerosols from the bag. Bronchodilator efficacy of albuterol aerosol using the bag was compared with that of the canister mouthpiece in 15 children aged 7 to 15 years. The results were nearly identical.
Marasmus in a 17-Month-Old Laotian: Impact of Folk Beliefs on Health
Authors: OBERG CHARLES N. , DEINARD AMOS
Published: December 2021

The recent influx of Southeast Asians from Laos, Viet Nam, Cambodia, and Thailand into the United States has introduced a variety of foreign cultures into Western society. At times these cultures and folk beliefs clash with those of Western society. These beliefs frequently have ramifications on the health of individuals and implications for accommodation requirements for our health care system.

Laos is comprised of a variety of ethnic groups including the Lao, Tai, Hmong, and Ka tribes.1 Each ethnic group has its own endogenous beliefs, but a belief in spirits or phi is evident in each. The following account is that of a Lao family, whose ethnic group accounts for 50% of the Laos population and 20% of the immigrants in the Twin Cities metropolitan area.
Corporal Punishment in Schools
Authors:   Committee on School Health
Published: December 2021

Since 1978, various committees of the American Academy of Pediatrics have intermittently addressed the question of corporal punishment and discipline.

A review of recent psychiatric, psychologic, and educational literature continues to accumulate evidence in opposition to corporal punishment in schools, although 47 states still have legislation permitting this management.

The American Academy of Pediatrics is opposed to the use of corporal punishment in schools, and urges all parents, educators, school board members, legislators, and other adults to seek the abandonment of corporal punishment and its legal prohibition in all states.

Employment of alternative methods1,2 for implementation of self-control and responsible behavior is recommended.
Protest Views of Singer
Authors: SINGER PETER
Published: December 2021

In Reply.—

Both Bongiovanni and Callie refer to Nazi Germany as a warning against abandoning the sanctity-of-life view. This appeal to the slippery slope argument is a gross oversimplification of the differences between our society and Hitler's Germany. Alexander, on whom Bongiovanni relies, neglects the importance of Nazi racism and of the fact that the Nazi euthanasia program was not intended for the benefit of the patients—it was conducted secretly, relatives were deceived about what happened, and privileged groups such as veterans were exempted from it.
An Outbreak of Clostridium difficile Necrotizing Enterocolitis
Authors: CHANCE GRAHAM W. , HAN VICTOR K. M.
Published: December 2021

In Reply.—

The observation made by Mathew et al on the lack of relationship between the isolation of Clostridium difficile and necrotizing enterocolitis (NEC) in their neonatal intensive care unit (NICU) is interesting, although the numbers are too small for relevant comment. Importantly, no mention was made on how the control subjects were selected.1 We agree that the colonization rate in NICUs may vary widely and may range up to 55% in certain units.2 In the subsequent four months following the outbreak that we reported, all infants admitted to our NICU had their stools tested weekly for C difficile.
The Natural History of Neonatal Jaundice
Authors: Kivlahan Coleen , James Elizabeth J. P.
Published: December 2021

The relationship between infant feeding type and the occurrence and natural history of neonatal jaundice in term newborn infants has been studied. A retrospective chart review of 124 records confirmed earlier reports indicating that jaundice is recognized more often in breast-fed than in formula-fed infants. A prospective cohort study of 140 term newborn infants was conducted using the Minolta Air-Shields transcutaneous jaundice meter. For 3 weeks, 115 white infants and 25 black infants were followed at predetermined intervals. The peak jaundice meter readings were higher and the elevated levels lasted longer in breast-fed than in formula-fed infants. Formula-fed infants' readings returned to base-line levels in eight days whereas the readings were still elevated in breast-fed infants when the study ended on the 21st day. Black infants had higher transcutaneous readings than white infants due to their deeper skin pigmentation, but otherwise they followed a course identical with that of the white babies. The distribution of jaundice in the white infants was bimodal; in approximately one fourth of the breast-fed infants, the jaundice meter readings reached levels corresponding to bilirubin values >13 mg/dL whereas the remaining three fourths followed a pattern similar to that of the formula-fed infants. It can be concluded that human milk feeding is associated with more prolonged hyperbilirubinemia than formula-feeding in normal term infants.
Symposium on Genetic Engineering and Phenylketonuria
Authors: Cederbaum Stephen D. , Koch Richard , Donnell George N.
Published: December 2021

STATEMENT OF PURPOSE

—George N. Donnell, MD

One might ask why have a conference about genetic engineering? The answer is clear. The subject matter has generated a great deal of interest; it has received a good deal of attention from the lay press. Industry has become involved, and many companies across our continent are utilizing the new technology for commercial application. There is no question that this area of genetics will have an impact on all of us. Clinicians will need to have more than a superficial grasp of this new area of medicine. The potential applications, the beneficial aspects, as well as the harmful effects must be appreciated.

