bluuebunny/crossref_metadata_2025 huggingface dataset:
Chloral Hydrate and the Carbon Dioxide Chemoreceptor Response: A Study of Puppies and Infants
Authors: Lees Martin H. , Olsen George D. , McGilliard Kip L. , Newcomb James D. , Sunderland Cecille O.
Published: December 2021

CO2 chemoreceptor function was assessed during natural sleep and following the administration of 100 mg/kg of chloral hydrate to 26 puppies. With chloral hydrate-induced sleep, there were no significant changes in ventilation or in CO2 chemoreceptor response. The ventilation and CO2 chemoreceptor response of a group of infants in natural sleep were compared with those of a group receiving 50 mg/kg of chloral hydrate. Tidal volume, O2 consumption, and CO2 elimination were slightly higher in the group given chloral hydrate. There was no difference in the CO2 chemoreceptor response. The proportion of time spent in rapid eye movement (REM) and non-rapid eye movement (NREM) sleep in chloral hydrate-induced sleep was similar to that occurring in natural sleep. Use of chloral hydrate stabilizes O2 consumption and CO2 production, and it greatly facilitates the assessment of chemoreceptor function in infants. The CO2 chemoreceptor response appears not to be altered in puppies or infants.
BOREDOM
Authors:   Student
Published: December 2021

Boredom kills, and those it does not kill, it cripples, and those it does not cripple, it bleeds like a leech, leaving its victims pale, insipid and brooding. Examples abound...

Television, the one-eyed beast blamed for scourges ranging from immorality to declining college-admission test scores, has probably helped bring home boredom to America. It has done so by offering us a splendidly wrongheaded view of how one goes about living the good life...

Boredom, at the very least, helps breed some of America's uglier social trends. The rate of teenage suicide has more than tripled in the United States since 1955, and psychiatrists across the country lay part of the blame to boredom born of unrealistic expectations and frustration. Divorce condemns nearly half of all marriages, and marriage counselors report boredom as a major cause. Drug and alcohol abuse—which has increased more rapidly in the past decade among middle and upper-class teenagers than among the less wealthy—is caused, in part, by the need to kill time.
PROLONGED YOUTH
Authors:   Student
Published: December 2021

Over the past twenty years a phenomenon called "youth" has supplanted the period once known as adolescence. The latter was an interlude within one's teens, in which those called adolescents awaited adulthood. It was often a painful span of years, with anxieties over acne and "being popular." It typically had some minor rebellions, largely involving being home by midnight. Indeed, adolescents usually couldn't wait to become adults. "Youth" is a much longer period, starting earlier and extending well into the twenties. And it is skeptical, even cynical, about the lives adults lead. In fact, youth may best be seen as a separate country, in which young people take out citizenship. That nation has a culture of its own which now reaches every hamlet.
Letter to the Editor
Authors: Greer Frank R. , Reeve Lorraine E. , Chesney Russell W. , DeLuca Hector F.
Published: December 2021

We would like to thank Little and Chadwick for their comments. It is true that the vitamin D content of human milk is very low, supplying less than the daily recommended dietary allowance. As observed by Chadwick, the vast majority of full-term breast-fed infants at present do not develop rickets despite the lack of vitamin D supplementation. While we would agree with Little that rickets does occur in breast-fed infants, we cannot confirm or deny his observation that the majority of full-term infants who develop rickets at the present time are breast-fed.
Letter to the Editor
Authors: Bureau Michel A.
Published: December 2021

The valuable comments of Christoffel are much appreciated. It is said that newborns do adapt to carboxyhemoglobin poisoning (from smoking) by increasing their hemoglobin concentration in blood. Recently, we have further explored the adaptability of newborns to maternal smoking by a study of oxygen dissociation curves in newborns of smoking mothers. Our preliminary results showed that the newborn adapts to maternal and fetal increases in HbCO by a very small left shift in the Hb-O2 dissociation curve and by an increase in hemoglobin.1
Breast Milk and Fluoride
Authors: Leparulo Yolanda A.
Published: December 2021

It is recommended that full fluoride dosage (0.25 mg/day) be given to babies that are completely breast-fed (regardless of local water fluoride content) because significant amounts are not passed in breast milk. However, if the infant drinks "some" fluoridated water how much is significant to affect the safety of exogenous fluoride dosage?

I have not seen this question referred to in the literature. Calculations are shown in the Table.

See table in the PDF file

Based on these calculations, if an infants drinks approximately 8 oz per day of 1 ppm of water, no fluoride should be used.
Letter to the Editor
Authors: Silverman William A.
Published: December 2021

The Denver group is to be congratulated for making a start in efforts to respond to the needs of families who wish their malformed or extremely premature infants to die humanely. And it is reassuring to read that "staff members find their involvement extremely gratifying and rewarding."

