bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Pulmonary Blastomycosis in Children: Clinical Course and Follow-up
Authors: Powell Dwight A. , Schuit Kenneth E.
Published: December 2021

The clinical courses of 14 children with acute pulmonary blastomycosis were studied. All the patients had a remarkably similar illness limited to the lungs with fever, malaise, and respiratory symptoms (cough, sputum production, chest pain, and vomiting). Despite eventual recovery with treatment in all instances, 13 of the 14 children persisted in having abnormal roentgenograms. Three children have demonstrated persistent mild obstructive airway disease for two to 12 months after completion of therapy. These data suggest that the initial illness following childhood infections with Blastomyces dematitidis is usually an acute pulmonary disease without systemic dissemination. Evidence of residual lung abnormalities conflicts with the recent concept of this being a benign, self-limited illness. Our findings suggest the importance of long-term follow-up as well as a need for more complete understanding of the full clinical spectrum and prognosis of acute pulmonary blastomycosis.
Cerebral Cysticercosis
Authors: Tasker William G. , Plotkin Stanley A.
Published: December 2021

A case of cerebral cysticercosis in an American child is described. The patient was only 2 years old and had never left the United States. Her symptoms began with febrile seizures and progressed to focal motor seizures. Cerebrospinal fuid pleocytosis with eosinophilia, candle-guttering of the walls of the ventricles on pneumoencephalography, and a titer of 1:4,096 against cysticercosis antigen in her blood led to the diagnosis. Over a five-year follow-up period, the patient's course has been one of resolution of her symptoms, improvement in her electroencephalogram, and excellent seizure control with anticonvulsant therapy. cysticercosis should be considered in the differential diagnosis of a child who shows CSF pleocytosis with eosinophilia, particularly if accompanied by focal seizures.
The Frequency of Pericardial Effusions in Bacterial Meningitis
Authors: Laird W. Pennock , Nelson John D. , Huffines F. Douglas
Published: December 2021

Because of our experience with four cases of purulent pericarditis complicating bacterial meningitis during a 13-month period, we performed a prospective study to determine the frequency of this complication. Echocardiograms were done on 100 patients with bacterial meningitis. Small or moderate pericardial effusions were detected in 19 patients, but none had symptoms or signs related to the effusion. Pericardiocentesis was done in one infant; all the other effusions resolved spontaneously. Patients with effusion were significantly younger than those without this complication, but no other significant risk factors were identified. A literature survey indicated that symptomatic pericarditis occurs in fewer than 1% of patients with meningitis. Conversely, in series of cases of purulent pericarditis, associated meningitis was reported in 12% of patients. We concluded that pericardial infection is common in patients with meningitis but that it is usually of no clinical significance and resolves with antibiotic therapy.
Vitamin E Absorption in Small Premature Infants
Authors: Bell Edward F. , Brown Elizabeth J. , Milner Ruth , Sinclair John C. , Zipursky Alvin
Published: December 2021

The absorption of vitamin E, given by orogastric tube, was studied in premature infants who weighed less than 1.5 kg at birth. After the administration of either dl-alpha tocopherol or the acetate form, plasma tocopherol levels increased. In a second blind trial, 28 infants received either 25 units of dl-alpha tocopherol or placebo during the first six weeks of life. Plasma tocopherol levels in all treated infants were sustained in the normal adult range. The vitamin E-deficient state of premature infants can be corrected by oral therapy alone.
Obstructive Sleep Apnea and Near Miss for SIDS: I. Report of an Infant With Sudden Death
Authors: Guilleminault Christian , Ariagno Ronald L , Forno Lysia S. , Nagel Lynn , Baldwin Roger , Owen Margaret
Published: December 2021

An infant girl followed up from birth to death at the University Medical Center had "congenital stridor" and a "near miss for SIDS" event at 3 months of age. As part of an ongoing SIDS research project, she underwent 24-hour polygraphic monitoring at 21 weeks of age. Sudden infant death occurred within 30 hours after the polygraphic study. Polygraphic data obtained from this infant are compared with those from control infants and other infants with near Miss for SIDS who were of similar ages. The number of mixed and obstructive respiratory events during sleep was abnormally high on the infant's recording. Histologic findings, involving particularly the midline structures of the brain stem, are discussed.
Placental Transfer of Theophylline: Two Case Reports
Authors: Arwood Larry L. , Dasta Joseph F. , Friedman Chad
Published: December 2021

The placental transfer of xanthine compounds such as caffeine and theophylline has only recently been recognized. By measuring serum theophylline concentrations in two mothers and their neonates at delivery, we have attempted to determine the extent and significance of placental theophylline transfer to the fetus. At delivery, the two maternal serum theophylline concentrations were 13 µg/ml and 11 µg/ml, and cord serum contained 12 µg/ ml and 11 µg/ml of theophylline, respectively. In our first case, the neonatal theophylline concentration at delivery was not reported, but a concentration of 13 µg/ml was obtained six hours after delivery. In the second case, the neonatal serum contained 14 µg/ml of theophylline at delivery, 3 µg/ml higher than the cord or maternal serum concentration. It is possible that the fetus behaves as a pharmacokinetically "deep" compartment with slower drug elimination relative to maternal excretion.

