bluuebunny/crossref_metadata_2025 huggingface dataset:
Photodistribution of Viral Exanthems
Authors: Gilchrest Barbara , Baden Howard P.
Published: December 2021

Two cases are presented in which a systemic viral illness produced a rash almost exclusively in sun-exposed areas. Correct diagnosis in the above cases required extensive investigation and contradicted the clinical impression of the involved physicians. This suggests that a wide spectrum of viral exanthems may present in this way occasionally, but escape detection, although more documented cases are needed to verify this statement. Wider appreciation of the phenomenon might prevent unfortunate errors in diagnosis and therapy. Hypotheses to explain the accentuation of viral exanthems in sun-exposed areas are developed.
GALEN ON A CRYING AND FUSSY INFANT
Authors: C. T. E.
Published: December 2021

Claudius Galenus, one of the greatest figures in medical history, was born at Pergamos in Asia Minor A.D. 131 and lived to be about 70 years old. He studied medicine at Alexandria, and in 162 settled in Rome, where in 169 he became personal physician to the Emperor Marcus Aurelius.

Among his voluminous writings, none is superior to his book entitled Hygiene (De Sanitate Tuenda). The quotation below taken from Dr. Robert M. Green's superb translation of Galen's Hygiene will show his practical approach in soothing a crying and fussy infant.

For no animal likes excess of anything, but always wants moderation. But moderation is not the same to all, for all moderation is relative to the individual. Therefore whoever undertakes the bringing up of infants must be able to guess accurately what is moderate and comfortable and provide this before increasing distress throws the body and mind into excess of activity, and if ever the increasing distress escapes his notice, to try to provide immediately the thing desired or to remove the annoyance either by rocking in the arms or by modulation of the voice, which sagacious nurses are accustomed to employ.

Once, when a baby had cried and fussed and tossed all day, and the nurse was completely at a loss, I discovered the cause of the trouble. For when he did not quiet down by having the nipple put in his mouth or by the nurse holding him in case he wanted to move his bowels or urinate, and was not consoled even when by taking him in her arms she tried to make him lie down, I inspected his bed and his coverings and his soiled clothing, and the baby himself dirty and unwashed, and ordered her to wash and wipe him, change his bed, and give him completely clean clothing.
The Pharmacologic Management of Status Asthmaticus in Children
Authors: Bierman C. Warren , Pierson William E.
Published: December 2021

This treatment protocol has been employed effectively as a specific guide. It also can be adapted to changing or unique clinical situations and aids in bringing optimum treatment to the child or adolescent with status asthmaticus.
The Guest Speaker Adds Some Thoughts
Authors: Williams Cicely D.
Published: December 2021

I am greatly honored by your publication of my Blackfan Lecture at Harvard on "Health Services in the Home."1

I also appreciate the notice given to the article by the commentary from Dr. David Nathan.2

Dr. Nathan is certainly entitled to interpret my feelings ("Be off" she states "with your ultrascience") and I am grateful to him for his interpretation. I was rather ashamed of my own moderation. But this was not what I stated.
Misinterpretation of Cerebrospinal Fluid Gram Stain
Authors: Joyner Ronald W. , Idriss Ziad H. , Wilfert Catherine M.
Published: December 2021

Several causes for false-positive Gram stains of cerebrospinal fluid (CSF) have been recorded previously! We report here an additional cause for misinterpretation of the cerebrospinal fluid Gram stain which is probably related to the use of an open needle to perform the lumbar puncture.

CASE REPORT

The patient was a 1,300-gm black female infant, delivered after a 33-week gestation, who developed mild respiratory distress and hyperbilirubinemia which resolved spontaneously within one week. She received penicillin G and kanamycin for her first five days of life because of apnea and bradycardia, but blood, urine, CSF, and a culture of the tracheal aspirate obtained prior to therapy were all negative for bacteria.
Another Cause of Petechiae Suggested
Authors: Gorlick Gary
Published: December 2021

The article entitled "Fever and Petechiae With Adenovirus Infection" by Sahler and Wilfert in the February 1974 issue of Pediatrics is most interesting, but contains one aspect which I should like to comment on. The inference is made that the petechiae seen on this child's body were the result of the adenovirus infection which is well established. I would suggest that the petechiae might have been caused by the Valsalva maneuver which so commonly follows either coughing or vomiting in children.
Comments on Linear Nevus Sebaceous Syndrome
Authors: Tripp John H.
Published: December 2021

Regarding the article by Lovejoy and Boyle (Pediatrics, 52:382, 1973, "Linear Nevus Sebaceous Syndrome," may I draw attention to yet another patient described in 19711 who was seen in London, and also question the inclusion of Lovejoy and Boyle's second patient in this syndrome.

Our patient mentioned above had the triad of diagnostic features associated with the syndrome described by Feuerstein and Mims,2 including linear sebaceous nevus (which however was not in the midline) salaam spasms, and developmental delay, though the latter was only moderate.
Iatrogenic Gangrene of the Buttock in 1950
Authors: McCandless A. E.
Published: December 2021

Dr. Hudson and I were interested in the case history of the infant who developed necrosis of the buttock following catheterization of an umbilical artery (Pediatrics, 53:106, 1974).

