bluuebunny/crossref_metadata_2025 huggingface dataset:
Defective Oxidative Metabolism in Newborn Neutrophils: Discrepancy between Superoxide Anion and Hydroxyl Radical Generation
Authors: Ambruso Daniel R. , Altenburger Karl M. , Johnston Richard B.
Published: December 2021

Investigation of oxidative metabolism in neutrophils (PMNs) from newborns was performed by measuring generation of superoxide anion (.O2-) and production of hydroxyl radical (.OH) in the resting state and after stimulation with opsonized zymosan or phorbol myristate acetate (PMA). Neutrophils from cord blood of ten term infants and normal adult controls were tested simultaneously. Cord PMNs generated significantly more .O2- than paired adult controls when stimulated with opsonized zymosan (P <.01) and produced less .OH with PMA (P <. 005). When the amount of .O2- and .OH released by newborn PMNs with both stimuli was expressed as percent of values obtained from paired adult controls, there was a discrepancy in the generation of these two radicals: newborn PMNs produced relatively less. OH compared to .O2-. This decreased ability to produce .OH could underlie defective bactericidal activity in PMNs of neonates.
Host Defenses in the Fetus and Neonate: Studies of the Alveolar Macrophage during Maturation
Authors: Bellanti Joseph A. , Nerurkar Lata S. , Zeligs Barbara J.
Published: December 2021

In recent years, an increasing investigative effort has been applied to the study of host defenses in the fetus and neonate.1, 2 The importance of this knowledge to medicine includes its immediate application in the perinatal period as well as its implications as antecedents of end stage disease in the adult. One of the most important initial defense systems is provided by phagocytic cells and of these the alveolar macrophage assumes central importance in the lung. Shown in Fig 1 is a schematic representation of the interactions of cells of the immune system with the environment and depicts the central role of the alveolar macrophage.

For the past several years, we have been interested in assessing factors relating to phagocytic function in both man3, 4 and the experimental animal.5-7 These studies arose from the well known clinical and experimental observations which suggested that infections, particularly those caused by bacterial organisms, are more frequently encountered in the young infant. The major emphasis of these studies in recent years has been the alveolar macrophage. The choice of this cell type is based upon the frequency and importance of respiratory tract infections in pediatrics. It would be neither possible nor appropriate for me to review all the investigations which have been carried out by many workers along these lines. Instead, I have chosen to present the results of three lines of our recent investigations dealing with the morphologic, biochemical, and functional maturation of the alveolar macrophage (AM) and their clinical application to current pediatric problems.
B Cell Function in the Newborn
Authors: Hayward A. R. , Lydyard P. M.
Published: December 2021

The function of B cells we have chosen for review is their maturation into antibody-producing plasma cells. Our own recent studies have centered on the factors that control the differentiation of mitogenstimulated B lymphocytes in human newborns. Human studies are necessary because the differences between the gestation times of experimental animals and man make extrapolation between species uncertain even with the use of age equivalence.1 While there is little evidence that healthy human fetuses are antigenically stimulated, responses to congenital infections do indicate that they have the capacity to respond before birth. Detailed information on the maturation of immune responsiveness in utero depends, however, on knowledge acquired from animal experiments. Relevant results from these are therefore briefly reviewed first.

GENERATION OF ANTIGEN BINDING (IDIOTYPE) DIVERSITY

Hypotheses to account for the means by which stem cells give rise to many clones carrying different individual specificities for antigen (idiotypes) have centered around the "germ line" and "somatic mutation" theories. These two may not be mutually exclusive. Convincing evidence for the germ line theory has come from sequence analysis of myeloma (monoclonal) proteins2 and, more recently, from hybridization studies.3 In the latter experiments the detection of DNA sequences coding for a myeloma-like λ light chain in mouse embryonic DNA indicated that some specificities are encoded in the genome. Experiments in mice4 and chickens5 have suggested that there is a genetically predetermined sequential expression of variable region genes during development which is followed by the appearance of a larger spectrum of specificities in the adult.
Cell-Mediated Immunity in the Newborn: Clinical Aspects
Authors: Wara Diane W. , Barrett Douglas J.
Published: December 2021

The clinical observation that the human newborn infant is uniquely susceptible to certain viral, fungal, protozoan, and bacterial infections has suggested that neonates may have impaired cell-mediated immune function. In order to diagnose primary cellular immunodeficiency during the neonatal period, it is necessary to define carefully normal cell-mediated immunity in term infants, premature infants, and infants with intrauterine growth retardation.

CELLULAR IMMUNITY: TERM INFANTS

The total lymphocyte count of a newborn infant is greater than 3,000/cu mm. Ferguson1 evaluated 25 healthy term infants (mean birth weight 3,130 gm) as control subjects for a study of children with intrauterine growth retardation. The healthy infants' total lymphocyte counts were 5,101 ± 1,821/cu mm. The subpopulation of lymphocytes that form total E rosettes and thus are defined as thymic derived lymphocytes has been reported as normal or decreased in term infant cord blood. In Ferguson's study, newborn E rosettes were 58% ± 7% in comparison to adult E rosettes of 57% ± 10%. Using comparable methods, four additional studies documented a decreased percent of E-rosette-forming cells in the cord blood of the newborn. The percent of total rosette formation in 13 cord blood samples averaged 33.3% ± 7.6% with a control adult mean in 15 samples of 5l.0% ± 6.5%.2 E rosettes were present in lower proportion in cord blood (53%) than in adult blood (65%) in a study by Campbell et al.3 Smith et al4 reported 53% rosette-forming cells in cord blood samples in contrast to 60% in adult samples. Ben-Zwi et a15 found 50% E-rosette-forming cells in cord blood in contrast to 59% in adult blood.
Assessment of Speech and Language Development in the Young Child
Authors: Bax Martin , Hart Hilary , Jenkins Sue
Published: December 2021