Serial serum theophylline concentrations in the neonates were determined at 6, 18, 30, and 40 hours after delivery. For the first 18 hours of life, both neonates' serum contained theophylline within or very close to the therapeutic range (10 to 20 µg/ml) in adults and children. Both neonates reported on in this article had minor clinical symptoms that may have been related to the theophylline present in their serum. Neonates of mothers receiving theophylline products should be monitored for the pharmacologic actions of theophylline.
The Validity of Parental Reporting of Infant Development
Authors: Knobloch Hilda , Stevens Frances , Malone Anthony , Ellison Patricia , Risemberg Herman
Published: December 2021

A developmental questionnaire, encompassing the ages from 4 weeks to 36 months. has been devised that, when completed by parents, can be used to screen children as being developmentally normal, questionable, or abnormal. A total of 526 infants were screened by this questionnaire at 28 weeks of age and then examined at 40 weeks of age by a full Gesell Developmental and Neurologic Examination. Underscreening of thos with major abnormalities was 2.6%, and of those with minor abnormalities 10%. Overscreening was 6% In view of the demonstrated high reliability and validity of the full Gesell Developmental and Neurologic Examination on which the questionnaire is based, the relatively small percentages of overscreening and underscreening make it the most accurate and useful screening questionnaire to date.
Elevated Levels of Sodium and Chloride in Milk From Mastitic Breast
Authors: Conner Alvin E.
Published: December 2021

Increased levels of sodium and chloride in milk from mastitic udders of cows is well-documented. A case is presented in which elevated levels of sodium and chloride occurred in milk from the human breast with chronic mastitis.
Fatal Tuberculosis in Young Children
Authors: Harris Vivian J. , Schauf Victoria , Duda Frank , White Harvey
Published: December 2021

Three young children with advanced cavitary pulmonary tuberculosis died between 1974 and 1978. Two of the patients had tuberculous meningitis as well. All diagnoses were verified at autopsy; however, all tuberculin skin tests were negative. These instances emphasize the difficulty of establishing the diagnosis of tuberculosis in young children. Tuberculosis should be considered in the differential diagnosis of cavitary chest disease in young children, even those with negative tuberculin skin tests.
Vitamin E: Where Do We Stand?
Authors: Phelps Dale L.
Published: December 2021

Patients with prolonged fat malabsorption and some premature infants receiving iron must be given vitamin E. Use of tocopherol therapy in BPD and RLF, while promising, is unproven and should be used only · in a controlled study. Research on the role of vitamin E in human physiology is entering a rapid-growth phase. I feel certain the near future will see scientifically well founded uses for this "vitamin without a disease."
New Thoughts on Pertussis
Authors: Katz Samuel L. , Wilfert Catherine M.
Published: December 2021

The success of initial pertussis immunization programs resulted not only in a sharp decrease in the incidence of the disease but also in a diminution of interest in and research on the organism, and complacency with regard to the vaccine itself.

Concern and apprehension about both the efficacy and the safety of pertussis vaccine have recently stimulated a renewed investigative interest in the biology of Bordetella pertussis. This occurs at a time. when cases of pertussis reported in the United States are at an all-time low (less than 2,000 in 1978 contrasted with more than 150,000 in 1950). This infrequency of clinical whooping cough contributes to our desire for a more critical examination of the rare serious complications attributed to the immunizing procedure.
Difficulties in Providing Intensive Care
Authors: Frader Joel E.
Published: December 2021

The results of a pilot project investigating the feelings, attitudes, and behavior of physicians working in a pediatric intensive care unit are presented. With recent technologic advances in our capacity to help patients suffering from catastrophic illness, various segments of American society have become concerned about the unrestricted use of medical science. Questions have arisen about the economic costs, long-term medical out-come, emotional costs to patients and families, legal problems, and ethical implications of "heroic" therapy. By contrast, we have asked relatively few questions about the social processes involved in providing intensive care. We know little about the emotional and functional responses of the physicians in critical care facilities, and their decision making processes remain obscure. This investigation evolved from the conviction that environments comprised of sophisticated medical technology and extensive life support systems pose pressing problems for those working and learning in them.
Enzymuria as a Marker of Renal Injury and Disease
Authors: Sheth Kumudchandra J. , Good Thomas A.
Published: December 2021

We concur with the comments made by Dr. Kunin and colleagues in their article on N-acetyl-β-glucosaminidase (NAG) as a marker of renal injury (Pediatrics 62:751, 1978). Despite a correlation between enzymuria and proteinuria in Figure 6, we feel that both proteinuria and enzymuria reflect the underlying renal damage. In addition to NAG, we also studied three other urinary lysosomal acidic hydrolases—β-galactosidase, α-fucosidase, and arylsulfatase—in children with renal disease.1 In three children with orthostatic proteinuria, despite increased proteinuria in upright posture, enzymuria remained normal both in recumbent and upright posture.1
Does Race Influence Blood Pressure and Bacteriuria?
Authors: Tunnessen Walter W. , Johnson Robert Wood
Published: December 2021