I suggest that they have a strong obligation to demonstrate that their "managed" approach1 is "gratifying and rewarding" to all (or even most) families who must go through this harrowing crisis in their lives.
Neonatal Fever
Authors: Huston Tim P.
Published: December 2021

Credit is due Voora et al1 for their timely study of a nebulous clinical situation; fever in the newborn. However, I must question their conclusions. Apparently the major factor leading to a work-up for bacterial disease (BD) in the neonates was fever (with or without accompanying signs). They mention only one nonfebrile neonate (out of 9,992) for whom a work-up for BD was done (although they imply that more work-ups were actually done). Hence, it comes as no surprise that fever was found to be highly sensitive in detection of BD.
Penicillin and Acute Rheumatic Fever
Authors: Boxerbaum Bernard
Published: December 2021

Introduction of secondary prophylaxis for patients with rheumatic fever is felt to be a major reason for improved prognosis of rheumatic heart disease.1,2(p163) The article by Ginsburg et al,3 raising questions concerning the efficacy of this practice, has prompted me to report our experience in the Rainbow Rheumatic Fever Clinic, Rainbow Babies and Childrens Hospital, where more than 80% of the patients receive 1,200,000 units of benzathine penicillin intramuscularly every 28 days. Seventy percent of the patients with rheumatic mitral regurgitation have lost their murmur, and no patient receiving regular intramuscular prophylaxis has developed stenosis.4
A Prospective Comparison of Urinary Tract Infections in Patients Treated with Either Clean Intermittent Catheterization or Urinary Diversion
Authors: Ehrlich Owen , Brem Andrew S.
Published: December 2021

Clean intermittent catheterization (CIC) has replaced urinary diversion as the treatment of choice for patients with neurogenic bladder. Yet, no well controlled studies are available assessing the efficacy of CIC over ileal loop diversion (ILD). Consequently, a one-year pospective study was carried out comparing short-term patient morbidity, infection rates, and bacterial organisms in 33 children with meningomyelocele. Twenty-four of the children were treated with CIC whereas nine children had an ILD. A minimum of four cultures per year were obtained on each patient. Patients maintained on CIC had 36.8% of their cultures positive for bacteriuria whereas children with ILD had 61.8% of their cultures positive (P < .001). The incidence of bacteriuria associated with clinical signs and symptoms was similar in both groups. Four of 24 children treated with CIC had sterile urine whereas none of the children with ILD were persistently free from bacteriuria. Only five of 24 children receiving CIC had 50% or more of their cultures positive as contrasted with seven of nine children with an ILD (P < .01). Escherichia coli accounted for approximately one third of organisms recovered from infected urine in both groups. Although the short-term morbidity associated with both treatment modalities is similar, the incidence of asymptomatic bacteriuria in children maintained on CIC is significantly less than in children with ILD. Whether this factor plays a role in determining long-term morbidity is a subject for further study.
Another Myth: Reduced Hospital Visiting by Inner-City Mothers
Authors: Blitzer Eleanor Crawford , Zuckerman Barry , Pozen Janet T. , Blitzer Peter H.
Published: December 2021

Hospitalization of young children produces stress that can be reduced by the presence of a parent. Inner-city parents, however, are generally believed to visit the hospital less often than more affluent parents. At Boston City Hospital pediatric nursing and medical staff (N = 60) were surveyed to obtain their impressions of maternal visiting and its determinants; then 80/94 consecutive admissions of children less than age 5 years were surveyed to record the mothers' actual visiting times. Each mother was interviewed to determine sociodemographic status, her perception of her child's behavior, and her perception about visiting. The staff believed that few mothers (20%) would visit more than 4 h/d, but the study showed that nearly three times this many mothers did visit more than 4 h/d. The median visit length was five hours, and 20% of the mothers roomedin at least once. Contrary to staff expectations, neither job nor child care responsibilities were related to visit length. Mothers who thought visits helped their children visited longer (10.6 v 5.3 hours, P < .001). Contrary to staff beliefs, most inner-city mothers successfully overcame external and emotional barriers to visiting their hospitalized children. Staff input and an educational effort might facilitate longer visits by the one third of mothers who did not recognize the importance of their visiting their children.
Long-Term Influence of Calcitriol (1,25-Dihydroxyvitamin D) and Supplemental Phosphate in X-Linked Hypophosphatemic Rickets
Authors: Chesney Russell W. , Mazess Richard B. , Rose Philip , Hamstra Alan J. , DeLuca Hector F. , Breed Alan L.
Published: December 2021

Ten patients with hypophosphatemic rickets (eight with X-linked familial form) were treated with vitamin D2 (10,000 to 75,000 units per day) and oral phosphate (1.5 to 3.6 gm) for a total of 438 treatment months. Therapy was then changed to calcitriol (17 to 34 ng/kg/day) and the same phosphate dose. Patients served as their own controls, and significant biochemical changes noted were an increase in immunoreactive parathyroid hormone from 29 ± 9 (SD) µlEq/ml (pre-phosphate) to 62 ± 34 on vitamin D2 plus PO4, then decreasing to 40 ± 20 on a regimen of 1,25-dthydroxyvitamin D (1,25(OH)2D) plus PO4; serum PO4 rose from 2.44 ± 0.45 (SD) mg/100 ml to 3.06 ± 0.79 and then to 3.43 ± 0.76; alkaline phosphatase activity decreased from 677 ± 298 (SD) UI/liter to 457 ± 183 to 290 ± 176. Serum calcium and creatinine levels were unchanged. Both urinary calcium excretion and caicium-creatinine ratio decreased after therapy with 1,25(OH)2D. Urinary phosphate excretion was higher after calcitriol administration. Serum 1,25(OH)2D levels were low in these vitamin D2-treated patients, and an inverse relationship between serum 25(OH)D and 1,25(OH)2D was found. Improved bone mineralization was evident from serial assessment by photon absorptiometry, and radial bone mineral content rose from 75.3% ± 2.2% of expected to 82.2% ± 1.4% (P < .005). Stature was improved when assessed by standard deviation for chronologic age but did not reach statistical significance. Long-term 1,25(OH)2D plus phosphate therapy appears to be more efficacious than vitamin D2 in this form of rickets, particularly in improving phosphate homeostasis.
International Symposium on Measles Immunization: Summary and Recommendations
Authors: KATZ SAMUEL L.
Published: December 2021

