bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronal Craniostenosis: Fetal Head Constraint as One Possible Cause
Authors: Graham John M. , Badura Richard J. , Smith David W.
Published: December 2021

A retrospective study of 11 instances of idiopathic coronal craniostenosis in otherwise normal children revealed that early lightening, prolonged moderate to severe pelvic discomfort late in pregnancy, and/or an abnormal fetal lie were unusual gestational features indicative of intrauterine constraint for eight of these patients. The impression of unusual constraint in utero was futher implied by finding associated positional foot deformities in four of these latter eight children. We hypothesize that prolonged constraint of the fetal head may limit anteroposterior growth stretch at the coronal suture and thereby predispose toward early sutural fusion.
Rubella Susceptibility in Sixth Graders: Effectiveness of Current Immunization Practice
Authors: Lawless Michael R. , Abramson Jon S. , Harlan Joseph E. , Kelsey Doris S.
Published: December 2021

Rubella hemagglutination inhibition antibody titer was determined for 702 sixth grade students from nine randomly chosen schools in a community served well medically. Rubella immunization had been given by private physicians, the health department, hospital clinics, and through a mass immunization effort in 1970. The overall susceptibility rate, as defined by a rubella hemagglutination inhibition titer of less than 1:8, was 15%. Susceptibility did not differ significantly in regard to sex, race, or source of vaccine. Of 469 children with a documented rubella immunization, 13.2% were susceptible or vaccine failures. Menarche was reported by 30% of the girls. To increase the level of protection against rubella during the childbearing years, continued emphasis on early childhood immunization combined with consideration of a booster rubella immunization for preadolescents is recommended.
Risk Factors in Retrolental Fibroplasia
Authors: Gunn Tania R. , Easdown Jane , Outerbridge Eugene W. , Aranda Jacob V.
Published: December 2021

Possible determinant factors that may increase the risk of the occurrence of retrolental fibroplasia (RLF) were analyzed in 80 infants born in 1975 and 1976 with birth weights between 501 and 1,500 gm and who survived. Active and/or cicatricial RLF occurred in 27 (33.8%) infants and the factors significantly associated with RLF were: gestational age (P < .001); apnea requiring bag and mask resuscitation with oxygen (P < .001); septicemia (P < .005); degree of illness; blood transfusion; and mechanical ventilation. Severe cicatricial RLF developed in eight (10%) infants (grades 2 to 5). In the group of infants all of whom had apnea which required resuscitation, septicemia was also significantly associated with RLF (P < .01). A highly significant association between RLF and severe myopia (P < .001) was found in follow-up in all infants. Data show a resurgence and high incidence of RLF in low birth weight infants who survived. Infants with these factors should be considered to have greater risk for the occurrence of RLF and ophthalmologic examination prior to, and within three months following discharge is recommended.
DENTAL RADIOGRAPHY DOSES AND CANCER
Authors: Miller Robert W.
Published: December 2021

The entire dentition from root to crown can be visualized on a single x-ray film through pantomographic radiology. The National Radiological Protection Board of Great Britain has measured tissue doses from seven types of pantomographic equipment and compared them with doses from full-mouth series and bitewing films (Wall BF, et al: Br J Radiol 52:727-734, 1979). The results indicated the dose to the thyroid, for example, to be between .001 rad and .03 rad for pantomography, .001 to .002 rad for a full-mouth series, and .002 rad for two left and two right bitewing films. The authors judged the tissue doses to [cause] "little or no increase in risk of somatic injury to the patient, provided the technique is not used to excess." They recommended that such examination should not be performed without justification more often than once annually up to 8 to 16 years of age, or more often than once every three to five years thereafter. [The risk of cancers from the cumulative dose to the population, assuming no threshold, was not discussed.]
Breast-feeding Reduces Incidence of Hospital Admissions for Infection in Infants
Authors: Fallot Mary E. , Boyd John L. , Oski Frank A.
Published: December 2021

The prevalence of exclusive breast-feeding among infants 0 to 3 months of age in a community was contrasted with the prevalence of breast-feeding among infants hospitalized for the presence of presumed or established infections. During a one-year period, 136 infants, 0 to 3 months of age, were admitted to the hospital. Among the hospitalized group, only 11.0% were being exclusively breast-fed as contrasted with an expected frequency of 25.2% based on community feeding patterns. No bacterial infections were documented among the breast-fed group while 27 bacterial infections were documented among 121 non-breast-fed infants. This survey indicates that exclusively breast-feeding during the first three months of life significantly reduces the incidence of infections that ultimately require hospitalization of infants.
Neonatal Herpes Simplex Virus Infection Introduced by Fetal-Monitor Scalp Electrodes
Authors: Parvey Louis S. , Ch'ien Lawrence T.
Published: December 2021