In January 1950 (Brit. Med.J., 1:233, 1950) we described 20 cases of unilateral sciatic paralysis sometimes accompanied by gangrene of the ipsilateral buttock considered to be due to accidental injection of a respiratory stimulant then in use, cycliton, into the umbilical artery, instead of the umbilical vein.
Neonatal Pneumopericardium
Authors: Yeh T. F. , Vidyasagar D. , Pildes R. S.
Published: December 2021

Four neonates with pneumopericardium were seen within a 12-month period. All infants received various methods of assisted ventilation. Two episodes were recognized early and prompt pericardial aspiration resulted in survival. One was asymptomatic, recognized by roentgenogram and treated conservatively. The fourth infant was recognized by postmortem roentgenograms. A clinical analysis of these four infants and that of 13 others reported in the literature is presented. Awareness of this complication in infants on IPPB or CDP, prompt diagnosis and therapy may be lifesaving.
Leukocyte Lactate Dehydrogenase in Bacterial Meningitis
Authors: Powers David W. , Ayoub Elia M.
Published: December 2021

Powers, D. W., and Ayoub, E. M.: Leukocyte lactate dehydrogenase in bacterial meningitis. Pediatrics, 54:27, 1974.

Figures 3 and 4 were reversed.
Letter to the Editor
Authors: Bauer Charles R. , Stern Leo , Colle Eleanor
Published: December 2021

We appreciate the opportunity to respond to Dr. Holzman's comments. The obstetrical data were not presented because in this small number of cases, no significant preexisting problems were present. One of us (C.R.B.) was present at each delivery and no significant intervention was required beyond bulb suctioning and oxygen.

Two infants were delivered by cesarean section, both in the <16-hour group. These were infants 1 and 2 in Table I; one developed RDS and one did not.
What Test and When?
Authors: Perrin James M.
Published: December 2021

The recent article by Thorpe and Werner1 provides a helpful review of some aspects of developmental screening tests. A few points might however be expanded upon to aid pediatricians in deciding when to use which inventory with which children.

The inventories are not all applicable to the same age ranges. The Denver Developmental Screening Test (DDST) has been standardized for the first six years of life, and is often used in pediatric practice in the first three years.2
Esophageal Atresia and Tracheoesophageal Fistula: Supportive Measures That Affect Survival
Authors: Koop C. Everett , Schnaufer Louise , Broennle A. Michael
Published: December 2021

The survival of infants with esophageal atresia with or without tracheoesophageal fistula has been analyzed over a 24-year period divided into three eras of five years each depending upon the quality of intensive care available and the most recent nine years' experience.

Early diagnosis and skillful transportation to definitive surgical care are essential. Diagnosis by x-ray with a coiled catheter in the upper esophageal pouch without the use of radiopaque material is beneficially reflected in a decreased incidence of pneumonia and a reduced mortality. The skills of anesthesia carried over into close supervision of respiratory care postoperatively have further increased the salvage rate of these infants.

As surgical technical problems have been overcome, the percentage of deaths due to associated major anomalies and pneumonia and/or sepsis has increased. Invasive techniques for diagnosis, for monitoring, and for treatment do not seem to be responsible for the sepsis.

In the most recent experience with 134 patients over nine years the overall survival was 66%; full-term infants had a 70% survival while the survival rate for prematures was 52%. In full-term infants without pneumonia and without a major associated congenital anomaly, the survival rate was 100% (44 patients).

Clearly the target for improvement in survival is the prevention of and the improvement in treatment of pneumonia and sepsis.
Screening, Screening Programs and the Pediatrician
Authors: Lessler Ken
Published: December 2021

For a pediatrician to evaluate his position and role in the health care of children, he must have clearly delineated what he means by "health." If, in addition, the pediatrician is to consider his stance with regard to screening, he must specify what he means by "screening," and outline what constitutes a "screening program."

HEALTH

The pediatrician's commitment to child development and the "welfare of children" suggests that he is interested in far more than biological survival or the absence of disease. His relative commitment to the two poles of this conceptual continuum–biological survival vs total human formation and growth–will strongly affect his approach to health screening. With one commitment, he will choose to put money and time into identifying comparatively rare but potentially fatal or crippling conditions; with a different perspective he may advise that resources be devoted to identifying conditions which are much more common but less physically dangerous. With one viewpoint, he will devote energy to identifying and helping children with language delays and other learning, social and emotional problems. With the other viewpoint, he may elect to screen only for heart disease, PKU, sickle cell disease and tuberculosis.

Although the choice may often be pragmatic rather than philosophical, the pediatrician must agree with Richmond and Weinberger that any consideration of the child "must include elements of the entire social milieu in which children develop–the educational system, the social system, the physical and emotional environment itself."1

SCREENING

Such an expanded concept of health requires a definition of screening which is less restrictive than the one recommended to the World Health Organization (quoted by Frankenburg2 in his symposium).
Current Status of Screening Children for Urinary Tract Infections
Authors: Kunin Calvin M.
Published: December 2021

There is ample evidence that significant bacteriuria is frequent enough and procedures for mass screening are sufficiently developed to enable this country to mount a large scale program directed to the early detection of urinary tract infections. Information is now available on the epidemiology of bacteriuria, the frequency of associated structural abnormalities and methods to provide effective management. It is also clear that most female children with urinary tract infection generally will have a good prognosis. Few will develop endstage renal failure, but symptomatic infection is commonly associated with considerable morbidity. Unfortunately, it is not as yet possible to predict which child is at high risk of developing serious complications without searching for structural or neurologic abnormalities or by following individual patterns of recurrence. The ultimate impact on health and longevity is unknown even using data from the most structured programs. There is also the danger that mass programs may lead to false hope and eventual disillusionment if they are limited to detect infection and do not provide for further diagnostic, therapeutic and long-term follow-up of patients.