The article by Etkin and O'Shea regarding correlations between bacteriuria in school-age girls and symptoms, patient history, and family history (Pediatrics 62:844, 1978) suggests that the discovery of bacteruria "...might ultimately be useful in identifying families at especially high risk for hypertension...." Before considering the usefulness of this method of identification it would be important to examine the source of the suggestion. The authors compared the results of parent questionnaires asking personal medical history between two groups:
You Need Teachers
Authors: Weinberger Miles
Published: December 2021

The excellent review article by Leffert1 and the accompanying commentary by Bergner2 made important points regarding the changing role of the pediatric allergist and the broad requirements for knowledge of any physicians who are to provide specialty care for children with asthma. While the current state of the art allows a high degree of control for this disease,3 considerable morbidity from inadequately treated asthma persists. This situation is unlikely to change rapidly unless departments of pediatrics place a high priority on ensuring that the modern allergist described by Dr. Bergner is on their faculty to teach the current housestaff and provide continuing education for the practitioner; only then will most general pediatricians be able to assume the role envisioned by Dr. Leffert.
An X-Linked Recessive Cardiomyopathy with Abnormal Mitochondria
Authors: Neustein Harry B. , Lurie Paul R. , Dahms Beverly , Takahashi Masato
Published: December 2021

A transvascular endomyocardial biopsy from an infant with cardiomyopathy and chronic congestive heart failure showed abnormal mitochondria when examined by electron microscopy. At necropsy, similar abnormal mitochondria were seen in skeletal muscles, liver, and kidney. The patient's family pedigree revealed several male babies who had cardiac disease and died in infancy. Myocardium obtained at necropsy from three cousins contained mitochondria with abnormalities similar to those from the proband. An X-linked recessive cardiomyopathy seems likely in this family.
Relevance of the Gestational Age Distribution of Meconium Passage in Utero
Authors: Matthews Thomas G. , Warshaw Joseph B.
Published: December 2021

The incidence of meconium staining of the amniotic fluid among the admissions to a newborn special care unit was determined. Meconium staining of the amniotic fluid was present in 251 (7.5%) of 3,374 admissions. The majority of those with meconium staining (98.4%) was of 37 weeks gestation or greater and none was less than 34 weeks gestation. The possible relevance of this gestational age distribution is discussed.
Adolescents with Myelodysplasia: Impact of Physical Disability on Emotional Maturation
Authors: Hayden Patricia W. , Davenport Sandra L. H. , Campbell Mary M.
Published: December 2021

Certain physical, psychological and social characteristics of 20 adolescents with myelodysplasia are compared to those of age and gender-matched controls. In addition to the obvious physical differences the areas of greatest concern are self-esteem and social-sexual adjustment. Family relations, feelings, and modes of expression were not different in the two groups. Lack of appropriate chores, decreased opportunities to interact and compete with peers, plus uncertainties about bowel and bladder continence appear to be the greatest impediments to emotional growth in this physically handicapped group of teenagers. Early recognition of such problems and finding strategies to overcome them are important aspects of the comprehensive care of any person with a chronic disability.
Myiasis Presenting as Cellulitis of the Cheek
Authors: Preiser Gary , Lavell Thomas E. , Dorsey William F.
Published: December 2021

A case of myiasis due to the northern cattle grub (Hypoderma bovis) in a 2½-year-old girl presenting as cellulitis of the cheek and periorbital cellulitis is detailed in this report. A literature review of similar cases reported over the past five years is included.
Acute Hydrocephalus and Death Following V-P Shunt Disconnection
Authors: Neuren Alan , Ellison Patricia H.
Published: December 2021

Acute hydrocephalus was described following sudden complete obstruction of cerebrospinal fluid (CSF) pathways.1 This is one of the many complications that have been reported with ventriculoperitoneal shunts.2 Rarely are these acutely lifethreatening. We report a case of acute hydrocephalus after sudden disconnection of a ventriculopertoneal shunt with subsequent death of the child.

See Images in the PDF file

CASE REPORT

A 5-month-old male infant developed bacterial meningitis in February 1976. Two months later, a ventriculoperitoneal shunt was inserted for treatment of progressive communicating hydrocephalus. On a follow-up examination in October 1976, he was reported to be mildly delayed without other neurologic handicap.
Quantitative Noninvasive Method to Measure Cerebral Blood Flow in Newborn Infants
Authors: Leahy Fergus A. N. , Sankaran Koravangattu , Cates Don , MacCallum Marilyn , Rigatto Henrique
Published: December 2021

We measured cerebral blood flow (CBF) in 32 healthy neonates by venous occlusion plethysmography. Mean CBF was 63 ml/min/100 gm which compared favorably with invasive methods used in older children and adult subjects. We suggest that this is a useful method to quantify CBF in neonates. It may be valuable in assessing sequential changes occurring during asphyxia, intracranial hemorrhage, or during administration of various gas mixtures and drugs such as theophylline.
Report of 65 Cases of Haemophilus influenzae b Pneumonia
Authors: Ginsburg Charles M. , Howard Jorge B. , Nelson John D.
Published: December 2021

