bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional Aspects of Obesity in Infancy and Childhood
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W. , Tomarelli Rudolph M. , Benson John D. , Purvis George A. , LiCari Jerome , Lockhart Haines B. , Saperstein Sidney , Anderson Betty E. , White Philip L. , Egan Mary C. , Cheney Margaret , Roy Claude , Moore Melinda , Chopra Joginder , Brown Myrtle L. , Sarett Herbert P. , Fjellstedt Thorsten J. , Teply L. J. , Kennedy Eileen , Darby William J. , Lewy Peter
Published: December 2021

Obesity is characterized by an excess of adipose tissue relative to lean body mass. With rare exceptions, it simply reflects a long-term imbalance in energy intake vs expenditure. The excess energy is stored as fat. The known metabolic correlates of this state are, for the most part, secondary events.1 The day-to-day "error" in intake or expenditure necessary to derange long-term energy balance is smaller than the accuracy with which either factor currently can be measured over long periods; therefore, the question of etiologies remains unanswered.

The systems regulating mammalian fuel homeostasis and food intake are complex, and many potential "lesions" could alter long-term energy balance. There are a number of experimental and genetic animal models in which regulatory or apparent metabolic disturbances result in obesity, but no similar abnormalities have been consistently demonstrated in individuals with simple obesity.2 However, the traditionally accepted causes of obesity, relative overeating and/or physical underactivity, may not be operating in all instances of simple obesity.3,4

ANTHROPOMETRY

Criteria for the diagnosis of obesity are difficult to establish because "optimal fatness is a conditional state. A man preparing for an emergency trek, a population entering a period of famine, a child entering a febrile illness or a growth spurt or a woman becoming pregnant will have physiological advantages from abundant stored fat."5 Medical considerations suggest that excessive adiposity (or leanness) is unhealthful; but cosmetic and other social considerations are generally preeminent in determining the acceptable range of body composition within a culture.

A variety of definitions of obesity have been devised for adults (weight-height indices that produce relative independence of weight from height).
Advantage of Latex Agglutination Over Countercurrent Immunoelectrophoresis in the Detection of Haemophilus influenzae Type b Antigen in Serum
Authors: Scheifele David W. , Ward Joel I. , Siber George R.
Published: December 2021

Detection of bacterial antigens has proved to be a valuable adjunct to early diagnosis of certain invasive infections. In the case of Haemophilus influenzae type b infections, capsular polysaccharide antigen (PRP) has been detected by a variety of techniques including countercurrent immunoelectrophoresis (CIE),1-3 latex particle agglutination (LPA),3,4 radioimmunoassay,5 and enzyme-linked immunosorbent assay (ELISA).6,7 There have been few prospective comparisons3,7,8 by which to establish the sensitivities and idiosyncrasies of these techniques. This report compares the two simplest techniques, CIE and LPA, in children with H influenzae b infections, drawing attention to a shortcoming of CIE in those with nonmeningeal infections.

METHODS
Lead Levels and Intelligence
Authors: Ernhart Claire B. , Landa Beth , Schell Norman B.
Published: December 2021

The issue raised in Needleman's commentary (Pediatrics 68:894, 1981) is the interpretation of two studies in an area in which methodologic concerns are paramount. We appreciate the pioneering efforts in the studies that preceded the Boston study1 and our current paper2; from these published reports and informal exchange of material all of us have learned much that guides more sophisticated endeavor. Two recent objective reviews3,4 describe some, but not all, of the design problems pertaining to the earlier works.
Dog Bites in Children Less Than 4 Years Old
Authors: Chun Yoon-Taek , Berkelhamer Jay E. , Herold Terry E.
Published: December 2021

Few situations are more anxiety provoking than that of a small child being attacked by a dog. On occasion dogs have been known to save human lives. Conversely, dogs have actually been known to kill (references 1 and 2; Chicago Sun-Times, March 31, 1980). Unfortunately, the incidence of dog bites has increased in recent years, and more than 1 million Americans are bitten by dogs every year.3-5 In addition, children are the most frequent victims.1,4-8 With the rising crime rate, more citizens are buying or even renting large and sometimes vicious dogs to protect their family or property. (Chicago Sun-Times, March 31, 1980, and reference 5).
Nuances or Nuisances for Cutaneous Bilirubinometry?
Authors: Engel Rolf R.
Published: December 2021

During the two years since Yamanouchi et al1 first reported their clinical evaluation of the Minolta bilirubinometer, an international distributor has been designated and in November 1981 the Food and Drug Administration approved the instrument (to be marketed as the Minolta Air-Shields jaundice meter by Narco Air-Shields, Hatboro, PA) for clinical use. The Minolta meter is compact, instantaneous, and extremely simple to operate, so that it has gained wider usage than previous methods2-5 that objectively measure icterus in newborns. In contrast to the unaided eye or the perspex icterometer,6 there is no opportunity for observer bias or for variations in ambient lighting to influence the determination with the Minolta meter.
Playground Injuries and Voluntary Product Standards for Home and Public Playgrounds
Authors: Werner Peter
Published: December 2021

