bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Exercise
Authors: COGLAND SHIRLEY M.
Published: December 2021

This is the second edition of this book, first published in 1949. The stated intent is "to suggest a basis for rational prescription and application of exercises, and to establish a number of simple rules directly applicable to individual cases." The introduction suggests that it is directed toward "most physical therapists, many nurses, and a growing circle of doctors." Possibly this diversity of intended audience accounts for the uneven presentation of material which extends from the labored obvious to the needlessly obscure. Adding confusion to the entire text is failure to use common accepted terminology either in the area of physiology or the language of therapeutic exercise.
THE PEDIATRICIAN'S INFLUENCE IN PRIVATE PRACTICE MEASURED BY A CONTROLLED SEAT BELT STUDY
Authors: Bass Lee W. , Wilson Thurlow R.
Published: December 2021

A pediatrician's personal influence by brief and casual discussion during a routine office visit has been demonstrated by this controlled study to be effective. Installation of seat belts was used to demonstrate this effectiveness. In 1964 all new cars will be equipped with seat belts so this problem may no longer need attention. Nevertheless, personal influence is an effective and powerful tool. When properly applied it can result in rich benefits for the patient and equally rich satisfaction for the pediatrician. It is the duty of all physicians to use this effective tool in the many areas of his practice.
THE THYMUS AND OTHER LYMPHOID TISSUES IN CONGENITAL AGAMMAGLOBULINEMIA
Authors: Gitlin David , Rosen Fred S. , Janeway Charles A.
Published: December 2021

The capacity to develop delayed hypersensitivity to Candida albicans, 2,4 dinitrofluorobenzene and 2,4 dinitrochlorobenzene was examined in a child with thymic alymphoplasia and congenital agammaglobulinemia, or congenital alymphocytosis, and in 7 patients with the nonlymphopenic form of congenital agammaglobulinemia. Delayed hypersensitivity to Candida albicans was also tested in 5 children with neither lymphopenia nor agammaglobulinemia. All of the 12 persons without lymphopenia demonstrated delayed hypersensitivity reactions to the intradermal injection of a Candida extract but the child with congenital alymphocytosis did not. Hyperergia to the halogenated dinitrobenzenes was induced in 5 of the 7 nonlymphopenic agammaglobulinemic patients, but could not be induced in the other 2 nor in the child with alymphocytosis.

Normal skin and thymic tissues transplanted to the child with alymphocytosis survived without evidence of rejection until the patient's death due to bilateral pneumonitis 40 days later, although there was some degeneration of the transplanted thymic tissue. The donor of the transplanted tissues proved to be hypersensitive to Candida, and 22 days after the homografting, the recipient was shown to have acquired this hyperergia. There was no improvement in the patient's condition nor was there a significant rise in circulating lymphocytes after the thymic implants.

The data suggest that the impairment in the capacity for the development of delayed hypersensitivity as well as the survival of the homografts observed in this child with thymic alymphoplasia may be attributable to the paucity of lymphocytes seen in this condition.
Letters to the Editor
Authors: CARTER SIDNEY
Published: December 2021

The primary purpose in quoting from the publications of Dr. S. Livingston, Dr. G. J. Millichap, and others was to indicate that there is no unanimity of opinion regarding the management of the child who has had a "simple" febrile seizure. It was the writer's intention to express briefly the views of others who have had long experience in the treatment of children with convulsive disorders. In attempting to be brief it was impossible to detail the entire philosophy of management of the authors quoted.
ATRIAL SEPTAL DEFECT IN INFANTS
Authors: Nakamura Frances F. , Hauck Anna J. , Nadas Alexander S.
Published: December 2021

1. Ten patients between the ages of 5 months and 2 years with the secundum variety of atrial septal defect were diagnosed by cardiac catheterization.

2. The hemodynamic and physiologic data classically associated with secundum atrial defects were found except for the unexplained existence in two cases of a pressure gradient between the atria.

3. Most of these patients were relatively asymptomatic, and the few who developed congestive heart failure were controlled medically until the optimum age for elective repair was reached.

4. All 10 patients are alive at the time of this writing.
How Important Are Macroglobulin Antibodies to the Newborn Infant?
Authors: DAVIS STARKEY D. , WEDGWOOD RALPH J.
Published: December 2021

In a letter to the editor in the February issue of Pediatrics (33:310, 1964), Rosen and Janeway suggested that infants dying from progressive vaccinia probably had the lymphopenic or athymic variety of agammaglobulinemia. Of interest in regard to this observation are recent reports of fatal progressive BCG vaccination in infants (Acta Paediat., 53:55, 1964). These cases also had hypoplasia of the thymus and agammaglobulinemia.

We would also like to comment on the paper by Rosen, Gitlin, and Michael in Pediatrics (31:197, 1963). The authors demonstrated (as have others) that antibodies in human serum against Gram-negative bacteria are almost entirely macroglobulins. Macroglobulins do not cross the placenta and are absent from the serum of newborn infants.
IMMUNOLOGICAL TOLERANCE AS A DEVELOPMENTAL PHENOMENON
Authors: Smith Richard T.
Published: December 2021

MY ATTRACTION to research and to the general problems of resistance and immunity can be directly traced to events of an internship thirteen years ago when I was stimulated by the clinical problem of neonatal sepsis. In my first attempts to understand some of the underlying mechanisms, I was drawn irrevocably into the center of scientific ferment which was then growing in the Department of Pediatrics at the University of Minnesota. Here McQuarrie had brought under one roof, nearly simultaneously, Robert Good, Lewis Thomas, Chandler Stetson, Lewis Wannamaker, and Floyd Denny. To each of them, as teacher, colleague, and abiding friend, I acknowledge an enduring debt, for they exposed me to their imaginative ways of thinking habits of productivity, high scientific standards, and devotion to truth. My colleagues of the subsequent years—Robert Bridges, Donald Eitzman, John Robbins, and Joseph Bellanti—have each contributed their ideas, hard work, and enthusiasm to building the body of data for which this Mead Johnson Award is bestowed. We are signally honored and are sincerely grateful to the American Academy of Pediatrics and to the donors of the prize.