An infant was severely infected with herpes simplex virus as a result of fetal monitoring with scalp electrodes on the buttocks. The first vesicles appeared at the site where the electrodes had been placed and, by day 9 after birth, additional lesions covered the entire perineum and lower extremities. The child developed acute meningoencephalitis and pneumatosis intestinalis. Herpes simplex virus was isolated from cultures of skin vesicle fluid, cornea, saliva, blood, and spinal fluid. The infection resolved after treatment with adenosine arabinoside, administered intravenously for 11 days and applied topically for another 15 days. A follow-up examination when the child was 2 years old disclosed no physical or neurologic abnormalities. This case illustrates the risk of introducing herpes simplex infection by internal fetal monitoring.
Burnout in the Neonatal Intensive Care Unit
Authors: Marshall Richard E. , Kasman Christine
Published: December 2021

Burnout, the loss of motivation for creative involvement, is an important reaction of the staff to the stresses of working in a neonatal intensive care unit. The characteristics and causes of burnout are presented from a clinical perspective. Strategies for reducing and coping with burnout are offered.
The Role of the Practicing Pediatrician in Resident Education
Authors: Greenberg Larrie W.
Published: December 2021

Pediatric practitioners have always participated in resident education activities; in fact, they have been the prime teachers of residents and medical students in many pediatric centers. They accepted without hesitation the dual responsibility of teaching without remuneration and patient care. During the last ten to 15 years, however, a number of factors have altered this traditional role:

1. The development of sophisticated subspecialties, although strengthening pediatric centers throughout the country, has weakened the role of general pediatricians. As pediatric departments and children's hospitals have become more specialized, the role of the general pediatrician has become less well defined. The pediatric practitioner has felt alienated and excluded and may become an endangered species in the academic setting.
Revised Recommendations on Rubella Vaccine
Authors: 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 , Hinman Alan R. , Jordan William S. , Larke R. P. Bryce , Meyer Harry M. , Easton James G.
Published: December 2021

The following recommended changes are similar to, but not identical with, those recommended by the US Public Health Service Advisory Committee on Immunization Practices in November 1978.1 These changes focus on more effective delivery of the vaccine to older individuals, in particular to females in the childbearing age group. All comments related to the vaccine and its use pertain to all licensed vaccines available in the United States, including the recently licensed RA27/3 vaccine.

The major objective of the National Rubella Immunization Program is the prevention of rubella infection in early pregnancy, which in turn will prevent infection of the fetus and consequent congenital rubella. Prior to vaccine licensure in 1969, approximately 15% of women of childbearing age were susceptible to rubella. At the present time, more than 83 million doses of live, attenuated rubella virus vaccine have been distributed in the United States, which has clearly resulted in a widespread reduction of epidemic rubella in preschool-and elementary school-aged children. However, since the use of rubella vaccine has not been universal in the target population (only about two thirds of the children 1 to 12 years old have been immunized) and since vaccine usage has disrupted the epidemic nature of rubella, the population for whom antibody protection is desired (women of childbearing age) is still suspected of being as susceptible, or more so, than in the prevaccine era. Indeed, serologic surveys indicate that persons in this age group have a percentage of susceptibility similar to that noted prior to 1969.
Letters to the Editor
Authors: Diamond Eugene F.
Published: December 2021

I am writing with regard to the statement by the Committee on Adolescence "Pregnancy and Abortion Counseling" (Pediatrics 63:920, 1979). While this statement is, in many ways, forthright and sensitive, it nevertheless tends to perpetuate some of the unfortunate fallacies which surround a much controverted issue.

First of all it identifies abortion as a "sexual matter." While it is true that sexual activity leads to pregnancy which may, in turn, lead to a request for abortion, the controversies regarding abortion are not merely sexual or even primarily sexual.
Valproic Acid Induced Pancreatitis in Children
Authors: Allen Richard J. , Coulter David L.
Published: December 2021

The recent report by Batalden et al,1 regarding pancreatitis associated with valproic acid (VPA) therapy is an important observation. We do not yet know how serious the situation really is. Death due to hepatic toxicity is another recently reported concern following the use of VPA in the treatment of children with convulsive disorders.2 With more experience such serious consequences are only now emerging, especially in children, and this contrasts strikingly with the virtual lack of harmful effects in adult short-term studies.3
Letters to the Editor
Authors: Squire Edward N. , Todd James K. , Favara Blaise E.
Published: December 2021

It is an appropriate conclusion that our data should "mitigate enthusiasm for the prospective use of WBC parameters in the diagnosis of infection of the newborn infant." Such enthusiasm for a laboratory test is usually the result of the overzealous interpretation of inadequately controlled comparative studies suffering from small sample size, or inappropriate extrapolation of limited conclusions to expanded populations. Very few diagnostic laboratory tests are so sensitive and specific that they lack significant false-positive or false-negative results, and the aforementioned white blood cell studies are commonly referred to as nonspecific indicators of inflammation with just cause.
Morning Plasma Cortisol Levels in Infants Treated with Topical Fluorinated Glucocorticosteroids
Authors: Weston William L. , Sams W. Mitchell , Morris Helen G. , Arthur James M. , Blakeman Gordon J. , Andresen Mary
Published: December 2021

