bluuebunny/crossref_metadata_2025 huggingface dataset:
Negative Serology for Hepatitis A and B Viruses in 18 Cases of Neonatal Cholestasis
Authors: Balistreri William F. , Tabor Edward , Gerety Robert J.
Published: December 2021

Serologic evidence of hepatitis A virus (HAV) or hepatitis B virus (HBV) infection was sought in 14 patients with biliary atresia and in four patients with neonatal hepatitis; maternal serum was also analyzed. Specific sensitive radioimmunoassays were used to detect HBV surface antigen (HBsAg) and antibody (anti-HBs); complement fixation was used to detect antibody to HBV core antigen (anti-HBc). Antibody to HAV (anti-HAV) was assayed by radioimmunoassay, as well as by immune adherence hemagglutination. There was no evidence of active or past HBV infection in any infant or mother studied. All three infants with detectable anti-HAV were born to mothers similarly anti-HAV positive; serial testing of sera from two of these infants documented disappearance of detectable anti-HAV by 9 months of age. It is unlikely, therefore, that either HAV or HBV had an etiologic role in neonatal cholestasis in these patients. The role of other (non-A, non-B) hepatitis viruses or nonviral etiologies must be investigated.
Toxic Epidermal Necrolysis in Childhood: Differentiation from Staphylococcal Scalded Skin Syndrome
Authors: Manzella John P. , Hall Caroline B. , Green John L. , McMeekin Thomas O.
Published: December 2021

The staphylococcal scalded skin syndrome usually occurs in children less than 5 years old, whereas drug-induced toxic epidermal necrolysis is considered a disease of adults.1 Except for the age differential, the two often cannot be distinguished clinically. Therefore, rapid and definitive biopsy diagnosis is essential in the management of patients with acute exfoliative skin disorders. We wish to report the case of a young child with proven toxic epidermal necrolysis and review the manifestations of this disease, as well as the staphylococcal scalded skin syndrome.

CASE REPORT

A 4-year-old white girl was admitted to Strong Memorial Hospital because of a generalized bullous eruption.
Management of a Potentially Harmful Health Behavior by Clinical Trial
Authors: Coifman Robert E.
Published: December 2021

A parent had been giving mega-doses of vitamin E to an 8-year-old child with 21-D trisomy for five years in the firmly rooted belief that this therapy was responsible for the child's freedom from constant symptoms of systemic and respiratory infection. The design of an unbiased double-blind clinical trial permitted the parent to reach, on her own, the face-saving conclusion that continuation of this therapy was no longer necessary. Applications of this approach and the underlying nonjudgmental attitude to other potentially harmful health behaviors and practices are discussed.
Mm Hg = Torr = 7.5006 Kilopascals = Confusion!
Authors: Van Gelder David W.
Published: December 2021

I am somewhat concerned about the potential adoption of the SI system (International System of Units) reported by the Committee on Hospital Care in the March 1980 issue of Pediatrics.

As a benighted practicing pediatrician I have enough difficulty engulfing the voluminous scientific literature; ingesting the significant nutritious wheat while regurgitating the indigestible chaff and repetitious non-nutritious pap. The introduction of an unfamiliar system of unit measurement into the literature will make this obligation even more difficult.
Letters to the Editor
Authors: Bachrach Steven
Published: December 2021

Dr O'Connor is correct that there have been a few reports of nutritional rickets reported in the United States in the past few years, in addition to ours. I hesitate, however, to generalize these findings too widely. Most of our cases were due to unusual feeding practices. Even with our addition of 24 cases, the total number of reported cases of nutritional rickets in this country is small, though there are probably many more cases that are not diagnosed or reported.
Is Tuberculin Testing Cost-Effective?
Authors: Lindenbaum Jeffrey E.
Published: December 2021

I read the article by Kraut et al on the assessment of tuberculin screening in an urban pediatric clinic and Dr. Kendig's2 editorial comment in the same issue. I noted that they recommended the continued use of the tine test despite its poor effectiveness, even in their high-risk population, as a screening tool (even less effective when one considers that of Dr Kraut's cases six of nine were identified as at risk by history). It would probably be even less effective in a predominantly middle class outpatient practice with much lower incidence and prevalence rates.
MARY TOFT OF GODLYMAN, ENGLAND, AND HER EXTRAORDINARY DELIVERY OF SEVENTEEN RABBITS IN 1726
Authors: C. T. E.
Published: December 2021

In 1726 the English medical world was split into factions of believers and nonbelievers by the report of two physicians that Mary Toft of Godlyman in the County of Surrey had given birth to seventeen rabbits.