This conference is designed to provide an orientation for the clinician and to highlight the social, economical, and ethical issues that the new technology has raised.

GENERAL INTRODUCTION

—Stephen D. Cederbaum, MD, and Richard Koch, MD

Phenylketonuria (PKU) was one of the first well-defined inborn errors of metabolism and one of the first to be successfully treated. The history from 1953 until recently had been one of an almost unbroken series of triumphs, each mitigating the adverse impact of this autosomal recessive disease. First the affected siblings of index cases, then the population at large was able to escape the consequences of PKU with the use of a phenylalanine restricted diet. Physicians accustomed to dealing with a developmental tragedy could look forward to meetings with normal patients who represented a therapeutic triumph. There was little concern when the burgeoning field of prenatal diagnosis bypassed PKU; it was, after all, a disorder that was readily treatable.
Spontaneous Mediastinal Emphysema
Authors: STURTZ GEORGE S.
Published: December 2021

Spontaneous mediastinal emphysema, an apparently uncommon disorder of children, is characterized by precordial pain, unusual crunching sounds heard over the precordium during auscultation, subcutaneous air palpable in the neck, and the presence of mediastinal air on the chest roentgenogram.

CASE REPORT

A 13-year-old male adolescent had worked all afternoon mowing lawns. When his gas-powered mower stalled, he restarted it by pulling the starter cord vigorously and frequently. After the evening meal, he clipped a hedge by hand. Within one hour, he developed severe substernal pain. He had a sense of substernal pressure. He felt "... as if I were going to explode," and thought he was having a heart attack.
Administration of Medication in School
Authors:   Committee on School Health
Published: December 2021

Many children with chronic disabilities or illnesses are able to attend school because of the effectiveness of their prescribed medication. Any student who is required to take prescribed medication during regular school hours should do so in compliance with school regulations. These regulations should include the following:

1. A physician should provide written orders with the name of the drug, dose, time interval when the medication is to be taken, and diagnosis or reason the medicine is needed.

2. The parent or guardian should provide a written request that the school district comply with the physician's order.

3. Medication should be brought to school in a container appropriately labeled by the pharmacist or the physician.

4. When the student does not regularly take his or her own medication, or if the parent or physician requests that school personnel administer the medication, provision should be made for the medication to be kept in a locked cabinet. Designated personnel must be available to administer the medication at agreed-upon times, and arrangements should be made for alternate personnel to perform the task in case of absence. The person administering the medication must keep a written record.

5. When the child is usually responsible for taking his/her own medication, he/she may do so in school without supervision by school personnel, provided the physician and parent have provided the required authorizations. The school administration should cooperate with the physician, parent, and child. In such instances, it is understood that the school bears no responsibility for safeguarding the medication or assuring that it is taken, and the parent should provide a written statement relieving the school of such responsibility.
Antimicrobial Prophylaxis in Pediatric Surgical Patients
Authors:   Committee on Infectious Diseases, Committee on Drugs, and Section on Surgery
Published: December 2021

This Policy Statement was retired May 1987.

A major use of antimicrobial agents in hospitalized children is prophylaxis of postoperative wound infections. In view of this frequent use and the emerging consensus on recommendations for prevention of surgical wound infections,1 the American Academy of Pediatrics has developed guidelines for surgical antimicrobial prophylaxis in children. Prophylaxis is defined as use of antimicrobial drugs in the absence of suspected or documented infection.