Accidents on home and public playgrounds account for more than 150,000 injuries per year. The Division of Hazard Identification and Analysis in the Bureau of Epidemiology has studied playground injuries. Swings, climbing apparatus, gliders, slides, and seesaws were listed as apparatuses associated with the highest percentages of injuries. Falls to the surface also accounted for a large percentage of injuries. Absorbent surfaces other than concrete or asphalt were recommended to reduce the severity of injuries. In addition to making recommendations on playground surfaces, the Consumer Product Safety Commission has developed voluntary product safety standards for home and public playgrounds. Guidelines for safe playgrounds are discussed as well as suggestions concerning people to contact at local, state, and national levels for advice on playground design and safety.
Cerebral Edema and Ophthalmoplegia Reversed by Mannitol in a New Case of Insulin-Dependent Diabetes Mellitus
Authors: Franklin Bonita , Liu John , Ginsberg-Fellner Fredda
Published: December 2021

Cerebral edema is a sometimes fatal complication of diabetic ketoacidosis which occurs unpredictably and when biochemical parameters show improvement. A case of a young, newly diagnosed insulin-dependent diabetic boy who developed this complication while receiving a low-dose continuous insulin infusion is reported. Two hours after treatment signs of headache, ophthalmoplegia, and blurred disc margins suggested early cerebral edema. Despite fluid restriction, avoidance of alkali, and phosphate supplementation, cerebral edema ensued three hours later. This complication was then reversed by administration of mannitol. Our patient's ophthalmoplegia, unlike typical diabetic ophthalmoplegia, improved immediately and completely resolved within two weeks after this episode. It is concluded that the use of mannitol in the cerebral edema of diabetic ketoacidosis is beneficial if it is instituted promptly.
Intrinsic Auricular Muscles and Auricular Form
Authors: Zerin Michael , Van Allen Margot I. , Smith David W.
Published: December 2021

Plical folding of the cartilagenous ear plate is largely determined by the insertions of four extrinsic and seven intrinsic auricular muscles. Dissection of ten external auricles from anencephalic fetuses of six or more months' gestation was done. The transversus and obliquus auricular muscles found in association with the antihelical fold were evaluated. Four auricles were of normal form and had the transversus and obliquus auricular muscles with typical insertions in the cartilage. Six of the ten auricles had a simplified form, with no antihelical folding in five and minimal development in one. Fibers from neither the transversus nor the obliquus auricular muscles were identified in these six ears. The results of these dissections strongly suggest that antihelical folding is determined by the presence of functioning transversus and obliquus auriculae muscles. Similarly it is proposed that normal folding of the auricular cartilage is dependent on the presence of functioning auricular muscles. In evaluation of the child with absence of normal ear form, these findings suggest that the unusual shape is due to abnormal placement and/or function of the intrinsic and extrinsic auricular muscles. These changes may be a subtle sign of neuromuscular weakness, abnormal muscle insertion or absence of muscle.
Relationship of Pneumothorax to Occurrence of Intraventricular Hemorrhage in the Premature Newborn
Authors: Hill Alan , Perlman Jeffrey M. , Volpe Joseph J.
Published: December 2021

The relationship of pneumothorax to the occurrence of intraventricular hemorrhage (IVH) has been studied in the premature newborn. The major objective of the study was to determine whether the systemic hemodynamic changes that occur with pneumothorax are reflected in the cerebral circulation and whether these changes play a role in pathogenesis of IVH. Blood flow velocity was measured in the anterior cerebral arteries by a transcutaneous Doppler technique in nine infants who developed pneumothorax in the first 3 days of life. At the time of pneumothorax there was a marked increase in flow velocity, especially during diastole, and, with resolution of pneumothorax, flow velocity returned to normal levels over the ensuing hours. The changes in flow velocity correlated closely with systemic hemodynamic changes that occurred with pneumothorax, ie, an increase in mean systemic blood pressure, especially diastolic pressure. IVH, documented by serial ultrasound scans, was observed shortly after pneumothorax in the nine infants. The data thus demonstrate a marked increase in flow velocity in the cerebral circulation at the time of pneumothorax. This increase is of importance in the genesis of IVH as is suggested further by the occurrence of IVH soon after the cerebral hemodynamic changes.
Milk and Lactation: Some Social and Developmental Correlates Among 1,000 Infants
Authors: Young H. Boutourline , Buckley Ann E. , Hamza Bechir , Mandarano Carmine
Published: December 2021

Breast-feeding and artificial feeding practices in a developing country were examined and related to some social and developmental factors. This was done during the course of a transverse-type growth study of 1,000 infants from birth to 26 months of age. Three types of feeding were identified: breast, mixed, and artificial. The families were divided into three social categories. To give time for the effects of the type of feeding, groups of children at 6, 8, 10, 12, 14, and 16 months of age were studied. In view of the lack of data on feeding effects upon large samples, the study was performed to assess the relative effects of feeding on early childhood development (Bayley Motor and Mental Scales), body length and weight, disease prevalence, clinical signs of allergies, and number of children in the family. Results showed that within the underprivileged group, there was evidence that breast-feeding promoted physical growth, sensory motor development, and resistance to infection. In mothers of both male and female infants who breast-fed, there was a protective effect against subsequent pregnancy up to ten months. Therefore, among the underprivileged in developing countries, every effort should be made to prolong breast-feeding and to assist mothers with health and nutrition education.
Abnormalities of Neutrophil Adherence in Newborns
Authors: Krause Peter J. , Maderazo Eufronio C. , Scroggs Mark
Published: December 2021