A clinical method of assessing speech and language development in preschool children is described. Sixty-two 3-year-old children were assessed by a pediatrician, a speech therapist, and a psychologist. In 55 children there was agreement between all three examiners. Three children with articulation problems were rated as having normal comprehensive and expressive language by the psychologist. Three children were rated as having normal speech and language development by the pediatrician and speech therapist but delayed by the psychologist; all three had behavior problems. One further child rated as having a speech and language problem by the pediatrician was rated as normal by the speech therapist and psychologist. It is concluded that pediatricians can make reliable assessments of speech and language development.
The Dietary Chloride Deficiency Syndrome
Authors: Grossman Harvey , Duggan Eileen , McCamman Sarah , Welchert Eleanor , Hellerstein Stanley
Published: December 2021

Chronic depletion of body chloride developed in a group of infants ingesting a diet consisting almost exclusively of chloride deficient Neo-Mull-Soy. Ten of the 12 infants were on this diet three to five months before loss of appetite, failure to thrive, muscle weakness, and lethargy led to a diagnostic evaluation. The outstanding laboratory features were severe hypokalemic metabolic alkalosis, low urinary chloride concentrations (< 10 mEq/liter), and erythrocyturia. There was marked decrease in weight for age in all 12 infants. Head circumference for age had decreased in five of six and length for age in five of ten infants for whom earlier measurements were available. The biochemical abnormalities reverted to normal following dietary supplementation with either sodium or potassium chloride. Appetite, affect, and muscle strength improved, and weight gain resumed. Head circumference for age has moved toward the percentile level present prior to starting Neo-Mull-Soy in all instances. With one exception, length measurements show a similar pattern. The erythrocyturia has decreased or vanished. Chloride deficiency led to contraction of the extracellular volume and the substitution of poorly reabsorbable anions for readily reabsorbable chloride. These alterations caused development of the negative hydrogen ion and potassium balances which led to the hypokalemic metabolic alkalosis.
Tourette's Syndrome: An Expanded View
Authors: O'Quinn Aglaia N. , Thompson Robert J.
Published: December 2021

Tourette's syndrome is a disorder of central nervous system functioning in which the most easily recognized symptoms of involuntary movements and vocalizations have been found to be responsive, in many cases, to pharmacotherapy with haloperidol. We have recently evaluated five patients with Tourette's syndrome and have been impressed with the learning difficulties, speech and language problems, and behavioral problems which accompanied the involuntary neuromotor manifestations. These lesser known manifestations were not improved with haloperidol, and in fact, the sleepiness associated with the use of haloperidol was thought to adversely affect school performance in two of our patients. Thus, a holistic approach to the evaluation and treatment of children with Tourette's syndrome is recommended. Early attention to possible speech and language difficulties, appropriate academic help, and counseling regarding behavior management are seen as management issues at least as important as medication management.
Phenol and Neonatal Jaundice
Authors: Rudensky Bernard , Eidelman Arthur I. , Isacsohn Meyer
Published: December 2021

The articles by Wysowski et al (Pediatrics 61:165, 1978) and Doan et al (Pediatrics 64:324, 1979), implicating the use of a phenolic disinfectant in the nursery as a cause of neonatal hyperbilirubinemia, led us to discontinue the use of phenolics and substitute chlorhexidine in its place. This change in policy was implemented with a certain degree of concern as "low level" disinfectants, such as chlorhexidine or quaternary ammonium compounds, have been implicated themselves as factors in the spread of nosocomial infections.1,2
Letters to the Editor
Authors: Katcher Avrum L.
Published: December 2021

We are all prisoners of our culture. This fact does not detract from the important message of Zambrana, Hurst, and Hite (Pediatrics 64:862, 1979).

I would, however, respectfully point out that their article is really about the employed mother, not the working mother. Mothers who are unemployed but occupied full time at home do not consider themselves as not working.
Double-Blind Trials with Stimulants for Hyperactivity
Authors: McLaughlin John F. , Tso Yvonne
Published: December 2021

The abbreviated laboratory double-blind trial for determining the effectiveness of stimulant medications described by Swanson et al1 will give reliable information regarding short-term drug effects, but may not allow one to draw any inferences about long-term effects. Two trials that we have conducted recently using the double-blind observation for several weeks in classrooms have yielded findings that could not be detected using the proposed abbreviated trials and call attention to other factors that may influence short attention span and distractibility in an individual child.
Stomach Emptying in the Newborn
Authors: Pildes R. S. , Blumenthal I. , Ebel A.
Published: December 2021

An error was made in the formula we used for measuring gastric emptying in a recent issue.1 The formula should be:

See Equation in the PDF File

See Image in the PDF File

See Table in the PDF File

The new formula does not change our conclusion that the pattern of gastric emptying in neonates is characterized by an initial rapid phase followed by a slower exponential phase. Similarly there were no significant differences between any of the four positions. The time taken for half and three quarters of the test meal to leave the stomach is longer than in the previous study but the differences were not significant in any of the four positions.
HISTORY OF A CASE OF STAMMERING, SUCCESSFULLY TREATED BY THE LONG CONTINUED USE OF CATHARTICS, AS REPORTED IN 1831
Authors: C. T. E.
Published: December 2021

Of all the therapies I have read about for stammering, the following, published in 1831, is the most unusual.1 One wonders whether "tincture of time" was not far more important than the use of cathartics.