FREQUENCY OF ANTIMICROBIAL PROPHYLAXIS

In an extensive study of patients in acute care general hospitals in Pennsylvania, 36% of antimicrobial courses were initiated for prophylaxis of infection after surgery or an invasive procedure, such as cystoscopy or cardiac catheterization.2 The prevalence and reasons for antimicrobial use have been studied primarily in general or adult hospitals, but the patterns of use in children are similar to those in adults.3-5 Two studies have demonstrated that prophylaxis accounts for approximately 75% of the antibiotic use on pediatric surgical services.4,6

The efficacy of antimicrobial prophylaxis in lowering the incidence of postoperative infection after certain types of surgery has been demonstrated amply in controlled clinical trials.7 These and earlier studies by Miles et al8 and Burke9 in experimental animals have delineated the principles for effective use of antimicrobial agents in surgical prophylaxis, including choice of drugs and when and how long they are to be given.

INAPPROPRIATE ANTIMICROBIAL PROPHYLAXIS

Prophylaxis has been incriminated as a major cause of inappropriate use of these antimicrobial agents in both adults and children.4,5,10-12 In 74% of antimicrobial courses given for prophylaxis in the Pennsylvania study, the duration exceeded 48 hours, an interval beyond which continuation has not been proven beneficial.2
Fungal Infections in Premature Infants
Authors: LANGDON DAVID R.
Published: December 2021

To the Editor.—

Baley et al, in "Disseminated Fungal Infections in Very Low-Birth-Weight Infants: Clinical Manifestations and Etiology" (Pediatrics 1984;73:144-152), provided a wealth of clinical detail about systemic candidiasis in very low-birth-weight infants and emphasized the increased risk in infants with a prolonged period of parenteral alimentation via central lines. They observed late-onset carbohydrate intolerance in these infected infants and imply that fungal sepsis may precipitate hyperglycemia.

The causal relationship and temporal sequence of such insidious conditions as hyperglycemia and candidemia may be difficult to establish in retrospect.
Fungal Infections in Premature Infants
Authors: BALEY JILL E. , KLIEGMAN ROBERT M. , FANAROFF AVROY A.
Published: December 2021

In Reply.—

Seventy percent of the low-birth-weight (LBW) infants whose condition was clinically diagnosed as systemic fungal infections demonstrated glucose intolerance. Langdon is correct that hyperglycemia, which may be found in young diabetic women, may encourage nonsystemic or local candidiasis. He is also correct that multiple factors may affect glucose tolerance in the sick low-birth-weight infant. Whereas it is possible that alterations in care or glucose intake might result in hyperglycemia, it is unusual for a low-birth-weight infant who has previously demonstrated stable glucose control to suddenly develop hyperglycemia and/or glycosuria at 5 weeks of age.
Resting Blood Pressure and Pulse Rate Distributions in Black Adolescents: The Philadelphia Blood Pressure Project
Authors: Hediger Mary L. , Schall Joan I. , Katz Solomon H. , Gruskin Alan B. , Eveleth Phyllis B.
Published: December 2021

Reference percentile distributions for blood pressure in black adolescents are not generally available. The most recently published BP percentile grids for children and adolescents were derived almost exclusively from information on white populations, and few data are available on the distribution of pulse rate for black adolescents. Reference percentiles for black adolescents for resting BP and 60-second pulse rate are presented. Given the tendency for high BP levels to track, these reference percentiles may be of value in determining the extent to which black adolescents are at risk for hypertensive disorders in adulthood. The percentiles were derived from a 3-year longitudinal study of black, urban Philadelphia adolescents, aged 12 to 17 years. Confirming results from studies of other populations in adolescence, a trend was found toward increased mean systolic BP for boys (P < .001), and that boys have significantly higher (P < .001) systolic BP than girls after chronologic age 15 years. Diastolic BP phase IV (muffling) exhibits no age or sex trends from ages 12 to 17 years, but adolescent girls overall have significantly higher (P < .001) phase V diastolic (disappearance) than boys. Sixty-second pulse rate declines for both boys and girls in adolescence, although at every age 60-second pulse rate means are significantly faster in girls than boys (P < .02). For girls older than 12 to 17 years, there is a significant, positive correlation between pulse rate and systolic BP (r = .16, P < .01) and between pulse rate and phase IV diastolic (r = .23, P < .01). On the other hand, pulse rate and BP are not significantly correlated in 12- to 17-year-old boys (r = -.04 systolic BP, r = .06 diastolic BP phase IV).
Acquired Chromosome Rearrangements, Including Fine Interstitial Deletions, in a Patient with Down Syndrome and Monoblastic Leukemia
Authors: Misawa Shinichi , Testa Joseph R. , Strauss Lewis C. , Leavitt Richard D. , Civin Curt I.
Published: December 2021

