bluuebunny/crossref_metadata_2025 huggingface dataset:
PICKWICKIAN SYNDROME
Authors: Yirka M.
Published: December 2021

A classic description of the association of the signs and symptoms of the PICKWICKIAN SYNDROME was written by Charles Dickens. The author refers to "a fat and red-faced boy in a state of somnolency." This boy was subsequently addressed as YOUNG DROPSY, YOUNG OPIUM-EATER AND YOUNG BOA CONSTRICTOR—no doubt in reference to his obesity, his somnolence and his excessive appetite.

A characteristic of these patients is an extraordinary degree of somnolence in which sleep may overcome the patient while he is sitting up or even while he is engaged in conversation or other muscular activity.
? Herpes Simplex Virus in Breast Milk
Authors: Kibrick Sidney
Published: December 2021

The article by Dunkle et al (Pediatrics 63:250, 1979) describes a 6-day-old infant with oropharyngeal lesions due to primary infection with herpes simplex virus type 1 (HSV-1). Recovery of the same virus type from breast milk on day 9 suggested that the milk was the source of the infant's infection. An alternate hypothesis, that the infection was acquired during delivery and subsequently colonized the breast, was considered unlikely since the mother had neither genital nor breast lesions.
House Officer Training Programs
Authors: Geertsma M. Alex
Published: December 2021

Werner et al's recent article (Pediatrics 63:491, 1979) on pediatric intern attitudes and interpersonal skills comes at a most fortuitous time for pediatrics. It raises an educational point worth special attention, particularly in light of the report of the Task Force on Pediatric Education.1

Within the last two years, several articles and commentaries have attempted to review the efforts of pediatric educators in the biobehavioral sphere. Anders' survey of pediatric training programs2 has revealed widespread interest in the topic, and yet disappointment with the actual incorporation of behavioral and developmental knowledge in house officer education.
The Effect of Feeding on Fat Deposition in Early Infancy
Authors: Ferris Ann G. , Beal Virginia A. , Laus Mary Jane , Hosmer David W.
Published: December 2021

Trained nutritionists surveyed 92 female infants and their mothers in Western Massachusetts at monthly intervals from birth to age 6 months. A diet history, a three-day record of food intake and 11 anthropometric measurements were obtained at each home visit. Skinfold measurements showed an earlier plateau than in other published studies. There were no significant differences in fat thicknesses when infants were classified by method of feeding until age 2 months, but formula-fed infants with solids started before age 2 months had the largest mean skinfolds which peaked at age 3 months and then decreased and became similar to those of the other groups by age 5 months.
Neonatal Hotline Telephone Network
Authors: Perlstein Paul H. , Edwards Neil K. , Sutherland James M.
Published: December 2021

By simplifying the process by which telephone contacts are made, improved communications were established between a university-affiliated newborn intensive care center and some of the community hospital nurseries that it serves as a regional resource. Initiation of the improved system of communications was associated with a significant improvement in the survival of infants transferred from the community hospitals to the regional care facility.
The Effect of Posture on Ventilation and Lung Mechanics in Preterm and Light-for-Date Infants
Authors: Hutchison Alastair A. , Ross Keith R. , Russell George
Published: December 2021

The effect of right lateral, supine, and prone postures on ventilation and lung mechanics was studied in 23 healthy newborn infants, ten preterm and 13 term, "light-for-date." In the preterm group, tidal volume, minute volume, elastic work, inspiratory viscous work, total viscous work, and the total work of breathing were significantly greater in the prone position than in the supine position. Results obtained in the lateral position did not differ significantly from those in the prone or supine positions. Posture did not significantly affect tidal volume or lung mechanics in the light-for-date infants. The prone position is suggested to be the optimum nursing posture for healthy preterm infants.
Asymptomatic Bacteriuria in Adolescent Girls: I. Epidemiology
Authors: Emans S. Jean , Grace Estherann , Masland Robert P.
Published: December 2021

Because the incidence of bacteriuria in asymptomatic school girls is low (1% to 2%), we examined possible risk factors in adolescents, such as previous history of urinary tract infection (UTI) and sexual intercourse (previous and recent).

Eight (1.6%) of 500 adolescent girls were detected with asymptomatic bacteriuria (ABU). Of 47 patients reporting a previous UTI, four (9%) were bacteriuric. Two other patients detected with bacteriuria had a history of enuresis; thus 6/8 adolescents with ABU had a history that suggests a need to screen for infection. A history of sexual activity was not helpful in case detection.