She attributed the occurrence of this remarkable event to maternal impressions:

As she was weeding in a Field, she saw a Rabbet spring up near her after which she ran with another Woman that was at work just by her: this set her a longing for Rabbets, being then, as she thought, five Weeks gone with Child; the other Woman perceiving she was uneasy, charged her with longing for the Rabbet they cou'd not catch, but she deny'd it: soon after another Rabbet sprung up near the same place, which she endeavour'd likewise to catch. The same Night she dreamt that she was in a Field with those two Rabbets in her Lap and awaked with a sick Fit which lasted till Morning; from that time for above three Months, she had a constant and strong desire to eat Rabbets, but being very poor and indigent cou'd not procure any.1

Mr. John Howard, the surgeon who attended the confinement, further certified that "when she was delivered of one Rabbet, another was immediately felt in her Belly struggling with such Violence that the Motion thereof cou'd be sensibly felt and seen." In all, seventeen rabbits were delivered at short intervals. King George I considered this event of such importance that he sent his own surgeon, Mr. Nathanael St. André (1680-1776), to investigate, and then Sir Richard Manningham (1690-1759), a distinguished accoucheur and Fellow of the Royal College of Physicians; the latter by threat of an operation extracted a full confession of the hoax by which Mrs. Toft had expected to obtain money from the sympathetic and curious.2
Disposition of Chloramphenicol in Low Birth Weight Infants
Authors: Glazer John P. , Danish Michele A. , Plotkin Stanley A. , Yaffe Sumner J.
Published: December 2021

Although infrequently an antibiotic of first choice for neonates, chloramphenicol (CL) may be indicated in selected instances of infection caused by aminoglycoside-resistant enterobacteriaciae, anaerobes, and ampicillin-resistant Haemophilus influenzae. Use of CL in neonates has been limited since the recognition that vascular collapse may occur as a consequence of dosage regimens tolerated by adults. With an assay that detects only active CL, we studied drug disposition in 13 low birth weight infants, eight between 1 and 8 days of age (group I), and five between 11 days and 8 weeks of age (group II). Peak serum CL concentrations ranged from 11.2 to 36.2 µg/ml in group I and from 10.0 to 36.2 µg/ml in group II, at doses ranging from 15 to 50 mg/kg/day, and 25 to 50 mg/kg/day, in groups I and II, respectively. Serum CL half-lives (T½) ranged from 10 to 36 hours in four of the eight group I patients; three of the remaining patients had T½ greater than 48 hours and the fourth patient accumulated CL in the interval between doses. T½ in group II ranged from 5.5 to 15.7 hours. Observed differences in T½ between groups I and II were statistically significant (P = .05) and could not be accounted for by factors other than postnatal age. These preliminary data suggest that although there appears to be an inverse relationship between CL T½ and postnatal age, there is sufficient variability in serum levels that monitoring must be performed in low birth weight infants treated with this drug.
Chloramphenicol Pharmacokinetics in Infants and Young Children
Authors: Sack Carolyn M. , Koup Jeffrey R. , Smith Arnold L.
Published: December 2021

We measured serum chloramphenicol concentrations in 17 hospitalized pediatric patients (aged 1 month to 6 years) after intravenous infusion of chloramphenicol succinate. The serum T½ ranged from 2.1 to 8.3 hours with a mean of 3.98 (SD 1.75) hours, while the apparent volume of distribution ranged from 0.78 to 2.09 liters/kg with a mean of 1.39 (SD 0.34) liters/kg. The total body clearance ranged 0.122 to 0.429 liters/kg/hour with a mean of 0.281 (SD 0.117) liters/kg/hour. Two patients were restudied, and had increased clearance during their hospitalization. Because of the wide variability in pharmacokinetics, we conclude that serum chloramphenicol concentrations should be monitored in infants and children.
Normal Pulmonary Vascular Resistance and Left Ventricular Hypertrophy in Young Infants with Bronchopulmonary Dysplasia: An Echocardiographic and Pathologic Study
Authors: Melnick Gregory , Pickoff Arthur S. , Ferrer Pedro L. , Peyser Juan , Bancalari Eduardo , Gelband Henry
Published: December 2021

To evaluate the cardiac anatomy and functional hemodynamics in young infants with chronic lung disease, nine patients, aged 2 to 7 months, with a clinical diagnosis of bronchopulmonary dysplasia (BPD) underwent echocardiographic examination. All infants required supplemental O2 (mean FIO2 35%) to maintain adequate systemic oxygenation (Pao2 greater than 50 mm Hg). None of the infants had evidence of a patent ductus arteriosus at the time of examination. Echocardiographic measurements of left and right ventricular systolic time intervals revealed normal systolic time interval ratios suggesting normal left ventricular systolic function as well as normal pulmonary vascular resistances. However, echocardiographic evidence of left ventricular hypertrophy was found in eight of the nine infants, while right ventricular anterior wall thickness and right ventricular diastolic dimensions were not increased. Two infants died; marked left ventricular hypertrophy was noted at the time of postmortem examination while the right ventricular wall thickness was normal. The findings of left ventricular hypertrophy led to a retrospective review of autopsy material of seven patients who died with BPD over the past year. In six of seven cases examined, left ventricular posterior wall thickening was noted (range 7 to 11 mm); while the right ventricular wall thickness was normal (range 2 to 5 mm). These data suggest that (1) as assessed by echocardiography, the pulmonary vascular resistance is not significantly elevated in young infants with BPD, and (2) a hypertrophic left ventricle evolves which may assume importance in the pathogenesis of pulmonary edema in BPD, though the precise etiology remains undetermined.
Subglottic Coccidioidomycosis Presenting with Persistent Stridor
Authors: Gardner S. , Seilheimer D. , Catlin F. , Anderson D. C. , Hernried L.
Published: December 2021