A female child with Down syndrome who developed acute monoblastic leukemia is reported. Anemia associated with milk leukopenia was first recognized when the patient was 14 months old. Acute monoblastic leukemia was diagnosed 1 year later; cytogenetic studies were performed on circulating leukemic cells at this time. Analysis of elongated, finely banded chromosomes revealed three structural rearrangements, including two rather subtle interstitial deletions, in addition to trisomy 21 which was representative of the patient's constitutional karyotype. The karyotype of the leukemic cells was 47,XX,+21,t(3;18)(p23;q11.2), del(7)(q31.1q31.3), del(9)(p22p24 or p21p23). The patient received no cytostatic chemotherapy and died 4 months after the diagnosis of acute leukemia was made.
Computed Tomography in an Infant with Salt Poisoning: Relationship of Hypodense Areas in Basal Ganglia to Serum Sodium Concentration
Authors: HABBICK BRIAN F. , HILL ALAN , TCHANG STANLEY P. K.
Published: December 2021

The pathogenesis of the intracranial complications of hypernatremia has been the subject of considerable research.1-5 The purpose of this communication is to report unusual appearances on computed tomographic (CT) scan of the brain in an infant who developed hypernatremia as a result of salt poisoning.

CASE REPORT

The patient, a 6-month-old male infant, was admitted for investigation of seizures. He had been admitted to another hospital on the evening of Jan 25, 1983, because of several episodes in which he rolled his eyes and had generalized stiffening and back arching. Diazepam had been given intramuscularly, and the infant was then given intravenous (IV) fluids (50 mmol of sodium chloride and 33.3 g of dextrose per liter).
Treatment of Occult Bacteremia
Authors: FELDMAN WILLIAM
Published: December 2021

To the Editor.—

I am concerned about the conclusions in the paper on treatment of occult bacteremia.1 Carroll at al recommend "expectant antibiotic therapy for children who have no obvious source of infection and who have the clinical characteristics associated with occult bacteremia." As a relatively large percentage of infants aged 6 to 24 months have high fevers at one time or another, the implications of this approach were it to be widely implemented would be great.
Rheumatic Fever Article Questioned
Authors: GRIFFITHS SYLVIA P.
Published: December 2021

To the Editor.—

The suggestion of Nordin1 that there may be a need to re-evaluate the current recommended prophylaxis for children with rheumatic fever is valid, particularly if carefully planned and controlled studies could be carried out. However, the author's contention that "It has been assumed that the levels of penicillin [following monthly intramuscular injection of 1.2 million units of benzathine penicillin G] are adequate to prevent reinfection with group A streptococcus, and hence to prevent recurrences of rheumatic fever" has always been qualified by others.
Physician Knowledge and Clinical Behavior Regarding Automobile Safety for Children
Authors: Faber Marilyn M. , Hoppe Sue K. , Diehl Andrew K.
Published: December 2021

A mail survey was conducted in May 1983 of pediatricians and family and general practitioners in San Antonio, TX, to assess their influence on automobile safety of patients. Information on sociodemographic data and personal and professional behavior with respect to automobile safety for children was elicited. A 17-item knowledge index was significantly correlated with physician's own use of seat belts, number of children less than 5 years old, exposure to use of child restraints during residency, clinical behavior (asking about use of child restraints during the first and subsequent well-child visits, instructing parents about automobile safety for children, dispensing literature in the office), being a pediatrician, and being Board certified. Knowledge was inversely correlated with physician's age. Education of parents by physicians about automobile safety for children was infrequent. Only 29% of physicians always or usually ask at the first well-child visit if child restraints are being used. Only 8% of physicians received training during their residencies; this points to a need for educating physicians in automobile safety for children.
Are Toy Guns Too Dangerous?
Authors: Tanz Robert , Christoffel Katherine K. , Sagerman Scott
Published: December 2021