A boy of robust form and florid aspect, of a healthy constitution, of more than ordinary activity both of mind and body, when between two and three years old, and after having acquired considerable readiness in speaking, was suddenly affected with so great a degree of stammering as to be almost incapable of uttering a single syllable. Two eminent physicians were consulted: they confessed their inability to propose any specific plan of treatment which might afford a prospect of success, but in consequence of a somewhat plethoric state of the child, they advised that a strong purgative should be given. The effect of the medicine appeared so favourable, that it was repeated three or four times, and each time with such decided benefit, as to leave no doubt on this point in the minds either of the parents or the practitioners. The complaint, however, shortly recurred, was again attacked with the same remedy, and was again subdued. After this plan had been continued for some time, it was conceived that, in addition to the purgative system, the effect of which, although so salutary, was temporary, further advantage might be obtained by adopting a system of diet which should permanently reduce the plethoric habit, and obviate the necessity for the continual repetition of the purgatives. This was accordingly done, and was rigidly adhered to for several years.
Letters to the Editor
Authors: Slovis Thomas L. , Hight Donald W. , Philippart Arvin I. , Dubois Reuben S.
Published: December 2021

I think this case illustrates how difficult it is to make the diagnosis of a multisystemic disease on the classic criteria for that disease. Dr Leggiadro correctly points out that the diagnosis of Kawasaki disease should be made only if certain diagnostic criteria, including the exclusion of other known disease processes, are met.

To make the diagnosis of acute rheumatic fever by the Jones's standards, there must be two major criteria and one minor criterion or one major and two minor.
Could It Be latrogenic Anemia
Authors: Margolis Lewis H.
Published: December 2021

Although there are several possible explanations for the occurrence of anemia in children with meningitis, Kaplan and Oski1 have neglected iatrogenic blood loss as a contributory cause. For the sake of discussion, assume that a child loses 60 ml of blood in four days, given the list of tests that the authors cite and the fact that the children with Haemophilus tend to be more ill than the other patients. If a 10-kg child has a blood volume of 750 ml, then the Table shows that by day 4 (the hypothetical low point) the red cell volume (hematocrit times blood volume) would have declined by 24 ml.
Letters to the Editor
Authors: De Swiet M. , Shinebourne E. A. , Fayers P. M.
Published: December 2021

We agree with Dr Gillum that omission of some of the readings made at ages 6 months and 1 year could have produced bias in the results that we have quoted for blood pressure at these ages. However, the 5-cm cuff whose results were omitted was one of the middle sized cuffs and therefore the weights of the infants whose blood pressures were omitted were in the middle of the distribution at each age. As the Table shows, their blood pressures when measured on other occasions were also not significantly different from the blood pressures of the entire study group.
Should Pediatricians Try to Prevent Coronary Artery Disease?
Authors: Haggerty Robert J.
Published: December 2021

Readers may remember Holtzman's commentary "Hyperlipidemia Screening: A Search for Heffalumps" in the August 1979 issue (Pediatrics 64:270, 1979). Dr Holtzman questioned whether the data supported attempts by pediatricians to screen for and prevent coronary artery disease, except in those with a very strong family history. He questioned "... whether those at risk will benefit from learning of the high probability that they will develop coronary disease or from diet modification...." Dr Glueck, supported by some of our reviewers, took exception at this point and wrote the commentary which follows. We gave Dr Holtzman an opportunity to respond, and his second commentary follows that of Glueck.
The Newborn Oxygram: Automated Processing of Transcutaneous Oxygen Data
Authors: Horbar Jeffrey D. , Clark John T. , Lucey Jerold F.
Published: December 2021

Hypoxemic and hyperoxemic episodes are common in newborns with respiratory disorders. We have developed a microprocessor-based data system for use with transcutaneous oxygen (TcPo2) monitors in an attempt to quantitate these episodes. The amount of time spent by an infant in each of ten preset TcPo2 ranges can be automatically recorded. These data are referred to as the oxygram. Fourteen newborn infants were monitored for a total of 552 hours using this system. They spent a mean of 2.96% of the time with a TcPo2 less than or equal to 40 torr and 0.26% of the time with a TcPo2 greater than 100 torr. Representative oxygrams are presented. Clinical and research applications of the data system are discussed.
ON GETTING AN ELIZABETHAN SCHOOLBOY UP IN THE MORNING
Authors: C. T. E.
Published: December 2021

The Dialogues by Claudius Hollyband and Peter Erondell, published in 1568, contain this conversation between Francis the schoolboy, a late riser, and Margaret, the maid.1 A similar conversation, save for different articles of clothing and a mother rather than a maid, might well be heard in 1980 in many American homes.