Of the 500 girls, 133 had a routine pelvic examination at the time of the visit. The procedure was not associated with bacteriuria, as measured by a home nitrite test each day for three days following the clinic visit.
Anatomic Confirmation of Echocardiographic Measurements in Neonatal Hearts
Authors: Warburton David , Singer Don , Bell Edward F. , Corwin Robert , Oh William
Published: December 2021

Significant correlations were demonstrated between echocardiographic measurements of left ventricular wall thickness, right ventricular wall thickness, septal thickness, left ventricular mass, aortic valve excursion, pulmonary valve excursion, mitral valve excursion, and tricuspid valve excursion and the same measurements made directly on the same hearts at autopsy. A new regression formula was derived for the calculation of echocardiographic right ventricular mass in life and was found to correlate significantly with right ventricular mass measured as the sum of right ventricular wall and septal volumes at postmortem examination.
Primary Malignant Lymphoma Cutis in an Infant: Case Report and Review of Literature
Authors: Bhanot Pardeep , Brough A. Joseph , Ravindranath Y. , Lusher Jeanne
Published: December 2021

A 6-month-old infant with primary malignant cutaneous lymphoma is presented. The histologic differentiation between benign cutaneous lymphoid hyperplasia and cutaneous malignant lymphoma is discussed. Intensive therapy is warranted at the onset because of early dissemination and poor response to treatment after dissemination.
Hypnotically Induced Pain Control in Sickle Cell Anemia
Authors: Zeltzer Lonnie , Dash Jerry , Holland J. Paul
Published: December 2021

Recurrent painful vaso-occlusive crises often represent sources of frustration and debilitation to those afflicted with sickle cell disease. We present two adolescents with sickle cell disease who have been able to gain control over the frequency and intensity of these crises by utilizing self-hypnosis. We feel that the utilization of similar technique(s) may allow many ill children and adolescents to obtain mastery over abnormal physiologic processes concomitant with their particular disease status.
A Comparison of Absentee Rates of Elementary Schoolchildren with Asthma and Nonasthmatic Schoolmates
Authors: Parcel Guy S. , Gilman Susan C. , Nader Philip R. , Bunce Harvey
Published: December 2021

Daily school attendance has been suggested as a health status measure for children. The present study compares school absence in children known to have asthma (N = 95) with a random sample of nonasthmatic elementary schoolchildren (N = 711). The differences in average percentage of days absent over one year were analyzed by comparing both groups' conditioning on ethnicity, sex, socioeconomic status, and grade. Children with asthma have a significantly higher absentee rate (absent 8.4% of days) than do nonasthmatic children (absent 5.9% of days) (P .001). This significant difference holds true regardless of ethnicity or sex and for most socioeconomic groups. A comparison by grade level shows a similar trend for children with asthma and nonasthmatic children: absentee rates decrease as children get older; however, except for one grade level, children with asthma have a greater percentage of school days absent. Mean absentee rates for children with asthma were different when compared according to their mother's percept of severity of asthma-mild (6.9), moderate (7.9%), and severe (13.9%).
Glossoptosis Revisited: On the Development and Resolution of Airway Obstruction in the Pierre Robin Syndrome
Authors: Mallory Susan Bayliss , Paradise Jack L.
Published: December 2021

The principal complication of the Pierre Robin syndrome is glossoptotic obstruction of the airway. Many infants so affected experience stormy courses, and some eventually die.1-3 In these severe cases the most familiar clinical features are asphyxia and inanition,4 but cor pulmonale5-7 and congestive heart failure2 have also been described.

We report here a case that seems noteworthy in two major respects. First, it constitutes only the third reported instance of Pierre Robin syndrome in which cor pulmonale and congestive heart failure developed, and subsequently, following relief of upper airway obstruction, resolved. Second, the course of clinical events provided new evidence bearing on both the mechanism of airway obstruction in the Pierre Robin syndrome and the nature of its resolution with increasing age.
Preliminary Observations on the Behavior of Children Present at the Birth of a Sibling
Authors: Leonard Carol H. , Irvin Nancy , Ballard Roberta A. , Ferris Carolyn , Clyman Ronald
Published: December 2021

In an effort to shift the focus of hospital birth toward a more family-centered, natural process, an Alternative Birth Center (ABC) was opened in May 1976, at Mount Zion Hospital and Medical Center, San Francisco. Its purpose is to provide a safe, comfortable environment in which women can labor and deliver their infants.1 In order to also bring in families who would have had home births, the setting has been made as much like home as possible. Pregnant women may choose whom to have present at birth. In the ABC, as in other alternative birth settings, many parents are insisting on having their other children present at the birth of a sibling (New York Times, July 12, 1977, p 34; March 17, 1978, section 2, p 4).
Care of the Newborn in the Delivery Room
Authors: Brann Alfred W. , Cefalo Robert C.
Published: December 2021

RATIONALE

The first minutes of life may determine the quality of that life. Prompt, organized, and skilled response to emergencies in this period requires that institutions delivering maternal-infant care have written policies delineating responsibility for immediate newborn care, resuscitation, selection and maintenance of necessary equipment, and training of personnel in proper techniques. These policies should be approved by the medical staff of the hospital. Each institution should develop a list of maternal and fetal complications that require the presence in the delivery room of an individual qualified in newborn resuscitation.

The individual who delivers the baby is responsible for the immediate postdelivery care of the newborn unless another person assumes this duty. Commonly, routine care of the healthy newborn may be delegated to appropriately trained nurses.

Recognition and immediate resuscitation of the distressed infant require an organized plan of action and immediate availability of qualified personnel and equipment. In general, the individual who resuscitates the newborn should be the one who is best qualified to do so.1

Planning for the provision of such services and equipment should be carried out jointly by the directors of obstetrics, anesthesia, and pediatrics with the approval of the medical staff. A physician must be designated to assume primary responsibility for the establishment of standards of care, review of practices, maintenance of appropriate drugs, and training and evaluation of personnel. Planning must include specific identification and immediate in-house availability of qualified personnel 24 hours a day.