Polymorphonuclear neutrophil (PMN) adherence to glass and nylon wool was examined in 19 healthy term newborns, 19 normal children aged 2 weeks to 17 years, and 33 adults in good health who were taking no medication. Using a whole blood glass adherence assay, neonatal PMN adherence (0.18 ± 0.16%) was significantly less than PMN adherence in children (7.4 ± 4.0%, P < .0001) and in adults (16.0 ± 4.5%, P < .0001). Similar results were obtained when separated neonatal and adult PMNs were used with both glass and nylon wool column adherence assays, indicating that decreased neonatal PMN adherence is due to a cellular defect. In other experiments there was significantly greater reduction in adherence of separated PMNs with addition of neonatal serum than with adult serum, indicating that a humoral inhibitor also contributes to decreased adherence of neonatal PMNs. Decreased neonatal PMN adherence may be one cause of the increased susceptibility of neonates to serious bacterial infections.
Traumatic Deaths from Dog Attacks in the United States
Authors: Pinckney Lee E. , Kennedy Leslie A.
Published: December 2021

A newspaper survey and search of the medical literature identified 74 deaths from dog attacks, 51 of which occurred in a designated five-year study period. Most attacks were by single pet dogs without a preceding history of viciousness and without known provocation by the victim. The highest number of deaths (23) occurred in infants less than 1 year of age. Most of the remaining victims were children aged 1 through 8 years, and elderly women.
Infant Cry: A Clue to Diagnosis
Authors: Golub Howard L. , Corwin Michael J.
Published: December 2021

It has been postulated that the infant cry is a reflection of complex neurophysiologic functions and that analysis of the infant cry can be utilized to assess the infant's status. To test this hypothesis a model of cry production was developed utilizing a computer-based signal processing system that enabled the observer to relate closely the acoustic properties of the cry to the anatomic and physiologic characteristics of the infant producing the cry. The cries of 87 infants were analyzed following a standardized pain stimulus. Cry features were grouped into eight evaluative tests. Only seven of 55 apparently normal term infants had the abnormality "glottal instability" whereas 11 of 12 infants with bilirubin values in the 10 to 20 mg/100 ml range displayed the glottal instability pattern. An additional group of 17 infants with a variety of problems was studied; 14 of 17 displayed two or more abnormalities, and ten of 12 infants with respiratory disease had a unique pattern. Of particular interest was the finding of acoustical features suggestive of a constriction in the vocal tract in three infants; two of these infants were studied prospectively and subsequently were victims of sudden infant death syndrome and the third had a sibling with recurrent apnea. These results suggest that the analysis of the infant cry holds promise for detecting a number of abnormalities and may prove valuable as screening test to detect infants at risk for sudden infant death syndrome.
Haemophilus influenzae Type b in a Nursery School: The Value of Biotyping
Authors: Prober Charles G. , Ipp Moshe M. , Bannatyne Robert M.
Published: December 2021

Meningitis due to Haemophilus influenzae serotype b biotype II occurred in a 2-year-old child who attended a nursery school along with 26 other 2-year-old children. Nasal swabs from these 26 contacts revealed a H influenzae type b colonization rate of 50% (13/26); simultaneously performed throat swabs detected a colonization rate of 4% (1/26). Biotyping of the H influenzae type b isolates revealed that only 46% (6/13) were the same biotype as the index case; the remaining seven isolates were biotype III. All children received treatment with 20 mg/kg/day of rifampin administered by the nursery school attendant as a single dose for four days before the results of the cultures were known. Eradication of H influenzae type b carriage was successful in three of the six biotype II carriers and five of the six biotype III carriers available for follow-up culture. It was concluded that: (1) the culture site utilized in determining H influenzae type b colonization rates may markedly influence the results obtained, (2) biotyping may be a valuable epidemiologic tool in investigating the contacts of patients with H influenzae type b disease, and (3) failures of rifampin to eradicate the carriage of H influenzae type b from the nasopharynx may occur. The prudent approach to the management of young contacts of patients with serious H influenzae type b disease is to recognize their high risk status and to maintain close surveillance of them. The role of chemoprophylaxis with rifampin remains mains to be established.
Laryngeal Candidiasis Presenting as Inspiratory Stridor
Authors: Jacobs Richard F. , Yasuda Kyle , Smith Arnold L. , Benjamin Denis R.
Published: December 2021

In 1970, Perrone1 first reported laryngeal obstruction secondary to Candida albicans infection in a newborn. There have been several descriptions of congenital or neonatal infection with C albicans including pustubar dermatitis,2 pneumonia,3 meningitis, and arthritis.4 However, none of these reports noted laryngeal involvement. Recently, laryngitis and esophagitis were described in children with chronic mucocutaneous candidiasis.5 Adult patients predisposed to invasive candidal infections have had laryngeal involvement; on occasion their initial symptoms were those of upper airway obstruction.6 Infants and newborns with inspiratory stridor are usually evaluated for laryngomalacia, congenital subglottic stenosis, or vocal cord paralysis. Candidal laryngitis presenting as inspiratory stridor has not been well documented in the pediatric literature.
Letters to the Editor
Authors: White Robert , Townsend Timothy R. , Moxon E. Richard
Published: December 2021