The passage of 20 years since the first International Conference on Measles Immunization in November 1961 has been accompanied by very significant advances in our understanding of the impact of measles among different groups, in the development and the utilization of measles vaccines, and in the control of the disease. Throughout all these considerations, there remains great variability. This is manifest in the surveillance data on morbidity and mortality, the extent of vaccine utilization, and the attitudes about measles as a serious public health problem. Because of these variations it is obvious that any recommendations must be evaluated carefully and adapted appropriately to meet the needs of a given nation, a population group, a geographic locale, or an environmental setting.
New Developments in Cardiopulmonary Resuscitation
Authors: ROGERS MARK C.
Published: December 2021

The concern of pediatricians with resuscitation is an ancient and honorable tradition, which traces its roots directly back to the Bible. In the Book of Kings, it is recorded that Elisha revived a male child, "putting his mouth on his mouth, his eyes upon his eyes and his hands upon his hands; and he stretched himself upon him, the flesh of the child became warm." From this base, resuscitation developed slowly over the centuries, moving from folk medicine resuscitation techniques such as suspending drowning victims upside down or rolling them over a barrel to the more scientific approaches which began in the middle of the 19th century.
Russell-Silver Syndrome and XXY Karyotype
Authors: BIANCHI ELENA , ARICO' MAURIZIO , SEVERI FRANCESCA , PASQUALI FRANCESCO
Published: December 2021

To the Editor.—

In 1974, we reported1 a 3-year 7-month-old boy with Russell-Silver syndrome and a 47,XXY karyotype. We considered it very likely that the XXY condition was a coincidence. Recently, we have observed a second patient with Russell-Silver syndrome and a 47,XXY karyotype. The patient's age is 1 year 10 months. The diagnosis was based on the infant's small size at birth (birth weight 1,750 g) despite being born at term, triangular shape of the face, downslanting oral corners, increased curve of the fifth fingers, asymmetry of the legs and feet and marked retarded skeletal age.
Pharyngeal Gonorrhea
Authors: SILBER TOMAS
Published: December 2021

To the Editor.—

Chacko et al1 advocate screening for pharyngeal gonorrhea, in adolescents who undergo genital cultures for gonorrhea. They base their recommendation on an incidence of 2.7% positive results. Their finding is almost identical with a prospective study we did in 1975,2 and with the high frequency of pharyngeal gonorrhea discovered in a prenatal clinic urban population.3 In addition, several years later we did a retrospective review of all our patients with pharyngeal gonorrhea and found the situation to be the same if not worse.4
Probable Graft-Versus-Graft Reaction
Authors: GITHENS JOHN H. , HAYWARD ANTHONY R. , LAUER BRIAN A.
Published: December 2021

In Reply.—

Buckner points out the difficulty in distinguishing a generalized viral infection from a graft-versus-host reaction (GVHR) on a clinical basis in the immunologically deficient infant. This was the initial differential diagnosis raised in our recent case report1 of an infant believed to have GVHR following an exchange transfusion. Although the presence of donor lymphocytes could not be documented in the blood by HLA typing in our case, we believe the evidence strongly favors the diagnosis of a GVHR rather than a generalized viral infection.
A Critical Dissection of Obstructive Apnea in the Human Infant
Authors: Van Someren V. , Stothers J. K.
Published: December 2021

It is universally accepted that with the cessation of airflow, the infant is technically apneic, but the significance of such respiratory "pauses" remains a matter of discussion. Central apnea is easily recognized, but the absence of airflow with continued "respiratory" movements is commonly interpreted as obstructive apnea. The respiratory pattern of individual normal and abnormal infants was studied in depth. Airflow was monitored using a recently devised facial plate thermistor system; chest movement was recorded by measuring changes in thoracic impedance. On several occasions, esophageal pressure was also recorded as was expired CO2. Using the above systems, it was confirmed that mouth breathing in the infant is confined to periods of crying or yawning, and that many "obstructive" episodes merely represent straining against a closed glottis during movement.
Infant Apnea: Polygraphic Studies and Follow-up Monitoring
Authors: Rosen Carol Lynn , Frost James D. , Harrison Gunyon M.
Published: December 2021