When the startling discovery of immunologic tolerance was made by Peter Medawar and his colleagues in 1953, our minds were prepared to accept the premise that profound immunologic deficiencies were characteristic of the neonatal period. The few clinical and experimental data available until then indicated clearly that the newborn infant was a poor antibody former, dependent upon an umbrella of transplacental antibody until the third or fourth month of life; that he was highly susceptible to bacterial and certain viral infections; and that he was deficient in localizing inflammatory stimuli. Medawar's disclosure was that perinatal injection of spleen cells from a donor mouse permanently endowed the recipient with a capacity to retain an otherwise unacceptable homograft. This experiment seemed to confirm the prediction of Sir McFarlane Burnet that foreign tissues or antigens which were encountered by the fetus during certain critical periods of development were endowed with self-markers of structural proteins, and, therefore, not recognized as foreign.
STUDIES OF SMALL INTESTINE DURING DEVELOPMENT
Authors: Sunshine Philip , Kretchmer Norman
Published: December 2021

Five infants with intolerance to lactose or sucrose and one infant with intolerance to both lactose and sucrose have been studied. These infants were symptomatic with fermentative diarrhea, vomiting, and failure to gain weight. The tolerance of these patients to disaccharides was measured, and the sugar or sugars to which they were intolerant were removed from their diets. The infants began to gain weight as their diarrhea abated. After they were asymptomatic and thriving for a period of time, they were re-examined and were found to respond normally to the ingestion of disaccharides.

Disacchariduria was detected in 5 of the 6 infants during the acute period of their disorders, but not at the time of their reexamination. This finding is probably correlated to the amount of disaccharide ingested and the activity of the specific intestinal disaccharidase at the time of the test.

The clinical symptoms and signs of these patients with acquired intolerance to disaccharides were identical to those of patients with congenital absence of intestinal disaccharidases.
PATHOGENESIS, INCIDENCE, AND POSSIBILITIES OF PREVENTING ALIMENTARY NITRATE METHEMOGLOBINEMIA IN INFANTS
Authors: Knotek Zdenek , Schmidt Pavel
Published: December 2021

It was shown in clinical experiments that alimentary methemoglobinemia in artificially fed infants is provoked by nitrites originating from nitrates contained in water used for diluting dried-milk preparations. The reduction of nitrates is induced by the influence of sporulating germs of B. subtilis contained as spores in the dried milk. In areas where water contains high concentrations of nitrates a great percentage of artificially fed infants are affected, even if the methemoglobinemia does not manifest itself clinically. Dried buttermilk contains microbes of lactic fermentation S. lactis, producing the antibiotic nisin. This prevents the growth of the sporulating microbes of B. subtilis. Consequently, prevention of this disease, caused by intoxication with nitrites, is possible, by the use of dried buttermilk for the artificial feeding of infants up to 3 months of age.
MEDICAL RESPONSIBILITY AND DRUG ADDICTION
Authors: Eisenberg Leon
Published: December 2021

The dismaying extent of addiction among young people, the complexity of its causation, and the grossly unsatisfactory results from current methods of management are all sharply posed in the accompanying review by Freedman and Wilson. This thoughtful condensation of the available literature may disappoint those looking for neat and simple formulations as to cause or cure. Easy slogans and hoary nostrums abound; they lack only facts to support them.

The correlations between low socioeconomic status, membership in ethnic groups shut out from full participation in American society, and the prevalence of addictive practices point to social class factors as important determinants of the behavior patterns that eventuate in addiction; yet addiction is not universal among the disadvantaged and is being discovered to an increasing extent among privileged youth.
EFFECT OF MAINTENANCE OF "NORMAL" SKIN TEMPERATURE ON SURVIVAL OF INFANTS OF LOW BIRTH WEIGHT
Authors: Buetow Kathleen Carney , Klein S. Wayne
Published: December 2021

Survival rates of premature infants weighing 1,000-1,500 gm at birth were compared in a series of infants placed in a special incubator designed to regulate skin temperature at 36.0°C (96.5°F) by means of infrared radiation and in a group of controls placed in a standard incubator warmed only by circulating air to an ambient temperature of 31.1-32.2°C (88-90°F). Improvement in survival among the babies whose skin temperature was maintained at 36.0°C was significant principally in those infants weighing between 1,251 and 1,500 gm at birth. It is suggested that this increased survival was due to the avoidance of the metabolic stresses consequent to cooling in this group of small infants who lack maturity but who are potentially capable of living when their needs are adequately supplied.
BODY TEMPERATURE AND SURVIVAL OF PREMATURE INFANTS
Authors: Day Richard L. , Caliguiri Lawrence , Kamenski Carolyn , Ehrlich Florence
Published: December 2021

One hundred and twenty-five premature infants were divided into two groups, one being treated in incubators at an air temperature of 31.8°C (89°F) and the other in the same style of incubator, but with more careful regulation of body temperature by a radiant heat device actuated by a thermistor taped to the abdomen and set for 36°C (97°F). There was a trend toward lower mortality among the heat lamp babies which was present in males and females, whites and Negroes, and which was not related to an accidental distribution of high risk infants to the control group. The advantage was most pronounced among babies vaginally born in the vertex position between birth weights of 800 and 1,599 gm inclusive. The cause of the excess mortality was not revealed by autopsy data. The results confirm those of Silverman, but extend them in that his "normothermic" babies were in conditions similar to our cold or control babies.