As Weber and Marks emphasize, our study found no apparent relationship between colonization and the occurrence of sepsis caused by enteric bacilli of a defined antimicrobial resistance pattern. Obviously, we did not wish to suggest that all similar surveillance programs be discontinued, but we do feel there is a need to examine components of such regimens in a critical fashion. If the objective of a surveillance system is not realized, its discontinuation may be justified.
When Is Lymph Node Biopsy Indicated in Children with Enlarged Peripheral Nodes?
Authors: Knight Philip J. , Mulne Arlynne F. , Vassy Louis E.
Published: December 2021

To better define the indications for diagnostic biopsy, 239 children who underwent peripheral lymph node biopsy were reviewed. The duration of the lymphadenopathy by history, the consistency of the lymph nodes, and the presence of more than one site of palpable adenopathy were not specific in differentiating serious diseases involving lymph nodes from reactive hyperplasia. The differential diagnosis of specific causes for lymph node enlargement is approached based on the child's age, the location of the adenopathy, and the presence or absence of lymph node fixation and tenderness. Most children with supraclavicular adenopathy, children sick with fever of one week's duration or with weight loss for which a specific diagnosis is not readily made, and some children with fixation of the lymph node to the overlying skin should undergo early biopsy. Excluding the above findings, when a specific diagnosis is not apparent, serial measurements with a ruler over several weeks appears to be the most reasonable method, at the present time, of discriminating hyperplastic lymph nodes from nodes that are involved by a progressive disease process.
Urinary Tract Infections in Young Infants
Authors: Ginsburg Charles M. , McCracken George H.
Published: December 2021

The clinical and laboratory features of urinary tract infections in 100 infants aged 5 days to 8 months are presented. Of the patients in the first three months of life 75% were boys, and of infants aged 3 to 8 months only 11% were boys; 95% of the infants were uncircumcised. Sepsis was documented in 31% of neonates, 21% of infants aged 1 to 2 months, 14% of those aged 2 to 3 months, and 5.5% of infants >3 months of age. Roentgenographic abnormalities of the urinary system were found in 45% of female and 7% of male infants. All infants responded promptly to antimicrobial therapy. The possible factors related to the predominance of male infants with urinary tract infections in the first three months of life are discussed.
Management of Pseudomonas Osteochondritis Complicating Puncture Wounds of the Foot
Authors: Jacobs Richard F. , Adelman Lee , Sack Carolyn M. , Wilson Christopher B.
Published: December 2021

Pseudomonas osteochondritis following puncture wounds of the foot is described in 13 children. All children had received at least one oral antibiotic and local wound therapy before admission; none had improved on these modalities. Pseudomonas aeruginosa was isolated alone from seven patients and with one or more other organisms from six patients. Initial administration of parenteral antibiotics active against Pseudomonas for one to 14 days did not result in clinical improvement. Eradication of Pseudomonas osteochondritis occurred in each patient only after thorough surgical debridement and curettage of all infected tissue. Following thorough surgical debridement, anti-Pseudomonas antibiotic therapy was continued for five to 14 days (10.8 ± 2.7 days). The successful treatment of Pseudomonas osteochondritis should include adequate surgical debridement of all infected tissue; following thorough debridement, only one to two weeks of anti-Pseudomonas antibiotic therapy appears to be necessary.
Relative Efficacy of an Incubator and an Open Warmer in Producing Thermoneutrality for the Small Premature Infant
Authors: LeBlanc Michael H.
Published: December 2021

To determine which warming system more closely approximates a neutral thermal environment, the oxygen consumption of 16 premature babies, weighing less than 1,500 gm each, was measured in a convectively heated incubator and under an open radiant warmer. Both systems were controlled to maintain a skin temperature of 36 C. The oxygen consumption of the infants was significantly higher under the radiant warmer. This result is in agreement with published data for this group of premature infants.
Partition of Energy Metabolism and Energy Cost of Growth in the Very Low-Birth-Weight Infant
Authors: Reichman Brian L. , Chessex Philippe , Putet Guy , Verellen Gaston J. E. , Smith John M. , Heim Tibor , Swyer Paul R.
Published: December 2021

Energy requirements are partitioned between needs for maintenance (including resting metabolism, thermoregulation, and muscular activity) and needs for synthesis and storage of new tissue. The partition of energy utilization was evaluated by 22 metabolic and nutritional balance studies in 13 formula-fed (SMA 20/24), growing, appropriate-for-gestational age, very low-birth-weight infants (mean ± SE birth weight, 1,155 ± 39 gm; study weight, 1,271 ± 60 gm; age at study, 21 ± 2 days; weight gain, 16.8 ± 1 gm/kg/day). Continuous opencircuit, indirect calorimetry was performed for periods of 6 ± 0.25 hours in a thermoneutral environment. Results expressed as mean kilocalories per kilogram per day (± SE) were: energy intake, 148.6 (± 3.9); stool and urine losses, 18.2 (± 1.5); metabolizable energy, 130.4 (± 3.5); "basal" metabolic rate, 47.0 (± 0.75); energy cost of activity, 4.3 (± 0.9); thermic effect of food, 11.3 (± 0.65); energy stored in new tissue, 67.8 (± 3.0). These results provide a partition of energy utilization in very low-birth-weight infants under thermoneutral conditions. Increased activity and a thermal environment outside the neutral range will augment maintenance energy requirements, thus decreasing the amount of energy available for growth if metabolizable energy intake remains constant. The energy cost of growth (ie, for synthesis of, and storage in, new tissue) was determined as 4.9 kcal/gm of weight gain. To attain the equivalent rate of intrauterine weight gain, a metabolizable energy intake of approximately 60 kcal/kg/day in excess of maintenance requirements of 51.3 kcal/kg/day must be provided.
Serum Penicillin Concentrations After Intramuscular Administration of Benzathine Penicillin G in Children
Authors: Ginsburg Charles M. , McCracken George H. , Zweighaft Teresa C.
Published: December 2021