For these reasons, urinary tract infection detection programs must be designed in relation to the realities of the current medical care system, the goals should be clearly defined and the expected result be stated honestly.

AIMS OF THE PROGRAM

There are two major reasons for screening children for urinary tract infection. One is to prevent the considerable morbidity from symptomatic infection and its complications so common in females throughout life. The other is to detect the population (often with anatomical abnormalities) at risk of developing pyelonephritis and subsequent renal damage.
Health Maintenance Profile for Office and Clinic Use
Authors: Lieberman Allan D. , Raynor Sandra
Published: December 2021

Health maintenance is a major concern for all physicians, but especially the pediatrician.

To provide an organized program of health maintenance within an office or clinic, we have designed a profile which simply and graphically describes what is needed for an infant or child at any age and insures that no element will be forgotten.

The profile encompasses all of the procedures, tests, and immunizations recommended by the American Academy of Pediatrics and those of interest to us. Extra spaces have been provided for additional procedures or immunizations that may be necessary.

To use the profile, one need only look at the age of the infant or child to determine what is to be done [unknown] and then cross the slash line showing that it was completed [unknown].
The Tuberculin Test
Authors: Sewell Edward M. , O'Hare Donna , Kendig Edwin L.
Published: December 2021

The tuberculin test is a major diagnostic tool. A positive reaction to the tuberculin test indicates the presence of tuberculous infection, but the degree of activity, if any, or the severity of the disease process cannot be thus determined. There are also other limitations of the test as noted later in this discussion.

A routine tuberculin test should be performed sometime during the first year of life and annually or biennially thereafter. It is, of course, always indicated when there has been known contact with a tuberculous adult. In the latter instance, if the tuberculin reaction is negative, the test should be repeated eight to ten weeks after the removal of the contact. If the child remains in contact with a tuberculous adult, the tuberculin test should be repeated at three-month intervals.

Tuberculin solution, utilized in skin testing, is available in two forms, purified protein derivative (PPD) and old tuberculin (OT) solution.

PPD is the tuberculin solution now recommended because it is a more specific product. It is the protein of the tubercle bacillus obtained from filtrates of heat-killed cultures of tubercle bacilli that have been grown on a synthetic medium and then precipitated either by trichloracetic acid or neutral ammonium sulfate. The latter precipitant is used in the United States. The World Health Organization has designated one large batch of PPD (No. 49608, manufactured by Dr. Florence Seibert in 1939) as the international standard tuberculin (PPD-S).1 PPD is available commercially; it was formerly dispensed in tablet form and dissolved in a measured amount of diluent before use.
Convulsions and Ritalin?
Authors: Chamberlain Robert W.
Published: December 2021

I have been following a 10-year-old boy with school problems related to his hyperactivity and short attention span. After an essentially normal neurological and psychological evaluation, he began taking 5 mg/day of Ritalin. This dose was increased weekly by 5 mg. When a dose of 15 mg/day was reached, he had a grand mal seizure. An electroencephalogram done one week later was normal. A neurologist of my acquaintance recalls a similar association in about four or five other patients out of many being followed by her who have been put on Ritalin.
Stuttering Is Not a Benign Disorder
Authors: Levy Harold B.
Published: December 2021

The letter from Dr. C. E. Healy1 noting the successful management of his patient with stuttering through the use of haloperidol (Haldol) deserves special comment. It adds to our knowledge of the use of this and other medications in the varying manifestations of fine central nervous system control as related to communication disorders. Other reports, chiefly in the British literature,2-4 confirm the efficacy of haloperidol in the amelioration of hyperactivity and other behavioral disorders seen in the syndrome of minimal brain dysfunction, indicating some common bond of biochemical disturbance as has been suggested by this correspondent elsewhere.5
Abortion Counselling: Focus on Adolescent Pregnancy
Authors: Nadelson Carol
Published: December 2021

The Supreme Court decision permitting abortion in the first trimester of pregnancy has resulted in a shift from preabortion psychiatric counselling to quick turnover at the expense of quality care. Adolescent girls, a high-risk population, should have experienced, nonjudgmental counselling in order to: (1) work through their feeling about pregnancy so that they can reach the best decision for themselves; (2) cope with the stress, guilt, and ambivalence they feel; (3) understand the psychological reasons for their non-use of contraceptives and thus avoid future unwanted pregnancies; (4) improve family relationships; and (5) understand the procedure itself.
T and B Lymphocyte Subpopulations in Children
Authors: Fleisher Thomas A. , Luckasen John R. , Sabad Andrej , Gehrtz Richard C. , Kersey John H.
Published: December 2021