The trends shown in this paper, taken in combination with those of the previous studies of Silverman, of Jolly et al., and of Buetow and Klein14 in this issue, point to the desirability of care in the control of the temperature of premature infants.
PLASMA AMINO ACIDS AFTER BIRTH
Authors: Ghadimi H. , Pecora P.
Published: December 2021

The concentration of the free amino acids of plasma during the neonatal period were studied by ion-exchange column chromatography in infants born prematurely or at term.

In prematures the effects of 4% protein formula were compared with 2% protein formula. The changes in concentration at 1, 2, 3, and 4 hours postprandial were also studied in two prematures aged 10 and 25 days.

A wide range for most amino acids especially in the premature group was observed. Increased concentrations of tyrosine up to 26 mg/100 ml as late as the fiftyseventh day of life were noted.

A steady postnatal decrease for lysine, taurine, and threonine was found in the few days of life from the high cord blood concentrations toward the base-line values of infancy.
SELECTIVE AUDIO-VISUAL INSTRUCTION FOR MENTALLY RETARDED PUPILS, Edward Goldstein. Springfield, Ill.: Charles C Thomas, 1964, 96 pp., $5.25
Authors: Byers Randolph K.
Published: December 2021

This little book is primarily educationally oriented. It does, however, provide a very useful review of the subject of education of mentally retarded children and the theories underlying it. It also reviews the subject of the development of motion pictures in relation to commercial use and in education. Finally, it records an experiment conducted among three experimental and two control groups of children in special classes in relation to learning about the process of food preparation and service.
In Reply: Gastrostomy for Feeding Premature Infants
Authors: S. C. A.
Published: December 2021

Dr. Keitel is comparing mortality in a selected group of infants (those chosen by Dr. Berg and his colleagues for gastrostomy after 24 hours of age) with that of infants in the same weight range but from an unselected group. Statisticians tell us such comparisons are not valid.

Neither Experience and Reason nor any other section of Pediatrics (except Letters to the Editor) is for the easy or careless publications of anything, whether intriguing but benign on the one hand, or potentially harmful on the other.
Rh Disease—Pregnancy Interruption
Authors: Bowman John M.
Published: December 2021

May I comment upon the article "Rh Disease–Pregnancy Interruption" by T. R. Boggs, Pediatrics, 33:758, 1964.

Dr. Boggs uses past history alone in determining the value of early induction and indications for its use in Rh isoimmunization. For the past ten years, we have used past history of disease and antibody titer together in deciding the same thing, and since December, 1961, have added spectrophotometric examination of amniotic fluid as a third and most important factor in arriving at a prognosis of impending fetal death, before stillbirth makes any effort at salvage hopeless.
In Reply: Rh Disease—Pregnancy Interruption
Authors: Boggs Thomas R.
Published: December 2021

I want to thank Dr. Bowman for his comments on my reporting of our experience in managing Rh-sensitized pregnancies. It is obvious, from his letter that Dr. Bowman and his co-workers are doing an excellent job in their efforts on behalf of the sensitized woman and her infant. It is gratifying to hear that he has met with greater success in the earlier terminations than we.

It is unfortunate if Dr. Bowman has gained the impression that we rely on maternal history alone in deciding which pregnancy to interrupt.
CHRONIC ACIDOSIS DUE TO AN ERROR IN LACTATE AND PYRUVATE METABOLISM
Authors: Israels S. , Haworth J. C. , Gourley Beth , Ford J. D.
Published: December 2021

A description is given of two unrelated North American Indian children who, at 11 and 9 months of age respectively, were found to have metabolic acidosis, associated with a high concentration of lactate and pyruvate in the blood. Both children were mentally retarded, suffered from convulsions, and showed obesity and muscular hypotonia.

Liver glycogen disease, diabetes mellitus, and chronic hypoxia were excluded in both cases. Decreased removal of pyruvate and lactate from the blood due to some, as yet, undetermined metabolic block appeared to be the most likely causative mechanism. As well as a defect in the metabolism of lactate and pyruvate, evidence of an abnormality of α-keto glutarate metabolism was found in one case.
Letters to the Editor
Authors: FINBERG LAURENCE
Published: December 2021

Dr. Jaffe is, of course, correct that it is often possible to culture H. pertussis from patients with whooping cough. Our statement in the paper referred to the facts as they are for our series, even though we regret the state of affairs.

We therefore very carefully listed the criteria by which the diagnosis was made in the absence of finding the specific etiologic agent. The method referred to by Dr. Jaffe for culturing the organisms was not the one that was employed by the Bacteriology Laboratory of the hospital.
Keeping Pediatricians in Practice
Authors: FAIGEL HARRIS C.
Published: December 2021

I read with great interest the letter from Dr. Gould (Pediatrics, 33:789) regarding pediatricians and their practices, and I must agree wholeheartedly that the flight of pediatricians into other fields is a tremendous problem.