Margaret. Ho Fraunces, rise and get you to school: you shall be beaten, for it is past seven: make yourself readie quickly, say your prayers, then you shall have your breakfast.

Francis: Margerite, geeve me my hosen: dispatche I pray you: where is my doublet? bryng my garters, and my shooes: geeve mee that shooyng horne.

Margaret: Take first a cleane shirte, for yours is fowle.

Francis: Make hast then, for I doo tarie too long.

Margaret: It is moyst yet, tarry a little that I may drie it by the fier.

Francis: I had rather thou shouldst be shent, than I should be either child or beaten: where have you layde my girdle and my inck-horne? Where is my gyrkin [jerkin] of Spanish leather of Bouffe? Where be my sockes of linnen, of wollen, of clothe? Where is my cap, my hat, my coate, my cloake, my kaipe [cape or short coat], my gowne, my gloves, my mittayns [mittens], my pumpes, my moyles [mules], my slippers, my handkerchief, my pointes, my sachell, my penknife and my books. Where is all my geare? I have nothing ready: I will tell my father ...
Impact of an Education Program on Perinatal Care Practices
Authors: Harlan William R. , Hess George E. , Borer Robert C. , Hiss Roland G.
Published: December 2021

Education of health professionals has an important role in improving health care. A media-based, self-instructional, perinatal education program was developed and field tested in rural and urban regions of Michigan. Cognitive tests, chart audits, and consultation/referral times were used to measure the impact on education and patient care. The program effectively increased knowledge and improved patient care practices by physicians and nurses. This study presents evidence that a targeted educational program in a media-based format can significantly improve perinatal care.
Development of Children's Concepts of Illness
Authors: Bibace Roger , Walsh Mary E.
Published: December 2021

This study examines the development of children's concepts of illness in light of Piaget's and Werner's findings regarding the ontogenesis of causal relations. Six developmentally ordered categories of explanation of illness have been articulated. These catagories, which are consistent with Piaget's three major stages of cognitive development, can be useful to pediatricians (1) in explaining illness and providing "reassurance" to children, (2) in developing meaningful health education strategies, and (3) in responding to the degree of control the child feels over the illness.
Dural Venous Sinus Thrombosis in Acute Lymphoblastic Leukemia
Authors: Lockman Lawrence A. , Mastri Angeline , Priest John R. , Nesbit Mark
Published: December 2021

Three children with acute lymphoblastic leukemia developed sagittal sinus thrombosis. One patient was in peripheral remission. One patient survived. In neither patient who died were the walls of the dural sinuses infiltrated with leukemic cells. Attention is drawn to this potentially treatable cause of central nervous system symptoms in childhood leukemia. Angiography is the diagnostic test of choice and can also demonstrate intracerebral hematoma and subdural hematoma, if present. Sinus thrombosis can occur either during exacerbation or remission of the basic leukemic process. The possibility that chemotherapeutic techniques predispose toward this complication is raised.
Cerebral Cysticercosis
Authors: Percy Alan K. , Byrd Sharon E. , Locke George E.
Published: December 2021

In this country, cerebral cysticercosis is not commonly implicated as the etiology of an otherwise uncomplicated seizure disorder occurring during childhood. Nine children with neurologic symptomatology and radiographic (computed tomography) evidence consistent with cerebral cysticercosis have been evaluated. Each patient was born and resided for some period (1½ to 10 years) in an endemic area. Principal symptomatology consisted of a generalized seizure disorder. EEGs were normal in five patients and nonspecific in two. Serologic studies on serum and CSF were negative in 8/9 patients including the single patient requiring surgical intervention for excision of a cysticercal cyst. Cerebral nuclide scanning was not helpful and skull radiography was used to diagnose intracerebral calcifications in six patients. Computed tomography revealed multiple calcifications in six patients and a solitary lesion in one. Five patients had enhancing cystic lesions including three of those with diffuse calcifications. Since the natural history of cerebral cysticercosis presenting in this fashion is benign, symptomatic treatment is often sufficient. Anticonvulsants generally provide adequate seizure control. In one patient, cyst removal was necessary to achieve seizure control. On the basis of this experience, conclusions are (1) that the incidence of cerebral cysticercosis in exposed children is higher than commonly appreciated, and (2) that computed tomography may assist in the establishment of the diagnosis.
Congenital Malaria Due to Plasmodium falciparum
Authors: Hindi Robert D. , Azimi Parvin H.
Published: December 2021

Malaria manifested during the first few months of life may be the result of acquisition during pregnancy, at the time of delivery, or by mosquito bite after birth. Both congenital and perinatal malaria are acquired by the transmission of parasitized maternal erythrocytes across the placenta. An infant is described whose mother was diagnosed to have malaria at six months of gestation. The infant developed intermittent fever at 5 weeks of age and presented with anemia and hepatosplenomegaly at 3 months of age at which time Plasmodium falciparum parasites were found on examination of thick smears of the infant's blood. IgG and IgM antimalarial antibodies were detected in maternal blood, but only IgG antibodies were found in the infant's blood at delivery and at the time of diagnosis. These transplacentally transmitted antibodies may afford transient protection for the infant and thus delay the onset of clinical manifestations. Due to the absence of an exoerythrocytic life cycle in congenitally acquired malaria, chloroquine is the drug of choice for treatment. Infections with chloroquine-resistant strains require multiple drug therapy.
Benign Subdural Collections of Infancy
Authors: Briner Susan , Bodensteiner John
Published: December 2021