Localized laryngeal coccidioidomycosis has been rarely reported and usually is associated with disseminated disease. This paper has described localized subglottic coccidioidomycosis in a 13-month old white boy who presented with persistent stridor. Medical management including intravenous amphotericin B resulted in complete eradication of the subglottic lesion.
Low Velocity Vehicular Injuries in Children—"Run-Over" Accidents
Authors: Bell Martin J. , Ternberg Jessie L. , Bower Richard J.
Published: December 2021

Fourteen children, mostly in the toddler to pre-school age group, were treated for injuries resultant from low velocity vehicular accidents in which the child was literally run over. Multiple system injury and visceral injury to brain, lungs, liver, and kidneys were noted. One death and several permanent disabilities resulted in this small group. Most of the accidents could have been prevented by closer supervision of the children. Devices such as childproof door handles, which are currently available, and audible backing signals, currently available on industrial vehicles, might further reduce the incidence of this type of accident.
Dengue Hemorrhagic Fever in North America: A Case Report
Authors: Spigelblatt Linda , Rosenfeld Robert , Bonny Yvette , Laverdiere Michel
Published: December 2021

Dengue hemorrhagic fever, a severe, often fatal, illness, occurs mostly in children and is characterized by a hemorrhagic diathesis, fever, vomiting, a maculopapular rash, liver involvement, and occasionally, a protein-losing shock syndrome.1 This disease is to be differentiated from dengue fever, a relatively benign disease occurring primarily in adults and manifested by myalgia, arthralgia, bone pain, and leukopenia. Cases of dengue fever in North America have been described among travellers from the Carribean.2-6 Dengue hemorrhagic fever is an epidemic disease described after World War II and limited to areas of Southeast Asia, India, and the Pacific islands.7-8

We believe this to be the first reported case in North America of dengue hemorrhagic fever with disseminated intravascular coagulation in a child of Southeast Asian origin.
MONTAIGNE ON MATERNAL IMPRESSIONS AS A CAUSE OF CONGENITAL MALFORMATIONS
Authors: C. T. E.
Published: December 2021

Michel Eyquem Montaigne (1533-1592), the brilliant essayist and skeptic, believed that maternal impressions could cause congenital malformations. In his essay, "On the Power of Imagination," written between 1572 and 1574, he gave the following reasons why he accepted this belief.1

Sometimes, however, one's imagination acts not only against one's own body, but against someone else's. And just as a body passes on its sickness to its neighbor, as is seen in the plague, the pox, and soreness of the eyes, which are transmitted from one body to the other—likewise the imagination when vehemently stirred, launches darts that can injure an external object. The ancients maintained that certain women of Scythia, when animated and enraged against anyone, would kill him with their mere glance.... We know by experience that women transmit marks of their fancies to the bodies of the children they carry in their womb.... There was presented to Charles, king of Bohemia and Emperor, a girl from near Pisa, all hairy and bristly, who her mother said had been thus conceived because of a picture of Saint John the Baptist hanging by her bed.

With animals it is the same: witness Jacob's sheep.
Differentiation of Organic from Nonorganic Failure to Thrive Syndrome in Infancy
Authors: Rosenn Daniel W. , Loeb Lorraine Stein , Jura Martha Bates
Published: December 2021

Differentiation between organic and nonorganic failure to thrive (FTT) often requires prolonged, complicated hospital evaluation. This study was aimed at developing a more direct diagnostic method for distinguishing hospitalized organic from nonorganic FTT infants on the basis of quantifiable social behaviors. An easily administered 1- to 7-point approach-withdrawal scale was created to monitor daily a standardized sequence of brief social interactions between examiner and infant. Behavioral profiles of three matched groups of patients aged 6 to 16 months were compared: eight infants with nonorganic FTT, ten infants with organic FTT, and seven normally grown infants hospitalized for medical reasons. An underlying behavioral pattern systematically and statistically distinguished nonorganic FTT infants from organic FTT infants and the control patients, despite the enormous variability in illness and social distortions in all three groups. Infants with nonorganic FTT predictably prefer distant social encounters and inanimate objects, while organic FTT infants and medically ill control patients consistently respond most positively to close, personal interactions such as touching and holding. Aside from helping to differentiate types of FTT, this study provides a reliable and clinically useful observational tool for easily monitoring ongoing socioemotional status of hospitalized infants.
Malignant External Otitis Due to Pseudomonas aeruginosa in Childhood
Authors: Sherman Philip , Black Steven , Grossman Moses
Published: December 2021

Malignant external otitis (MEO) is a severe variant of external otitis. As originally described by Chandler1 in 1968, MEO is an infection of the external ear canal, usually due to Pseudomonas aeruginosa, which is associated with systemic invasion, significant neurologic sequelae, and a high mortality rate. The vast majority of cases have occurred in elderly adults with diabetes mellitus. We present a case of MEO occurring in a 6-year-old child and have compared the findings in our case with those in the adult literature.

CASE REPORT

A previously well 6-year-old boy developed otitis media one month prior to admission which was treated with 5 ml of trimethoprim-sulfamethazole orally twice a day (3 mg of trimethoprim per kilogram of body weight per day).
Rubella and Acute Appendicitis
Authors: Rabau M. Y. , Avigad I. , Wolfstein I.
Published: December 2021

Rubella, a common viral disease of childhood is characterized by maculopapular rash, lymphadenopathy, and mild respiratory and systemic symptoms. Although the association between rubella and acute appendicitis is uncommon, one should be aware of their simultaneous occurrence.