I cannot agree entirely with Dr. Gould's suggested changes. What he has described (skilled nurses doing routine care) is basically the feldscher system as it has operated in Russia since the days of the czars. Whether or not the American public would accept this is immaterial. What is really needed is a reappraisal of the reasons physicians become pediatricians and the training they take in preparation for practice.
THE INVOLVEMENT OF THE LABIAL MUCOUS SALIVARY GLAND IN PATIENTS WITH CYSTIC FIBROSIS
Authors: Warwick Warren J. , Bernard Betty , Meskin Lawrence H.
Published: December 2021

Biopsy of the labial mucous salivary gland provides a microscopic observation of the typical acquired pathology of the mucous glands in patients with cystic fibrosis. It is potentially a powerful test in the diagnosis of the disease and may be more valuable than the duodenal aspiration test of pancreatic insufficiency in discriminating patients with cystic fibrosis from patients who have other diseases with similar symptoms.
Advances in Pediatrics, Vol. XIII,
Authors: S. C. A.
Published: December 2021

This book is impossible to review in any detail. Yet it should interest the pediatric reader not only for the information in its pages but also for the light it throws upon what is happening to our specialty. Six subjects are covered in this new annual volume: "Porphyria in Childhood (Ihsan Dogramaci, of Ankara), "Ventricular Septal Defect" (Mary Ellen Engle, Kathryn H. Ehlers, Tomiko Ito), "Progress toward Transplantation of Tissues" (R. A. Good, Carlos Martinez, Alan E. Gabrielson), "Acute Bacterial Meningitis" (R. J. Haggerty, M. Ziai), "Thyroiditis in Childhood" (Gilles Leboeuf, A. M. Bongiovanni), and "Nutritional Disorders . . . in the Tropics" (C. C. de Silva).
INDICATIONS FOR OXYGEN THERAPY IN THE NEWBORN
Authors: Tizard J. P. M.
Published: December 2021

IT IS ALWAYS a difficult task to praise famous men, the more difficult for me in the case of Dr. Blackfan since this particular Blackfan Memorial Lecture is also linked with the memory of Dr. Bronson Crothers. Dr. Wilson's admirable biographical memoir of Dr. Blackfan could bring him to life for the reader if anything could. Yet the fact is that I knew Dr. Crothers: I mourned his death and he is therefore as alive for me as if he was sitting in the front row lighting and relighting a much tortured pipe.

As you know, Dr. Crothers was to me a hero, as evidently was Dr. Blackfan to his students, yet in the schoolboy sense of the word he lacked one conventional attribute of heroism. I refer to the olympian attitude of mind which one is apt to expect from the favorites of the Gods and which was so conspicuous a part of the therapeutic armamentarium of the physicians of the nineteenth century and indeed some of them today. He was the antithesis of Robert Louis Stevenson's fashionable physician, Sir Faraday Bond, who as you may remember, would call you back even after you had paid your fee, to say with stentorian emphasis "I had forgotten one caution: avoid kippered sturgeon as you would the very devil." In his gentle way, Dr. Crothers spoke the truth to the parents of his patients; if they found it too uncomfortable they might leave him but they always came back eventually when they realized that it was on the basis of acceptance of the tragic fact of the permanency of brain damage that most could be done to help their children.
THE DIETARY MANAGEMENT OF LEUCINE-SENSITIVE HYPOGLYCEMIA, WITH REPORT OF A CASE
Authors: Roth Henry , Segal Stanton
Published: December 2021

A dietary regimen, which has been found useful in the management of leucine-sensitive juvenile hypoglycemia, is described. Hypoglycemia is avoided by a combination of leucine restriction and postprandial carbohydrate feedings. Leucine restriction is achieved primarily through limitation of dietary protein, but sufficient protein is supplied to fulfill the minimum requirement. Through the use of this regimen it was possible to achieve satisfactory symptomatic control without the use of corticosteroids.
MORQUIO'S DISEASE
Authors: Schenk Eric A. , Haggerty James
Published: December 2021

The radiologic and morphologic changes seen in a patient with Morquio's disease who came to autopsy are described and discussed. Pathologic changes were limited to cartilage and consisted of cytochemically definable lesions of the matrix characterized by the presence of amorphous and fibrillar lesions and the accumulation of foam cells. An abnormal accumulation of mucopolysaccharides in foam cells and cartilage matrix was present. No evidence of visceral storage of mucopolysaccharides, such as is seen in Hurler's disease, was present. In addition to Morquio's disease, this patient had a patent ductus arteriosus.

Clinical features and radiologic changes in an older living sibling, who has had Morquio's disease and is now apparently developing the Morquio-Ullrich variant, are described.
The Child Who Has Had One Convulsion
Authors: CASTIGLIONE JOHN B.
Published: December 2021

Dr. H. Lester Medlinsky's letter (Pediatrics, 34:438, 1964) regarding his clinical experience with febrile convulsions certainly expresses a view with which I agree.

On the basis of my own experience, I have concluded that the course of simple febrile convulsions is altered by daily medication. Almost all of my patients who have been on daily medication have not had recurrences of the simple febrile seizures. I agree wholeheartedly with Dr. Medlinsky that the impact of a convulsive disorder on a family unit is profound and disrupting.
Hospitalization of Children
Authors: STRAUS PIERRE
Published: December 2021

I would be very thankful if you would publish in your columns "Letters to the Editor" these few comments concerning hospitalization of children:

I have read with most interest Dr. Bongiovanni's Commentary (Pediatrics, 34:1) on the International Seminar on the Hospitalization of children as well as the letters of Dr. Wegman and of Dr. Meyer respectively published in the September and November issues of Pediatrics.