Four asymptomatic infants with macrocrania, abnormal transillumination, and characteristic computed tomography scans are described. All had bilateral subdural collections, normal brain size, modest ventricular enlargement, and prominent cerebral sulci and interhemispheric fissures. Although these latter findings are often interpreted as atrophy, these infants had normal development and rapidly growing heads. No treatment beyond diagnostic subdural punctures was performed. After up to 13 months of follow-up, the size of the subdural collections was either stable or decreasing in all four infants.
Clinical Expressions of Immotile Cilia Syndrome
Authors: Turner J. A. Peter , Corkey Christopher W. B. , Lee John V. C. , Levison Henry , Sturgess Jennifer
Published: December 2021

To date three distinct morphologic types of immotile cilia disorder in man have been recognized. Patients with the disorder have variable clinical manifestations of disease of the upper and lower respiratory tract. Twenty-one patients with immotile cilia syndrome have been evaluated from the standpoint of history, clinical presentation, radiologic changes, pulmonary function tests, and mucociliary clearance. The results have been compared to the pathologic changes noted on ultrastructural examination of the cilia. Although clinical severity does not correlate with the type of abnormality found, a profile of clinical signs and symptoms suggestive of immotile cilia syndrome has emerged. The triad of productive cough, sinusitis, and otitis was a consistent finding in all. Situs inversus occurred in only half of the patients.
Renal Failure as a Complication of Acute Antihypertensive Therapy
Authors: Green Thomas P. , Nevins Thomas E. , Houser Mark T. , Sibley Richard , Fish Alfred J. , Sinaiko Alan R.
Published: December 2021

Adult patients with long-standing hypertension have been reported to experience an impairment in renal function when treatment with potent vasodilating agents is initiated. To document that this sequence may occur in children as well, we report the case of a 4-year-old boy with renal disease in whom reduction of blood pressure to normal levels was accompanied on three occasions by oliguric renal failure. During each episode, the correlation between reduction in blood pressure and increase in serum creatinine level was significant (P < .05); furthermore, the slope ofthe relationship was similar with each episode. This phenomenon suggests an impairment of renal autoregulation in this patient. Maintenance of normal blood pressure for several months was accompanied by a gradual return of renal function to pretreatment levels. This case suggests that particular attention should be paid to renal function during the initiation of antihypertensive therapy, particularly in patients with renal vascular damage. Present evidence does not appear to warrant modification of the current therapeutic philosophy of aggressive management in patients with severe hypertension.
Meningococcal Meningitis in Familial Deficiency of the Fifth Component of Complement
Authors: Peter Georges , Weigert Mary Beth , Bissel Arthur A. , Gold Ronald , Kreutzer Donald , McLean Robert H.
Published: December 2021

Absence of the fifth component of complement (C5) by immunochemical assay and marked deficiency by hemolytic assay (<0.1%) was found in a family in which the oldest male child had suffered severe and recurrent meningococcemia at age 15 years, two brothers developed meningococcal meningitis four years later (at ages 18 and 14 years), and a sister had the gonococcal arthritis-dermatitis syndrome. Although group-specific meningococcal antibody was present in the sera from all four siblings, serum bactericidal activity against Neisseria meningitidis could be demonstrated only in the presence of exogeous rabbit complement. Serum total hemolytic complement activity was undetectable in all four, but was restored to normal by the addition of purified C5. Subsequently, a second episode of group Y meningococcal meningitis was experienced by one brother and presumed gonococcal arthritis-dermatitis syndrome recurred in the sister. The family is the largest C5-deficient kindred to be reported and emphasizes the importance of C5 in host susceptibility to invasive Neisseria infections. In contrast to the peak incidence of N meningitidis disease in the general population in the first year of life, age of onset of meningococcal infection in these patients and in the 13 previously reported patients with terminal complement component deficiency has usually been in adolescence and early adulthood.
Cellulitis: Treatment with Cefoxitin Compared with Multiple Antibiotic Therapy
Authors: Santos José Ignacio , Jacobson Jay A. , Swensen Paul , Palmer W. Martin
Published: December 2021

Cefoxitin, a parenteral cephamycin β-lactam antibiotic was prospectively evaluated as a single drug alternative in 31 children with cellulitis and the results of therapy were compared retrospectively with those from prevailing multiple antibiotic therapy for cellulitis in 56 children. Periorbital and lower extremity cellulitis accounted for more than 60% of the cases in both study groups. The most common bacterial agents included Haemophilus influenzae, Staphylococcus aureus, and group A β-hemolytic Streptococcus. In as many as 50% of the cases, no etiologic agent could be found. In addition to blood cultures, cellulitis leading edge aspirate cultures were helpful in establishing the etiologic diagnosis. Of 52 patients sampled in the combined studies, 21% had positive aspirate cultures in the presence of negative blood cultures. The outcome and mean duration of hospital stay were similar in both groups. No severe adverse reactions were encountered. The mean number of antibiotics used in the retrospective study was three (range 1 to 7) whereas cefoxitin alone was used in the prospective study. All organisms isolated in the prospective study were susceptible to cefoxitin. Single antibiotic therapy with cefoxitin appears to be as safe and as effective in the treatment of cellulitis in children as multiple antibiotic therapy.
Aerobic and Anaerobic Bacteriology of Cutaneous Abscesses in Children
Authors: Brook Itzhak , Finegold Sydney M.
Published: December 2021