RESPONSIBILITY

Responsibility for identification and resuscitation of the distressed infant may rest with a physician or may be delegated to appropriately trained nurse anesthetists, labor and delivery room nurses, nurse midwives, nursery nurses, or respiratory therapists.
Medical Alternative for Students
Authors: Stuckey Allen , Puczynski Mark , Palfrey Judith S. , Hunt-Glover Jemetta
Published: December 2021

Nearly 1 million teenagers drop out of high school each year.1 The failure of our public schools to design innovative and relevant curriculum is underscored in academic and lay literature as partially responsible for the enormously high drop-out rate.2-6 "Alternative education"7,8 which allows youngsters to choose particular topic areas,

has been suggested as an approach to this critical problem.

At the English High School in Boston, a very successful alternative program called M*A*S*H (Medical Alternative for Students in Hospitals) has been in existence for four years.
HARRIET MARTINEAU AND THE MANNERS OF AMERICAN CHILDREN, AS VIEWED IN 1834
Authors: C. T. E.
Published: December 2021

Harriet Martineau (1802-1876) was an enormously popular English writer as well as a prominent figure in literary circles. A visit to America in 1834 inspired several unflattering words on the American way of life. However, her comments about the manners of American children were almost always favorable, as this excerpt will indicate.1

For my on part, I delight in the American children; in those who are not overlaid with religious instruction. There are instances, as there are everywhere, of spoiled, pert, and selfish children. Parents' hearts are pierced there, as elsewhere. But the independence and fearlessness of children were a perpetual charm in my eyes. To go no deeper, it is a constant amusement to see how the speculations of young minds issue, when they take their own way of thinking, and naturally say all they think. Some admirable specimens of active little minds were laid open to me at a juvenile ball at Baltimore. I could not have got at so much in a year in England. If I had at home gone in among eighty or a hundred little people, between the ages of eight and sixteen, I should have extracted little more than "Yes, ma'am," and "No, Ma'am." At Baltimore, a dozen boys and girls at a time crowded round me, questioning, discussing, speculating, revealing in a way which enchanted me. In private houses, the comments slipped in at table by the children were often the most memorable, and generally the most amusing part of the conversation.
Child Abuse: Least Harmful, Most Protective Intervention
Authors: Solnit Albert J.
Published: December 2021

Preventing child abuse protects children the most; and yet, tragically, there will always be some child abuse in a free society. In order to maximize the prevention of child abuse, we should provide attractive, accessible, noncoercive health (both physical and mental) and social services that strengthen parents' autonomous efforts to nurture and protect their children. Such services should include health care, counseling, homemaker and parent aide services, psychotherapy, economic and employment assistance, and developmental evaluation and guidance. Given a free choice, all parents want their children to grow up in a healthy, well-functioning way that enables them to maximize their potential.
Angel Dust: Possible Effects on the Fetus
Authors: Golden Nancy L. , Sokol Robert J. , Rubin I. Leslie
Published: December 2021

A case report of an infant whose mother used phencyclidine (PCP, "angel dust") during pregnancy is presented. As a neonate, the infant showed abnormal behavior and an unusual appearance, and later, spastic quadriparesis. Based on previous animal studies, it is likely that this infant had prolonged exposure to PCP as a fetus. His abnormal neonatal behavior was consistent with previously reported effects of this drug. The relationship between his exposure to PCP and his dysmorphology and spasticity remains speculative. It is suggested that clinicians be alert to further cases of these associations.
Child Abuse Intervention: Conflicts in Current Practice and Legal Theory
Authors: Markham Barbara
Published: December 2021

Recent litigation of child abuse cases indicates that two contradictory policies compete for court approval. One policy would reduce the amount of intervention into abusive families on grounds of privacy. The other seeks to maintain and expand channels of investigation and treatment. While attempting to prescribe a comprehensive approach to child abuse, these conflicting policies, in fact, address different problems in child protection. Without a treatment formulation that focuses on the separate issues raised by each policy, it is not clear that clinicians will be able to sustain child abuse investigatory and protective authority against the privacy attack. This treatment synthesis must entail development of standards that maximize protection of the child from caretakers at the earliest stages of risk and protection from administrative procrastination in case resolution. Protecting the child rather than the family institution should provide the central focus of policy formulation.
Bacterial Colonization of Radial Artery Catheters
Authors: Adams James M. , Speer Michael E. , Rudolph Arnold J.
Published: December 2021

In 147 radial artery catheterizations performed, blanching or embolization was noted in 10.8% of the patients. Only a single episode of catheter-related septicemia was observed (0.6%). Mean duration of catheterization was 48 ± 6 hours. Of 110 catheters cultured 25.4% grew bacteria; most organisms cultured were non-pathogenic. Duration of catheterization and intravascular infusion did not alter the incidence of catheter colonization.
Results of Four Years of Intermittent Human Growth Hormone (hGH) and Fluoxymesterone Therapy in Hypopituitary Dwarfism
Authors: Kirkland Rebecca T. , Harrist R. B. , Clayton George W.
Published: December 2021