As my contribution to this Seminar has been partly the subject of the discussion may I add some comments:
Letters to the Editor
Authors: RAY C. GEORGE , WEDGWOOD RALPH J.
Published: December 2021

We are grateful to Dr. Delta for bringing to our attention these additional reports of listeriosis in infancy. These cases add further substance to the purpose of our paper: (1) Listeriosis in infancy is not as uncommon as might appear from sporadic, isolated case reports. (2) There may be a common denominator of the disease useful to the clinician and epidemiologist. (3) "Standard" antibiotic therapy for neontal sepsis may not be the treatment of choice.
THE BACTERIOLOGIC FINDINGS, STREPTOCOCCAL IMMUNE RESPONSE, AND RENAL COMPLICATIONS IN CHILDREN WITH IMPETIGO
Authors: Markowitz Milton , Bruton H. David , Kuttner Ann G. , Cluff Leighton E.
Published: December 2021

1. Cultures of the skin, nares, and pharynx were examined in 303 children with impetigo. One hundred and seventy-two skin cultures were positive: 50 for beta hemolytic streptococci, 104 for coagulasepositive staphylococci, and 18 for both organisms. Beta hemolytic streptococci were present in nasopharyngeal cultures of 26 children, 18 of whom also had these organisms in the skin. Staphylococci were found in 114 cultures of the nares and in 58 children these bacteria were also present in the skin culture.

2. Of the 68 strains of beta hemolytic streptococci cultured from the skin, 53 were group A, one was group C, and 14 could not be grouped.

3. Only 4 of the group A strains were typable by the precipitin reaction. None of the strains were known nephrotoxic types. Twenty-one strains were typed by slide agglutination: 20 showed agglutination patterns considered to be characteristic of impetigo strains.

4. Twenty-five of 68 children with streptococci in the skin lesion had an elevated ASO titer. In 76 children with negative skin cultures, there was serologic evidence of streptococcal infection. On the basis of combined bacteriologic and serologic findings, 144 children (48%) with impetigo had evidence of streptococcal infection.

5. Ninety-nine of the 122 strains of staphylococci isolated from the skin and 86 of 114 strains cultured from the nose were phage-typed. Phage-type 71 was the most common typable strain from both sources.

6. At the first visit, 6 children had acute glomerulonephritis and 8 had microscopic hematuria. An additional 14 patients showed transient hematuria on follow-up examination.

7. The group of children with pure cultures of streptococci who received penicillin appeared to improve more rapidly than those who received only local treatment. On the other hand, in patients with mixed cultures of streptococci and staphylococci as well as those with pure cultures of staphylococci, there was no difference in response in those given penicillin as cornpared with those treated with ammoniated mercury.

8. In 5 children, microhematuria was not prevented by the administration of penicilun 7 to 10 days before the appearance of the abnormal urinary findings.

9. The strains of group A streptococci isolated from skin lesions showed several distinctive patterns by the slide agglutination technique similar to those observed by other workers. Also in accord with English investigators, one phage-type of staphylococcal predominated in the strains isolated from the skin lesions.

10. Abnormal urinary findings are cornmon in children with impetigo, but are usually not associated with infection with the known nephrotoxic types of group A streptococci.
THE SWALLOWING MECHANISM OF THE NEONATE I. ESOPHAGEAL AND GASTRIC MOTILITY
Authors: Gryboski Joyce D.
Published: December 2021

Patterns of esophageal motility are presented from 30 infants who were studied before and after the initiation of feeding and from 15 premature infants who were studied only after they had fed several days. Sucking occurs in only small bursts of 3 to 4 sucks in the neonate who has never fed, but in longer efficient bursts of 10 to 30 sucks in the neonate who has taken feedings for several days. The infant under 12 hours old and the premature infant have frequent simultaneous contractions of the esophagus and many biphasic peristaltic waves which probably represent an incoordination of the esophageal response to deglutition and neuronal immaturity. These abnormalities occur less frequently in the 3-day-old infant. In the majority of term and premature infants the inferior esophageal sphincter mechanism is located at or above the effective diaphragmatic hiatus and its tone is poor.
Kernicterus in Small Premature Infants
Authors: STERN LEO , L. DENTON RONALD
Published: December 2021

The hyperbilirubinemia of prematurity is considered to be the result of an immaturity of the glucuronyl transferase system in the liver. Although hyperbilirubinemia is common, kernicterus, in the absence of hemolytic disease is said to be rare. Thus, the indication for exchange transfusion in icterus of prematurity and the level at which it should be performed remain subjects for considerable difference of opinion.

We have recently observed the occurrence of six cases of kernicterus in small premature infants in the absence of hemolytic disease. There were five female and one male infants in the group. All six were premature, both by weight and gestational ages.
STATEMENT ON TREATMENT OF PHENYLKETONURIA COMMITTEE ON THE HANDICAPPED CHILD
Authors:   COMMITTEE ON THE HANDICAPPED CHILD
Published: December 2021

IN RESPONSE to many requests from individuals and agencies, the following statement on the present status of treatment of phenylketonuria (PKU) has been prepared. The Committee on Fetus and Newborn has reviewed the present status of neonatal screening for inborn errors of metabolism (e.g., PKU and related problems) and is reporting separately.