During a rubella epidemic in the Tel Aviv area, two children were operated on because of an attack of acute appendicitis. R.S. a 10-year-old boy had rubella of two days duration and abdominal pain and vomiting which had started one day prior to admission.
Group B Streptocococcal Colonization
Authors: Wald Ellen R.
Published: December 2021

I regret that neither Dr Speck nor Dr Herrera had the opportunity to review the published version of the paper "Group B Beta Hemolytic Streptococcal Colonization" (Am J Dis Child 131:178, 1977) since our results are indeed contradictory to theirs (Pediatrics 62:863, 1978). The results of our study have prompted us to use Triple dye in our nursery (University of Maryland Hospital) as routine cord care since 1975. It is difficult to demonstrate that this kind of intervention reduces illness as well as colonization inasmuch as illness occurs in only 1% of colonized infants.
JOHN EBERLE ON THE RUINOUS EFFECTS OF MATERNAL ALCOHOL INTAKE ON THE LIFE AND HEALTH OF THE FETUS-IN-UTERO (1833)
Authors: C. T. E.
Published: December 2021

John Eberle (1788-1838) in his Treatise on the Diseases and Physical Education of Children, published in 1833, included a chapter on the conduct of mothers during pregnancy. Long before the current concern about the fetal alcohol syndrome, Eberle, almost a century and a half ago, was warning prospective mothers about the "ruinous effects" of alcohol on the fetus, as is evident in the following quotation.1

The majority of children born of decidedly intemperate mothers, are weak and sickly, and but few of them arrive at the age of adolescence. Many females appear to think, that although these and other melancholy consequences follow in the train of habitual intemperance, it is extremely improbable that any injury can result to themselves or the foetus, from the occasional use of small portions of spirituous liquors. Were it indeed absolutely certain, that the use of such potations, would always be restricted to occasional small portions, the indulgence would perhaps, rarely occasion any serious consequences. But as no prudence and resolution can be safely regarded as an entire protection against the gradual formation of the habit of intemperance, where such drinks are occasionally taken during gestation, even though it be at very considerable intervals and in very moderate quantities at first, it is far the safest plan, to abstain wholly from every kind of spirituous liquors.
Fibrosing Pancreatitis—An Obscure Cause of Painless Obstructive Jaundice: A Case Report and Review of the Literature
Authors: Meneely Raymond L. , O'Neill James , Ghishan Fayez K.
Published: December 2021

We report a 3-year-old asymptomatic patient who had obstructive jaundice. Percutaneous transhepatic cholangiogram showed total obstruction of the distal common bile duct. At laparotomy, fibrosing pancreatitis was found. Sphincteroplasty and choledochoduodenostomy relieved his symptoms. A review of the literature disclosed ten patients, nine of whom had abdominal pain. Fibrosing pancreatitis should be considered in the differential diagnosis of obstructive jaundice in children, even in the absence of abdominal pain.
Hepatobiliary Scintigraphy with 99mTc-PIPIDA in the Evaluation of Neonatal Jaundice
Authors: Majd Massoud , Reba Richard C. , Altman R. Peter
Published: December 2021

Hepatobiliary scintigraphy with technetium 99m-labeled p-isopropylacetanilido iminodiacetic acid (99mTc-PIPIDA) was used to evaluate 22 neonates with mixed jaundice. Ten patients were proved to have biliary atresia; ten others were diagnosed as having neonatal hepatitis. In the remaining two, jaundice was secondary to prolonged hyperalimentation. Initial studies in all ten patients with biliary atresia showed no evidence of excretion of the tracer into the intestinal tract. Following three to seven days of oral administration of phenobarbital, repeat studies were performed in six of the ten patients. None showed evidence of excretion. Initial studies of the 12 patients with intrahepatic cholestasis showed definite excretion in five, questionable evidence of excretion in two, and no demonstrable excretion in five. Studies after phenobarbital therapy in five of the seven patients with questionable or no excretion on the initial studies showed definite excretion in four. Only in one patient who had poor hepatic extraction did the phenobarbital therapy not change the scintigraphic pattern. The authors conclude that hepatobiliary scintigraphy with 99mTc-PIPIDA after three to seven days of phenobarbital therapy is a highly accurate test for differentiating biliary atresia from other causes of neonatal jaundice.
The New Morbidity: Use of School and Community Health Care Resources for Behavioral, Educational, and Social-Family Problems
Authors: Nader Philip R. , Ray Laura , Brink Susan G.
Published: December 2021

The extent of the use of services for the new morbidity, that is, children's behavioral, educational, and family-social problems, has not previously been the subject of a community-based prospective study. The demographic characteristics and utilization of school and community health care resources over a two-year period are compared for two groups selected from a random sample (n = 671) of elementary school children. Twentyfour percent (n = 164) were observed to have behavioral, educational, or social-family problems requiring attention or intervention by health or educational personnel. This group was compared to their schoolmates (n = 507) not so identified. Although no overall differences in sex, ethnic background, or family structure were identified, the children with new morbidity problems were more frequently in the lowest socioeconomic group, and had lower reading achievement scores and higher rates of absenteeism. The new morbidity group also had higher rates of utilization of services both at school and at community sites of health care, not only for new morbidity complaints, but for other problems as well. The data suggest that this portion of the school-aged population places a significant demand for health care resources on both community and school sites. The findings support the need for training of physicians in the care and prevention of such problems.
A WARNING: AN EPIDEMIC OF BABY POWDER ASPIRATION
Authors: Mofenson Howard C. , Greensher Joseph
Published: December 2021

Recently a pediatrician brought to the attention of the Nassau County Medical Center Poison Control Center his concern over baby powder aspiration. He had just encountered his second case in two months; one of these required hospitalization.