In order to investigate the synergistic effect on growth of human growth hormone (hGH) and an anabolic agent, fluoxymesterone, 28 children with hypopituitarism received the combined therapy in an intermittent regimen for one to four years. Fourteen of the children had received prior therapy with growth hormone alone. All of the children were prepubertal. They had a mean chronologic age (CA) of 9.53 years ± 2.33 SD and mean bone age (BA) of 6.05 years ± 2.07 SD. The change in BA/change in height age (HA) ≤1 in 15 of the 28 children (53.6%). The change in HA/change in CA was ≥1 in 17 of 28 (60.7%). The 14 children who had received hGH therapy alone, group A, had a growth velocity of 4.72 cm/yr ± 1.24 SD in the year prior to the combined treatment. This did not differ significantly from the average growth velocity of 5.58 cm ± 1.47 SD during the first year of combined therapy. The average growth velocity of the remaining 14 children, group B, during the first year of combined therapy was 6.72 cm/yr ± 1.01 SD. This differed significantly from the growth velocity of group A before combined therapy (P < .001) and also during the first year of combined therapy (P < .025). The overall mean growth rate in the second year, 5.33 cm, was less than that of the first year, P < .025, and was not different from that achieved with hGH alone. Furthermore, the velocity in each of the following years was similar to that of the second year. The use of intermittent combined therapy in the doses employed in this study does not appear to be of benefit in prolonging catch-up growth in hypopituitary patients. This regimen provides acceleration of growth in the initial year of therapy for those children who have not received prior hGH therapy.
THE FIRST MENTION OF TIC DE SALAAM IN AMERICAN MEDICAL LITERATURE (1896)
Authors: C. T. E.
Published: December 2021

I believe the following description of tic de salaam, or infantile spasms, published in 1896, was the first mention of this condition in American medical literature.1

A convulsive form of disease, little known and but rarely described...is the form of epilepsy known to the French writers as Tic de Salaam, a condition which is observed almost exclusively in first infancy. Text-books of pediatrics in the English language contain no reference to it, either under this name or any other. Two or three cases which have recently come under the observation of the writer prompt him to a few remarks anent this condition.

In the forms usually observed, the disease is made up of a series of rapid, oscillating movements of the head and superior part of the body (spasmus salutans), which occur with a rapidity varying from 10 to 30 times per minute. In some instances, during the height of the attack, the upper extremities are shot into the air, and for the moment remained fixed, while the eyeballs are rolled up, and the face has a fixed, non-expressive appearance. Whether or not consciousness is entirely lost during this period cannot be said with certainty—first of all, because of the tender age of the patient, and secondly, because the rapid, fluctuating movements prevent the patient from answering or communicating. In marked contrast to the ordinary epileptic convulsions, whether they be of the "petit mal" or "grand mal" form, is the absence of any warning, and the rapidity with which the little sufferer regains his composure after an attack—that is, there seems to be none of the customary drowsiness, stupidity and desire to be left severely alone, as after an attack of epilepsy....
Syngeneic Bone Marrow Transplantation in a Patient with Metastatic Neuroblastoma Refractory to Conventional Therapy
Authors: Spruce Wayne E. , Blume Karl G. , Ellington Owen B. , Schmidt Gerhard M. , Zusman Jaime
Published: December 2021

A child with metastatic neuroblastoma refractory to conventional chemotherapy was treated with lethal doses of chemotherapy and total body irradiation followed by syngeneic bone marrow transplantation. A complete remission was achieved. However, the tumor recurred after six months, and the patient succumbed to disseminated neuroblastoma nine months after marrow grafting.
DR WILLIAM A. ALCOTT ON MATERNAL DOSING AND DRUGGING AS THE MAJOR CAUSE OF INFANT MORTALITY IN 1854
Authors: C. T. E.
Published: December 2021

Among the most outspoken of American health reformers of the mid-nineteenth century was Dr William A. Alcott of Boston. The health reformers offered an alternative to a public dissatisfied with the heroic practice of most physicians of this period by emphasizing that the individual had it in his or her own power to keep all members of the family in good health by forgoing most of the drugs prescribed by allopathic physicians.

Alcott1 was particularly concerned with the huge extent of infant mortality caused by "maternal dosing and drugging." He wrote:

But whether ignorant or somewhat enlightened, the vast majority of our mothers doctor, more or less, their own children. At least, if they refuse to call it doctoring, they give them a vast amount of small elixirs, cordials, etc. The closets of not a few house-keepers are a complete apothecary's shop. They may, it is true, have smaller parcels then the regular apothecary; but they have almost as great an assortment. And they not only keep it; they administer it. They may not intend it; they do not mean to give much; sometimes they really think they do not give much. But it comes to pass, in the course of the year, that much is given by somebody; and I greatly fear that the mother must be held responsible for it....