Twenty-six infants with unexplained and apparently life-threatening apnea were evaluated clinically, underwent eight- or 12-hour polygraphic recordings during sleep, and were then observed on home monitors. The one exception was an infant who was treated with theophylline and not monitored at home. Clinical evaluation revealed a history of vomiting in 19 infants, gastroesophageal reflux (GER) on esophagram in 19, and subtle neurologic abnormalities in ten. Polygraphic studies revealed questionable EEG abnormalities in nine infants, abnormal rapid eye movement (REM) time in four, prolonged apnea in one, and increased frequency of brief mixed (central and obstructive) and obstructive apneas in five. Of the 11 infants who underwent pH monitoring during their polygraphic sleep studies, seven had at least one recorded episode of GER, but the episodes were not accompanied by apnea or bradycardia. Thirteen infants had a subsequent episode of apnea that required stimulation, and in eight infants, cardiopulmonary resuscitation was given. There was two deaths. Two infants subsequently developed seizure disorders. Three of the five infants who underwent surgical fundoplication had recurrent apneic episodes. GER commonly occurred in these infant apnea patients but did not correlate with the clinical outcome. Although subtle abnormalities may be detected by sophisticated polygraphic monitoring studies, they are not predictive of recurrent apnea or death. Home monitoring may be useful in detecting the infant at risk for recurrent life-threatening apnea and in providing some safeguard for that infant.
Speculation on Carbon Dioxide and Retrolental Fibroplasia
Authors: WOLBARSHT M. L. , GEORGE GREGORY S. , KYLSTRA JAN , LANDERS M. B. , SHEARIN W. ARTHUR
Published: December 2021

To the Editor.—

Gole and Gannon1 have apparently misconstrued our letter.2 It was not our intention that the proposed model for the development of retinopathy of prematurity (ROP) be accepted as a basis for clinical treatment. Instead, this model was propounded in hopes of stimulating further research into the possible role of CO2 in the pathogenesis of ROP. Therefore, we must respond to their charges of "speculation" by stating that this letter was obviously speculative in nature; however, all the assumptions made can be defended.
Alternative to Diminishing Rural Pediatric Health Services
Authors: APPEL TED C.
Published: December 2021

To the Editor.—

I read with great interest the recent article by Budetti et al1 concerning trends in distribution of child health providers. Clearly it appears that, overall, there are fewer pediatricians practicing in rural areas and that a large share of health services to rural children are currently delivered by family and general practitioners. The authors suggest that this trend implies that rural access to pediatricians will continue to be limited and that efforts of the pediatric community should be directed toward training family practitioners to fill more of this role.
Acute Versus Chronic Salicylate Poisoning
Authors: FINK CHESTER W.
Published: December 2021

To the Editor.—

The paper by Gaudreault et al1 comparing acute versus chronic salicylate poisoning is misleading in that the two groups are in many ways dissimilar and therefore really cannot be compared. The acute group was comprised of healthy children whereas the chronic group was comprised of ill children who probably had one or more of the signs and symptoms upon which severity was based (nausea, vomiting, dehydration, etc) prior to ingesting salicylate. This may have played a part in their disease in spite of the comments to the contrary.1
Illegal Number Crunching
Authors: GROOTHUIS JESSIE R.
Published: December 2021

In Reply.—

The authors would like to thank Student for bringing to our attention the point that utilizing mean and standard deviation to analyze Apgar scores is not appropriate. We further feel that this information would be of benefit to other investigators, as a great deal of analysis is done on such nonarithmetic operations as clinical scoring systems and staging of malignancies (as two examples). This point may therefore be as enlightening to other investigators as it was to us.
Aminophylline Confusion
Authors: PATANO THOMAS
Published: December 2021

To the Editor.—

In reading the statement of the Section on Allergy and Immunology of the American Academy of Pediatrics,1 I have come across an item that I believe needs clarification. On page 876, the fourth paragraph refers to the fact that for each milligram per kilogram (of lean body weight) of aminophylline, one can expect to see an average of a 2 µg/mL increase in the serum theophylline concentration.

Unfortunately, this statement doesn't reflect any footnotes or reference numbers.
Naldecon Claims Disputed
Authors: LUCIANO WALLY , WADE PHILLIP H. , O'BRIEN DOUG
Published: December 2021

To the Editor.—

In the October 1982 issue of Pediatrics is an advertisement by Bristol Laboratories concerning the use of Naldecon to improve the therapeutic outcome of otitis media with effusion. The advertisement states: "Naldecon improves therapeutic outcome in otitis media. A landmark study found that adjunctive administration of one antihistamine/decongestant liquid did more than relieve nasal symptoms. Naldecon actually improved the therapeutic outcome!"

This statement appears to be in direct conflict with the study cited in the advertisement.1
Mothers Are Always the Problem—or Are They? Old Wine in New Bottles
Authors: CHESS STELLA
Published: December 2021

Pediatricians know that it is desirable for an infant to have a healthy start in life. But they also know that the young child who suffers inadequate nutrition, a severe infection, or physical trauma, is not thereby doomed, except in extreme cases, to a life of physical inadequacy. The human organism is resilient and in most instances capable of recouping the damage caused by malnutrition, infection, or trauma.

The issue is the same for psychological development. It is desirable for the mother and the father to have immediate and active contact with their newborn baby. But absence of such contact does not prevent parent bonding to the infant nor does it doom the infant to less than optimal development. A relaxed and emotionally positive attachment between the 1-year-old infant and the mother is indeed valuable. But the mother does not need extraordinary capacities for this to occur. And if, for some reason, either the mother's bonding to the infant or the infant's attachment to the mother is impaired, this does not foretell failure in later emotional relationships. The establishment of reasonable feeding and sleep routines and ease in toilet training are assets for healthy development. But difficulties with these or other socialization landmarks do not necessarily predict psychological outcomes.