During a 14-year period there were 65 cases of pneumonia caused by Haemophilus influenzae b; 83% were children less than 2 years of age and 80% of illness occurred in winter and spring. The roentgenographic picture was consolidative pneumonia in 75% and pleural effusions were present in 75% of all cases. Ten patients had associated meningitis and three had purulent pericarditis. Otitis media was diagnosed in 43% and H influenzae b was isolated from eight middle ear aspirates. Three patients (5%) died. Recommendations for diagnosis and treatment are made.
Nasopharyngeal Carriage of Antibiotic-Resistant Haemophilus influenzae in Healthy Children
Authors: Lerman Stephen J. , Kucera Jon C. , Brunken Jan M.
Published: December 2021

We selected 16 schools representing a broad socioeconomic cross-section of metropolitan Omaha and obtained nasopharyngeal cultures for Haemophilus influenzae from 1,084 healthy 4- to 7-year-old children. We found that 34.2% of the children carried nontypable strains and 2.0% carried type b strains. Carriage rates were not influenced by recent illness, family size, or number of people sharing a bedroom.

The prevalence of ampicillin-resistant H influenzae in the sample population was 0.9% for nontypable strains and 0.4% for type b strains; it was not significantly different in the group of children who had recently used β-lactam antibiotics. One child carried a nontypable strain which was resistant to both chloramphenicol and tetracycline, the first chloramphenicol-resistant H influenzae detected in Omaha.

A survey of healthy children may be a useful method for projecting a community's risk of disease caused by ampicillin-resistant H influenzae. Among the nasopharyngeal isolates from healthy children, 2.7% of nontypable strains and 18.2% of type b strains were resistant to ampicillin (P < .01). During the same five-month period in Omaha, clinical failure in the treatment of otitis media with ampicillin was uncommon and four (20.0%) of 20 cases of H influenzae type b bacteremia and meningitis were caused by ampicillin-resistant organisms.
Refractory Hypoglycemia Associated with a Malpositioned Umbilical Artery Catheter
Authors: Nagel Jon W. , Sims J. Stephen , Aplin Charles E. , Westmark Edward R.
Published: December 2021

An infant with unexplained hypoglycemia who responded poorly to medical management had the tip of his umbilical artery catheter positioned near the major arteries supplying the pancreas. Catheter repositioning resulted in immediate normoglycemia. A "reactive" response to the direct infusion of glucose is postulated on the basis of the clinical response and a decrease in serum insulin/blood glucose ratio.
Intrahepatic Cholestasis Associated with Parenteral Nutrition in Premature Infants
Authors: Beale E. F. , Nelson R. M. , Bucciarelli R. L. , Donnelly W. H. , Eitzman D. V.
Published: December 2021

Sixty-two premature infants less than 2,000 gm birth weight received parenteral nutrition (PN) during periods of respiratory distress with feeding intolerance. Intrahepatic cholestasis (direct bilirubin ≥ 1.5 mg/dl) associated with PN developed in 14 or 23% of these infants. The mean time on PN to onset of cholestasis was 42 days, and the cholestasis persisted as long as the infants continued to receive PN. All five infants who had serial follow-up laboratory studies showed an eventual return of direct bilirubin levels to normal. The direct bilirubin level appeared to be the best clinically available test to monitor for the onset and to follow the resolution of this complication. The very low birth weight infants < 1,000 gm appeared to be at an increased risk of developing cholestasis with an incidence of 50%. However, there was no correlation between the length of time PN was administered to onset of cholestasis and the gestational age or birth weight of the infants. These tiny premature infants also received PN for significantly longer periods of time, and the longer the infusions were administered the greater was the risk of cholestasis developing.
Bilirubin: Worked Out Years Ago?
Authors: Levine Rodney L.
Published: December 2021

1. The free bilirubin theory proposes that unbound bilirubin binds to and enters cells. The theory is simple, reasonable, and attractive.

2. To date, there is no evidence to support the free bilirubin theory over other possible mechanisms.

3. The measurement of free bilirubin is now technically possible for mixtures of purified bilirubin and albumin. Measurement in serum is promising, but proven methods still elude current capabilities.

4. At present, there is no justification for the use of free bilirubin tests in the management of jaundice. This evaluation holds for related tests, regardless of aliases: reserve binding capacity, bilirubin binding capacity, albumin saturation, loosely bound bilirubin, gel bound bilirubin, and binding affinity.

5. For smaller prematures, the concentration of total bilirubin at which the risk of kernicterus exceeds the risk of treatment is unknown. There is no scientific basis to guide the clinician in deciding when to institute treatment of jaundice in these babies.