Toy guns with projectiles may injure young children. A study was undertaken to assess the danger posed by these toys and the regulations governing them. Us Consumer Product Safety Commission (CPSC) data indicate that toy guns with projectiles cause relatively few injuries, mostly to young boys. The magnitude of the problem is smaller than that of nonpowder and powder firearms. Most often, toy gun injuries are to the face and eyes. Of the estimated 818 injuries in 1980 and 1981, 2.9% required hospitalization. More than 400 days were lost from school and work, and there were nearly 3,000 days of restricted activity due to these toy gun injuries. The hazard posed by toy guns with projectiles can be reduced through the legitimate regulatory authority of the Consumer Product Safety Commission with minor impact on retail cost, toy industry sales, and the play value of the toys. The yearly cost to consumers from increased regulation would probably be similar to the annual cost of the injuries. Regulation is warranted to protect young children who use these toys.
Potential of Moxalactam and Other New Antimicrobial Agents for Bilirubin-Albumin Displacement in Neonates
Authors: Stutman Harris R. , Parker K. Michael , Marks Melvin I.
Published: December 2021

The effects of several novel antibiotics on in vitro binding of bilirubin to human serum albumin were investigated. At physiologic bilirubin-albumin ratios and pH values, aztreonam, imipenem, azlocillin, enoxacin and ciprofloxacin did not compete with bilirubin at drug concentrations less than 900 µg/mL. Cefoperazone caused an apparent increase in unbound bilirubin only at concentrations greater than 35 µM (330 µg/mL). Moxalactam, however, caused a linear increase in unbound bilirubin, greater than that seen with sulfisoxazole, over the entire range of antibiotic concentrations. These results may have implications for the use of these newer antimicrobial agents in neonatal infections.
Outbreaks of Group A Streptococcal Abscesses Following Diphtheria-Tetanus Toxoid-Pertussis Vaccination
Authors: Stetler Harrison C. , Garbe Paul L. , Dwyer Diane M. , Facklam Richard R. , Orenstein Walter A. , West Gary R. , Dudley K. Joyce , Bloch Alan B.
Published: December 2021

Two outbreaks of group A streptococcal abscesses following receipt of diphtheria-tetanus toxoid-pertussis (DTP) vaccine from different manufacturers were reported to the Centers for Disease Control (CDC) in 1982. The clustering of the immunization times of cases, the isolation of the same serotype of Streptococcus from all cases in each outbreak, and the absence of reported abscesses associated with receipt of the same lots of vaccine in other regions of the country, suggest that each outbreak was probably caused by contamination of a single 15-dose vial of vaccine. The preservative thimerosal was present within acceptable limits in unopened vials from the same lot of DTP vaccine in each outbreak. Challenge studies indicate that a strain of Streptococcus from one of the patients can survive up to 15 days in DTP vaccine at 4°C. Contamination of vials during manufacturing would have required survival of streptococci for a minimum of 8 months. Preservatives in multidose vaccine vials do not prevent short-term bacterial contamination. Options to prevent further clusters of streptococcal abscesses are discussed. The only feasible and cost-effective preventive measure now available is careful attention to sterile technique when administering vaccine from multidose vials.
Lack of Adverse Side Effects of Oral Ferrous Sulfate Therapy in 1-Year-Old Infants
Authors: Reeves Jerry D. , Yip Ray
Published: December 2021

An evaluation was made of 278 healthy-appearing 1-year-old infants who were tested for iron deficiency to determine the relative frequency of adverse side effects attributable to oral iron treatment. After obtaining parental informed consent, laboratory tests of iron status were performed on venous blood and infants with hemoglobin level greater than 10.5 g/dL were randomly chosen to receive 1.2 mL of ferrous sulfate (FeSO4) drops (about 3 mg of iron per kilogram per day) or equal volume of placebo for 3 months. After 3 months of treatment, infants were to return to the clinic for repeat blood testing, compliance estimation, and evaluation for possible adverse side effects. There was no significant difference (P > .50) in the frequency of vomiting, diarrhea, or fussiness in iron-treated infants (6%) compared with placebo-treated infants (9%). Constipation was slightly more frequently reported (P = .03) in placebotreated infants (9%) than in iron-treated infants (1%). Compliance with therapy was confirmed in 179 completely evaluated infants by the lack of remaining medication at 3 months, the higher incidence (P < .0001) of dark stools reported among iron-treated infants, and the changes in laboratory tests of iron status. No parents reported dark stools as an adverse effect of therapy. It is concluded that once daily, moderate-dose FeSO4 therapy given to fasting 1-year-old infants results in no more gastrointestinal side effects than placebo therapy.
Hyperosmolar Oral Medication and Necrotizing Enterocolitis
Authors: MUTZ ALFRED E. , OBLADEN MICHAEL W.
Published: December 2021