In the article "Morning Plasma Cortisol Levels in Infants Treated with Topical Fluorinated Glucocorticosteroids" by Weston et al (Pediatrics 65:103, 1980) an error has been noted in the description of the method used for cortisol assay. Samples were assayed by the competitive-protein binding radioassay of Murphy, which permits measurement of cortisol in 0.1-ml aliquots of plasma (0.2 ml for a duplicate determination) with a coefficient of variation of 7%.1,2 The Spencer-Peet fluorometric method, noted incorrectly in the text, would require a much larger volume of plasma than that obtained from the infants. References: (1) Murphy BEP: Some studies of the protein-binding of steroids and their application to the routine micro and ultramicro measurement of various steroids in body fluids by competitive protein binding radioassay. J Clin Endocrinol Metab 27:973, 1967; (2) Morris HG, DeRoche G, Winkler SM, et al: Effect of oral prednisone on the measurement of plasma steroid concentrations by the competitive protein binding radioassay. J Pediatr 85:248, 1974.
Human Milk Banking
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W.
Published: December 2021

In the article "Human Milk Banking" (Pediatrics 65:854, 1980) the name of the principal author of the Committee on Nutrition, Claude C. Roy, MD, was inadvertently omitted from the list of committee members.
Wilms' Tumor in a Patient with an Incomplete Form of Beckwith-Wiedemann Syndrome
Authors: Sotelo-Avila Cirilo , Gonzalez-Crussi F. , Starling Kenneth A.
Published: December 2021

Patients with incomplete forms of Beckwith-Wiedemann syndrome (BWS) associated with solid tumors have been described in the literature, but they have not been sufficiently appreciated. A review of reports of children with asymmetry and intra-abdominal malignancy disclosed 12 patients who might represent BWS either incompletely manifested or insufficiently described1-12 (Table). Seven of these patients had nephroblastomas,1-7 two had adrenal cortical carcinomas,8,9 two had hepatoblastomas,10,11 and one had hepatocellular carcinoma.12 Three of these children had, or subsequently developed, a second tumor. One had nephroblastoma and adrenal adenoma1 another a bilateral cortical carcinoma metastatic to the liver and a lumbar lipoma9; the last one a nephroblastoma followed by the appearance of adrenal cortical carcinoma and breast fibroadenoma.7
Letters to the Editor
Authors: Cohen Stanley A. , Hendricks Kristy , Walker W. Allan
Published: December 2021

Dr. Forsyth's letter and insightful comments are appreciated. It provides the impetus and forum to clarify some potentially confusing statements in our recent publication.

A statistical attrition bias is possible since only 26 complete dietary records were available for follow-up. The patients were drawn from a total population of 500 outpatients seen in our clinic over a 2½-year period. They were examined by various physicians and dieticians during that time. Although vigorous attempts were made to obtain initial and follow-up data on all of the patients with chronic nonspecific diarrhea, those data were not obtainable from all of the patients.
Erythromycin for Pneumonia—A Troublesome Recommendation
Authors: Fischer Gerald W. , Bass James W. , Arthur James D.
Published: December 2021

We read with interest the report by Ginsburg and associates (Pediatrics 64:283, 1979) on Haemophilus influenzae pneumonia. Viruses unquestionably cause the vast majority of pneumonias in children. Although the pneumococcus most certainly remains the most common cause of bacterial pneumonia, H influenzae type b should no longer be considered a rare or uncommon etiology. We have previously noted that H influenzae type b was the single most common bacteria isolated from blood, CSF, empyema fluid, or lung aspirates in a group of children with pneumonia over a five-year period in Hawaii.1
Infant Formulas Contain Variable Amounts of Fluoride
Authors: Marcus Steven M.
Published: December 2021

Attention should be drawn to an article by Tinanoff and Muller (J Dent Child 45:53, 1978) dealing with the fluoride content in milk and formula for infants. There is little doubt that the use of a fluoride supplement in nonfluoridated areas consistently lowers the mean caries scores for both primary and permanent teeth. Many pediatricians are in the habit of prescribing supplemental fluoride for all children regardless of the type of diet in such areas.
Decreased Oxygenation and Hyperlipemia During Intravenous Fat Infusions in Premature Infants
Authors: Pereira Gilberto R. , Fox William W. , Stanley Charles A. , Baker Lester , Schwartz Jacob G.
Published: December 2021

Eighteen appropriate-for-gestational-age premature infants with birth weights ranging from 0.77 to 1.89 kg received 1 gm/kg of body weight of fat emulsion, intravenously, over a four-hour period. Infants less than 1 week of age developed a significant decrease in Po2 levels (P < .05) during the fat infusion period. There were no changes in other pulmonary function parameters. Infants less than 1 week of age also developed significantly higher peak levels of plasma triglycerides than infants 2 to 3 weeks old (P < .05). A correlation between increment in triglyceride levels and postnatal age was demonstrated (r = .75), with the younger infants presenting the higher triglyceride levels. This study demonstrates that: (1) small premature infants receiving intravenous fat are more susceptible to hyperlipemia and hypoxemia during the first week of life; (2) hypoxemia associated with intravenous fat infusion does not result from changes in lung dynamics; (3) the capacity to tolerate intravenous fats is enhanced after the first week of life.
Etiology of Pertussis Syndrome
Authors: Keller Margaret A. , Aftandelians Rouben , Connor James D.
Published: December 2021