6. Hyperbilirubinemia can lead to kernicterus. Whether it causes other, milder forms of neurologic and developmental damage is unknown. At present, there is no basis for treating jaundice with the hope of preventing such damage.
Pathogenesis of Intraventricular Hemorrhage
Authors: Wible Kenneth L.
Published: December 2021

The article by Kenny et al (Pediatrics 62:465, 1978) on the pathogenesis of intraventricular hemorrhage has prompted some thoughts regarding the role of rapid infusion of concentrated bicarbonate solutions and their relationship to neonatal intracranial hemorrhage. I should like to suggest that perhaps rather than the osmotic influences as has often been suggested, we may be dealing with the pharmacologic effect of excessive amounts of CO2 transiently generated in the cerebral capillary bed by the reaction of these concentrated solutions with excessive free hydrogen ion.
In Reply: Pathogenesis of Intraventricular Hemorrhage
Authors: Kenny John D. , Garcia-Prats Joseph A.
Published: December 2021

Dr. Wible's comments are interesting and may indeed offer an explanation for the occurrence of IVH in some infants. Since our study pertained to the acid-base status of premature infants at birth this hypothesis does not apply to the infants we studied; nevertheless, it offers an additional role for elevated pCO2 in the etiology of this condition. The relationship between rapid infusion of bicarbonate and IVH has not been adequately established although it has been shown that slow infusions do not increase the risk of IVH.1
Improved Perinatal Knowledge and Care in the Community Hospital Through a Program of Self-Instruction
Authors: Kattwinkel John , Cook Lynn J. , Nowacek George A. , Ivey Hallam H. , Short Jerry G.
Published: December 2021

Evaluation of the perinatal in-patient services of nine rural community hospitals (CH) revealed that equipment and cognitive knowledge were inadequate for the complexity of patients cared for. These deficiencies were present despite prior exposure to traditional continuing education programs.

In response to these findings, a six-month perinatal educational program was developed. The program is unique in that it is: (1) initiated by a hospital self-inventory through which patient care goals and the corresponding equipment, services and personnel needs are identified; (2) entirely CH based except for a workshop held at the regional center for two CH staff nurses who subsequently coordinate the program in their hospital; (3) self-paced and self-instructional (five books covering 19 subjects and 20 skills); and (4) completed by nurses, physicians, and support personnel thus facilitating uniform patient care and nurse-physician communications.

The program was delivered to 362 CH nurses, physicians, and support personnel, representing 77% of total available perinatal health care professionals from the nine CH. Test scores improved by 24 percentage points with perinatal professionals approaching or exceeding criterion level following the program. A review of 1,404 CH charts showed that 12/28 patient care practices improved significantly. Spontaneous performance of eight pretransport stabilizing activities improved from 44% to 86%.

It is concluded that a self-study, community-based program of this type can markedly improve both the knowledge of CH perinatal professionals and the CH care for transported and locally-managed babies.
Hypophosphatemic Rickets: Effect of 1α, 25-Dihydroxyvitamin D3 on Growth and Mineral Metabolism
Authors: Chan James C. M. , Bartter Frederic C.
Published: December 2021

Growth retardation nearly invariably accompanies hypophosphatemic rickets. Studies were conducted in an adolescent male with this disorder as follows. Protocol I: age, 6 to 16 years; treatment per day, 5,000 to 80,000 units vitamin D2, 1,760 to 2,200 mg phosphorus, orally as buffered phosphate; growth velocity, 5 to 6 cm/year. Protocol II: age 16 to 17 years; treatment per day, 1α,25-dihydroxyvitaniin D3, 1 µg; 2,200 mg of phosphorus, orally as buffered phosphate; growth velocity, 14 cm/year. The height improved from less than third percentile for the decade during study protocol I to the 25th percentile during protocol II. Mineral balance studies showed a reduction of urinary and stool phosphorus during treatment protocol II, while the patient was receiving metabolic diet. The serum phosphorus improved from 2.2 to 4.3 mg/dl and radiologic healing of rickets was documented. No hypercalcemic episode was encountered. The data support the contention that lα,25-dihydroxyvitamin D3 is the treatment of choice for hypophosphatemic rickets.
Potential Effect of Demographic and Other Variables in Studies Comparing Morbidity of Breast-Fed and Bottle-Fed Infants
Authors: Sauls Henry S.
Published: December 2021

Comparing the morbidity of breast-fed and bottle-fed infants is confounded by inherent differences in breast-feeding and bottle-feeding mothers and their infants. Self-selection introduces complex variables encompassing much more than milk source used for infant feeding. Reasons for selecting breast or bottle feeding relate to demographic, socioeconomic, educational, ethnic, cultural, and psychological factors, as well as maternal and infant physical and emotional health. Many of the differences in the maternal populations may affect infant care practices, access to medical care, and infant health status.