Upon reviewing our Poison Control Center Logs we were astounded to discover 40 calls to our center during the past six months (Jan 1, 1980 to June 30, 1980), or approximately one of every 100 calls for children under the age of 5 years involved potential powder aspiration. Nine of these calls originated from emergency rooms, five from physicians' offices, and 26 from mothers at home. We are presently doing a retrospective and prospective analysis of these calls. However, we do feel that this hazard represents a sufficient threat to children of fatal aspiration of powder that the pediatricians responsible for their care be notified without waiting for the results of our study. The Consumer Product Safety Commission has also been notified of this hazard.

Baby powder is not considered harmful by most parents. Physicians caring for children should emphasize to parents that powders are not considered essential to the routine skin care of infants, but if powders are purchased, they should be stored out of reach of children because of their potential hazard. Some powder containers have the appearance of a baby bottle and may be mistakenly used in such a manner.
DANIEL DEFOE ON THE DEPLORABLE EFFECT OF THE GREAT LONDON PLAGUE OF 1665 ON WOMEN WITH CHILD
Authors: C. T. E.
Published: December 2021

Daniel Defoe (c. 1659-1731) in his graphic pseudo-historical journal, published in 1722, concerning London in the year of the Great Plague of 1665, vividly described with intensely human characters, ordinary people caught in a terrible tragedy they could scarcely comprehend. An example is his description of the pitiable state of women in labor during the calamitous year of the plague.1

... Let me first mention that one of the most deplorable cases in all the present calamity was that of women with child, who, when they came to the hour of their sorrows and their pains came upon them, could neither have help of one kind or another, neither midwife or neighbouring women to come near them. Most of the midwives were dead, especially of such as served the poor; and many, if not all the midwives of note, were fled into the country; so that it was next to impossible for a poor woman that could not pay an immoderate price to get any midwife to come to her, and if they did, those they could get were generally unskillful and ignorant creatures; and the consequence of this was that a most unusual and incredible number of women were reduced to the utmost distress. Some were delivered and spoiled by the rashness and ignorance of those who pretended to lay them. Children without number were, I might say, murthered by the same, but a more justifiable ignorance, pretending they would save the mother, whatever became of the child; and many times both mother and child were lost in the same manner; and especially where the mother had the distemper, there nobody would come near them, and both sometimes perished. Sometimes the mother has died of the plague, and the infant, it may be, half born, or born but not parted from the mother.
ON DRESSING THE AMERICAN NEWBORN INFANT A CENTURY AGO
Authors: C. T. E.
Published: December 2021

In 1866, Dr W. B. Fletcher of Indianapolis, Indiana described the "time-honored folly of the absurd and cruel system of the first dressing" of the newborn infant as follows:

In most cases, as soon as the child is born and the cord divided, it is tied and the baby given to an employed nurse, some wise neighbor, or friend. The question of "What will she do with it" may best be solved by watching her. First she huddles it up in an old shawl or other garment. She is careful to cover its head, as though it were a young puppy she would smother; or rid the world of an infant cat. In a few moments, someone brings water, soap and towels, and also a heap of old linen, and a trunk full of new. The good woman now turns to the blazing fire, or the hot stove, that the baby may not take cold, and while the youngster implores with yells and cries, she bakes its tender skin on one side while she dabbles its head, eyes, mouth and body with a vile solution of frequently very bad soap. After this ceremony has been past (it matters not whether the child be cleaner than before) she turns her attention to the cord, upon which she frequently deposits, slyly, some pestiferous saliva. "It's healin'," she says, and now she follows authority. First, she cuts or burns a hole in the centre of a bit of cloth, through which she draws the cord.
Candidal Splenic Abscesses Complicating Acute Leukemia of Childhood Treated by Splenectomy
Authors: Wald Barton R. , Ortega Jorge A. , Ross Lawrence , Wald Pamela , Laug Walter E. , Williams Kenneth O.
Published: December 2021

Two patients with acute leukemia were found to have candidal splenic abscesses. Both patients were in remission and had normal granulocyte counts at the time the abscesses became evident. Both patients were treated with splenectomy and antifungal therapy with a definite response. The incidence and treatment of fungal splenic abscesses in leukemic patients is discussed with emphasis on the role of splenectomy.
Linoleic Acid Supplementation
Authors: Parsons H. G. , Pencharz P. B.
Published: December 2021

In the letter "Linoleic Acid Supplementation" by Parsons and Pencharz (Pediatrics 66:812-813, 1980) an error has been noted in the 15th line of the letter (p 812, column 1). The sentence should read: Furthermore, it must be realized that the conversion of dietary fat to tissue fat is approximately 99% efficient, whereas the conversion of carbohydrate to fat (14 glucose + 12 O2→ tripalmitylglycerate + 33 CO2 + 21 adenosine triphosphate) results in a loss of approximately 15% of the ingested energy.3
Letters to the Editor
Authors: McLaughlin John F.
Published: December 2021

The point made in the second paragraph of the above letter regarding the interpretation of the lower limits of sensitivity of the tests for mercury vapor is noteworthy. The author is also correct in pointing out that threshold limit values are established for eight-hour days for adult workers and not 24-hour exposure of small infants in incubators.