But now for the consequences of this maternal dosing; for this it is with which medical men have chiefly to do. Next to bad food and wretched cookery, as I have before intimated, this error is productive of more sickness and premature death than any other.
Hepatic Monoamine Oxidase Deficiency in Reye Syndrome
Authors: Mitchell Robert A. , Arcinue Edgardo L.
Published: December 2021

Faraj et al1 recently reported a positive correlation between plasma tyramine levels and the number of days in coma, for patients with biopsy-proven Reye's syndrome. They suggested that the mitochondrial injury might have a disruptive effect upon hepatic monoamine oxidase, with a subsequent decrease in clearance of tyramine. We have reached a similar conclusion on the possible role of tyramine in the development of the encephalopathy, based on the finding that the hepatic monoamine oxidase activity was reduced about 60% in stage V Reye's syndrome patients.
Hyperlipidemia Screening Is Worthwhile
Authors: Freis Peter C.
Published: December 2021

Neil A. Holtzman, MD (Hyperlipidemia screening: A search for heffalumps. Pediatrics 64:270, 1979) writes persuasively discouraging hypercholesterolemia screening and therapy in childhood. His commentary would easily dissuade the primary physician from appropriate intervention on his pediatric patients' behalf to minimize every coronary risk factor. The author unfortunately pays little attention to the children who would benefit most from hypercholesterol screening, those with a family history of premature cardiovascular disease. This is misleading. We must redirect our thinking to a continued effort to seek and minimize more appropriately coronary risk factors.
All Is Well in Perinatal Land
Authors: Grossman Lindsey K.
Published: December 2021

Dr William A. Silverman's review of the career of Dr Martin A. Couney1 as an exhibitor of premature infants in the late nineteenth and early twentieth centuries was interesting. I found it difficult to imagine, however, how this exploitation was permitted to go on as long as it did.

I am even more amazed at Dr Silverman's concluding remarks. Although I agree that there is indeed a "disturbing detachment from reality" present for parents, patients, and staff in today's intensive care nurseries, I heartily disagree that, when compared with the technical energy expended to save the child's life, no similar "effort is mounted to deal with the enormous problems which face the graduate at home and in the community."1
Letters to the Editor
Authors: Silverman William A.
Published: December 2021

For my peace of mind (and for the readers of Pediatrics) I fervently hope that Dr Grossman can demonstrate that my fears are groundless and my criticism unjustified. But we will need more than the bland assurances he makes in his letter.

I will be looking for something in the nature of an "environmental impact report" to document his implied claim that all is well in perinatal-land. Present-day actions in this field of medicine create public policy—unreviewed and unlegislated.
They Don't Do Very Well
Authors: Wallace Sheila J.
Published: December 2021

I have read the article by Nelson and Ellenberg (Pediatrics 61:20, 1978) on febrile convulsions with considerable interest and cannot agree with Dr J.W. Freeman (Pediatrics 61:806, 1978) that they show "these children do well—even without therapy." Nelson and Ellenberg's study did not record prophylaxis with anticonvulsants, and they are therefore not able to know whether those children who were at greatest risk of further seizures had them prevented.

In their initial report, Nelson and Ellenberg1 found that 22% of the whole group of 1,706 children were neurologically suspect or abnormal prior to their first fit, but they do not say how many of the children who did not have convulsions were considered other than normal at comparable ages.
New Use of a Metal Detector
Authors: Lewis S. Robert
Published: December 2021

I offer my recent observation on a new technique for following the passage of a coin through the digestive tract. Several months ago I was called by a distraught mother who informed me that her 7-year-old daughter had just swallowed a quarter. X-ray did reveal the coin located in the stomach. I reassured the family informing them that it would pass through in the next few days. After about two weeks of stool gazing and nonpassage the child was x-rayed again, and to my dismay I noted that the coin had not budged and less reassuringly sent them home to await passage of the pesky coin.
Hypertension and Hematuria Secondary to Parapelvic Cyst
Authors: Chan James C. M. , Kodroff Michael B.
Published: December 2021

A parapelvic cyst is a well encapsulated collection of fluid outside of the renal parenchyma. It may give rise to urinary tract obstruction. Such a cyst at the renal pelvis may cause localized hydronephrosis, cortical thinning from intrarenal compression, and secondary hypertension remediable by surgical correction. However, to our knowledge, such a case has not been previously reported in the pediatric literature.

CASE REPORT

An 8-year-old black boy was evaluated for asymptomatic microscopic hematuria of six months' duration. There was no history of renal or cardiovascular diseases or of hypertension in the family. Blood pressure, which was 100/60 mm Hg initially, rose to 140/94 mm Hg at six-month follow-up visit.
Progress in Phenylketonuria: Defects in the Metabolism of Biopterin
Authors: Berlow Stanley
Published: December 2021

Although progress in a major biological frontier, the neurosciences, has been both rapid and broadly based, it has offered little to the practical pediatrician. Some recent reports may forecast a change. Careful study of an old subject, phenylketonuria (PKU), has opened up a new area of research that has great potential significance.

Five years ago in London, Smith et al1 described three children with "PKU" who had an unusual clinical course. Despite early diagnosis and treatment with a low phenylalanine diet, these patients developed progressive neurological disease and died. The atypical course, a high tolerance for phenylalanine, and normal phenylalanine hydroxylase activity on liver biopsy in one of the children led them to the astute speculation that this syndrome was a new form of "hyperphenylalaninemia" probably due to a defect in the metabolism of biopterin.
Infant Apnea Syndrome
Authors: Lewak Norman
Published: December 2021

Enough is enough! I protest the continued use of the inaccurate diagnostic abomination, "Near Miss for Subden Infant Death Syndrome Infants," as found on page 369 of your September 1979 issue. The predictable result of using that unfortunate term is found on the cover of that issue—the babies were "promoted" from "near miss" to just plain "sudden infant death syndrome infants."