Concentrations of penicillin were measured in serum samples of 26 children who received benzathine penicillin G (BPG) alone or in combination with procaine penicillin (PBPG). Both preparations were well absorbed; peak concentrations of penicillin after PBPG administration were 25-fold larger than those after BPG. One third and one half of serum samples from BPG and PBPG patients, respectively, contained no measurable penicillin activity at 18 days. At 30 days, there was no penicillin activity in any of the samples. These data raise questions regarding the use of BPG and PBPG for prophylaxis of group A streptococcal and pneumococcal infections.
Milk Feeding Patterns in the United States During the First 12 Months of Life
Authors: Martinez Gilbert A. , Dodd David A. , Samartgedes Jo Ann
Published: December 2021

In the article "Milk Feeding Patterns in the United States during the First 12 Months of Life" by Martinez et al (Pediatrics 68:863-868, 1981), corrections should be made in Table 5 (p 865) and Table 6 (p 866). In Table 5, Income, 1980 ≥$15,000 should read 46.6 (not 38.1). In Table 6, values for Income, In Hospital should read as follows: <$15,000, 50.5 (not 39.9); $15,000-24,999, 57.1 (not 53.9); ≥$25,000, 62.2 (not 58.8).
Unbound Bilirubin and Kernicterus in Low-Birth-Weight Infants
Authors: Cashore William J. , Oh William
Published: December 2021

Unbound bilirubin, bilirubin binding capacity, and bilirubin binding affinity were determined by the horseradish peroxidase method at the time of maximum hyperbilirubinemia and/or before exchange transfusions in 13 preterm infants who later died and had autopsies performed. Five of the 13 infants had kernicterus at autopsy. There were no significant differences in weight, gestational age, highest indirect bilirubin level, albumin concentration, severity of acidosis, use of assisted ventilation, sepsis, or other major clinical complications between the five infants with kernicterus and the eight infants without kernicterus. Compared with the eight nonkernicteric infants, the five kernicteric infants had significantly higher unbound bilirubin concentrations (13 ± 10 vs 27 ± 9 nmoles/liter, respectively, P < .05) and significantly lower bilirubin binding capacity and affinity. The data suggest an association between low bilirubin binding capacity and affinity, increased unbound bilirubin, and kernicterus in preterm infants with severe clinical complications.
Oral Electrolyte Solutions for Infantile Diarrhea
Authors: Santosham Mathuram , Bertrando Robert , Foster Stephan , Garrett Steven
Published: December 2021

In a letter in the September issue,1 Walker raises the same issues that were discussed in his recent letter to The New England Journal of Medicine2; namely: (a) Fluids prescribed for ingestion during typical episodes of diarrhea in the United States should contain less than 17 mmoles of sodium per liter. (b) Oral rehydration solutions containing 80 to 90 mmoles of sodium per liter, similar to the solution recommended by the World Health Organization (WHO) should be administered under direct supervision (implying a hospital setting).
Congenital Cytomegalovirus Infection: Diagnostic and Prognostic Significance of the Detection of Specific Immunoglobulin M Antibodies in Cord Serum
Authors: Griffiths Paul D. , Stagno Sergio , Pass Robert F. , Smith Richard J. , Alford Charles A.
Published: December 2021

Specific immunoglobulin M antibodies were detected by radioimmunoassay (RIA-IgM) in cord sera from 83/93 (89%) babies congenitally infected with cytomegalovirus (CMV) but in 0/104 cord sera from uninfected control subjects. The type of maternal infection did not affect the ability of the assay to identify congenital infections, but increased RIA-IgM titers were found more frequently in cord sera from babies infected following primary CMV infections (9/18; 50%) than following recurrent CMV infections (1/12; 8%) (P < .05). The magnitude of the fetal immune response was related to disease inasmuch as 14/40 (35%) babies with increased RIA-IgM titers were symptomatic at birth compared with 1/43 (2%) with lower titers (P < .001). When combined with the results of testing for rheumatoid factor and total IgM, the RIA-IgM assay defined subgroups of babies with generally poor (7/15; 47% symptomatic at any stage) or generally good (0/21 symptomatic) prognoses. Prospective studies currently identifying cases of congenital CMV infection may wish to use these three serologic techniques as the results obtained appear to have prognostic significance for those babies who are initially asymptomatic.
Child Health and Social Status
Authors: Egbuonu Lisa , Starfield Barbara
Published: December 2021