Specimens from 209 cutaneous abscesses in children were cultured for aerobic and anaerobic microorganisms. Of these, nine (4%) were sterile and 51 (24%) yielded pure cultures that were predominantly Staphylococcus aureus. The rest of the abscesses yielded growth of two or more aerobic and/or anaerobic organisms. The data were organized according to these anatomic locations: head, neck, trunk, finger, nailbed, hand, leg, buttocks, perirectal, and vulvovaginal areas. Aerobic bacteria only were present in 92 specimens (46%), anaerobes only were isolated in 52 (26%), and mixed aerobic and anaerobic bacteria were present in 56 abscesses (28%). A total of 467 isolates (270 anaerobes and 197 aerobes) were recovered, accounting for 2.3 isolates per specimen (1.3 anaerobes and 1.0 aerobes). The presence of more than one anaerobe per abscess was obtained from the vulvovaginal, buttocks, perirectal, finger, nailbed, and head areas. Aerobes were more prevalent in the neck, hand, leg, and trunk areas. The predominant aerobes recovered were: S aureus (89 isolates), α- and nonhemolytic streptococci (29), group A β-hemolytic streptococci (16), Enterobacter (10), and Escherichia coli (8). The predominant anaerobes recovered were anaerobic Gram-positive cocci (79 isolates), Bacteroides sp (116, including 31 B melaninogenicus group and 29 B fragilis group), and Fusobacterium sp (39). Our findings indicate the polymicrobial nature and predominance of anaerobes in cutaneous abscesses in children in perirectal, head, finger, and nailbed areas.
Aplastic Anemia Complicating Infectious Mononucleosis: A Case Report and Review of the Literature
Authors: Lazarus Kenneth H. , Baehner Robert L.
Published: December 2021

A 12½-year-old white girl developed pancytopenia and severe aplastic anemia three weeks following symptoms of infectious mononucleosis. Pancytopenia complicating infectious mononucleosis has been reported in only nine previous cases and only three were proven to have aplastic anemia. The mean time from onset of symptoms of infectious mononucleosis to the nadir of pancytopenia was 21.3 days with a range of seven to 49 days. Two patients died from complications of the pancytopenia. In those patients who recovered, the mean time from diagnosis of the pancytopenia to recovery of bone marrow function was 6.25 days with a range of four to eight days. In contrast to other causes of aplastic anemia, return of normal platelet levels coincided with recovery from pancytopema. The etiology of the pancytopenia and aplastic anemia are unknown but immunologic causes are suspected because of the rapid recovery of the bone marrow and its possible responsiveness to steroids.
Letters to the Editor
Authors: Ostrow J. Donald , Cohen Arnold N.
Published: December 2021

We are delighted to respond to the criticisms of Drs McDonagh and Lightner of our review article on phototherapy (Pediatrics 65:740, 1980).

1 and 2. Dr McDonagh correctly notes that he did not administer rose bengal but rather hemato-porphyrin to Gunn rats in showing that a singlet oxygen photosensitizer could dramatically accelerate the photocatabolism of bilirubin in these animals.1 However, it is not appropriate for McDonagh to deny that he proposed that generation and addition of singlet oxygen is a major mechanism of phototherapy, as the experiment cited above was used as evidence for this view.
Swallowed Toothpaste—A Danger or Not
Authors: Carey William B.
Published: December 2021

How concerned should we pediatricians be about the fact that young children frequently swallow fluoridated dentifrices while brushing their teeth?

The recent recommendation of the Academy's Committee on Nutrition for a decrease from 0.5 to 0.25 mg/day for children less than 2 years of age was "to reduce the possibility of mild fluorosis."1

According to the American Dental Association, the usual amount of dentifrice used on a toothbrush contains approximately 1 mg of fluoride (personal communication from American Dental Association to E. J. Beadle, DDS, 1980).
Changing Feeding Trends as a Cause of Electrolyte Depletion in Infants with Cystic Fibrosis
Authors: Laughlin James J. , Brady Mary Sue , Eigen Howard
Published: December 2021

Between June 1979 and June 1980, 16 infants with cystic fibrosis (CF) were cared for at the James Whitcomb Riley Hospital for Children. Five of these children (average age 5.8 months) had a total of eight episodes of electrolyte depletion, with six episodes unassociated with high environmental temperature, fever, or significant gastrointestinal symptoms. Their primary symptoms were poor weight gain and anorexia. According to their dietary records, these five infants, at the time of their initial presentation, had an average electrolyte intake of 8 mEq of sodium, 12 mEq of potassium, and 10 mEq of chloride per day. All infants had been fed either standard infant formula or breast milk. Infant feeding surveys indicate that the estimated average sodium intake of 6-month-old infants has decreased from 45 mEq/day in 1965 to 15 mEq/day since 1977 when manufacturers stopped adding salt to baby foods. In addition, since 1971 the percentage of infants 6 months of age receiving breast milk or standard infant formula rather than cow's milk, which is high in sodium content, has increased from 33% to 72%. This decreased salt intake places the infant with CF at greater risk for electrolyte depletion than in the past. It is expected that a larger percentage of infants with CF will have electrolyte depletion as their initial symptom especially during periods of increased sweating or when electrolyte losses are experienced during gastrointestinal illnesses. CF should be suspected in any infant with electrolyte depletion, and infants known to have CF need daily salt supplementation. Serum electrolytes should be measured if the infant is experiencing weight loss or anorexia, particularly during periods of excessive salt losses.
Increased Blood Pressure Following Pupillary Dilation with 2.5% Phenylephrine Hydrochloride in Preterm Infants
Authors: Lees Bonnie J. , Cabal Luis A.
Published: December 2021