There is considerable discrepancy of opinion regarding the treatment of phenylketonuria. The enthusiasts say that with adequate mass screening, diagnosis, and early treatment, phenylketonuria can be eliminated as a cause of mental retardation; the doubters believe that there is need to improve screening procedures and that the efficacy of treatment leaves much to be desired.

AREAS OF AGREEMENT ON TREATMENT

In spite of discrepancies in the available data, certain facts appear to warrant acceptance, namely:

1. If PKU is detected early, and the infant is started on the proper diet before 6 months of age, and then is "adequately" maintained, the child usually will demonstrate borderline to average intelligence at 5 years of age. The earlier treatment is begun, in general, the better the result.

2. For the infant being treated with a diet low in phenylalanine, the acceptable concentration of phenylalanine in the serum probably lies above 3 mg/100 ml and below 8 mg/100 ml. Some insist that it be kept below 4-6 mg/100 ml. Concentrations over 12 mg/100 ml are almost certainly too high to achieve best results.

3. For optimum results the diet must be maintained rigidly and constantly, and at the same time the parents must also offer the child the usual affection, stimulation, discipline, and security necessary for normal behavioral development.
Fecal Retention in Cystic Fibrosis
Authors: EKELUND HANS
Published: December 2021

In the July, 1964, issue of Pediatrics, (34: 72), Snyder et al. published a report of fecal retention in children with cystic fibrosis. According to Snyder only 19 cases of this entity have been reported up to now. For that reason it might be of some interest to add another case to the series. This case was admitted to our clinic shortly after we had received our July copy of Pediatrics, a remarkable coincidence.
Human Genetics
Authors: GERALD PARK S.
Published: December 2021

The author, in the Preface, describes his book as a "survey of human genetics." As such, it is a commendable addition to the growing volume of literature in this area. The ten short chapters include a wide variety of subjects, ranging from human cytogenetics through the genetic determination of protein structure to the mathematical aspects of genes in families and populations. Since this is but one volume of a series devoted to genetics, many subjects are given briefer treatment than might otherwise be expected, and the author refers the reader to other volumes for more extensive discussion of them.
SERUM BUTANOL-EXTRACTABLE IODINE CONCENTRATIONS IN PREMATURES
Authors: Marks Alan N. , Man Evelyn B.
Published: December 2021

Normal, full-term neonates have the highest circulating thyroxine-like iodine concentrations observed during the life span of humans (7.2-15.2 µg/100 ml) These elevated serum Butanol-Extractable Iodine concentrations have also occurred in neonates over 2,500 gm in birth weight who required exchange transfusions.

Data are presented on low BEI's of 20 neonates under 2,000 gm in birth weight in a series of 201 BEI measurements on 187 newborns. Mean BEI values increased progressively through 500 gm increments in birth weight from the 2,000-2,500 gm to the 3,500-4,000 gm group, without further rise for infants over 4,000 gm. Requirement of thyroid hormones has been discussed in relation to development of the central nervous system.
ESTIMATION OF THE SERUM BETA1C GLOBULIN CONCENTRATION: ITS RELATION TO THE SERUM HEMOLYTIC COMPLEMENT TITER
Authors: Klemperer Martin R. , Gotoff Samuel P. , Alper Chester A. , Levin Alan S. , Rosen Fred S.
Published: December 2021

The depression of a single serum protein, the beta1C globulin (normally 130-155 mg/ 100 ml) to below 80 mg/100 ml is manifested by a decreased hemolytic complement titer. Since this protein can be measured by an immunodiffusion methol, its immunoassay can be used as a substitute for the hemolytic titration of complement in the diagnosis of patients with acute glomerulonephritis, systemic lupus erythematosus, and the nephrotic syndrome. A rapid immunoassay of the serum beta1C globulin can be easily performed.
Pilonidal Sinus in Infancy
Authors: LEWIN RICHARD A.
Published: December 2021

The case presented is of a newborn infant with a fulminating infection with Staphylococcus aureus arising from a pilonidal sinus. The patients admitted over a 10-year period to Louisville Children's Hospital with a diagnosis of pilonidal sinus are reviewed. The disease appears to be of congenital origin in this age group. The potential danger of this condition in infants is emphasized.
THE USE OF AMNIOCENTESIS AND FETAL TRANSFUSION IN ERYTHROBLASTOSIS FETALIS
Authors: Liley A. W.
Published: December 2021

In the Rhesus-sensitized woman spectrophotometric analysis of amniotic fluid allows a direct assessment of fetal condition independent of history and antibody titer and behavior. Obstetrical interference can be avoided where it is unnecessary and timed accurately where it is essential. Amniocentesis can also detect babies who will not reach a reasonable maturity alive or in viable condition. After amniographic assessment and under radiographic control percutaneous intraperitoneal transfusion of the fetus with packed erythrocytes can ensure fetal survival to a more viable maturity and produce a baby in good condition for pediatric care.
PRENATAL TREATMENT OF ERYTHROBLASTOSIS FETALIS FOLLOWING HYSTEROTOMY
Authors: Adamsons Karlis , Freda Vincent J. , James L. Stanley , Towell Molly E.
Published: December 2021

In recent years considerable progress has been made in diagnosis and treatment of the erythroblastotic fetus. Many aspects of the problem, however, remain to be solved. Perhaps the most urgent one is earlier diagnosis: delaying treatment until demise is imminent is unlikely to lead to optimal outcome. Interference in the transfer of bilirubin across the placenta is probably a late phenomenon, present only when placental perfusion is impaired and the diffusion distance is increased by stromal edema of villi. Hence, the currently accepted indications for operative intervention are present only when the fetus has been severely affected for some time. It is possible that changes in fetal heart rate, either spontaneous or in response to a given stimulus, might reveal an incipient anemia not yet reflected in the composition of amniotic fluid. Determination of the excretion pattern of chorionic gonadotropin might also be of value. Changes in the appearance of placental villi obtained by needle biopsy and examined by phase contrast microscopy have been helpful in diagnosing impending hydrops. The benefits of this procedure, however, must be weighed against the potential danger of increasing maternal sensitization.