Studies published to date have not quantified these confounding effects and other potential biases in comparing morbidity of breast- and bottle-fed infants and the relationship between milk source and incidence of infantile disease remains in question. There is need for more cautious use of the available data and investigators must seek ways to design future studies to take into account the differences between breast-feeding and bottle-feeding mothers that affect both reported and actual infant morbidity.
The Influence of Different Electrode Temperatures on the Recorded Transcutaneous Po2 Level
Authors: Löfgren O. , Jacobson L.
Published: December 2021

The technique of transcutaneous monitoring of oxygen partial pressure (Ptco2,), first described in 1969, provided a new clinical possibility for continuous and noninvasive surveillance of changes in the oxygenation of the organism. To obtain optimal arterialization of the skin and thus a reliable recording, the electrodes used have been supplied with microheating elements. The electrode temperature used implies the risk of producing burns; this is especially true when the measurements are performed in patients with decreased skin circulation or in immature children with a thin and vulnerable skin. Thus, a careful choice of the electrode temperature is important in PtcO2 recording; a higher temperature is desirable for obtaining adequate arterialization, whereas a lower temperature is preferred for reducing the risk of burns. The electrode temperatures described for PtcO2 measurements range from 42-45 C. A systematic study with the Radiometer TCM 1 equipment showed that changing the electrode temperature influences the PtcO2 in a systematic way within the temperature range 43.0-45.0 C. The study also showed that simultaneous measurements obtained from two electrodes with different temperatures showed a highly parallel course and a comparable oscillating pattern within this temperature range. The results of the present study suggest that an electrode temperature of 44.5 C may be the most appropriate for this equipment in clinical applications with newborns.
Increase of IgA-Bearing Peripheral Blood Lymphocytes in Children with Henoch-Schoenlein Purpura
Authors: Kuno-Sakai Harumi , Sakai Hideto , Nomoto Yasuo , Takakura lwao , Kimura Mikio
Published: December 2021

Aberration of IgA-bearing peripheral blood lymphocytes in children with Henoch-Schoenlein purpura has been investigated. Eighteen children with Henoch-Schoenlein purpura demonstrated a marked increase of IgA-bearing lymphocytes in peripheral blood during the acute phase of the disease. The levels of IgA-bearing lymphocytes returned to the normal levels after the acute symptoms of Henoch-Schoenlein purpura had subsided. However, in patients who developed purpura nephritis, the increased levels of IgA-bearing lymphocytes in peripheral blood were retained after the disappearance of purpura, and lasted for more than 12 months. It is concluded that the monitoring of IgA-bearing peripheral blood lymphocytes is useful for the screening of patients with Henoch-Schoenlein purpura and purpura nephritis.
Refractory Pneumocystis carinii Infection in Chronic Granulomatous Disease: Successful Treatment with Granulocytes
Authors: Pedersen F. Karup , Johansen K. Staehr , Rosenkvist Joergen , Tygstrup lnge , Valerius Niels H.
Published: December 2021

Pneumocystis carinii pneumonia developed in an 11-year-old girl with chronic granulomatous disease who had normal cellular and humoral immunity. The patient remained febrile during treatment with sulfame-thoxazole-trimethoprim and pentamidine but became afebrile when treated with a series of 12 granulocyte transfusions combined with sulfamethoxazole-trimethoprim. In addition to documenting P carinii infection in chronic granulomatous disease our findings suggest that granulocyte transfusions may be of value in the treatment of severe infections in chronic granubomatous disease.
Thiethylperazine (Torecan)-Associated Dystonic Reactions in Children
Authors: Lacouture Peter G. , Mitchell Allen A. , Lovejoy Frederick H.
Published: December 2021

The phenothiazines are probably the most commonly used medications for the symptomatic relief of nausea and vomiting and may be effective irrespective of the primary cause.1,2 Along with their beneficial effects, these agents carry with them a risk of extrapyramidal side effects which may appear as parkinsonian syndromes, akathisias, acute dystonic reactions, and tardive dyskinesias.3 syptoympttoms commonly associated with acute dysic reactionsns with phenothiazines include oculogyri crisis, torticollis, trismus, facial grimace, protusion of the tongue, hyperreflexia, opisthotonos, and rigidity. The majority of these reactions have been reported in children taking the drugs in therapeutic doses.4-6 We wish to report four cases of acute dystonic reactions occurring in association with thiethylperazine (Torecan), a phenothiazine that has recently experienced increased pediatric usage.
Streptococcal Antigenicity in Mucocutaneous Lymph Node Syndrome and Hydropic Gallbladders
Authors: Krensky Alan M. , Teele Rita , Watkins John , Bates Jon
Published: December 2021

Two patients with apparent mucocutaneous lymph node syndrome (MLNS) and hydrops of the gallbladder have presented with elevated antistreptolysin O (ASO) titers. Notably, in none of the cases previously reported in the literature, has ASO titer been mentioned. The patient described by Goldsmith1 had a hydropic gallbladder, massively hypertrophied mesenteric lymph nodes and other signs and symptoms of the syndrome with negative throat culture, and a variety of serologic examinations reported, but no ASO titer.
Contraception in the Adolescent: Current Concepts for the Pediatrician
Authors: Greydanus Donald E. , McAnarney Elizabeth R.
Published: December 2021