Heart rate and blood pressure changes following 0.5% tropicamide and 2.5% phenylephrine hydrochloride were evaluated in seven ill preterm infants (birth weight, 910 to 2,060 gm; gestational age, 26 to 36 weeks) during the first day of life. Each infant was monitored continuously for 30 minutes before and for 75 minutes after, instillation of the pupillary dilators. There were no significant changes in the heart rate, whereas a significant increase in systolic, diastolic, and mean arterial blood pressure was found. The increase in arterial blood pressure was detected at two minutes, peaked at eight minutes, and remained at significantly higher levels for 30 minutes after instillation. Because of the potential relationship between increased blood pressure and intraventricular hemorrhage, arterial blood pressure must be monitored during instillation of mydriatic drugs in the preterm infant.
Adrenocortical Tumor in a Patient with Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency
Authors: Pang Songja , Becker Dorothy , Cotelingam James , Foley Thomas P. , Drash Allan L.
Published: December 2021

An adrenal cortical tissue tumor developed in a patient with poorly controlled salt-losing congenital adrenal hyperplasia. A 16-year-old girl became progressively virilized from 13 to 16 years of age. Base line serum progesterone, 17-hydroxyprogesterone, and testosterone levels were high and there was a diurnal pattern of the hormones. Initially elevated urinary 17-ketosteroid and serum steroid levels were decreased by high dose dexamethasone therapy, and at laparotomy an adenoma was found in the cortex of the hyperplastic left adrenal gland. It is inferred that persistent adrenocorticotropic hormone stimulation may result in neoplastic transformation of hyperplastic adrenal cortical tissue in patients with congenital adrenal hyperplasia.
Primary Nonspecific Ileal Ulceration as a Cause of Massive Rectal Bleeding
Authors: Sunaryo Francis P. , Boyle John T. , Ziegler Moritz M. , Heyman Sydney
Published: December 2021

A case of primary ulceration of the ileum in the absence of a Meckel's diverticulum or ectopic gastric tissue is described. Although this condition is infrequently observed, it should be considered as a potential cause of massive rectal bleeding, iron deficiency anemia of unknown cause, perforation, or partial small bowel obstruction. The diagnosis is normally made at surgery. Segmental resection with end-to-end anastomosis is the treatment of choice. Recurrence following surgery is rare.
What Are Healthy Blood Pressures for Children?
Authors: Adams Forrest H. , Landaw Elliot M.
Published: December 2021

In his report of March 1977 to the President of the United States,1 Dr Robert Levy, director of the National Heart, Lung, and Blood Institute, pointed out that cardiovascular diseases account for more than half of the deaths and approximately one third of the economic costs of all diseases in the United States. Hypertension is a major contributing factor in these cases, and Levy estimated that at least 27 million people in the United States suffer from it, but many do not know they have it. Thus, hypertension is a common and important disorder in the United States.

Crucial to a discussion of the problems of hypertension are the answers to such questions as: what constitutes hypertension in the adult or the child; conversely, what are "healthy" blood pressures for both groups; when does hypertension start; and what are the causes of hypertension?
Introduction to Urea Cycle Symposium
Authors: Koch Richard
Published: December 2021

When Donough O'Brien reviewed the field of metabolic diseases in 1965, he discussed disorders implicating carbamylphosphate synthetase (CPS), ornithine transcarbamylase (OTC), argininosuccinic acid (ASA) synthetase, and argininosuccinic acid lyase. Arginase defects had not yet been encountered. Several cases of argininosuccinic aciduria had been reported, but only single cases of CPS, OTC, and ASA synthetase defects had been described. The succeeding 15 years have seen much progress in this field, much of it reflecting the efforts of individuals participating in this program.

My first contact with disorders of the urea cycle was in 1976 when a suspected OTC deficiency in a female infant was identified by Dr Kenneth Shaw, for a colleague of ours at the University of Southern California Medical Center. I was asked to help with the care of that infant, who died many months later of meningitis. Largely due to Ken's indefatigable efforts in screening high-risk infants for metabolic diseases, we have seen various urea cycle defects identified in several other infants. However, we have sometimes encountered the unexpected in attempting to confirm the clinical diagnosis by enzyme analysis. The following comments on two patients exemplify the situation.

Patient C.S. was in a coma on admission; his blood ammonia level was 895 µg/100 ml. Urinary orotic acid levels were elevated and our clinical impression was that the patient had a variant of an OTC defect. Analysis of the liver biopsy specimen revealed 35% CPS, 42% OTC, 24% ASA synthetase, 100% ASA lyase, and 31% arginase.