Optimal technique and timing for administration of red cells remain to be determined. Different approaches may be preferable at various gestational ages. Close to the time of extrauterine viability and in the absence of hydrops the method introduced by Liley may prove to be the most satisfactory. Earlier in gestation techniques which provide the fetus with an indwelling catheter, either intravascular or intraperitoneal, probably hold greater promise. Bone marrow as the site of infusion might offer advantages and should also be considered. Whether the insertion of a catheter is accomplished better during hysterotomy or by means of a transabdominal needle puncture with the aid of a fluoroscope or amnioscope, remains to be determined. For the hydropic fetus near term, exchange transfusion in utero might be lifesaving.
Hypophosphatemic Rickets, Hyperglycinuria, Glycosuria, etc
Authors: STICKLER GUNNAR B.
Published: December 2021

The study of a patient with hypophosphatemic rickets, hyperglycinuria, glycosuria, and glycyl-prolinuria by Dr. Charles R. Scriver and co-workers (Pediatrics, 34:357) was of great interest to me. However, I must take issue with certain interpretations of data presented by these authors. It is stated, "The fecal excretion of phosphorus was slightly more than the urinary excretion. On the assumption that fecal phosphorus has the relation: 0.5 X fecal calcium/calcium intake X phosphorus intake, the fecal phosphorus was an appropriate amount.
Letters to the Editor
Authors: SCRIVER C. R. , GOLDBLOOM R. B. , ROY C. C.
Published: December 2021

Dr. Gunnar Stickler's letter raises a number of controversial questions, none of which we will be able to answer satisfactorily. We suspect he knew this when he raised the questions. We described the facts and interpreted them with caution, not claiming that our opinions are the correct ones. On the other hand, Dr. Stickler's interpretations are not necessarily the right ones either. The following thoughts in response to Dr. Stickler's sticklers are not so much rebuttals as statements of some factors he didn't mention!
THE EXCRETION OF TWO Δ5-3β-OH, 16α-HYDROXYSTEROIDS BY PATIENTS WITH CONGENITAL ADRENAL HYPERPLASIA
Authors: Reynolds John W.
Published: December 2021

The urinary excretion of two Δ5-3β-OH, 16α-hydnoxysteroids, 16-OH-pregnenolone (16-OH-PG), and 16-OH-dehydroepiandrosterone (16-OH-DHA), has been determined in 18 patients with the C-21 hydroxylase deficiency type of congenital adrenal hyperplasia (CAH). The excretion of 16-OH-PG was generally above the normal range in young infants, fell over the first 4 months and was present in only one of eight control urine samples from patients with CAH over 5 months of age. The excretion of 16-OH-DHA was generally within the normal range in the young infants, fell over the first 4 months, and was not found in urine samples from CAH patients over 5 months of age. ACTH was administered to eight of the CAH patients and caused an increased excretion of both steroids when they were present in control urine samples. Of the five patients receiving ACTH who had neither steroid present in control urine, 16-OH-PG appeared in the two youngest but 16-OH-DHA appeared in none. The ratio of urinary 16-OH-PG/16-OH-DHA was significantly greater in the CAH patients than in the endocninologically normal patients. It was concluded that the pattern of excretion of 16-OH-PG and i6-OH-DHA in patients with CAH is an exaggeration of the normal infant pattern caused by the endogenous ACTH stimulation. The possible role of the fetal zone of the adrenal cortex in the secretion of these steroids was considered but the available evidence indicated that the permanent cartical zone was the site of origin.
Herpangina: The Etiologic Spectrum
Authors: Cherry James D. , Jahn Charles L.
Published: December 2021

The etiology of herpangitic enanthem cannot be restricted to certain Coxsackie A viruses. Zahorsky1, 2 and others3-5 considered herpangina a specific febrile disease, but in light of more recent studies6-17 and the presently reported cases, it would seem more appropriate to restrict the use of the term "herpangina" to the description of the characteristic oropharyngeal lesions. Enanthem is one of the protean manifestations of enterovirus infection and is must be included along with other signs and symptoms in the over-all differential diagnosis of summer febrile illness.
Editor'S Note
Authors: Dodge Warren F.
Published: December 2021

Dr. Dodge commented as follows:

Thank you for the opportunity to comment upon the letter from Dr. McCrory. There appears to be no major disagreement between us n the treatment of infants with chronic renal osteodystrophy. Our reasoning in submitting his short report was not to recommend dietary estriction of phosphorus as the sole means of therapy, but, rather, to once again call attention to its inherent dangers if pursued too zealously.