The "Infant Apnea Syndrome" is long overdue. You, I am certain, understand the consequences of connecting by nomenclature all the infants with SIDS and all the infants with severe apnea (and thus with apnea monitoring).
Who Gives Nutritional Advice? Who Follows It?
Authors: Barness Lewis A.
Published: December 2021

Nutritional advice is rampant. Nutritional books, nutritional articles, specialty magazines, health food stores, and weight reduction institutes all give advice. Proposed national dietary guidelines have been published and more are likely to follow. Some respite from the flood may occur following a lawsuit against the estate of Adele Davis and her publishers following the death of an infant who was treated by his parents according to information they gleaned from one of Adele Davis' books.

Many reasons have been given for the proliferation of "nutritional experts." Hard data, easily verifiable, are hard to obtain. The minimal needs for vitamins and minerals can be verified in animals and confirmed by elimination of disease symptoms.
Prophylaxis and Treatment of Neonatal Gonococcal Infections
Authors: Segal Sydney , Anyan Walter B. , Hill Reba M. , Kauffman Ralph E. , Mofenson Howard , Pruitt Albert W. , Shinefield Henry R. , Singer Harvey S. , Weinberger Miles M. , Brann Alfred W. , Hall Robert T. , Harper Rita G. , Little George A. , Maisels M. Jeffrey , McCracken George H. , Poland Ronald , Sunshine Philip , Whittinghill John A. , Mortimer Edward A. , Fulginiti Vincent A. , Brunell Philip A. , Calderon Ernesto , Cherry James D. , Ector Walton L. , Gershon Anne A. , Gotoff Samuel P. , Hughes Walter T. , Peter Georges
Published: December 2021

The Center for Disease Control (CDC), after consultation with a panel of experts, has revised its recommendations for prevention of gonococcal ophthalmia neonatorum. These recommendations now state, "ophthalmic ointment or drops containing tetracycline or erythromycin or a 1% silver nitrate solution" are effective and acceptable.1-3 This is a change from previous recommendations which highlighted silver nitrate as the primary agent for prophylaxis.4 The American Academy of Pediatrics' committees support these recommendations.

The prevalence of largely asymptomatic genital gonococcal infection in pregnant women and the occurrence of gonococcal ophthalmia in untreated infants (estimated at 28%)5 born to infected women indicate the need for continued prophylaxis for all newborn infants.
Nasal CPAP and Work of Breathing Study Questioned
Authors: Kattwinkel John
Published: December 2021

The paper by Goldman et al (Pediatrics 64:160, 1979) comparing the mechanics of breathing in neonates treated with nasal vs mask continuous positive airway pressure (CPAP) recommends that, since nasal CPAP appeared to increase the work of breathing, "other methods be considered for the delivery of CDP (continuous distending pressure)." As a strong proponent of nasal CPAP, I would like to express several concerns with the study and its interpretation.

First, according to the authors' drawing, the nasal device used for the study had been modified with a PE 20 sampling catheter inserted through one of the prongs.
Home Monitoring of Infant at Risk for Apnea
Authors: Berger Lawrence R.
Published: December 2021

Home monitoring of infants at risk for severe apnea involves considerations of monitor technology, patient selection, family dynamics, and medical support. The commentaries by Drs Nelson, Stark, et al, and Lucey of the article by Kelly, Shannon, and O'Connell (Pediatrics 61:511-514, 1978) all focus on the issues of monitor fallibility and limitations in predictive testing of at-riskness. Kelly et al state that "our experience indicates that supervision of home monitoring should include 24-hour availability of medical, technical, and counseling assistance."
Age and Blood Pressure
Authors: Krovetz L. Jerome
Published: December 2021

This is written in corroboration of a recent editorial by Dr Forrest H Adams on blood pressure in children in the United States. Dr Adams stated that "the blood pressure should remain stable for life in the absence of disease.... The normal aging process is unaccompanied by an increase in blood pressure."

In 1972, we published a study on hemodynamic data1 obtained on normal subjects undergoing cardiac catheterization. A total of 365 normal subjects, 1 day to 69 years of age, were analyzed.
Evaluation of Perinatal Care Education Programs
Authors: Hein Herman A. , Ferguson Norma N.
Published: December 2021

Dr Kattwinkel, et al,1 are to be congratulated on their approach to improved perinatal care in rural community hospitals. They state that their study "represents the first attempt to systemically examine the problems hindering the delivery of optimal perinatal care in the community hospital and then to design a program around these problems."