One hundred patients with clinical pertussis were studied to determine the etiology of pertussis syndrome. Forty-two (42%) of the patients had either Bordetella pertussis or Bordetella parapertussis isolated from the nasopharynx. In an additional 36 (36%) patients, B pertussis was isolated from the nasopharynx of the associated index case or family contact case. Thus, Bordetella was isolated from 78 (78%) of the patients or from their immediate family group. Of the 22 culture-negative patients residing in culture-negative families, 12 had serologic evidence of Bordetella infection and another was from a family group in which two members were seropositive. Therefore, 91 patients (91%) had bacteriologic or serologic evidence of Bordetella infection themselves or within their families. Viral cultures were obtained on 75 of the patients. Adenoviruses were isolated from 33% of those with positive cultures for B pertussis and from 14% of those with negative cultures. In the group without direct or indirect, bacteriologic or serologic evidence of Bordetella infection, the adenoviral isolation rate (13%) was not significantly different from the adenoviral isolation rate (33%) in patients with a positive bacterial culture. These data do not support a role for adenovirus alone in causing pertussis syndrome.
Efficacy of a 12-Hour Sustained-Release Preparation in Maintaining Therapeutic Serum Theophylline Levels in Asthmatic Children
Authors: Kelly H. William , Murphy Shirley
Published: December 2021

The purpose of this study was to determine whether a new sustained-release theophylline preparation TheoDur could maintain therapeutic serum theophylline levels in asthmatic children on a 12-hour dosage regimen. Twenty asthmatic children aged 6 to 18 years with a mean of 11.4 years who required continuous theophylline therapy for control of their asthma were enrolled in the study. Each patient's dosage was titrated to achieve a six-hour postdose serum theophylline level between 10 and 20 µg/ml. The patients required a mean ± SEM dose of 10.0 ± 0.54 mg/kg every 12 hours which gave a mean ± SEM six-hour postdose serum theophylline level of 15.65 ± 0.72 µg/ml. At the end of five days on this dosage, the patients were admitted and serum theophylline levels were determined every three hours for 24 hours. The mean ± SEM difference between maximum and minimum serum theophylline levels (ΔTL) for the group was 4.5 ± 0.3 µg/ml. There was not a significant difference in the ΔTL between the two age groups (6 to 9 years, 4.5 ± 0.5 µg/ml and 10 to 18 years 4.5 ± 0.4 µg/ml). In conclusion, TheoDur will maintain therapeutic serum theophylline levels with minimal fluctuations in asthmatic children on a 12-hour dosing schedule.
Erroneously High Dextrostix Values Caused by Isopropyl Alcohol
Authors: Grazaitis David M. , Sexson William R.
Published: December 2021

Glucose oxidase peroxidase chromogen reagent (Dextrostix) in combination with the Eyetone colorimeter has become increasingly popular in the rapid detection of hypoglycemic states in the newborn. Although the reliability of this system is well documented, there are several factors which can compromise the accuracy of the procedure. One such problem is the glucose reading given after a blood-alcohol combination is tested. By decreasing the light reflected from the strip, the optical electrical interpretation of the Dextrostix is altered by alcohol such that there is an apparent increase in the glucose level as read by the eyetone meter.
American Trypanosomiasis (Chagas' Disease) in a Canadian Immigrant Infant
Authors: Montalvo-Hicks Lucy D. C. , Trevenen Cynthia L. , Briggs James Nixon
Published: December 2021

A case of American trypanosomiasis (Chagas' disease) is reported. A 13-month-old Mennonite girl who immigrated to Canada from Paraguay, died at the Children's Centre in Winnipeg from an acute myocarditis due to infection with Trypanosoma cruzi. This diagnosis should be considered when a patient from an endemic area presents with a clinical picture of myocarditis.
Rising Antibody Titer to Mycoplasma pneumoniae in Acute Pancreatitis
Authors: Oderda Giuseppina , Kraut Jerome R.
Published: December 2021

Biliary tract disease and alcohol abuse are the most common causes of acute pancreatitis in adults.1 This is in contrast to children in whom the majority of cases were due to steroid therapy, trauma, biliary tract disease, and infection.2 The idiopathic form comprises 20% of the cases.2 Uncommon causes include other drugs, diabetes mellitus, duodenal ulcer, cystic fibrosis, hyperlipoproteinemia, hyperparathyroidism, septic shock, pregnancy, porphyria, kwashiorkor, and scorpion bites.2

Mycoplasma pneumoniae has recently been recognized as a possible cause of pancreatitis in adults.3-6 This paper reports a child who had acute pancreatitis associated with a rising antibody titer to M pneumoniae.
Screening for Angel Dust in Newborns
Authors: Marble Richard D. , Thomas Richard G. , Sterling Melvyn L.
Published: December 2021

It was with interest that we read the article "Angel Dust: Possible Effects on Fetus," by Golden et al (Pediatrics 65:18, 1980). We have become increasingly aware that as phencyclidine (PCP) has reemerged as the most commonly abused street drug1 the pool of unborn fetuses at risk has also increased. Although no literature is available concerning transplacental passsage of PCP in humans, Cummings et al,2 have shown that crosses the placenta in pigs. Cummings et al demonstrated that the plasma PCP level of the piglet is approximately ten times that of the mother when the drug is given intramuscularly shortly before cesarean delivery.
Reliability of Ultrasound in Diagnosis of Intracerebral Hemorrhage and Posthemorrhagic Hydrocephalus: Comparison with Computed Tomography
Authors: Silverboard Gerald , Horder Mary H. , Ahmann Peter A. , Lazzara Anthony , Schwartz James F.
Published: December 2021