T and B lymphocyte subpopulations were examined in the peripheral blood of children using the E and EAC rosette assays. Children under 18 months of age were found to have a decreased percentage of E-binding (T) lymphocytes and an increased percentage of EAC-binding (B) lymphocytes compared to older children (18 months to 10 years) and adults. The absolute number of E-binding and EAC-binding lymphocytes was increased in children under 18 months of age.
Drs. Kattwinkel, Fanaroff and Klaus Reply
Authors: Kattwinkel John , Fanaroff Avroy A. , Klaus Marshall H.
Published: December 2021

We appreciate Drs. Gresheim and Schreiner's comments and are pleased to hear that they also are having good results with nasal CPAP. We have recently corresponded with a large number of neonatal centers who have been using nasal CPAP. Several of them noted that with endotracheal CPAP they too were able to improve oxygenation in a few babies who had "failed" the nasal approach. It certainly seems worth a try if the infant is not apneic, thus requiring controlled mechanical ventilation.
Sacral Agenesis
Authors: Say Burhan , Coldwell James C.
Published: December 2021

We were interested in the report by Thompson et al.,1 emphasizing the seriousness of the urological problems associated with sacral agenesis which are often overlooked by the pediatrician. We have just submitted a report for publication on the hereditary aspects of this malformation.2 In the family we studied, the proband, a 4-year-old girl, had severe urinary incontinence and a neurogenic bladder in addition to partial sacral agenesis. In the light of the report by Cohn and Bay-Nielsen,3 who proposed that this anomaly is, occasionally, inherited as an X-linked dominant entity, we investigated the family further.
Nurses Volunteer Help
Authors: Parker Nancy J.
Published: December 2021

The Executive Committee of the Department of School Nurses, NEA welcomed "Concepts of School Health Programs" from the AAP1 and felt it was very comprehensive in the broad definition of school health programs. There were a few specific comments which I trust AAP will not object to my sharing in the hopes of providing increased and improved dialogue between our two organizations and disciplines.

First, there appears to be a matter of semantics with the words "primary health care."
Lettrt To The Editor
Authors: Holliday Malcolm A.
Published: December 2021

Two letters raise questions concerning the need infants and children have for fluoride. A recent statement by the Committee on Nutrition reviewed the subject generally. The question of whether infants under 6 months of age should receive fluoride has not been examined. The logic for its benefit during this period of rapid bone and tooth growth is strong. However, the low content of fluoride in human and other mammalian milks (<0.2 mg/liter) suggests caution. This has led the Committee on Nutrition to avoid recommending the addition of fluoride to infant formulas.
Lettrt To The Editor
Authors: Gilchrest Barbara , Baden Howard P.
Published: December 2021

We are grateful to Dr. Cherry for his careful reading of our report. The figures are indeed reversed, and viruses exceeding 30 mµ in diameter are correctly considered large. We regret that we were unaware of the earlier reports of photodistributed viral exanthems cited by Dr. Cherry, although his own report does not explicitly describe a photodistribution. Apparently computer searches are restricted to the preceeding decade! However, if like so many "discoveries" in medicine, our observation is an old one, we hope it may nevertheless be helpful to the practicing physician.
Nosocomial Influenza Infection as a Cause of Intercurrent Fevers in Infants
Authors: Hall Caroline B. , Douglas R. Gordon
Published: December 2021

All patients on an infants' ward manifesting intercurrent fevers were studied for viral and bacterial etiology during a community outbreak of influenza A. During a one-month period, of 29 infants admitted to the ward, 17 were hospitalized for seven or more days. Intercurrent fever complicated the course of 13 (76%) of these 17 infants. Nosocomially acquired influenza A infection was found in 12 (92%) of the 13 infants. Two of these also contracted a dual infection with influenza B. The fever lasted an average of 2.7 days with a peak of 38.2 to 39.8 C. Initial white blood cell counts tended to be high and Shifted to the left. These infants appeared to be at high risk for developing lower respiratory tract disease. Seven of the 12 had infiltrates on chest X-ray, and five subsequently developed a secondrly bacterial pneumonia. These infants tended to be young, five were under 6 months, and all but one had underlying cardiorespiratory disease. They also appeared to have prolonged shedding of influenza virus from their nasal secretions. Six of seven shed the virus for 7 to 21 days.
Antiviral Chemotherapy and Neonatal Herpes Simplex Virus Infection: A Pilot Study—Experience With Adenine Arabinoside (ARA-A)
Authors: Ch'ien Lawrence T. , Whitley Richard J. , Nahmias Andre J. , Lewin Edward B. , Linnemann Calvin C. , Frenkel Lawrence D. , Bellanti Joseph A. , Buchanan Robert A. , Alford Charles A.
Published: December 2021

Among 13 neonates with herpes simplex virus (HSV) infection, eight had disseminated disease, one localized CNS disease, and in four the infection was confined to the skin and eyes. Ara-A, a purine nucleoside with anti-viral activity against DNA-viruses, was given (10 to 20 mg/kg/ day) by a continuous 12-hour intravenous drip for 10 to 15 days. In all, ara-A administration was begun within three to eight days after the appearance of skin vesicles which represented the hallmark of the disease. Both diagnosis and ara-A treatment were much delayed in one infant without skin vesicles and four infants whose skin vesicles appeared late, long after the occurrence of CNS damage. In this group of infants with disseminated disease, four died and one infant was left with severe neurological deficits.