As I have stated previously,19 "The emotionally traumatized child is not doomed, the parents' early mistakes are not irrevocable, and our preventive and therapeutic intervention can make a difference at all age-periods."
Environment, Genes, and Alcohol
Authors: GOLDEN NANCY L.
Published: December 2021

In Reply.—

Casey's point is well taken. An association between socioeconomic status and infant outcome has been documented. Our study and control groups were not matched on that factor, but on age, race, and gestational age at birth. A retrospective analysis of the socioeconomic status of study and control mothers indicates that they are all of low socioeconomic status (Hollingshead groups 4 and 5) and that there is no significant difference between the study and control groups.
Osmolality of Substances Used in the Intensive Care Nursery
Authors: Ernst Judith A. , Williams Janice M. , Glick Melvin R. , Lemons James A.
Published: December 2021

It has been well documented that the administration of hypertonic substances to the newborn may result in a variety of adverse effects, including hepatic, intestinal, and/or neuronal injury. Furthermore, neonates are exposed to a large number of drugs and other substances while in the intensive care nursery setting. As few data are available that document the actual osmolality of many of the substances employed in caring for the sick neonate, the present study measured the osmolality of 64 medications as well as 23 formulas or nutritional supplements used in the intensive care nursery. Osmolality was determined by both vapor pressure and freezing point depression. Results indicate that a large number of medications normally administered by the enteral route possess a markedly elevated osmolality in excess of 2,000 mosm/kg H2O. Although parenterally administered medications normally have a much lower osmolality, several possess significantly elevated levels. It is recommended that measures be taken to minimize the osmolality of substances administered to the critically ill newborn whenever possible.
Guidelines for Pediatric Intensive Care Units
Authors:   Committee on Hospital Care and Pediatric Section of the Society of Critical Care Medice
Published: December 2021

The second half of the 20th century has produced an explosion of knowledge applied to the critically ill. The pathophysiology of life-threatening processes such as shock, respiratory failure, and increased intracranial pressure has been explored extensively. Advances in electronic patient monitoring, pharmacology, and improvement in transport systems are but a few of the factors that have drastically changed the nature of critical care.

Simultaneous with the scientific and technical advances has been the evolution of the pediatric intensive care unit (PICU). Children have special medical needs, and it is appropriate, therefore, to provide their critical care in units of excellence dedicated exclusively to children, where care is provided by pediatric specialists. There is also increasing recognition of the degree of sophistication implicit in the term "intensive care," which has culminated in the acceptance by the American Board of Medical Specialists of the joint application by the American Boards of Anesthesiology, Internal Medicine, Pediatrics, and Surgery for a Certificate of Special Competency in Critical Care Medicine. Thus, a new subspecialty has been born which reflects the developments in this field.

The purpose of this paper is to provide guidelines for pediatric intensive care units which will serve as a reference for those wishing to develop new units or to modify existing ones. The contributors to this set of guidelines have included pediatricians, anesthesiologists, intensivists, emergentologists, surgeons, engineers, nurses, and child life specialists who focus on the care of children in hospitals.

The following should be interpreted as guidelines only. Because of continuing ongoing developments in this field, periodic revisions of these guidelines will be necessary.
Aluminum Toxicity
Authors: SHERRARD DONALD J.
Published: December 2021

To the Editor.—

The article by Griswold et al1 is useful in demonstrating again the toxicity of aluminum. Several points in the case report, however, demonstrate that a fair amount of information accumulated in adult nephrology may be unknown to pediatricians.

First, hypercalcemia is common with this form of osteomalacia.2-5 Second, the mild parathyroid hormone elevations in this patient were almost certainly due to retention of inactive parathyroid hormone metabolites as a result of renal insufficiency.6 The combination of hypercalcemia and minimal parathyroid hormone elevation led to an inappropriate, indeed hazardous parathyroidectomy.
Prediction of Child Abuse—Does It Work?
Authors: BALABAN DONALD J. , GOLDFARB NEIL I.
Published: December 2021

To the Editor.—

Rosenberg et al1 report on a prospective, "random" study of 476 patients up to 2 years of age seen in an emergency room. The paper is concerned with a problem of importance to health care providers and of great interest to parents and society. The paper reports statistically significant differences in rates of observed or reported child abuse between children grouped according to the presence of certain abnormal features. Our concern is that the reported results may be easily misinterpreted and, therefore, may be misleading.
Noninvasive Diagnosis of Pulmonary Hemorrhage in Rheumatoid Arthritis
Authors: O'BRODOVICH HUGH M. , WAY R. CLIFTON , ANDREW MAUREEN , DENT PETER B.
Published: December 2021

The noninvasive diagnosis of pulmonary hemorrhage usually relies upon the presence of hemoptysis or hemosiderin-laden macrophages in the sputum. Respiratory tract secretions, however, may be contaminated with blood during passage through the large airways or upper respiratory tract, and hemosiderin-laden macrophages may be found in the sputum of patients with other diseases such as pulmonary edema. In addition, pulmonary hemorrhage may occur without associated hemoptysis or significant changes in the chest roentgenogram.1 We have used serial measurements of the pulmonary uptake of carbon monoxide combined with M-mode echocardiography to monitor left atrial size in order to document pulmonary hemorrhage in an 11-year-old girl with rheumatoid arthritis.
Bonding, Humanism, and Science
Authors: EMDE ROBERT N. , OSOFSKY HOWARD J.
Published: December 2021

To the Editor.—

We are concerned about possible misinterpretations arising from the review of parental bonding studies.1. Our concern is of two sorts: (1) that we not lose ground concerning improved options for families now available in hospitals partly because of the trail-breaking work of Klaus and Kennell, and (2) that we maintain some historical perspective about the research enterprise in general and research related to social policy in particular.