Subependymal and intraventricular hemorrhage are frequent complications of the high risk preterm infant. It has been stated recently that ultrasound may be used to diagnose intraventricular hemorrhage. A comparative prospective study of ultrasound scan (US) with a commercially available B-mode real time linear array US machine and the computed tomography (CT) scan was undertaken to determine the accuracy of US in diagnosing the presence and quantity of subependymal and intraventricular hemorrhage and in following infants with hemorrhage for the development of progressive hydrocephalus. There were 101 patients followed with serial US examination for evidence of subependymal and/or intraventricular hemorrhage. CT correlation was obtained on each patient. The US examination correlated with the CT scan in 77 of these 101 patients. The demonstration of hydrocephalus by US in eight infants with posthemorrhagic hydrocephalus was reliable, and the correlation with CT scan was excellent.
The Immotile Cilia Syndrome: A Cause of Recurrent Pulmonary Disease in Children
Authors: Rooklin Anthony R. , McGeady Stephen J. , Mikaelian Diran O. , Soriano Raymond Z. , Mansmann Herbert C.
Published: December 2021

Immotile cilia syndrome was diagnosed in two male siblings, aged 32 months and 5 years, who had recurrent pneumonia, wheezing, and bronchitis. The youngest child had recurrent atelectasis, chronic sinusitis, recurrent otitis media, and failure to thrive. Neither child had situs inversus. Electron micrographs done on nasal mucosal biopsies revealed absent dynein arms. Symptoms were controlled in the younger brother by using daily antihistamine-decongestant and bronchodilator therapy. The immotile cilia syndrome must be considered in children before labeling chronic respiratory disease as idiopathic.
Diaper Dermatitis: Current Concepts
Authors: Weston William L. , Lane Alfred T. , Weston Janet A.
Published: December 2021

Diaper dermatitis may result from prolonged skin contact with wetness and bacteria. Ammonia plays no apparent role in the generation of diaper dermatitis. Candida albicans frequently contaminates a diaper dermatitis and should be considered present in any diaper dermatitis known to be present for longer than three days. Topical fluorinated glucocorticosteroids, boric acid, and mercury-containing preparations should be avoided in the diaper area because of their toxicity.
Amniotic Fluid α-Fetoprotein in Fetal Obstructive Uropathy
Authors: Dean William M. , Bourdeau Emory J.
Published: December 2021

Amniotic fluid α-fetoprotein has been associated with various congenital anomalies. A diagnosis in utero of urinary obstruction associated with elevated α-fetoprotein is reported. Subsequent fulguration of type I posterior urethral valves was done. A possible mechanism for elevated α-fetoprotein with obstructive uropathy in utero is discussed.
Rumination—A New Complication of Neonatal Intensive Care
Authors: Sheagren Thomas G. , Mangurten Henry H. , Brea Frantz , Lutostanski Susan
Published: December 2021

The infant rumination syndrome has not been previously reported in a neonatal intensive care setting. We recently managed three infants in our newborn intensive care unit who developed rumination following chronic courses in the unit. The events leading to this condition in each infant are described, as well as the successful treatment program that was instituted. With recognition of factors predisposing to this disorder, the problem may be avoided, providing these infants with the best chance for optimal development despite the need for prolonged intensive care.
The Pediatrician and Corporal Punishment
Authors: Wessel Morris A.
Published: December 2021

Concern about child abuse causes many pediatricians to question the widespread use of corporal punishment as a method of disciplining children.

The "spare the rod and spoil the child" philosophy is deeply ingrained in American child rearing. This allows—indeed encourages—many parents and other adults caring for children to spank or hit with the hand, belt, or paddle, or to force a child to stand for long periods of time or to institute other immoderate measures when disciplining seems to be necessary. This acceptance of corporal punishment as a way of dealing with children poses an important question: Why is this true in America while in Luxemburg, Holland, Austria, France, Finland, Sweden, Denmark, Belgium, Cyprus, Japan, Ecuador, Iceland, Italy, Jordan, Mauritius, Norway, Israel, The Philippines, Portugal, and Russia, legislation prohibits the use of corporal punishment by educational personnel? And in Sweden, this prohibition now includes parents!1
Billings Method of Contraception in Adolescents
Authors: Silber Tomas J.
Published: December 2021

I read the article on contraception in the adolescent by Greydanus and McAnarney in the January issue with mixed feelings. On one hand, it was an excellent review. On the other hand, this was just the article on which I had been working for the last year and which I had just finished in January; "c'est la vie." I use this opportunity though to rescue part of my effort and to bring to the attention of interested pediatricians a method that was overlooked by the authors1: the so-called "Billings method" or "fertility awareness method" which is often confused with the rhythm method, but which is based on a completely different principle: taking into account that there is a warning to impending ovulation.
Multipurpose Rubber Tubing for Use in Tympanocentesis and Pneumatic Otoscopy
Authors: Bergeson Paul S. , Armstrong Craig W.
Published: December 2021