An overview is presented of the major methods of contraception available to the sexually active adolescent. Emphasis is given to the combined birth control pill, while the literature describing absolute and relative contraindications to oral contraception is reviewed. It is noted that adolescents with chronic illness must also be evaluated for contraceptive needs. Other methods covered include the intrauterine device, barrier methods (diaphragm, condom, and vaginal contraceptives), injectable contraceptives, postcoital contraception, and methods under current investigation. The approach to each patient must be individualized, based on her coital activity, understanding of alternatives, medical status, and what method is chosen.
Bile Acid Excretion and Patterns of Fatty Acid Absorption in Formula-fed Premature Infants
Authors: Finley Allen J. , Davidson Murray
Published: December 2021

Balance studies of individual fatty acid (FA) absorption and bile acid (BA) excretion were performed in 23 healthy premature infants fed proprietary formulas, utilizing gas-liquid chromatography. There was a direct correlation between the amount of BA excreted and absorption. This correlation was valid for total fat and for unsaturated dietary FA. Malabsorption of saturated FAs was in proportion to their hydrocarbon chain length and is best explained by their aqueous solubiity, independent of BA. Assays of total FA absorption by gas-liquid chromatography and by the method of van de Kamer appear to be interchangeable.
Asymmetric Crying Facies: An Alternative Interpretation
Authors: Monreal F. Javier
Published: December 2021

The asymmetric crying facies syndrome is currently attributed to hypoplasia of the DAOM. In this condition the lower lip, symmetrical at rest, becomes tilted towards the so-called normal side when the patient cries, as the maldeveloped DAOM fails to pull down the corner of the mouth in the opposite side. We have several patients with the typical appearance of this syndrome who also display perioral anomalies in the supposedly normal or strong side. Based on these patients, we question the sidedness of the anomaly and postulate that very frequently the side of the lip that pulls lowest is the abnormal one.
Paroxysmal Dystonic Choreoathetosis of Mount and Reback
Authors: Tibbles J. A. R. , Barnes S. E.
Published: December 2021

Paroxysmal dystonic choreoathetosis is a rare and intriguing familial disorder that was first described in 1940 by Mount and Reback.1 Their patient was a young, male adult textile worker whose attacks had begun in infancy. They were characterized by an aura of a feeling of tightness in the neck and waist, together with a sensation of tiredness. This was followed by involuntary flexion of one or both arms and posturing of the legs, and was succeeded by choreoathetoid movements and dysarthria. The attacks lasted for up to two hours, during which time the patient was conscious, and recurred on an average of one to three times per day.
Neonatal Codeine Withdrawal in Infants of Nonaddicted Mothers
Authors: Mangurten Henry H. , Benawra Raghbir
Published: December 2021

The problem of neonatal narcotic withdrawal has been well described.1-4 The extensive literature on this topic has predominantly described infants of chronically addicted mothers. In many instances the mother's addiction is well known; ideally, when appropriate communication has taken place between obstetric and neonatal personnel, the latter can anticipate a problem in the infant and be prepared to treat accordingly. We have recently managed two infants with classic manifestations of withdrawal following maternal use of codeine-containing medications by nonaddicted mothers prior to delivery. Each infant was initially sent to a regular newborn nursery. In each instance, there was a significant delay before the diagnosis of withdrawal was considered.
National Surveillance of Kawasaki Disease
Authors: Morens David Michael , Anderson Larry J. , Hurwitz Eugene S.
Published: December 2021

Information about 261 cases of Kawasaki disease (KD) was reported to the Center for Disease Control (CDC) between July 1976 and July 1978. KD occurred at all times of the year in young, previously healthy children throughout the United States. KD was more common in infants and toddlers, males, and Asian and part-Asian children. The illness was characterized by acute onset of prolonged high fever; maculopapular or scarlatiniform rash; adenopathy; injection of the conjunctival and mucous membranes of the upper respiratory tract; redness of the palms and soles; indurative edema of the extremities; desquamation; arthralgias; and elevated white blood cell count, erythrocyte sedimentation rate, and platelet count. Complications included gallbladder disease and carditis; 2.8% died. Surviving patients were hospitalized for a mean of 8.9 days.
The Association of Kernicterus with Bacterial Infection in the Newborn
Authors: Pearlman Mark A. , Gartner Lawrence M. , Lee Kwang-Sun , Eidelman Arthur I. , Morecki Rachel , Horoupian Dirkan S.
Published: December 2021

A total population of 29,395 neonates cared for in the six-year period from 1971 to 1976 was reviewed for evidence of autopsy-proven kernicterus. A total of 327 neonates died and 232 were autopsied. The only cases of kernicterus occurred in four near-term infants with antemortem proven sepsis. All four of these infants weighed more than 2,200 gm and were delivered after gestations of either 36 or 37 weeks.