Most investigators appear to be in agreement hat renal osteodystrophy may accompany chronic renal insufficiency.
THE PLASMA FREE FATTY ACID COMPOSITION AND BLOOD GLUCOSE OF NORMAL AND DIABETIC PREGNANT WOMEN AND OF THEIR NEWBORNS
Authors: Chen Chiung H. , Adam Peter A. J. , Laskowski Donald E. , McCann Michael L. , Schwartz Robert
Published: December 2021

The blood glucose and plasma FFA content and composition of the newborns of normal women, gestational diabetics, and insulin-dependent diabetics were analyzed. Normal maternal FFA levels were twice the fetal values; by 2 hours of age FFA increased fourfold over initial values in normal infants, while infants of gestational diabetics had a threefold rise, and those of insulin dependent diabetics only twofold. Blood sugar at the same time decreased, and there was an inverse relationship between blood glucose in the normal infants and FFA. This relationship is altered in the infant of the diabetic mother.

Gas chromatography of plasma indicated a higher ratio of unsaturated to saturated FFA in mothers compared to infants. No pattern differences were noted between the normal and diabetic mothers, except that the latter had higher oleic acid. In the initial 2 hours of life, the patterns changed, although no differences were noted between infants of diabetic mothers and normals.

The observations suggest: (1) The metabolic interrelationships of glucose and FFA in the normal infant are different from those in the infant of the diabetic mother. The latter infant has a state of physiological hyperinsulinism. (2) Plasma FFA in the fetus is derived from both fetal fat synthesis as well as placental transfer. (3) The infant of the diabetic mother does not differ from the normal as regards FFA composition.
URINARY EXCRETION OF CITRIC ACID CYCLE METABOLITES IN PREMATURE NEWBORN INFANTS WITH AND WITHOUT A RESPIRATORY DISTRESS SYNDROME
Authors: Wu P. Y. K. , Oh W. , Polar E. , Metcoff J.
Published: December 2021

The excretion of CAC acids in the urine of 6 "normal" premature infants was measured during the first 24 hours of life and for a 12-hour period during the subsequent 48-hour period of life. Similar measurements were obtained in 10 premature infants with a respiratory distress syndrome (RDS). The CAC acids were quantified by gradient elution silicic acid column chromatography. Quantifiable acids included a pyruvate adjacent ("X") fraction, and pyruvic, lactic, citric, α-ketoglutaric, succinic, fumaric, malic, and acetic acids. Some of the urines did not contain all of the acids. Fumaric, malic, and succinic acids were encountered less frequently and the sample limitation precluded comparative analysis either with increasing neonatal age or between groups of premature infants without or with a RDS. Of the acids recovered in sufficient quantity to merit comparison, a significant increase in excretion of pyruvic and citric acids was observed during the 48-72 hour period in both groups of infants. The increment of citric acid excretion was greater (p < 0.02) in the infants without a RDS. The infants with RDS tended to excrete more pyruvic-like, lactic, malic, and acetic acids than did non-distressed subjects. ix-ketoglutaric acid increased as perinatal acidosis diminished. There were too few observations to lend statistical credence to these latter observations, which require further study. The intrinsic renal mechanism responsible for excretion of the CAC acids may be relevant to renal metabolism, which determines renal functional homeostasis in the neonatal period.
SURVIVAL TIME OF CIRCULATING LONG-ACTING THYROID STIMULATOR IN NEONATAL THYROTOXICOSIS: IMPLICATIONS FOR DIAGNOSIS AND THERAPY OF THE DISORDER
Authors: Sunshine Philip , Kusumoto Howard , Kriss Joseph P.
Published: December 2021

We have described an infant with neonatal thyrotoxicosis who developed supraventricular tachycandia, goiter, and periorbital edema. Both the baby's and mother's sera contained the long-acting thyroid stimulator (LATS). While the level of LATS remained unchanged in the serum of the mother, it rapidly fell in the serum of the infant. The biological half-life of LATS in the infant's serum was calculated to be 6 days, and by the age of 21 days no LATS activity could be detected. Based on these findings, antithyroidal treatment which had been instituted soon after birth was discontinued on the thirty-eighth day without recurrence of signs or symptoms of thyrotoxicosis.

In addition to conventional antithyroid therapy for thyrotoxicosis, exchange transfusion and prenatal corticosteroid therapy of the mother may be considered when neonatal or maternal serum LATS titers, respectively, are very high.
GROWTH HORMONE
Authors: Root Allen
Published: December 2021

Growth hormone influences protein, fat, carbohydrate, and mineral metabolism. It promotes nitrogen retention, growth of cartilage, transportation of amino acids through the cell wall, and incorporation of amino acids into protein. This factor mobilizes free fatty acids from adipose tissue and increases the serum concentration of these substances; long-term administration of this hormone is followed by depletion of body fat stores and inhibition of fatty acid synthesis. In diabetic subjects growth hormone administration is followed by hyperglycemia, glycosuria, and ketosis; its effect on carbohydrate metabolism in normal subjcets is more subtle. Sodium, potassium, and inorganic phosphate are retained following the administration of growth hormone. Hypercalciuria also accompanies such treatment, an effect mediated through the parathyroid glands.

Human growth hormone may be detected in the serum through the use of the radioimmunoassay. The hypothalamus is intimately involved with the control of the secretion and release of growth hormone from the pituitary. There is a correlation between the availability of glucose for metabolism and the plasma concentration of growth hormone; when glucose is unavailable growth hormone is released in order to provide a substitute source of energy, fatty acids.

The administration of growth hormone to the patient with hypopituitarism is followed by growth in many instances, but it has not usually been effective in promoting growth in individuals with other abnormalities. Acquired resistance to the effect of growth hormone is accompanied by the development of antibodies directed against this protein.