Eight infants (four with disseminated and four with localized skin disease) with skin vesicles as the earliest sign of infection received ara-A early, within three days after the onset of neurologic signs. All survived with no neurologic deficit at 6 months to 1 year of age. There was no apparent toxicity of ara-A to the bone marrow, liver, or kidney.
ILLEGITIMATE ISOLATION
Authors: Myrdal G.
Published: December 2021

Any attempt to analyze the impact of health or education measures without taking other policy measures into consideration involves the logical fallacy of illegitimate isolation.
Danger of Styrofoam Cups
Authors: Reiman Reuben
Published: December 2021

Accident prevention has commanded the increasingten attention of the pediatrician in recent years. One of the more obvious precautions has been to protect infants and children from toys or other objects which have sharp or small parts which might become dislodged and subsequently swallowed or aspirated.

Now, I wish to direct attention to another possible peril. Recently, believing it to be safe, a mother in my practice gave her 8-month-old infant a Styrofoam cup with which to play.
Could It Have Been Pertussis?
Authors: Berliner Benjamin C.
Published: December 2021

I am not sure that Lewak's theme1 is borne out by his case description. Despite the absence of findings at autopsy, it is difficult for me to think of this infant as being a victim of sudden infant death syndrome. As a matter of fact, I would respectfully suggest that this baby had pertussis. This would certainly not be an unusual mode of death.
Guidelines for Living With a Hyperactive Child
Authors: Schmitt Barton
Published: December 2021

Most pediatricians agree that medications should be prescribed sparingly for hyperactive children and not at all before school age.

The parent with a hyperactive preschooler needs specific advice on how to cope with such a child on a day-to-day basis. The following office handout entitled "Ten Guidelines for Living With a Hyperactive Child" has been utilized for four years. It has been a helpful adjunct to verbal anticipatory guidance and may be useful to other pediatricians.
Endometrial Pathology and Its Relation to Estrogen Therapy in Patients With Hypogonadism
Authors: Rosenwaks Zev , Urban Maria D. , Wentz Anne C. , Lee Peter A. , Parmley Tim H. , Migeon Claude J. , Jones Georgeanna S. , Woodruff J. Donald
Published: December 2021

Clinical observations suggest that estrogen levels above physiologic plasma concentration can result in pathologic endometrial changes. Patients with feminizing ovarian tumors and those with the polycystic ovary syndrome who have excessive amounts of endogenous estrogens have a high incidence of endometrial cancer.1-4 Several investigators have noted the development of atypical hyperplasia and adenocarcinoma in women receiving prolonged treatment with various estrogen preparations, including the sequential oral contraceptives.5-11 Until recently, the association of exogenous estrogens with carcinoma of the endometrium had been based on clinical impression, but convincing epidemiological data had been lacking. Recent reports by Smith et al.12 and Ziel and Finkle13 indicate that the risk of endometrial cancer is 5 to 14 times greater in women taking exogenous estrogens.

Patients with hypogonadism are frequently treated with estrogenic substances to initiate the development of breasts and menstrual bleeding. Most of these patients are then maintained on estrogenic preparations for years. Therefore, this group of subjects provides a model for the study of possible development of endometnial changes in response to estrogen therapy.

To date, there have been 12 reported cases of endometrial adenocarcinoma in gonadal dysgenesis patients who received estrogen therapy.14-19 Eleven of these women were known to have received diethylstilbestrol; one patient was taking a sequential ethinyl estradiol-dimethisterone preparation at the time of the study and had previously taken an unknown estrogen preparation for four years.

This article presents information about the relationship of estrogen therapy and endometrial histology in 43 hypogonadal patients followed up in the Pediatric Endocrine Clinic and the Department of Gynecology and Obstetrics at The Johns Hopkins Hospital, Baltimore.
Aplasia Cutis Congenita Complicated by Sagittal Sinus Hemorrhage
Authors: Schneider Brian M. , Berg Robert A. , Kaplan Allen M.
Published: December 2021

An infant with aplasia cutis congenita complicated by sagittal sinus hemorrhage is described. In cases of large defects, plastic surgical repair has been recommended for prevention of hemorrhage and infection. The complication of sagittal. sinus hemorrhage should be considered in patients with large midline scalp defects, especially when associated with absence of the underlying cranium.
Thrombocytopenia: First Symptom in a Patient with Dyskeratosis Congenita
Authors: De Boeck Kris , Degreef H. , Verwilghen R. , Corbeel L. , Casteels-Van Daele Maria
Published: December 2021

A case of dyskeratosis congenita is reported. This rare hereditary disease usually has the following progression: ectodermal dystrophy (reticular skin pigmentation, nail dystrophy, leukokeratosis of mucosal membranes), appearing in the first decade, followed in about 50% of these patients by a hematopoietic disorder resembling Fanconi's anemia, usually developing in the second or third decade. Carcinomas may occur in leukokeratotic areas in the third, fourth, or fifth decade. This patient's clinical course is interesting because the thrombocytopenia developed as an isolated symptom at the age of 5 years and preceded the skin anomalies by three years. The diagnosis of dyskeratosis congenita was made only after an evolution of five years. The diagnosis of dyskeratosis congenita—although it is a rare disease—should be considered in every child first seen with aplastic anemia or thrombocytopenia.
Optimistic Finances Questioned
Authors: Vandervoort Robert , Bloom Sheila
Published: December 2021

Drs Weiss and De Jong (Pediatrics 66:91, 1980) are to be commended for sharing information about the costs and revenues associated with their pediatric continuity program. Such an analysis is important for departments of pediatrics in understanding the financial impact of their training program and for helping them make better informed decisions about the future course of such programs.