I am not familiar with the references cited regarding mercury vapor. I reviewed the paper briefly with Dr Celia Mae Scott, our industrial hygienist and one of my co-authors on this same subject.
Counseling Families and Deciding Care of Severely Defective Children: A Way of Coping with ‘Medical Vietnam’
Authors: Duff Raymond S.
Published: December 2021

Medical paternalism supported by hospitals and courts has been, will be, and should be used in those few situations where clearly incompetent or irresponsible parents resist treatment that health professionals generally agree is needed and effective. If used in other circumstances, it is likely to erode family and professional autonomy and bring about an oppressive "medical Vietnam" (costly, sometimes abusive, use of technology to ensure biologic existence with little regard for quality of child and family life and competing interests). Families must be relied upon to help resolve most complex tragedies because there is no better alternative. They are likely to become stronger if they participate in decisions for care of their severely defective children. Such decisions logically include those for life or death.
Nasopharyngeal Carriage of Haemophilus influenzae Type b: Attempted Eradication by Cefaclor or Rifampin
Authors: Yogev Ram , Melick Cheryl , Kabat Kathy
Published: December 2021

The efficacy of cefaclor and rifampin in eradicating Haemophilus influenzae type b (HITB) from the nasopharynx of day care center and household contacts of children with HITB meningitis was evaluated. In 38/50 children treated with cefaclor, the carrier state persisted, a failure rate of 76%. Although cefaclor failed to eradicate HITB from many carriers, an appreciable reduction in the intensity of colonization following teatment was noticed. When rifampin was used in 17 children who had failed to respond to cefaclor, persistence of the carrier state with HITB was found in only two children, a failure rate of only 12%. During the study, two episodes of invasive HITB disease were documented to be acquired from sources other than the index cases or from children who were screened, which suggested the need to reevaluate the usually recommended strategy to screen for carriage and to treat only the immediate contacts 6 years of age and younger. Furthermore, the most appropriate agent for eradicating nasopharyngeal carriage of HITB awaits additional studies.
Trampolines II
Authors: Holroyd H. James , Garrettson Lorne K. , Greensher Joseph , McIntire Matilda S. , Krassner Leonard S. , Chi Wing Ng Raymond , Overbach Avrin M. , Rumack Barry H. , Widome Mark D. , Armstrong George D. , Imhulse Diane , l'Archeveque Andre , Othersen H. Biemann , Flynn Thomas G. , Kennell John H. , McLeod Robert N. , Shaffer Thomas E. , Strong William B. , Thornton Melvin L. , Van Rooy Clemens W. , Burkett Lucille , Baker Fred W. , Malacrea Richard
Published: December 2021

In September 1977, the Academy published a statement calling for a ban on the use of trampolines in schools because of the high number of quadriplegic injuries caused by this apparatus.1 A considerable amount of thought and action resulted. The Academy does not endorse trampoline use, but a revision of the Academy's position to allow for a trial period of limited and controlled use by schools seems appropriate. However, careful assessment of the incidence and severity of injury must continue during this trial period.

The trampoline is a potentially dangerous apparatus, and its use demands the following precautions:

1. The trampoline should not be a part of routine physical education classes.

2. The trampoline has no place in competitive sports.

3. The trampoline should never be used in home or recreational settings.

4. Highly trained personnel who have been instructed in all aspects of trampoline safety must be present, when the apparatus is used.

5. Maneuvers, especially the somersault, that have a high potential for serious injury should be attempted only by those qualified to become skilled performers.

6. The trampoline must be secured when not in use, and it must be well maintained.

7. Only schools or sports activities complying with the foregoing recommendations should have trampolines.
Letters to the Editor
Authors: Lattimer John K.
Published: December 2021

Dr Grünberg obviously follows his patients personally, with sensitivity and rare perception. I am only sorry we did not spot his article in the Archives of Pediatrics of Uruguay, since it would have been one more excellent reference in support of our thesis. We agree wholeheartedly with all of his points.
Congenital Asplenia: Immunologic Assessment and a Clinical Review of Eight Surviving Patients
Authors: Biggar W. Douglas , Ramirez Ricardo A. , Rose Vera
Published: December 2021

Eight children with congenital asplenia syndrome have been studied for their cardiac and immunologic status. All patients were >2 years of age and had severe complex cyanotic heart disease. All eight patients had abnormalities of cardiac and/or visceral situs. All patients had evidence of pulmonary stenosis or atresia and a common atrium or large atnal septal defect. Five patients required palliative cardiac surgery. All patients were given prophylactic antibiotics; there were no documented episodes of sepsis. One patient had an isolated deficiency of IgM; two patients had an isolated deficiency of IgE. Seven of eight patients were immunized with a dodecavalent pneumococcal vaccine. Four of the seven patients failed to have a twofold or greater antibody response. Our findings suggest that prophylactic antibiotics may reduce the incidence of sepsis in the asplenia syndrome. Because the prognosis for these patients must be optimistic, we recommend early documentation of splenic function in children suspected of having the asplenia syndrome, prophylactic antibiotics, and parent education. Children immunized with bacterial vaccines should have their antibody responses monitored.
A Flaw in the Study of Bacteremia
Authors: Mcclelland Charles Q. , Paulson Jerome A.
Published: December 2021