Few would fail to give major credit to Klaus and Kennell and the Cleveland pediatric group for their reports concerning the beneficial effects of allowing parents to be with their infants in the postpartum period.
Handicapped Infants
Authors: SCHULMAN STANFORD T.
Published: December 2021

To the Editor.—

The following statement has been approved by the majority of faculty members of the Department of Pediatrics of Northwestern University Medical School and The Children's Memorial Hospital.

"Recently issued federal regulations called for posting of signs and provision of `hot lines' to report cases where treatment is withheld from handicapped infants. Such regulations implied that a widespread campaign exists whereby hospitals and physicians secretly decide who should survive. In fact, no such sinister campaign exists.
Sleep and Nasal Obstruction
Authors: VAN SOMEREN V. , STOTHERS J. K.
Published: December 2021

In Reply.—

While we agree with Shaw that nasal obstruction is one possible cause of sudden infant death syndrome (SIDS), the purpose of our article was to highlight the pitfalls in diagnosing obstructive apnea.

Implicit in his letter is a criticism of the direction of SIDS research over the past few years: countless hours of "respiratory" monitoring of questionable physiologic quality and analysis of dubious meaning, usually followed by complex statistical comparisons of little clinical import. We share this view and hope that research along such lines will cease shortly to make demands on already strained financial resources.
Effect of Informed Parental Consent on Mothers' Knowledge of Newborn Screening
Authors: Holtzman Neil A. , Faden Ruth , Chwalow A. Judith , Horn Susan D.
Published: December 2021

To determine whether knowledge was improved as a result of obtaining informed consent from parents for newborn screening of their infants for phenylketonuria (PKU) and other hereditary metabolic disorders, new mothers in seven Maryland hospitals were interviewed either before receiving a standard disclosure (n = 210) or after giving consent (n = 418). The mean knowledge score of the women interviewed after giving consent was significantly higher (P < .001). Receiving the disclosure was a more powerful predictor of knowledge score, accounting for 40% of the variance, than demographic factors, which accounted for 9%. Women whose consent was obtained just prior to discharge tended to have lower knowledge scores than women whose consent was obtained earlier (P = .03). Women with higher knowledge scores were somewhat less likely to favor consent than women with lower scores. Although consent may not be appropriate for some low-risk procedures, informing parents can be easily and inexpensively accomplished.
Impact of Litigation on Immunization of Children
Authors: BRUNELL PHILIP A.
Published: December 2021

There have been an increasing number of lawsuits claiming compensation for injuries related to vaccines. Increased litigation can be expected to result in reluctance on the part of some practitioners to use certain vaccines, consideration in changes in recommendations for immunization, and increased cost of vaccines.

The costs of oral polio vaccine (OPV) and diphtheria-tetanus-pertussis (DTP) vaccine have been increased markedly presumably because of litigation. It is estimated that the nearly tenfold increase in DTP vaccine charged by one manufacturer could add approximately $50 million per year to the cost of protecting children against these diseases. Manufacturers have been leaving the vaccine business and now only a few remain.
Interaction of Theophylline with Erythromycin Base in a Patient with Seizure Activity
Authors: Parish Ruth Ann , Haulman N. Jean , Burns Robert M.
Published: December 2021

A pediatric patient who was taking carefully monitored doses of theophylline for chronic asthma, was placed on erythromycin base for bronchitis. She subsequently developed theophylline toxicity which caused her to experience seizure activity. Any patient taking a theophylline preparation who is then placed on ANY of the available erythromycin compounds must have close monitoring of serum theophylline levels.
Study on Cystic Fibrosis Criticized
Authors: NEWMAN THOMAS B.
Published: December 2021

To the Editor.—

The study design and data of Ater et al1 do not justify the authors' conclusion that iron deficiency contributes to relative anemia in patients wih cystic fibrosis. The statistically significant (but meager) increase in hemoglobin concentration in their study came only after vitamin E was added to the regimen of oral iron. They apparently assume that since an increase in hemoglobin could not be correlated with an initially low serum tocopherol level, the vitamin E supplementation had no effect.
Outcome of Complicated Pregnancies of Less Than 27 Weeks of Gestation
Authors: BENNETT FORREST C.
Published: December 2021

In Reply.—

I would certainly agree with Kilbridge and Elliot that obtaining outcome information from perinatal teams utilizing specified management approaches is the optimum. Attitudes of obstetricians and pediatricians about extremely low-birth-weight infants can influence both mortality and morbidity. Thus, the necessity for consistent cooperation and communication in the care of the extremely premature maternal-fetal unit is increasingly important both clinically and medicolegally. The surprisingly good early outcome of many extremely low-birth-weight survivors, as reported by us and others, mandates such an approach.
Adolescent Chest Pain
Authors: SMITH MARK SCOTT
Published: December 2021