However, the authors have presented an even more optimistic picture of the financial position of the continuity practice than seems to be justified by the description of the program.
Letters to the Editor
Authors: Felice Marianne E.
Published: December 2021

Drs Behar and Stewart raise several issues that merit clarification:

1. Do adolescents who attempt suicide "tend to have previous psychiatric disorders"or disturbed personalities? Drs Behar and Stewart cite two studies1,2 that indicate that adults who successfully complete suicides have serious psychiatric disorders. It is not certain that this conclusion applies to adolescents, particularly those who make a suicide gesture or suicide attempt. Although no reference was given for the study by Crumley and discussed by Drs Behar and Stewart, we presume the reference to be the recent paper by Dr Crumley in the Journal of the American Medical Association.3
Considerations in Evaluating Changes in Outcome for Infants Weighing Less Than 1,501 Grams
Authors: Knobloch Hilda , Malone Anthony , Ellison Patricia H. , Stevens Frances , Zdeb Michael
Published: December 2021

Neonatal mortality for 285 infants and developmental outcome for 158 infants with birth weights of 751 to 1,500 gm, born in the Capital Regional Perinatal Center between July 1975 and December 1979, were compared with the findings in 1952, in 1965 to 1967, and in 1968 to 1970. In the 1,001- to 1,500-gm group, mortality decreased and there was an 18% incidence of major neuropsychiatric disability compared to the 48% found in 1952 when the same examination techniques and diagnostic criteria were used. More 751- to 1,000-gm infants survive now also, but 40% have a major handicap. There is a high incidence of preconceptional, prenatal, perinatal, and postnatal abnormalities in this group of very lowbirth-weight infants, but the incidence is significantly higher in those with major disabilities. The infants who die and those who have subsequent major neuropsychiatric abnormalities require the sophisticated techniques of neonatal intensive care, whereas these procedures are not needed or are used only briefly for the infants who are normal. In upper New York State, the demographic shifts in race, age, parity, education, and induced abortions account for 13% of the drop in neonatal mortality in the 1,001- to 1,500-gm group. These demographic as well as social and medical care changes must be taken into account in any evaluation of the decreasing mortality and morbidity that has occurred. Improvements in prenatal, obstetric, and neonatal care appear to be doing for the 751- to 1,000-gm group now what the then high-level care in 1952 did for the 1,001- to 1,500-gm group, when mortality decreased but only half of those who survived were normal.
Abilities of Children Who Were Small-for-Gestational-Age Babies
Authors: Harvey David , Prince Joyce , Bunton Jim , Parkinson Christine , Campbell Stuart
Published: December 2021

A follow-up study of 51 small-for-gestational-age babies, whose intrauterine growth was monitored by serial ultrasonic cephalometry, was carried out at a mean age of 5.1 years. The developmental abilities of the children were assessed by using the McCarthy Scales of Children's Abilities and the results were compared with those of a group of matched control subjects. Children whose head growth began to slow before 26 weeks' gestation had significantly lower scores for the general cognitive index than control children. This did not occur in children whose head growth began to slow later in gestation. Scores for Perceptual-Performance and Motor scales in the McCarthy scales were also lower for the children whose head growth slowed before 26 weeks' gestation, when compared with those of control children. There were no differences in the developmental scores of the children when they were divided into groups according to birth-weight percentiles. We conclude that prolonged slow growth in utero affects a child's later development and abilities, in particular, perceptual performance and motor ability.
Measles Immunity After Revaccination: Results in Children Vaccinated Before 10 Months of Age
Authors: Linnemann Calvin C. , Dine Mark S. , Roselle Gary A. , Askey P. Anne
Published: December 2021

Measles immunity was studied in children in a private pediatric practice who had been revaccinated because they had received their primary measles vaccination before 1 year of age. Antibody was measured in 72 of these children who had received the first injection of live measles virus vaccine at <10 months of age, and the second at >1 year of age. Of the 72 children, 29 (40%) had no detectable antibody and the geometric mean titer for the group was approximately 1:4. Of the children with low antibody titers, 15 were given a third injection of measles vaccine and five (33%) still did not respond. Cell- mediated immunity as indicated by lymphocyte transformation to measles antigen was measured in 11 of the children. Five (45%) had responses to measles antigen, but the responses did not correlate with the presence or absence of antibody. This study confirms the observation that revaccination is unsuccessful in many children who received measles vaccine in the first year of life, and shows that even a third injection of vaccine may fail to produce a significant antibody response.
JAMES JACKSON ON THE SECOND DENTITION (1855)
Authors: C. T. E.
Published: December 2021

James Jackson (1777-1867) has been called the most conspicuous physician in the medical annals of Massachusetts. He was a founder of and the first physician to the Massachusetts General Hospital. In 1812 he succeeded Benjamin Waterhouse as the Hersey Professor of the Theory and Practice of Medicine at the Harvard Medical School.