In June 1975, we published an article in this journal describing "an evaluation of perinatal care practices in Iowa community hospitals."2 The evaluations were accomplished by a perinatal team during visits to the hospitals.
Letters to the Editor
Authors: Krishnamoorthy K. S. , Shannon D. C.
Published: December 2021

We are pleased that Dr Miller agrees with the main conclusion of our report that the prognosis for newborns with intraventricular hemorrhage is not a hopeless one. Knowing this outcome we, like Dr Miller, also wish to know more precisely the other factors that contribute to poor outcome. This can only be determined by quantifying neurodevelopmental status as a part of a carefully controlled prospective study.
Posthemorrhagic Hydrocephalus in the Preterm Infant
Authors: Chaplin Edward R. , Goldstein Gary W. , Myerberg David Z. , Hunt Jane V. , Tooley William H.
Published: December 2021

Between 1969 and 1978 we treated 22 low birth weight infants for delayed onset posthemorrhagic hydrocephalus. All developed clinical signs of hydrocephalus after 2 weeks of age. The diagnosis was determined in 12 infants before August 1974, and they were treated by surgical placement of a shunt. In the ten infants born after September 1974, an attempt was first made to control the hydrocephalus with repeated lumbar puncture and diuretics prior to placing a shunt. In seven of the ten the hydrocephalus was successfully arrested by medical therapy alone. Follow-up assessments at 1 to 8 years of age were done on 18 infants. Two of the 12 treated by permanent shunts and three of six treated medically had an IQ score of 85 or greater. These results indicate a poor long-term outlook for the low birth weight infant who develops clinically overt hydrocephalus after intracranial bleeding.
LEUKEMIA AND RADIATION
Authors: Miller Robert W.
Published: December 2021

A report of leukemia incidence in a cohort of atomic-bomb survivors in Hiroshima and Nagasaki, 1950-1971, has revealed that the larger the exposure dose and the younger the age at exposure, the greater was the rate of leukemia and the shorter the interval to occurrence (Ichimaru M, Ishimaur T, Belsky JL: J Radiat Res 19:262-282, 1978). Chronic granulocytic leukemia passed its peak occurrence in all age groups within ten years of exposure, the peak being greater among persons who were under 15 years of age at the time of the bomb (ATB). The excess was exhausted by the 15th year after exposure among them and among the next older cohort (15 to 29 years ATB).

Acute leukemia peaked soonest among persons exposed under 15 years of age ATB, and progressively later in successive age groups. Each peak was of similar amplitude, but the decline in rates was slower as age ATB increased. After childhood exposure, the excess was no longer discernible 15 years after the bomb, but persisted among older groups more than 25 years after exposure, in proportion to their age at the time of the bomb.

The vast majority of the excess involved nonlymphocytic leukemia, except among persons exposed before 20 years of age (12 cases), as compared with persons above this age (four cases). Thus, age is very much related to susceptibility and the type of leukemia that is induced by radiation exposure.
Rubella Immunization: Present Status and Future Perspectives
Authors: Krugman Saul
Published: December 2021

Sixteen years have elapsed since the last major epidemic of rubella in the United States. Prior to 1964, extensive outbreaks occurred at about six- to nine-year intervals. These outbreaks were associated with the birth of many thousands of infants with one or more of the following defects: cataracts, deafness, cardiac malformations, and brain damage causing mental retardation, cerebral palsy, or severe behavior disorders. In addition, many pregnancies were terminated by spontaneous or therapeutic abortions. This devastating "rubella problem" provided the motivation for the development of rubella vaccine.

The live attenuated rubella vaccine was licensed for use in 1969—two to four years before the next anticipated epidemic.
Nasal Prongs and Work of Breathing
Authors: Cats B. P.
Published: December 2021

The subject of the article by Goldman et al1 is without doubt a highly interesting one to which our attention had been drawn a few years ago. We became aware of the fact that, although most of our neonates treated with continous positive airway pressure (CPAP) did well, some seemed to become exhausted very quickly by the apparently increased work of breathing. They developed an extreme metabolic acidosis and subsequent need for mechanical ventilation.

It is known from exercise physiology that during the early phase of exercise, anaerobic processes supply part of the energy-need.
Neonatal Infection and White Blood Cell Count
Authors: Töllner U. , Pohlandt F. , Kleinhauer E.
Published: December 2021

There are some new interesting aspects in the paper of Squire, Favara, and Todd.1 The authors liked to mitigate the enthusiasm for the prospective use of WBC parameters in the diagnosis of infection of the newborn infant. Twenty percent infected newborns and even 13% of fatal cases in their series had totally normal hematologic studies. These data are inconsistent with some previously published results.2,3 Kuchler et al2 found in all but one case of their series (n = 29) of neonatal septicemia an abnormal high relative count of band cells.
Grommets Don't Work
Authors: Fox A. Mervyn
Published: December 2021

I would like to draw to the attention of readers of the paper by Donaldson ("Surgical Management Eustachian Tube Dysfunction and its Importance in Middle Ear Effusion," Pediatrics 61:6774-6777, 1978) a recent report by Brown et al (Brown MJKM, Richards SH, Ambegaokar AG: "Grommets and Glue Ear—A Five-Year Followup of a Controlled Trial," J R Soc Med 71:353-356, 1978) in which the results of management of seromucinous otitis media were studied in 60 matched pairs of ears by drainage in one ear and conservative management in the other.
Should Emphasis Be on Monitoring or Diagnosis
Authors: Herbst John J. , Bray Patrick F. , Book Linda S.
Published: December 2021

The article by Kelly et al1 is an accurate description of the symptomatic treatment and outcome of this distressing problem. We feel that such an approach should clearly be the last resort, and it is unfortunate that a need for a specific diagnosis was not stressed.