We have read with interest the article by Drs Baron and Fink (Pediatrics 66:171, 1980) entitled, "Bacteremia in Private Pediatric Practice." The authors attempted to identify the incidence and significance of bacteremia in febrile children between 3 and 24 months of age having no identifiable source for their fever and receiving care in a private practice setting. We have serious concerns, however, regarding the design of the study and the validity of the conclusions presented in their paper.
Lower Hematocrit Levels in Blacks Are Not Due to Diet or Socioeconomic Factors
Authors: Garn Stanley M.
Published: December 2021

Having been involved in the question of black-white differences in hemoglobins and hematocrits from the very start (appropriately published in the Journal of the National Medical Association, Pediatrics, Journal of Pediatrics, American Journal ofClinical Nutrition, etc),1,2 I am intrigued with the statement of Dutton reprinted in the July issue ofPediatrics (66:A62, 1980) suggesting that all of the difference is socioeconomic and dietary in nature.

From the start of our studies we considered this possibility only to reject it first for the State of Michigan, then for the ten states (and New York City) involved in the Ten State Nutrition Survey, and finally in many other data bases including the NCPP (National Collaborative Perinatal Project) of the National Institute of Neurological and Communicative Disorders and Stroke.
Fluoride in Infant Formulas and Fluoride Supplementation
Authors: Barness Lewis A.
Published: December 2021

The January 1979 Statement by the American Academy of Pediatrics Committee on Nutrition on fluoride supplementation included a revised dosage schedule and carried a footnote stating that commercial infant formulas would not be manufactured with fluoridated water by the time of publication of the statement (Pediatrics 63:150, 1979). Recent Letters to the Editor1,2 suggest that pediatricians may not yet be fully aware of the new recommendations on fluoride supplements and on the current status of fluoride levels in infant formulas.
Pediatrician Intervention in Mother-Child Interaction
Authors: Casey Patrick H.
Published: December 2021

I would like to congratulate the individual authors and the editorial staff who produced the series of papers published in the August issue of Pediatrics regarding perinatal and postnatal intervention on the mother-child interaction. The research methodology of the papers was of high quality and the thoughtful editorial comments by Dr Haggerty helped tie the papers together and put them in appropriate context.

I would like to contribute to the discussion regarding the variability of results in such studies.
Inverted Tandem Duplication of the Middle Segment of the Long Arm of Chromosome 14
Authors: Strain James E. , Smith Ann C. M. , Ward Brian E. , Robinson Arthur
Published: December 2021

In the article "Inverted Tandem Duplication of the Middle Segment of the Long Arm of Chromosome 14" by Strain et al (Pediatrics 67:273-276, 1981) the following omission. As described in the report of the cytogenetic findings, the proband is partially trisomic for the medial portion of the long arm of chromosome 14 (q243→q130). In addition, the proband is partially monosomic for the terminal portion of chromosome 14 (q321→qter). Monosomy for the terminal portion of the long arm of chromosome 14 may, in part, account for the phenotypic variability of the reported cases when compared to previous reports of trisomy 14 without the presence of partial monosomy.
Effect of Oxygen Administration During Sleep on Skin Surface Oxygen and Carbon Dioxide Tensions in Patients with Chronic Lung Disease
Authors: Hazinski Thomas A. , Hansen Thomas N. , Simon Julie A. , Tooley William H.
Published: December 2021

Hypoxemia, hypercarbia, and cor pulmonale ultimately occur in most patients with chronic lung disease. Although oxygen therapy may reduce or delay the development of pulmonary hypertension and myocardial failure in these patients, its use is thought to lead to CO2 narcosis and apnea. The effect of O2 administration during sleep has been examined in 12 patients (seven with cystic fibrosis, three with bronchopulmonary dysplasia, one with bronchiolitis obliterans, and one with severe hypersensitivity pneumonitis) using skin surface O2 (Roche) and CO2 (Radiometer) electrodes. Both electrodes were calibrated over wet gas and applied at 44 C. Ten patients had chronic hypercarbia (Paco2 62 ± 19 torr; range 46 to 103 torr) when awake. Humidified oxygen was administered by nasal cannula, Venturi mask, or head hood. Oxygen flow was increased every 20 minutes for 80 minutes or until the patient awoke. In eight of ten patients with hypercarbia and in the two normocarbic patients, skin surface carbon dioxide tension (Psco2) increased by 10% or less as the skin surface oxygen tension (Pso2) was increased. In the remaining two patients with hypercarbia (both had cystic fibrosis) Psco2 increased 18% and 24% as Pso2 was increased. These last two patients with depressed responsiveness to co2 could not be separated from the other patients by clinical or laboratory criteria. It is concluded that skin surface blood gas tensions are a simple and reproducible method for adjusting oxygen therapy in patients with chronic lung disease, and although the response to oxygen varies from patient to patient, most patients with chronic hypercarbia retain their central responsiveness to CO2 during sleep and for them O2 therapy is probably safe.
Toxoplasmosis: A Treatable Neurologic Disease in the Immunologically Compromised Patient
Authors: Emerson Ronald G. , Jardine David S. , Milvenan Eileen S. , D'Souza Bernard J. , Elfenbein Gerald J. , Santos George W. , Saral Rein
Published: December 2021