In his immensely popular, Letters to a Young Physician,1 first published in 1855, Jackson described the diseases he believed were caused by the second dentition as follows:

The occurrence of diseases during the first period of dentition is familiarly known, and attributed to the irritation of the coming teeth. It is not so well known that the appearance of the permanent teeth, also, is attended by diseases of various kinds. I feel satisfied, however, that this is the case....

During the second dentition, then, a liability to disease may be remarked as well as during the first, though not so great. Besides this general liability, there are certain morbid affections which are in a good measure peculiar to the period....I think the most common period of suffering from the second dentition is from the tenth to the thirteenth year. The most characteristic affections are wasting of flesh and nervous diseases. The boy loses his comeliness, and his complexion is less clear, while emaciation takes place in every part, though mostly, perhaps, in the face. The nervous symptoms are various; but the most common are a change in the temper, and a loss of spirits. With these there is some loss of strength.
Terminology: Near-Miss SIDS
Authors: Nickerson Bruce G.
Published: December 2021

The National SIDS Foundation recently issued a statement1 proposing that the term "infantile apnea" be used in place of "near-miss SIDS." I appreciate the Foundation's desire to avoid the confusion that the term near-miss SIDS carries but I decry transferring that confusion to the previously well-defined term "apnea." Apnea is defined as transient cessation of respiration.2 Use of the term infantile apnea should be reserved for infants who clearly (preferably objectively) have had cessation of respiration.
TRENDS
Authors: HUBBARD JOHN P.
Published: December 2021

AT THE present writing, the 81st Congress has reconvened but it is doubtful whether much, if any, attention will be given to the many health bills which have been discussed at such length in Committee and on the Floor. By the time this review and preview is published, the 81st Congress will have finally adjourned and all unfinished business in the nature of bills which have not been enacted into law will be washed off the slate. But this does not mean that the unresolved issues will necessarily be dead; they may be introduced in the 82nd Congress and appear in similar, if not identical, form. It is timely, therefore, to consider the status of certain of the health bills as a guide to the situation that we may expect to see unfold in the newly elected Congress.

Compulsory Health Insurance

Despite the all-out campaign waged by the AMA and many other powerful organizations, compulsory health insurance will undoubtedly continue to be a storm center. A bill for compulsory health insurance has been introduced, in one form or another, into every Congress since the first Wagner-Murray-Dingle Bill was introduced in 1943. It is not likely that the 82nd Congress will break this chain.
SPECIAL REVIEWS
Authors: STOKES JOSEPH , MCLEAN EDWIN B.
Published: December 2021

From the foregoing, it is evident that the first approach to the problem of iron deficiency anemia in infancy is one of prevention. It is essential to obtain the cooperation of the obstetrician in preventing iron deficiency during pregnancy and in allowing the newborn infant to receive as much of the placental blood as possible. When a deficiency is known to have been present in the mother during pregnancy, it is advisable to administer adequate doses of iron to the infant during the early months of life. Iron therapy for the infant or child who has already developed iron deficiency should be provided in adequate amounts. Dietary iron alone should not be relied upon to bring about recovery. Iron therapy will not prevent the anemia of prematurity but may be helpful in preventing the deficiency of this metal which can develop during recovery therefrom. Transfusions when indicated in the anemia of infection will supply needed iron to care for any associated iron deficiency. Iron deficiency due to chronic hemorrhage demands therapy directed toward the primary cause. In chronic gastrointestinal disease orally administered iron may not be well tolerated and repeated transfusions may be contraindicated. In these rare instances intravenously administered iron is a valuable therapeutic agent.
USE OF THE PERTUSSIS AGGLUTINOGEN SKIN TEST IN A WELL BABY CLINIC
Authors: BARYSH NOAH
Published: December 2021

Intradermal skin tests with pertussis agglutinogen were performed on 234 infants.

In one group of 100 infants skin tested with this material, at least three months after pertussis prophylaxis, it was found that 92% had positive (immune) skin reactions.

In a second group of 134 infants skin tested prior to pertussis vaccination, 83% (111) had negative skin reactions. In 66 of these 111 infants tested after pertussis prophylaxis, 92% developed a positive skin response.

The pertussis skin agglutinogen test can be used to determine the efficiency of materials used for pertussis prophylaxis.

The pertussis skin agglutinogen test is a reliable indicator of the immune response of an infant to H. pertussis immunization and is recommended as an effective agent for determining the susceptible infant—one lacking the minimal clinical protection against pertussis—after pertussis vaccination.
SPHEROCYTOSIS AND INCREASED FRAGILITY OCCURRING IN ERYTHROBLASTOSIS FETALIS ASSOCIATED WITH ABO INCOMPATIBILITY
Authors: ROBINSON GEOFFREY C. , PHILLIPS RUTH M. , PRYSTOWSKY MILTON
Published: December 2021

Four cases of hemolytic disease of the newborn infant are reported. There was ABO incompatibility and high maternal immune antibody titre after delivery. Immune antibody was demonstrated in the sera of 3 of the 4 infants.