Available evidence regarding the relationship between socioeconomic status and health in childhood has been summarized. Only studies that used income, education, or occupation as measures of socioeconomic status and provided data obtained subsequent to legislation facilitating access to care have been cited. Data are presented on the prevalence and severity of illness (mortality, acute conditions as a group, chronic conditions as a group, and hospitalization), sequelae of prematurity, and specific common health problems and their sequelae. These specific health problems are lead poisoning, vision problems, otitis media and hearing loss, cytomegalic inclusion disease, asthma, psychosocial and psychosomatic problems, and iron deficiency anemia. All of the above (with the possible exception of asthma) are more prevalent among poor children than among nonpoor children. Even more striking is the evidence for consistently greater severity of problems or likelihood of sequelae among poor children. Although causality cannot be inferred from these data, the findings suggest a need for more basic research on the social correlates of disease, on the effect of social progress on disease prevalence and severity, and on the effect of medical care in overcoming the disadvantage associated with low socioeconomic status.
Urinary Excretion of Calcium Following an Oral Calcium Loading Test in Healthy Children
Authors: Stapleton F. Bruder , Noe H. Norman , Jerkins Gerald , Roy Shane
Published: December 2021

The ratio of urinary calcium (UCa)/urinary creatinine (UCr) concentrations (mg/mg) during calcium loading has been used to diagnose hypercalciuric states in adults. The UCa/UCr ratios have been examined before and after an oral dose of calcium in 48 healthy children following five days of abstinence from dietary milk products. No differences in UCa/UCr ratios were observed between sexes, races, or age groups. UCa/UCr ratio before the calcium dose was 0.09 ± 0.12 (mean ± 2 SD) and increased to 0.12 ± 0.15 in urine samples collected for four hours after the calcium load. A direct relationship between UCa/UCr ratio and urinary sodium (UNa)/UCr ratio was observed (r = .57, P < .01). In six children, calcium loading studies were repeated without prior restriction of dietary calcium. Dietary calcium intake before the calcium loading had little effect upon UCa/UCr ratio before the calcium dose in these six children (0.068 vs 0.08); however, UCa/UCr values after the calcium load were significantly lower (0.08 vs 0.15) when no dietary calcium restriction preceded the calcium-loading study. These data may allow characterization of renal hypercalciuria and gastrointestinal hyperabsorption of calcium in children with urolithiasis.
Intermittent Diaphragmatic Hernia of Bochdalek: Report of a Case and Literature Review
Authors: Hight Donald W. , Hixson S. Douglas , Reed Joseph O. , Watts Frederick B. , Hertzler Jack H.
Published: December 2021

Congenital diaphragmatic hernias appearing in late infancy or childhood are entities distinct from the more common newborn disorder. "Delayed" diaphragmatic hernias are associated with prior normal chest roentgenograms. Symptomatic intermittent herniation of abdominal viscera through a congenital posterolateral defect has not been previously reported in 17 cases of late-onset diaphragmatic herniation and may explain the latency period seen in older children.
A Review and Analysis of the Effectiveness of Early Intervention Programs
Authors: Simeonsson Rune J. , Cooper David H. , Scheiner Albert P.
Published: December 2021

A review was made of 27 studies describing early intervention for biologically impaired infants and young children. Although every study provided some type of documentation of outcome, most studies failed to meet common criteria for scientific research, such as specification of inclusion criteria, documentation of reliability, random assignment, and/or the use of control/contrast groups. Studies were grouped into four classifications on the basis of experimental design as follows: retrospective, prospective-no control group, prospective-control/contrast group, and prospective-random group assignment. A comparative analysis was made of the effectiveness of findings on the basis of statistical evidence and clinical support. Statistical procedures were used in 59% of the studies and statistical support for the effectiveness of early intervention was reported in 48% of the studies. Effectiveness on the basis of subjective, clinical conclusions was reported in 93% of the studies. Implications of the discrepancy between effectiveness based on statistical evidence and clinical conclusions are discussed.
Posttransfusion Cytomegalovirus Infections
Authors: Sandler S. Gerald , Grumet F. Carl
Published: December 2021

Although cytomegalovirus (CMV) infection has been recognized as a potential hazard of blood transfusion since 1966,1 few transfusion services provide blood components that have been selected specifically for low risk of infectivity with CMV. The objective of this commentary is to provide a review of the epidemiology of posttransfusion CMV infections with special reference to recent recommendations for its control by donor antibody screening and other blood bank procedures.

In the healthy immunocompetent child or adult, posttransfusion CMV infection usually results in asymptomatic seroconversion or is manifested as a mild heterophile-negative mononucleosis syndrome. There is minimal morbidity associated with these transfusion-related infections and, therefore, minimal need for special CMV-free blood components.2
Letters to the Editor
Authors: Eisenberg Leon
Published: December 2021

Mittleman insists upon the difference between words that obscure and those that accurately communicate reality. It is one of the few points on which we agree. He transmutes my phrase "right to reproductive freedom" to his phrase "murder ... unborn children." To him "it is self-evident" that abortion is murder and that human life begins at conception. He adds: "There are no legitimate arguments about these facts!"