To the Editor.—

The observation of Finer et al1 of necrotizing enterocolitis following administration of oral vitamin E is in accord with our observation of necrotizing enterocolitis following administration of oral nystatin in preterm infants According to the suggestion of White and Harkavy2 that hypertonic formula may result from added oral medication, we determined the osmolarity (freezing point microosmometer Knauer) and pH (Digi 520, WTW) of 63 commercial liquid drugs dispensed for drop application and commonly used in European intensive care nurseries.
Vitamin K Deficiency
Authors: PAYNE NATHANIEL R. , HASEGAWA DUANE K.
Published: December 2021

In Reply.—

We agree with Aballi that a combination of factors placed our patient1 at high risk for vitamin K deficiency during her first month of life. These factors include decreased intestinal absorption of vitamin K due to the cholestatic liver disease of α-1-antitrypsin deficiency and a diet consisting solely of breast milk which is known to have little vitamin K.

Aballi correctly points out the lack of data on the role of vitamin K in preventing late-onset hemorrhagic disease.
Risk Factors of Diabetic Retinopathy
Authors: MALONE JOHN I.
Published: December 2021

In Reply.—

Marks correctly points out that any study "that attempts to relate complications of diabetes to glycemic control should at least have one cohort that achieves good control." However, we were not comparing the effects of "good control" v "poor control." Instead, we selected a group of insulin-dependent diabetic youths without significant retinopathy and followed them for 4 to 6 years. Half of the group developed retinopathy; the other half did not. Our report indicated the ways these two cohorts differed.
Development, Design, and Sample Composition
Authors: Bryla Dolores A.
Published: December 2021

Following its introduction in 1947 for treatment of erythroblastosis fetalis and in 1949 for hyperbilirubinemia, exchange transfusion became accepted as the most effective means of preventing increasing serum bilirubin concentrations in the newborn infant from reaching a hazardous level.2 At that time, there was general agreement that the risk of bilirubin encephalopathy increased when serum bilirubin concentrations exceeded 20 mg/dL of serum and that this risk became greater with increasing concentrations. The safety of exchange transfusion was assessed by Boggs and Westphal14 in 1960 and found acceptable for that time.

In 1958, Cremer et al22 reported a distinct lowering of serum bilirubin levels in infants exposed to direct sunlight. This observation was followed by development of light sources for exposure of infants to treat or prevent hyperbilirubinemia (phototherapy).

Although phototherapy had been used and reported in Europe and South America, it was not until 1968 that the first study64 appeared in the pediatric literature of the United States. Other studies36,41,83 followed and suggested a potential role for phototherapy in the management of hyperbilirubinemia of the newborn infant. However, these studies suffered from lack of a sufficient number of patients to accommodate appropriate statistical adjustment procedures for the many known confounding variables. Also, these studies had inadequate numbers of control infants and phototherapy-treated infants who were followed long enough to perform evaluations of the impact of the mode of therapy on such parameters as hearing, sight, speech, IQ, and behavioral performance.31,74

DEVELOPMENT OF THE STUDY

In May 1972, the National Research Council of the National Academy of Sciences established a Committee on Phototherapy in the Newborn.
Neonatal and Infant Mortality in Relation to Phototherapy
Authors: Lipsitz Philip J. , Gartner Lawrence M. , Bryla Dolores A.
Published: December 2021

Of all the parameters for assessing the effectiveness and safety of phototherapy in the management of neonatal hyperbilirubinemia, none is as unambiguous as death. Although death rates are definitive, any relationship to the treatment modality or lack thereof may be confounded by other events. No prior data suggest the possibility of either enhanced or reduced mortality in infants treated with phototherapy.34,50

The groups were allocated randomly and the care given the two groups was the same, with the exception that one group received phototherapy. It was stipulated that research protocol requirements were at no time to take precedence over the medical care needs of the infant.

RESULTS

Seventy-two (10.7%) of the 672 newborns entered into the phototherapy group and 62 (9.3%) of the 667 newborns in the control group died during the first year of life. During the period prior to discharge from the nurseries, there were 68 (10.1%) deaths in the phototherapy group and 51 (7.6%) in the control group. All of the deaths except one in each group were in newborns who weighed less than 2,000 g at birth. These differences, as well as deaths in the first seven or 28 days of life, were not significantly different (X2 with Yates correction) when P < .05 was taken to be the upper level of significance (Table 1).