The difficulties in making an unequivocal diagnosis are discussed and the diagnostic value of immune antibody in the infant's serum is emphasized.

The presence of spherocytosis and altered erythrocyte hypotonic fragility during the hemolytic phase is noted. These findings are similar to cases of acute hemolytic anemia in adults previously reported.
NEUROLOGIC COMPLICATIONS OF HERPES ZOSTER
Authors: NACHMAN ADOLPH R.
Published: December 2021

Three cases of neurologic complications of herpes zoster are reported. The relation of herpes zoster to varicella is discussed.
RESPONSE OF THE SERUM HYALURONIDASE INHIBITOR AND MUCOPROTEINS TO ADRENOCORTICOTROPIC HORMONE IN RHEUMATIC STATES
Authors: ADAMS FORREST H. , KELLEY VINCENT C. , DWAN PAUL F. , GLICK DAVID
Published: December 2021

ACTH was administered to 13 patients with acute rheumatic fever and to two with rheumatoid arthritis. The following observations were made: [See Chart 6 in Source Pdf]

1. The elevated nonspecific hyaluronidase inhibitor concentration of the serum dropped rapidly, usually to normal values, within 10 to 15 days, and subsequently the values became subnormal. This seemed to follow closely the subjective improvement in the patient's condition.

2. The elevated serum mucoprotein concentrations slowly returned to normal over a period of 3 to 4 months.

3. In instances in which the ACTH was withdrawn, or in which the dosage was reduced before a substantial drop of the mucoprotein level had taken place, the disease recurred.

4. ACTH administered to a patient with combined diabetes mellitus and rheumatic fever effected an increase in the insulin requirement to approximately double that of the pre-ACTH period. As the ACTH was gradually withdrawn, the insulin need returned to the pre-ACTH amount. The effect of ACTH on this patient's rheumatic fever was similar to the others receiving the hormone.
VOLUMETRIC AND MICROSCOPIC PATTERN OF BONE MARROW IN NORMAL INFANTS AND CHILDREN
Authors: STURGEON PHILLIP
Published: December 2021

With the use of the described bone marrow aspiration and concentration (volumetric) technic, the percentage distribution of the major categories of cells appears to follow the general pattern reported from studies of bone marrow in infants and children by the direct smear technics.

The percentage distribution of nucleated cells from sternal and iliac aspirations in the age range studied showed no apparent differences between the two sites nor influence of age on the data.

In normal individuals as young as 1½ years of age and with advancing age thereafter, an increasing number of tibial aspirations show a very low percentage of normoblasts (0-5) and a majority of lymphocytes and segmented neutrophils.
ELECTROENCEPHALOGRAPHY OF THE NEWBORN INFANT
Authors: HUGHES JAMES G. , DAVIS BILLIE CAMP , BRENNAN MARJORIE LEAK
Published: December 2021

A report is given concerning normal electroencephalographic patterns of premature infants in the first days of life. Thirty-one EEGs on 22 premature babies constitute the basis of the report.

Three main frequency bands were noted: waves of 2.5 to 4/sec. which usually appeared singly at amplitudes of 45 to 80 microvolts; waves of 5 to 7/sec. occurring in episodes of 1 to 1½ sec. at 25 to 40 microvolts; and frequencies of 11 to 15 cycles/sec. which appeared in episodes of 3/5 to 2½ sec. at amplitudes of 10 to 20 microvolts. The 11 to 15 cycle waves appeared more consistently than did the other frequencies observed, and were usually more prominent in the frontal region.

These findings indicate that in premature infants cortical electric activity from the frontal region is more well developed in regard to frequency, amplitude and rhythm than are the brain potentials from other areas of the cortex.

This observation is contradictory to what would be expected from a consideration of the embryonic maturation of the human cortex.
THE PRESIDENT'S PAGE
Authors: BEAVEN PAUL W.
Published: December 2021

THE latest Academy directory has been sent to the membership. I want to call your attention to the first part of this directory. The first few pages are taken up with the district and state chairmen. These are important in a democratic organization such as ours. Note the name of your state chairman and give him your cooperation in whatever he is doing. He was elected to that office and wants your ideas. Note the name of your district representative, for he was also elected, and by reason of this office is a member of the Executive Board which is the governing body of the Academy.

If you turn to page 9 and following, you will note some changes in committees. This is an attempt at clarification, based on some of the recommendations of the Reorganization Committee which was appointed by Dr. Sisson when he was President. The standing committees were the suggestion of that committee and are seven in number.

The Advisory Committee for Child Health is a purely advisory committee. It has no power except to render an opinion for the Executive Board. Its chairman is the immediate past president and its members are, in almost every instance, chairmen of other Academy committees. Ex officio members of this committee are the Scientific Program Chairman and the Editor of Pediatrics and of course the President. This gives the Executive Board, through the President, the collective opinion of those that are particularly well acquainted with the several areas of work in which the Academy interests itself. It is in effect a cabinet for the President.