Despite his assertion of absolute rectitude on these questions, there is continuing public debate on precisely these issues.
Letters to the Editor
Authors: St. Geme Joseph W.
Published: December 2021

We have worked diligently to establish a tone and consistent attitude whereby residents and their general attending physicians (full-time and voluntary, clinical faculty) consult widely with subspecialty services but retain unequivocal responsibility for management of their patients. This attitude has meshed well with the philosophy that fellows should emphasize research rather than patient care. General pediatric residents serve as the major liaison for subspecialty consultation with their colleagues when they pursue assigned or elective rotations in subspecialty disciplines.
Conjunctivitis-Otitis Syndrome
Authors: Bodor Frank Franjo
Published: December 2021

Purulent conjunctivitis associatedwith otitis media was studied in 124 patients in a private practice over a period of one year. Of the 132 patients seen with purulent conjunctivitis, 96 (73%) concurrently had otitis media. In 28 (47%) of 60 families with more than one child, siblings of the index cases had either purulent conjunctivitis or otitis media, or both, simultaneously or within one month. During the study period, conjunctival cultures were obtained from 75 patients with purulent conjunctivitis-otitis media and patients with purulent conjunctivitis whose siblings had purulent conjunctivitis-otitis media or otitis media. Haemophilus influenzae was isolated from 55 (73%). Thirty-one of the patients had nasal cultures done simultaneously with conjunctival cultures. An identical pathogen was isolated from 27 (87%) patients.
Relationship Between the Magnitude of Bacteremia in Children and the Clinical Disease
Authors: Sullivan T. Dennis , LaScolea Leonard J. , Neter Erwin
Published: December 2021

The relationship between the magnitude of bacteremia due to Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis and the clinical diagnosis was determined on 79 children who were not receiving prior antibiotic therapy and had fever, either in the presence or absence of focal signs of infection. Bacteremia was quantitated by the recently described Quantitative Direct Plating procedure in which heparinized blood (0.5 ml each) is plated onto blood and chocolate agar plates. Additionally, blood was cultured by means of the radiometric Bactec technique. In the case of H influenzae and S pneumoniae, 23 (92%) of 25 patients with more than 100 organisms per milliliter of blood had meningitis or epiglottitis in contrast to only four (9.5%) of 42 patients with <100 organisms (P < .001). No significant difference was noted in the magnitude of bacteremia due to N meningitidis among 12 patients with meningitis or other serious infections. The possible predictive value of the quantitation of bacteremia is illustrated by the observation of three children with seemingly mild respiratory infection and counts in excess of 100 organisms per milliliter who, within 20 hours, developed meningitis or epiglottitis. High bacterial counts of H influenzae and S pneumoniae in excess of 100 organisms per milliliter of blood should alert the physician to the existence or possible development of serious disease.
POWER STATISTICS NEEDED
Authors:   Student
Published: December 2021

The results of...analysis [of statistical proof asserted in "negative" medical trials published in six major medical journals] support the hypothesis that research in [clinical] medicine lacks adequate power.
Effectiveness of Positioning Therapy for Gastroesophageal Reflux
Authors: Meyers William F. , Herbst John J.
Published: December 2021

The therapeutic effects of positioning and state of alertness were evaluated in 79 patients with gastroesophageal reflux (GER) and 49 nonreflux patients by extended esophageal pH monitoring during the two-hour postprandial period. The amount of GER in nonreflux patients was not significantly affected by changes in position or state of alertness whereas patients with GER demonstrated consistent decreases in the percent time and frequency of reflux episodes while asleep compared with being awake. In patients with GER, less reflux occurred while upright than supine during awake but not during asleep periods. The 30-degree elevated prone position was superior to the supine or upright positions while patients were awake or asleep. A beneficial effect of the 30-degree elevated supine position was not noted. Patients with respiratory disease, with severe esophagitis, or who required surgical correction of GER all responded to positioning or alertness changes in the same manner.
Immersion Accidents in Hot Tubs and Whirlpool Spas
Authors: Monroe Byron
Published: December 2021

Accidents are currently the single greatest cause of death for children in the United States.1 Twenty percent of these accidental deaths of children less than age 5 years and 5% of the accidental deaths of children 5 to 19 years of age are due to drowning.2 For each drowning, there are other nonfatal immersion accidents in which there is a high morbidity.3,4

Immersion accidents in whirlpool spas (Jacuzzi) and hot tubs present several types of danger to children. This paper reviews experience in this area and describes several unique injuries associated with these recreational facilities.

During the last five years there were 23 admissions to Cottage Hospital of children less than age 18 for drowning or near drowning in the Santa Barbara, CA area (population 180,000).
Reye Syndrome and Aspirin Use: The Role of Prodromal Illness Severity in the Assessment of Relative Risk
Authors: Wilson John T. , Brown R. Don
Published: December 2021

In response to "Aspirin and Reye Syndrome" by the Committee on Infectious Diseases of the American Academy of Pediatrics (p 810), we offer comments which are restricted to our analysis of existing epidemiologic study data, portions of which were provided to us by the Ohio, Michigan, and Arizona investigators. This commentary should not be construed as our approval or disapproval of aspirin use in children. Rather, it summarizes our specific disagreements with the interpretation of the state epidemiologic data that were the basis of the report by the Committee on Infectious Diseases. We have found that an unassessed confounding variable of large magnitude is common to the state studies.
Epileptics and School Personnel
Authors: Beringer Gary B. , Biel Marcia , Ziegler Dewey K. , Lai Chi-Wan
Published: December 2021