To the Editor.—

I read with extreme interest the article on adolescent chest pain by Pantell and Goodman.1 This was an excellent clinical study and I agreed entirely with their findings. I am curious why they registered surprise at the finding that the majority of adolescents with chest pain felt this indicated "heart" problems since this is a common concern and previously reported.2

Of additional interest is a report of 100 children and adolescents who were evaluated in a pediatric cardiology department.
Adolescent Chest Pain
Authors: GOODMAN BENJAMIN W. , PANTELL ROBERT H.
Published: December 2021

In Reply.—

Brown has focused on both diagnostic and selection criteria in order to explain the discrepancy between the prevalence of costochondritis in our two studies.1,2 Our techniques for palpation did differ and may in part have accounted for a difference. We believe the most appropriate comparison group for our population is Brown's patients with chest pain; however, inasmuch as 80% of his patients with chest pain and 77.5% of his patients with abdominal pain had costochondritis the discrepancy with our rate (16%) is not attributable to selection criterion.
Adolescent Chest Pain
Authors: LANTNER INGRID L.
Published: December 2021

To the Editor.—

I have some questions about Pantell and Goodman's article on adolescent chest pain.

Was there any urine testing for cannabinoids? Were there inquiries regarding the use of marijuana? It's not unusual for teenagers to smoke this drug exclusively. In my pediatric practice, I have seen several adolescents with left-sided or substernal pain, in some instances not accompanied with chronic cough. The roentgenograms of the chest, EGG, tuberculosis tests, and other routine laboratory tests were negative, including some skin tests for respiratory allergies in a few.
Congenital Leukemia: Two Transient Regressions Without Treatment in One Patient
Authors: CHU JEN-YIH , O'CONNOR DENNIS M. , GALE GORDON B. , SILBERSTEIN MICHAEL J.
Published: December 2021

In Reply.—

The cases of congenital leukemia described by Warner et al further illustrate the interesting but poorly understood features of congenital leukemia. In the last 20 years in our hospital, there have been five cases of congenital leukemia, all diagnosed between 1975 and 1979.1 These five infants developed leukemia between ages 1 day and 8 weeks. As we pointed out in our paper, there is some difficulty in classifying the cell type of some newborns with congenital leukemia.2
Postmortem Protocol
Authors: KRONICK JONATHAN B. , SCRIVER CHARLES R. , GOODYER PAUL R. , KAPLAN PAIGE B.
Published: December 2021

In Reply.—

We agree that a total body radiograph would be a useful addition to the protocol in some cases. Collection of a CSF sample would also be useful in other situations. Our protocol is neither exclusive nor inclusive for all situations. Our primary goals are to improve diagnosis, increase awareness that mutation is an important cause of death in infancy and childhood, and deal as best we can with the possibility of recurrence. In this regard we are pleased that Whelan and Neidengard et al and others hold similar views.
Early Diagnosis of Cystic Fibrosis: To Screen or Not To Screen—An Important Question
Authors: FARRELL PHILIP M.
Published: December 2021

To the Editor.—

Cystic fibrosis (CF) is one of the most complex disorders faced by pediatricians and continues to be not only a challenge but an enigma for both physicians and researchers. Although there is no cure for the pulmonary disease associated with CF, a variety of clinical observations1-3 strongly suggest that early recognition and aggressive treatment can have a beneficial effect on the course of the disease. Thus, there has been considerable interest in the possibility of routine neonatal diagnosis by screening.
Uses Higher Level
Authors: COCHRAN WILLIAM D.
Published: December 2021

To the Editor.—

Watchko and Oski's one act play about yellow fever among pediatricians was deeply appreciated (Bilirubin 20 mg/dL = vigintiphobia Pediatrics 1983;71:660-663). I note they cite several of the Acta Paediatrica Scandinavica articles for their references but fail to cite my favorite by Bengtsson and Verneholt (Acta Paediatr Scand 1974;63:70-80). In this article 108 Coombs negative term infants were reported and followed from ages 6 to 13 years, all of these infants had a peak bilirubin > 20 mg/dL.
Who Has Bugs?
Authors: KULBERG ALAN , GOLDFRANK LEWIS
Published: December 2021

To the Editor.—

Recently, a 26-month-old female child was brought into our emergency service by her mother who claimed that the child had "bugs." An extensive search for head lice, scabies, or any other evidence of infestation revealed nothing.

When the mother was questioned again about where the bugs were, she pointed to the child's skin and tried to demonstrate that she too had them, by vigorously "rubbing" them out of her palms and forearms, again to no avail. It was then noticed that the mother was slightly tremulous and diaphoretic while obviously intensely concerned about the "bugs."
Methodologic Standards for Controlled Clinical Trials of Early Contact and Maternal-Infant Behavior
Authors: Thomson Mary Ellen , Kramer Michael S.
Published: December 2021

To provide an objective evaluation of published studies on the effect of early contact on subsequent maternal-infant behavior, a set of 11 methodologic standards generally applicable to controlled clinical trials of perinatal care was developed. Sixteen reports of early contact trials were assessed and seven of the 11 standards were found to be satisfactorily fulfilled. The four "problem" standards were: adequate definition of subjects, randomization, subject bias, and treatment contamination (care giver) bias. Of the five best trials fulfilling eight or more of the standards, three reported a beneficial effect of early contact, while two demonstrated no effect. The evidence that early contact improves subsequent maternal-infant behavior thus remains inconclusive. It is urged that for future research in this domain more attention be given to adequate subject definition, strict randomization procedures, and safeguards against bias by the subjects or their care givers.
Prevention of Perinatal Transmission of Chronic Hepatitis B Surface Antigen (HBsAg) Carrier State
Authors: SINATRA FRANK R. , TONG MYRON J.
Published: December 2021