The authors do not clearly indicate the evaluation of these patients. Some patients had episodes of transient airway obstruction with apnea. The authors also indicate that some patients had clinical evidence of seizure disorders but they do not clarify whether all of these patients had EEG findings consistent with epilepsy.
Control of Oxygenation during the Transport of Sick Neonates
Authors: Miller Carol , Clyman Ronald I. , Roth Robert S. , Sniderman Susan H. , Ballard Roberta A. , Henning Douglas , Riedel Philip , Rosen Alan , Burden Linda
Published: December 2021

A safe neonatal transport system is an essential component in the regionalization of perinatal care. Despite efforts to provide continuous intensive care to sick infants during transport,1-5 several studies have revealed an increased morbidity and mortality among infants transported to newborn intensive care units (NICU) compared with those infants born at the NICU.6,7 There is little information available about the adequacy of monitoring and maintaining oxygenation and acid-base status during infant transport. In a preliminary study we examined the ability of a neonatal transport team to maintain an infant's Pao2 (46 to 100 torr), pH (7.25 to 7.55), and Paco2 (20 to 50 torr) in the "physiologic" range during transport.
Giant Retroperitoneal Lipoma in Children
Authors: Sullivan Walter G. , Wesenberg Richard L. , Lilly John R.
Published: December 2021

Giant retroperitoneal lipoma is an unusual and benign tumor in children. Characteristically, afflicted patients are seen with only an abdominal mass and thus enter into the diagnostic mix of intra-abdominal tumors of childhood. Two recent patients treated at our institution represent the 13th and 14th reported cases of retroperitoneal lipoma in children and demonstrate that there are distinct diagnostic criteria for the lesion which, if appreciated, obviate the need for a prolonged and detailed investigation.

CASE REPORTS

Case 1

The mother of a 4-year-old girl reported that an abdominal bulge had been present in her child since she was a toddler. The mass was firm, immobile, and mainly in the left lower abdomen but extending past the midline.
Acute Mercury Poisoning After Polyvinyl Alcohol Preservative Ingestion
Authors: Seidel James
Published: December 2021

Polyvinyl alcohol preservative (PVA) is used routinely in the laboratory for collection of specimens for examination for ova and parasites.1-4 PVA, presently used at Harbor-UCLA Medical Center, contains: 4.5% mercuric chloride, 5% polyvinyl alcohol, 30% denatured alcohol, 4.5% acetic acid, and 1.5% glycerin in an aqueous solution. The kit, as shown in the Figure, contains three bottles with 10-ml aliquots of PVA, wooden sticks for mixing the specimen, and written instructions for collection of the specimens. The bottles are clearly labeled as poison in English and Spanish, and specific verbal as well as written instructions are given to patients and their families when the ova and parasite kits are dispensed.
Letters to the Editor
Authors: Volpe Joseph
Published: December 2021

Dr. Knight's letter questions the predictive value of the neonatal neurologic examination. It states that the neurofindings of Nelson and Ellenberg (Pediatrics 64:225, 1979) indicate a high false-positive rate for the relation between an abnormal neonatal neurologic examination and subsequent neurologic abnormality (ie, "cerebral palsy"). Because of this, Dr Knight indicates that "many would interpret the data as questioning the predictive value of the neonatal neurologic examination."

I would disagree with such an interpretation of the Nelson and Ellenberg data for several reasons.
Vegetarianism and Breast-feeding
Authors: Dillard Robert P.
Published: December 2021

In their article, Shull et al1 imply that the mode of breast -feeding is causally related to the observed differences in growth velocity. They do this even though: (1) no food intake data were obtained on the breast fed infants; (2) type of supplemental feeding received by breast-fed infants older than 6 months was unknown; (3) maternal nutritional status while nursing was unknown; (4) measurements of the child's nutritional status other than growth velocity were not made; (5) dietary disparities appeared present within macrobiotic and nonmacrobiotic groups; (6) parental socioeconomic class was not evaluated.
Efficacy of Rifampin in Eliminating Pharyngeal Carriage of Haemophilus influenzae Type b
Authors: Shapiro Eugene D. , Wald Ellen R.
Published: December 2021

Household contacts less than 6 years of age of children with Haemophilus influenzae type b meningitis are at increased risk of developing systemic H influenzae type b disease. Positive oropharyngeal cultures for H influenzae type b were found in 17/97 patients (18%) and 7/62 staff members (11%) at a chronic care facility at which two patients had developed ampicillin-resistant H influenzae type b meningitis. H influenzae type b colonization was eliminated in 8/9 carriers treated with a single daily oral dose of rifampin, 20 mg/kg/day (maximum 600 mg) for four days; colonization persisted in 9/10 control subjects (Fisher's exact test P < .001; corrected X2 P < .005). After treatment of additional H influenzae type b-positive individuals and the remaining control subjects, rifampin was found to have eradicated H influenzae type b in a total of 24/25 carriers (96%). All isolates of H influenzae type b were sensitive to rifampin at either 0.5 or 1.0 µg/ml. Rifampin is effective in eliminating the H influenzae type b carrier state and may be useful in preventing associated H influenzae type b disease in close contacts of children with H influenzae type b meningitis.