We were delighted to read the article, "Simplified Technique for Tympanocentesis" (Kaplan SL, Feigin RD: Pediatrics 62:418, 1978). Indeed, we have tried the combination of rubber tubing, tuberculin syringe, and short beveled needle and found it to be an easy and effective method for aspiration of the middle ear. Using the Welch-Allyn operating otoscope requires only a 3.75-cm (1.5 in) needle. With the diagnostic and fiberoptic pneumatic otoscopes of the same brand, we find it useful to use an 8.8-cm (3.5 in) spinal needle and bend it to 45 degrees approximately at the middle.
Letters to Editor
Authors: Kaplan Sheldon L. , Feigin Ralph D.
Published: December 2021

We are pleased indeed that others have found the simplified technique for tympanocentesis that we reported helpful in pediatric practice. The authors of the letter above asked whether we feel that a filter and adapter are necessary since they have found a specific rubber tubing that can provide an airtight seal without the need of an adapter and filter. We feel that the modification of our technique described by the authors is quite acceptable but would prefer the filter element if possible since it prevents contamination of material aspirated into the syringe by saliva contributed by the physician-operator.
Letters to the Editor
Authors: Lamola A. A. , Blumberg W. E. , Brown Audrey K.
Published: December 2021

We agree with the basic point of the letter of Drs Cembrowski and Garber that information in our paper1 is not sufficient for judging the accuracy of the hematofluorometry assay for total blood bilirubin in a way that would satisfy standard evaluation methodology. Data which answer almost all the questions of Cembrowski and Barber are included in a paper by Cashore et al2 which should have been published simultaneously with our paper but was inadvertantly delayed. The authors from Bell Laboratories (W.E.B., J.E., and A.A.L.) apologize for being remiss in reporting data concerning all the standard evaluation tests. Such a report is in preparation.
Current Circumcision Practices: Canada
Authors: Wirth John L.
Published: December 2021

Current statistics of circumcisions performed in Canada are reported, by province. Statistics of circumcisions performed in the United States 30 years ago are also reported, by race and region.
Fever
Authors: Kluger Matthew J.
Published: December 2021

Fever, the regulation of body temperature at an elevated level, is a common response to infection throughout the vertebrates. Mammals and birds rely on both physiologic and behavioral mechanisms to raise their body temperatures to this elevated thermoregulatory "set-point" during infection. Lower vertebrates such as fishes and reptiles primarily rely on behavior to elevate their body temperatures. For example, the febrile lizard will spend greater lengths of time near a heat source, and as a result its body temperature rises. A fever appears to be induced by a variety of substances such as bacteria, viruses, and fungi. These inducers of fever result in various types of phagocytes producing a heat-labile protein(s?), endogenous pyrogen. It is this endogenous pyrogen that is thought to result, ultimately, in the thermoregulatory set-point being raised. Within the past several years considerable evidence has accumulated that moderate elevations in body temperature are beneficial to the infected host. Studies with bacterial and viral infected animals have shown that moderate fevers increase survival rate. Many components of the nonspecific host defense response to infection such as leukocyte mobility, lymphocyte transformation, and effects of interferon, appear to be enhanced by elevations in temperature that simulate moderate fevers. In addition, some evidence indicates that a fever in conjunction with the changes in plasma iron levels known to occur during infection is a synergistic host defense response. More research needs to be done to determine for specific diseases whether moderate fevers are beneficial, neutral, or harmful to the infected host.
Inexpensive Method of Increasing Immunization Rates
Authors: Chilton Lance A.
Published: December 2021

Recently an 18-month old child with an ear infection was brought to our clinic for treatment. The medical student who saw the patient and who had been taught to be complete found that the child had had no immunizations. She was told by the mother that the child had had a cold every time he had an appointment for "shots." The child received diptheria-pertussis-tetanus, oral polio, and measlesmumps- rubella immunizations in addition to amoxicillin.

Had the mother made a real effort to obtain the immunizations or was this merely a convenient excuse? Although we could not know the answer to this question, we do know that the policy of many public health nurses and other health-care providers in our community is that a child must be in perfect health before an immunization can be given.
Prevention and Treatment of Neonatal Herpes
Authors: Brunell Philip A.
Published: December 2021

It is estimated that the number of cases of genital herpes infection in the United States can be numbered in the millions. Genital herpes infections are sexually transmitted; consequently, affected women are mainly in the child-bearing age group. Herpes infection is a problem to the pediatrician as it affects the sexually active adolescent and also the newborn infant. Recommendations for the management of the pregnant woman with genital herpes infection to minimize the risk to the newborn infant have been published recently.1 The plan calls for avoidance of vaginal delivery in women who are identified as having genital herpes infection.
Linoleic Acid Supplementation
Authors: Parsons H. G. , Pencharz P. B.
Published: December 2021

The study of Chase et al1 was designed to determine whether linoleic acid supplementation would lead to a greater improvement in the growth and clinical status of children with cystic fibrosis than would be expected to result from an increased energy intake alone. There are two points that we would like to make regarding this study. The first is that there is a significant difference in the effective energy for growth in the two intravenous regimes used.
Screening for Biopterin Disorders in PKU
Authors: O'Brien Donough
Published: December 2021

It is now recognized (Pediatrics 65:806, 1980) that a small proportion of cases of phenylketonuria (PKU) may be due to abnormalities in the metabolism of biopterin. These cases do not respond to the restriction of dietary phenylalanine, but may be benefited by neurotransmitter replacement therapy. A specific diagnosis is therefore desirable.