DEATHS BY BIRTH WEIGHT SUBGROUPS

The number of newborns entered into each study group and the deaths prior to discharge from the hospital for the birth weight groups 1,000 g or less and 1,001 to 1,999 g are indicated in Table 2.
Intracerebral Hemorrhage in the Full-Term Neonatal Infant
Authors: Bergman Ira , Bauer Roberta E. , Barmada Mamdouha A. , Latchaw Richard E. , Taylor H. Gerry , David Ronald , Painter Michael J.
Published: December 2021

Supratentorial intracerebral hemorrhage was diagnosed in 18 full-term neonates, including six with primarily intraparenchymal hemorrhage and 12 with primarily intraventricular hemorrhage. Precipitating or associated factors were hypoxic-ischemic injury in five patients, polycythemia in two, and cranial birth trauma in two. Nine other infants had no identifiable medical risk events. The pathogenesis of intraparenchymal hemorrhage was probably related to hemorrhagic infarction, but the pathogenesis of intraventricular hemorrhage was often unknown. All 17 survivors returned for neurologic and developmental examinations between 1 and 7 years of age. Follow-up assessments were normal in nine children and abnormal in eight. Two had perceptual difficulties, three had moderate-to-severe cognitive deficiencies (two of the three had hemiplegia), and three had severe mental and neurologic handicaps. Eight of nine children with known or suspected hypoxic-ischemic or traumatic insults suffered moderate-to-severe disabilities whereas eight of nine children with no known precipitating cause for their hemorrhage developed normally.
Mechanism of Action of Indomethacin in Tubular Defects
Authors: Usberti Mario , Pecoraro Carmine , Federico Stefano , Cianciaruso Bruno , Guida Bruna , Romano Anna , Grumetto Lucia , Carbonaro Lucia
Published: December 2021

Indomethacin, a potent prostaglandin synthesis inhibitor, has been proven to be effective in a number of tubular defects characterized by enhanced prostaglandin (namely, prostaglandin E2 (PGE2) production, but its mechanism of action is poorly understood. To elucidate further the mechanism(s) by which indomethacin reverses the abnormal tubular functions, five children with different tubular defects (nephrogenic diabetes insipidus, three cases; Fanconi syndrome, one case; and pseudohypoaldosteronism, one case) were treated with indomethacin. Indomethacin, 1 mg/kg every eight hours, was given for 1 week to all children and then was given chronically to four of the children who responded to the drug. Its use was suspended in a 10 year-old-boy with nephrogenic diabetes insipidus because it proved ineffective. To assess the site along the nephron where indomethacin affects the solute and water excretion, an acute water load study was performed in three responsive children before and during the treatment. Indomethacin did not significantly alter the glomerular filtration rate but was effective in reducing diuresis and levels of urinary sodium and potassium excretion. In the child with Fanconi syndrome, indomethacin was also effective in controlling the urinary loss of phosphate, urate, glucose, and bicarbonate. Results of the water load studies show that indomethacin decreases the delivery of solute from the proximal tubule, reduces the fractional free water clearance, and increases the urine-plasma osmolar ratio. The rate of urinary excretion of prostaglandin E2 was high in all five children; it decreased below normal values in four of them after 1 week of treatment. In the child with nephrogenic diabetes insipidus who did not respond to indomethacin therapy, prostaglandin E2 excretion decreased but the rate remained higher than normal. These results suggest that indomethacin induces retention of solute and water mainly through an enhanced proximal tubular reabsorption.
Incarcerated Youths: Urgent Needs
Authors: OWENS JAMES W. M.
Published: December 2021

Each year in the United States, approximately 1 million children are incarcerated. Fewer than half are held in juvenile facilities; the remainder are kept in adult jails. The conditions under which many of the children are confined and the results of their incarceration are often damaging to the child and to society.1,2

The American Academy of Pediatrics has had a long-standing concern with the special needs of youths incarcerated in detection and long-term residential facilities. The numbers of these children and the emotional, social, health, legal, and other problems that they and their families face are impressive.

In 1973, the Academy published its first statement on health standards for juvenile court residential facilities.3