In their paper on utilization of school health resources for common pediatric disorders, Brink and Nader1 provide data about seizures in the Galveston Independent School District over a five-year period. From their figures 1 and 2, it appears that only one child experienced a seizure (.004 proportion due to seizures multiplied by 328 provider-initiated episodes yields 1.312, or one seizure). As their focus is upon overall care, the authors emphasize asthma maintenance and treatment, probably because of its frequency being higher than that of seizures in this population.
Opinion on a Computer
Authors: Weir Michael R.
Published: December 2021

I was interested in your commentary concerning the use of small computers (Pediatrics 69:121, 1982). The process that I used to select a home computer may be of help to other physicians. Since each computer has specific characteristics and requirements, the first problem is to identify exact needs and uses for the equipment. Potential uses include but are not limited to: word processing for letter, report, or manuscript preparation (requires a printer); educational programs for adults and children; games and entertainment; writing programs to better understand computer capabilities (children and adults); data manipulation; and continuing medical education.
Does Phenobarbitone Prevent Periventricular Hemorrhage in Very Low-Birth-Weight Babies?: A Controlled Trial
Authors: Morgan M. E. I. , Massey R. F. , Cooke R. W. I.
Published: December 2021

The effect of prophylactic phenobarbitone in reducing periventricular hemorrhage was evaluated by a controlled trial in 60 very low-birth-weight infants. The incidence and severity of periventricular hemorrhage, as assessed by real-time ultrasound did not differ significantly between treated and untreated infants. Phenobarbitone may be less useful in preventing neonatal brain injury than previously suggested.
Radioactive Excretion in Human Milk Following Administration of Technetium Tc 99m Macroaggregated Albumin
Authors: Pittard W. B. , Merkatz R. , Fletcher B. D.
Published: December 2021

Albumin-tagged sodium pertechnetate (technetium) is routinely used in nuclear medicine for scanning procedures of the lung. The rate of excretion of this radionuclide into breast milk and the resultant potential radiation hazard to the nursing infant have received little attention. Therefore the milk from a nursing mother who required a lung scan because of suspected pulmonary emboli using an intravenous injection of 4 mCi of technetium Tc 99 macroaggregated human serum albumin was monitored. Albumin tagging severely limited the entrance of technetium into her milk and the radio-activity of the milk returned to base line by 24 hours. A total of 2.02 µCi of technetium was measured in the 24-hour milk collection after technetium injection and 94% of this amount was excreted by 15.5 hours. This amount of technetium administered orally to a newborn would deliver a total body radiation dose of .3 mrad. Therefore, an infant would receive trivial doses of radiation if breast-feeding were resumed 15.5 hours after administration of the radionuclide to the mother and nursing can clearly be resumed safely 24 hours after injection.
Breast-feeding and Respiratory Virus Infection
Authors: Frank Arthur L. , Taber Larry H. , Glezen W. P. , Kasel Gary L. , Wells Christine R. , Paredes Abel
Published: December 2021

Thirty-nine breast-fed and 42 bottle-fed infants were followed up from birth over a four-year period. Virus infection was documented by culture and serologic testing, and history and physical examination were recorded for all episodes of respiratory illness. There were no statistically significant differences in rates or distributions of infection with individual viruses or with all viruses over the first three or six months or during the second six months of life in the two groups, nor were there statistically significant differences in rates or distributions of disease of the upper and lower respiratory tract or total respiratory disease, except for decreased disease of the lower respiratory tract in bottle-fed infants in the second six months. There were trends to decreased morbidity in breast-fed infants in the first three and six months and more episodes of pneumonia and bronchiolitis in bottle-fed infants in the first six months (P < .05) but similar use of medical care by both groups. High cord blood titers to two viruses were not associated with evidence of breast-feeding protection from infection with those two agents. Breast-fed babies do not have fewer respiratory virus infections or illnesses but may experience less severe illness.
Management of Massive Hepatic Hemangiomas in Infants and Children: A Review of 13 Cases
Authors: Pereyra Robert , Andrassy Richard J. , Mahour G. Hossein
Published: December 2021

From 1958 through 1978, 13 patients with diffused hepatic hemangioma were seen at Childrens Hospital of Los Angeles. Based on this experience and review of the literature, liver biopsy in these patients was found to be unnecessary and hazardous. Diagnosis can be made by dynamic and static hepatic scintigraphy and selective hepatic arteriography. Nonsurgical measures including treatment of congestive heart failure, corticosteroids, and radiotherapy are recommended for treatment of these patients. Surgery should be reserved only for emergencies, such as rupture of the tumor and hemorrhage, or for patients with severe congestive heart failure unresponsive to medical treatment. For the latter group of patients hepatic artery ligation is recommended. Hepatic artery embolization has recently been used, but experience with this new mode of therapy is limited.
Plasma Cell Granuloma of the Lung in Children
Authors: Monzon Carlos M. , Gilchrist Gerald S. , Burgert E. Omer , O'Connell Edward J. , Telander Robert L. , Hoffman Alan D. , Li Chin-Yang
Published: December 2021

Three children with plasma cell granuloma of the lung had a syndrome characterized by digital clubbing, roentgenographic evidence of an intrapulmonary lesion with a diverse configuration, elevated erythrocyte sedimentation rate, elevated serum immunoglobulin levels, and thrombocytosis.