The Nutrition Committee of the American Academy of Pediatrics, in conjunction with the Society for Inherited Disease, announces the availability of an exploratory screening program for new cases of PKU for urinary biopterins.
How Could You?
Authors: Altenburger Karl M.
Published: December 2021

I am disappointed that the editors of the official publication of the American Academy of Pediatrics would choose to publish the commentary entitled "What is Scientific Proof?1 Such publication in the absence of further commentary lends the support at the Academy to a call for the acceptance of an ill-defined symptom complex allegedly due to the ingestion of certain foods. While some may have reservations about the application of the scientific method to the subject in question, the editors of this journal should have none.
Infant Enrichment Programs
Authors: Denhoff Eric
Published: December 2021

The recent article by Piper and Pless1 typifies studies necessary to help place early infant intervention programs on a more objective basis. There is a great need for controlled studies on the effects of various treatments and/or education methods on biologically handicapped babies. This point is emphasized in a current review being prepared for the members of the Committee on Children with Handicaps, American Academy of Pediatrics.

One anticipates both favorable and adverse reactions to the Piper-Pless article.
Group F Streptococcus Associated with Intrauterine Pneumonia
Authors: Wells David W. , Keeney Glenward T.
Published: December 2021

Much attention has recently been focused on the increase in neonatal morbidity and mortality from non-group A beta hemolytic streptococcal infections. The vast majority of these infections have been identified as members of group B; however, neonatal meningitis and/or sepsis due to groups C, D, E, and G have been reported.1-4 A case of group F septicemia has been noted by Nyhan and Fousek,5 but no details of the case were discussed. The following case documents the development of an intrauterine pneumonia after premature and prolonged ruptured membranes associated with Group F streptococci.
Letters to the Editor
Authors: Barness Lewis A.
Published: December 2021

I think that both this letter and the preceding one emphasize some of the dilemmas that the Committee on Nutrition went through in trying to come to agreement on the recommendations of the onset of supplemental foods. First, I would not quarrel with the caloric intake, nor the weight of the 2-month-old infant. The caloric intake may be considered on the upper limits for this age group. Second, I certainly do agree that most children do well with many different types of varieties of feeding, so far as we can tell.
Assessment and Evaluation of Child Health Associates
Authors: Silver Henry K. , Ott John E. , Dungy Claibourne I. , Fine Louis L. , Moore Virginia M. , Krugman Richard D.
Published: December 2021

More than 20 studies have been carried out of child health associates to assess their knowledge, training, and practice; their ability to interpret and integrate data; their cognitive knowledge and psychomotor and interpersonal skills; and their competence and effectiveness as primary health care providers. The results of the assessment and evaluation studies of child health associates indicate that they can determine the health status and manage the health care of patients in ambulatory settings and in the newborn nursery with a degree of skill and competence approaching that of pediatricians. Child health associates can provide comprehensive primary health care for more than 90% of children seen in these settings. The high degree of acceptance of child health associates by families and their demonstrated proficiency and cost-effectiveness document that they can be an important source of primary health care for most children.
Chronic Cough in Children: A Manifestation of Airway Hyperreactivity
Authors: Cloutier Michelle M. , Loughlin Gerald M. , DeCubellis Stephen D. , Crowder Mark H.
Published: December 2021

Fifteen children who presented with chronic cough as an isolated manifestation of respiratory disease were evaluated for the presence of exercise-induced airway hyperreactivity. Pulmonary function tests using air and a helium/oxygen gas mixture were performed before exercise. Air curves alone were performed repeatedly after exercise. Eight subjects were also evaluated by spirometry and maximum expiratory flow volume curves before and after isoproterenol inhalation on a separate day. Ten subjects had normal pulmonary function tests at rest and five had isolated minor abnormalities. No significant changes in pulmonary function tests were recorded after inhalation of isoproterenol in the eight subjects studied. Following exercise, all 15 subjects demonstrated changes in pulmonary function tests which were similar to those seen in children with mild exercise-induced bronchospasm. After institution of theophylline, exercise-induced decreases in flow rates low in the vital capacity were blocked in all subjects; however, several subjects had persistent mild decreases in peak flow. Within six months of discontinuing the theophylline, cough recurred in 11 of the 15 subjects. Nine subjects were restudied after return of their cough. Exercise again resulted in decreased lung function. Reinstitution of theophylline eliminated the cough in these nine subjects. This study demonstrates that chronic cough in some children may be a manifestation of airway hyperreactivity. Both the cough and the reactivity can be blocked with theophylline.
Takayasu's Arteritis: The Relationship with Tuberculosis
Authors: Pantell Robert H. , Goodman Benjamin W.
Published: December 2021