In Reply.—

In response to the letter by Salvioli and co-workers, although we would agree that the incidence of perinatal transmission of hepatitis B from HBeAg-negative mothers is low, the consequences may be severe. One of the three infants in our study was born to a HBeAg-negative and anti-HBe-positive American mother of European ancestry.1 Following publication of our original report, we cared for an infant who developed fulminant icteric hepatitis 8 weeks after being born to a HBeAg-negative and anti-HBe-positive mother.
Food and Drug Administration Warning on Dead Space in Tracheal Tubes
Authors: HAFFNER MARLENE E.
Published: December 2021

To the Editor.—

A health hazard concerning device incompatibilities has recently come to the attention of the Food and Drug Administration (FDA)/National Center for Devices and Radiological Health (NCDRH). This hazard, which affects newborns and small infants almost exclusively, can occur when certain breathing system connectors and adapters intended to reduce dead space are used together. The connectors and adapters are made by many different companies. The FDA/NCDRH recently sent a letter to all US hospitals advising them of the problem.
Intestinal Flora Rediscovered
Authors: BARNESS LEWIS A.
Published: December 2021

To the Editor.—

The article by Yoshioka et al on intestinal flora in neonates1 is important not only for the information it contains, but also for the admonishment that man is mortal and fame is fleeting.

Paul Gyorgy and co-workers,2-4 beginning in 1953 and continuing for the next 23 years, wrote not only of the importance of lactobacillus bifidus in the stool flora of human infants, but also characterized some of the factors that were responsible for this flora.
Intravenous Nitrogen Intake Requirements in Full-Term Newborns Undergoing Surgery
Authors: Zlotkin Stanley H.
Published: December 2021

To determine the intravenous intake of nitrogen needed to duplicate the weight gain and nitrogen retention observed in healthy infants fed human milk, full-term infants had weight change and nitrogen balance measured postoperatively while they were receiving two different parenteral regimens which provided adequate energy (87 kcal/kg/d) and varying intakes of nitrogen as crystalline amino acids (290 to 579 mg/kg/d) over a six-day period. Weight change was similar to that observed in breast-fed infants (35 g/d) and was independent of nitrogen intake. A significant correlation was observed between nitrogen intake and retention (r = .71, P < .01). Substituting the rate of nitrogen retention observed in thriving full-term infants fed human milk into the regression equation describing the relationship between nitrogen intake and retention, the nitrogen intake required by parenterally fed infants in order to duplicate the accretion rate of their milk-fed counterparts was 280 mg/kg/d. After correcting for individual variation, recommended intravenous amino acid intakes range from 2.3 to 2.7 g/kg/d depending on the commercial amino acid formulation chosen and providing that adequate amounts of energy are concurrently infused.
Floor Furnace Burns
Authors: GROSSMAN ELMER R.
Published: December 2021

To the Editor.—

Bergen and Kalishman1 concluded their article, "Floor Furnace Burns to Children," with suggestions for prevention. As our pediatric practice is in an area with old homes that have these hazardous furnaces, we have for many years recommended a simply made wooden grid which fits over the furnace outlet. An adult or older child can step over it as it is only about eight inches high. If made according to the instruction sheet (Figure), it will withstand prolonged use without danger of charring or burning, replacing the danger of burned extremities with the annoyance of stubbed toes.
Facial Characteristics of Children Who Breathe Through the Mouth
Authors: Bresolin Dante , Shapiro Gail G. , Shapiro Peter A. , Dassel Steven W. , Furukawa Clifton T. , Pierson William E. , Chapko Michael , Bierman C. Warren
Published: December 2021

There are many claims that abnormal breathing patterns alter facial growth; however, there are limited controlled data to confirm these claims. Thirty children with allergy, aged 6 to 12 years, who had moderate-to-severe nasal mucosal edema on physical examination and who appeared to breathe predominantly through the mouth and 15 children without allergy who had normal findings from nasal examination and who appeared to breathe predominantly through the nose were evaluated. All subjects received an intraoral clinical examination and cephalometric radiograph analysis. In comparison with children who breathed through the nose, children who breathed through the mouth had longer faces with narrower maxillae and retruded jaws. This supports the hypothesis that children with nasal obstruction and who appear to breathe through the mouth have distinctive facial characteristics.
Death and the Pediatric House Officer Revisited
Authors: Sack William H. , Fritz Gregory , Krener Penelope Garrison , Sprunger Lewis
Published: December 2021

Thirty-six third-year pediatric residents at four Western university training programs were interviewed individually and retrospectively about the magnitude of their clinical experience in managing the treatment of chronically ill and dying children, as well as the psychosocial educational curriculum of their training program as it pertained to these experiences. The residents managed an average of 35 dying children during their first 2½ years of pediatric residency. They imparted the news of a potentially fatal disease to an average of 33 families during this same time span. There was a disparity between the magnitude of the clinical experience and the time and emphasis on these issues in the residency curriculum. The implications of these findings for an improved educational curriculum in the psychosocial care of dying children are discussed.