A 10-year-old girl with aplastic anemia developed seizures and a mild hemiparesis following a bone marrow transplant. Based on serologic evidence and a computed tomography scan, which showed a left parietal lucency with ring enhancement, a diagnosis of toxoplasmosis was considered. A brain biopsy of the lucent area demonstrated inflammation and necrosis but no organisms were seen. During a six-week course of pyrimethamine, sulfadiazine, and folinic acid therapy there was clinical and neuroradiologic resolution. The short course of therapy as well as the inadvertent substitution of folic acid for folinic acid and trimethoprim-sulfamethoxazole for sutfadiazine resulted in the reappearance of neurologic deficits. Reinstitution of appropriate therapy produced gradual improvement over a nine-month period. Serial computed tomography scans correlated with the clinical course. In the immunologically compromised host CNS toxoplasmosis should be considered in the differential diagnosis of an evolving CNS syndrome. Early detection and prolonged therapy with appropriate drugs can result in a favorable outcome. Computed tomography scanning may be helpful in diagnosis and follow-up.
Steam Vaporizer Injuries
Authors: Colombo John L. , Hopkins Robert L. , Waring William W.
Published: December 2021

There were an estimated 656 cases of vaporizer-related injuries seen in hospital emergency departments in 1979. Two cases of burns with respiratory involvement are described. Both children were directly exposed to steam from commercial vaporizers and suffered cutaneous and respiratory burns. These cases emphasize the hazards of steam vaporizers, devices that have no proven therapeutic benefits.
Cardiac Catheterization in the Pediatric Patient
Authors: Gersony Welton M. , Bierman Frederick Z.
Published: December 2021

Cardiac catheterization has been the major tool of the pediatric cardiologist in the assessment of congenital heart disease. Intracardiac shunts and pressure gradients are specifically meaasured, and anatomic features are visualized by means of angiography. The risk of such studies in experienced laboratories is extremely low even among small, severely ifi infants. In recent years, with the increasing effectiveness of surgical techniques for repair of complex congenital cardiac lesions, the importance of obtaining detailed anatomic description has become magnified. In parallel with the greater need for information, angiographic techniques have improved to a remarkable degree over the past decade. Sophisticated angle cineangiography has replaced the standard anterior-posterior and lateral projections of the past.1
HLA Antigens in Mucocutaneous Lymph Node Syndrome in New England
Authors: Krensky Alan M. , Berenberg William , Shanley Karen , Yunis Edmond J.
Published: December 2021

HLA antigens were evaluated in 27 patients with mucocutaneous lymph node symdrome (Kawasaki disease) in the Boston area. In contrast to previous Japanese studies, no incidence of HLA-Bw22 was found. A significant increase (P .002), however, in HLA-Bw51 was found in the patients with mucocutaneous lymph node syndrome as compared to an appropriate control population. To our knowledge, this is only the second disease associated with HLA-B5 specificity. The observations illustrate the lack of unified genetic predisposition for a disease in two ethnic groups, white and Japanese. Such findings may have genetic implications regarding interhuman variation in immune responsiveness.
First Aid for the Choking Child
Authors: Holroyd H James , Aronow Regine , Greensher Joseph , Krassner Leonard S. , Othersen H. Biemann , Rumack Barry H. , Toledo J. Rafael , Widome Mark D. , Gross Richard H. , Armstrong George D. , L'Archevêque André , Mofenson Howard C.
Published: December 2021

The aspiration of a foreign body is a common hazard and the second greatest cause of home accidental death in children less than 5 years old.1 The National Safety Council reported more than 450 childhood deaths in 1978 caused by the accidental ingestion or inhalation of objects or foods resulting in the obstruction of respiratory passages. Pediatricians must emphasize the dangers of this emergency situation and teach first aid measures essential for proper evaluation and treatment. Much existing data on treating the choking child are anecdotal. Review of the available literature suggests that the following approach be adopted.

Any foreign body in the upper airway is an immediate threat to life and requires urgent removal. If the child can speak or breathe and is coughing, any maneuvers are dangerous and unnecessary. If the choking child is unable to breathe or make a sound, turn the child's head, place the child face down over your knees, and forcefully give four back blows. If this procedure fails to propel the object from the windpipe deliver four chest thrusts rapidly. Repeat these procedures as necessary if there is no response. Finger probing of the mouth should be attempted only if the foreign body is visualized. If the victim is an infant, place him over your forearm for the maneuvers. Older children can be placed on the rescuer's lap or on the floor.

Pediatricians should familiarize themselves with recommended methods of cardiopulmonary resuscitation (CPR) for the various age groups.2 Remember, if the child is able to breathe and make sounds, and is coughing, these maneuvers are not needed.
Letters to the Editor
Authors: Benfield D. Gary , Leib Susan
Published: December 2021

We appreciate Dr Altemeier's interest in our paper, and would like to respond to the issues he has raised.

As stated in the paper, during the time period of the control group study, standard nursery care was given to all infants in the neonatal intensive care unit. There were no infants receiving the prescribed enrichment procedures at that time. Parents of the control infants gave their informed written consent for their infants to participate in a research project to measure their infants' growth and development.