A 12-year-old girl developed Takayasu's arteritis (pulseless disease) within a month of the appearance of tuberculous cervical adenitis. This unusual form of arteritis is common in Japan and Korea but has rarely been reported in individuals born in the United States. The etiology is unclear. The literature currently hypothesizes an autoimmune basis and treatment with steroids. Although a tuberculin sensitization pathogenesis has been suggested, a close temporal relationship with the onset of a tuberculous process has not previously been documented. The likelihood of uncovering tuberculin sensitivity or active tuberculosis in patients with Takayasu's arteritis is substantially higher than in the general population in all countries analyzed. The natural history of this arteritis is highly variable. The adolescent described in this paper has demonstrated complete symptomatic remission as well as return of pulses simultaneous with antituberculosis therapy.
Carnitine in the Perinatal Metabolism of Lipids I. Relationship Between Maternal and Fetal Plasma Levels of Carnitine and Acylcarnitines
Authors: Novak Milan , Monkus Ellen F. , Chung Dina , Buch Maria
Published: December 2021

Since premature infants have a limited capacity for fatty acid oxidation, supplementation with carnitine may improve their utilization of fat. Documentation of the source and extent of fetal carnitine reserves should explain the possible need for exogenous carnitine in the neonate. Correlation between free carnitine concentration in maternal and umbilical arterial plasma at birth (r = .45, P < .01) indicates that the initial concentration of free carnitine in the newborn depends on the maternal level. Thin-layer chromatography shows more γ-butyrobetaine in maternal than umbilical arterial plasma indicating higher availability of the precursor of carnitine biosynthesis. Elevated fatty acid oxidation in maternal tissues seems to be reflected by larger amounts of long-chain acylcarnitines in maternal plasma. Shortchain acylcarnitines, mainly acetylcarnitine, are higher in the umbilical vein than in maternal plasma (P < .01) indicating that the conceptus (the placenta or fetus) is either producing more or utilizing less acetylcarnitine. Plasma levels of carnitine rapidly decrease in premature newborns during the first three days after birth if no exogenous carnitine is given (P < .001), while no significant changes of total carnitine were detected in adult patients on total parenteral alimentation for one week. This difference indicates lower carnitine depots or limited capacity for carnitine biosynthesis in neonates. The possibility still requires further investigation that the development of the optimal rate of fatty acid oxidation in human newborns, as well as in other newborn mammals, may depend on the supply of exogenous carnitine.
The Velo-Cardio-Facial Syndrome: A Clinical and Genetic Analysis
Authors: Shprintzen Robert J. , Goldberg Rosalie B. , Young Dennison , Wolford Larry
Published: December 2021

Thirty-nine patients with the velo-cardiofacial syndrome are described in order to further delineate this probably common recurrent pattern congenital malformation syndrome. Frequent features include cleft palate, cardiac anomalies, typical facies, and learning disabilities. Less frequent findings include microcephaly, mental retardation, small stature, slender hands and digits, minor auricular anomalies, and inguinal hernia. The Robin malformation sequence was found in four patients. The congenital heart anomalies most frequently involved a ventricular septal defect, with or without a right-sided aortic arch. There were four instances of familial transmission in the sample population. These included two cases of maternal transmission of the syndrome to daughters, one case of maternal transmission to a son, and one case of maternal transmission to both a son and daughter. There was no particular difference in expression between male and female patients so that even though X-linked dominant transmission is possible, the velo-cardio-facial syndrome is likely to be an autosomal dominant recurrent pattern syndrome.
Effect of Pediatricians' Counseling on Infant Restraint Use
Authors: Reisinger Keith S. , Williams Allan F. , Wells JoAnn K. , John C. Eric , Roberts Thom R. , Podgainy Helen J.
Published: December 2021

The effect of pediatricians' counseling to parents on infant restraint use was studied. The study population consisted of 269 women who gave birth to infants consecutively in Pittsburgh hospitals and requested that their infants be cared for by three pediatricians in a group practice. An experimental group received education regarding crash protection of infants traveling in cars during their postpartum stay and at their infants' 1 and 2 months of age well-child visits. Educational inputs included: discussions by the pediatricians on how to protect infants in cars, a pamphlet on car safety, a formal prescription for a restraint, and an actual demonstration by pediatricians of correct use of an infant restraint. A comparison group was not provided such education. Evaluation was based on actual observations of how infants were traveling in cars when they arrived at the pediatricians' office for well-child care at 1, 2, 4, and 15 months of age. Use of restraints anchored by car seat belts in the experimental group was higher than in the comparison group at each observation point by 23% at 1 month, 72% at 2 months, 9% at 4 months, and 12% at 15 months of age. The results indicated that pediatricians can be effective in increasing the protection of infants in cars, at least at the age (2 to 3 months) when the car-occupant death is especially great, but in this study the effect of their education was largely diminished by four months. Pediatricians should routinely educate their patients about crash protection of infants, but further studies are needed to determine techniques that can be used to maximize the magnitude and duration of positive effects. Additional techniques to increase the crash protection of infants, such as improved interior compartment designs and air bags, are also necessary and should be encouraged by pediatricians and other physicians.