Patient N.G. was born in a nearby medical center and shortly thereafter became lethargic, vomited, and lapsed into a coma.
Increased Intracranial Pressure and Cystic Fibrosis
Authors: Kritchman Ben
Published: December 2021

After reading the article "Increased Intracranial Pressure Following Treatment of Cystic Fibrosis" (Pediatrics 66:622, 1980), the thought suddenly struck me: Is the bulging fontanel following nutritional improvement in children with cystic fibrosis or deprivation dwarfism actually due to rapid brain growth? Would as little as six days promote such rapid brain growth as to be evident in a bulging fontanel? I, for one, do not feel this should be accepted as true dogma unless there is objective evidence of such rapid brain growth.
POLIOMYELITIS OCCURRING AFTER ANTIGEN INJECTIONS
Authors: ANDERSON GAYLORD W. , SKAAR AUDREY E.
Published: December 2021

In poliomyelitis patients who have received some antigen during the month prior to onset there is a high degree of correlation between site of paralysis and site of injection. Such cases tend to show a different distribution of paralysis and a more severe paralysis than do comparable children immunized 2 to 6 months previously, immunized in previous years or never immunized.

The time interval between date of injection and onset of illness suggests some relationship other than chance. There is no evidence that this relationship is associated with any one antigen. There is no evidence that the influence of the antigen persists, or in any way conditions the response to poliomyelitis virus for longer than one month.

Since immunization is an elective procedure, it can well be delayed during outbreaks of poliomyelitis; but there is no suggestion that the postponement should be more than temporary.
Lung Defenses Against Infection: A Clinical Correlation
Authors: Murphy Shirley , Florman Alfred L.
Published: December 2021

The current state of knowledge of lung defenses has been reviewed. First, mechanical factors such as aerodynamic filtration and mucociliary transport were considered. Then, in general terms, the contributions of alveolar macrophages, neutrophils, lymphocytes, and immunoglobulins, and the roles of complement, antiproteases, lysozyme, and fibronectin were examined. Interactions between these components may regulate their effect. Finally, the responses to five specific micro-organisms were reviewed to illustrate different aspects of the lung's defenses. Streptococcus pneumoniae was selected as a representative extracellular bacterial pathogen, Mycobacterium tuberculosis as an intracellular bacterial pathogen, Mycoplasma pneumoniae because it elicits significant humoral and cell-mediated immunity, respiratory syncytial virus as an example of a local viral pathogen, and measles as a viral pathogen that causes generalized disease. It was shown that these responses may not always be beneficial for the host. For each of the five infections, recommendations for improving the outcome were made.
Recurrent Bilateral Pleural Effusions Secondary to Superior Vena Cava Obstruction as a Complication of Central Venous Catheterization
Authors: Dhande Vijay , Kattwinkel John , Alford Bennett
Published: December 2021

Five babies (birth weight 730 to 1,120 g) who developed bilateral pleural effusions as a complication of the use of central venous catheters are described. The effusions occurred seven to 19 days after initial placement or change of a central venous catheter. All required repeated thoracenteses to remove fluid accumulation of up to 200 mL/kg/d. The fluid was a clear transudate, but it became chylous when feedings were given. Venograms and autopsies demonstrated obstruction of the superior vena cava with drainage occurring through collaterals to the azygous vein and inferior vena cava. Silastic gas-sterilized catheters implanted in animals for four and 24 hours showed fibrin deposition when scanned by electron microscopy. No deposition occurred on autoclaved catheters after four hours and there was minimal deposition after 24 hours. It may be concluded that the pleural effusions resulted from obstruction of thoracic lymph flow into the venous system. Vena caval thrombosis may have been enhanced by 2-chloroethanol or ethylene oxide residues from gas sterilization of Silastic catheters.
Plasma Threonine in Premature Infants
Authors: RÄIHÄ NIELS , RASSIN DAVID , GAULL GERALD
Published: December 2021

In Reply.—

The major point raised by the letter of Rigo and Senterre is that the plasma threonine concentration should decrease with increasing gestational age in the groups with high threonine intake (>1,500 µmol/kg/day). These are the infants receiving a milk formula containing 3.0 g/100 mL of protein in one of our first studies.1 In our recent study on term infants2 the threonine intake in the formula-fed infants was <1,500 µmol/kg/day. Plasma threonine values in relation to gestational age from the first study are shown in the Table.
Methylphenidate Hydrochloride Given With or Before Breakfast: I. Behavioral, Cognitive, and Electrophysiologic Effects
Authors: Swanson James M. , Sandman Curt A. , Deutsch Curtis , Baren Martin
Published: December 2021

Methylphenidate HCl (Ritalin) is usually given for the treatment of hyperactivity or attention deficit disorder (ADD) at 30 minutes to one hour before meals. This schedule is based on the assumption that, when taken with meals, its absorption or metabolism is altered. However, no behavioral or pharmacologic data exist to support this recommendation. Eleven patients with attention deficit disorder were tested to evaluate this hypothesis using a double-blind crossover design (methylphenidate with or before breakfast) with a placebo control condition. Parents' ratings, performance on a paired-associate learning test, and cortical auditoryevoked potentials were measured. All of these measurements showed clear differences between the placebo condition and conditions when medication was given. However, none of the measurements showed a significant difference between the conditions when methylphenidate was given with breakfast and the condition when methylphenidate was given 30 minutes before breakfast.