These cases of kernicterus occurred during a period when more aggressive management of hyperbilirubinemia in low-birth-weight infants had apparently eliminated immaturity as a predisposing factor in the development of kernicterus, uncovering bacterial infection as the major remaining etiologic co-factor.
Neonatal Renal Failure: Usefulness of Diagnostic Indices
Authors: Mathew Oommen P. , Jones Alan S. , James Elizabeth , Bland Harold , Groshong Ted
Published: December 2021

Forty-two oliguric neonates were prospectively studied to evaluate the usefulness and reliability of various diagnostic indices in differentiating renal failure from functional (prerenal) oliguria. Twenty-two infants had functional oliguria, 16 had renal failure, and four infants had probable early renal failure. Statistically significant differences between functional oliguria and renal failure were found with regard to the urine sodium, urine to serum ratios of sodium, urea, and creatinine, renal failure index, and fractional excretion of sodium. However, sharp demarcation of the two groups was possible only when the renal failure index or fractional excretion of sodium was used. Fractional excretion of sodium values of 2.5 or greater seem to differentiate renal failure from functional oliguria in this study.
The Outcome of Prolonged Coma in Childhood
Authors: Margolis Lewis H. , Shaywitz Bennett A.
Published: December 2021

The outcome of prolonged, nontraumatic coma (greater than five days) in 16 children is reviewed to determine operational clinical parameters which may assist in both clinical decision making and counseling of parents. The children were evaluated by physical and neurologic examinations and school reports one to five years after coma. Six children are normal, six have minor handicaps (attention deficit disorder, minor motor disorders, mild retardation, personality disorders), and four have sustained major sequelae (severe retardation, uncontrolled seizures, blindness). Anoxia, as an etiology of coma and the need for assisted ventilation, were significant indicators of a less than normal outcome. Our results suggest that elevated intracranial pressure of greater than two days duration and deep coma of greater than two weeks were indicators of an abnormal outcome. In view of the improving technical capability to care for these children, but limited past experience, clearly defined defined and uniform criteria are needed both to assess children during coma and to evaluate them upon recovery.
Transient Bacteremia Following Endotracheal Suctioning in Ventilated Newborns
Authors: Storm Wolfgang
Published: December 2021

Endotracheal suctioning is a routine procedure in ventilated newborns. A study of ten neonates demonstrates the association of transient bacteremia with endotracheal suctioning. This complication in ventilated newborns, with colonization of the respiratory tract by the same organism, must be considered in the pathogenesis of systemic infection.
Immune Competence of Newborn Lymphocytes
Authors: Handzel Zeev T. , Levin Stanley , Dolphin Zippora , Schlesinger Menachem , Hahn Thalia , Altman Yehudit , Schechter Bilha , Shneyour Amir , Trainin Nathan
Published: December 2021

The immune competency of peripheral blood (cord) lymphocytes of newborn infants has been investigated by a battery of assays in vitro. Number of T cells was enumerated by E-rosette formation and a cytotoxicity assay by using an anti-human-thymocyte antiserum. Lymphokine production as an indicator of T cell function was evaluated by leukocyte migration inhibition factor production following stimulation with various mitogens, and "viral" and "immune" interferon production in response to stimulation with polyriboinosinic -cytidilic acid and phytohemagglutinin, respectively. Ability to respond to mitogens was also tested by means of 3H-thymidine uptake into DNA, and by measuring the early synthesis of protein by lymphocytes by means of 3H-leucine uptake. Lymphocyte cyclic adenosine monophosphate levels in resting cells and after trypsin treatment was also used as a test of cellular competency. Total B cells was evaluated by EAC-rosette formation, and class specific surface membrane immunoglobulin-bearing cells were assayed by the peroxidase immunoenzymatic method. Normal children and adults served as controls. The results indicated that no significant differences in immune competency could be shown between newborns and older people except for lymphocyte cyclic adenosine monophosphate levels which were lower in the newborns, both in resting and in stimulated cells. The relationship between this latter finding and the immune status is as yet not clear. It is concluded that neonatal lymphocytes are essentially immunocompetent, with the expression of their immune capabilities in vivo becoming apparent only after encounter with environmental antigenic stimuli.
Neonatal Heelstick Blood Culture
Authors: Knudson Richard P. , Alden Errol R.
Published: December 2021

A new micro-heelstick blood culture technique was evaluated in 40 neonates who were believed to be clinically septic. Heelstick cultures were positive in 11 and peripheral venous cultures were positive in eight. All eight venous cultures had positive heelstick cultures. Heelstick blood cultures seem to be at least as sensitive as venous cultures.
Effects of Inspired Oxygen on Echocardiographic Assessment of Pulmonary Vascular Resistance and Myocardial Contractility in Bronchopulmonary Dysplasia
Authors: Halliday Henry L. , Dumpit Fe M. , Brady June P.
Published: December 2021

We studied the effects of minor changes of inspired oxygen in ten preterm infants (birth weight: 700 to 1,780 gm; postnatal age: 4 to 18 weeks) with severe bronchopulmonary dysplasia. We compared the echocardiogram, capillary blood gases, and calculated venous admixture when the oxygen level was raised or lowered by 10% of the initial value. Mean ambient inspired oxygen was 0.31, capillary Po2 was 62 torr, and calculated venous admixture was 40%. The ratio of right ventricular preejection period to right ventricular ejection time (RPEP/RVET) was 0.32, suggesting mild increase in pulmonary vascular resistance. In all instances, there was echocar-diographic evidence of further increase in pulmonary vascular resistance with a minor decrease in inspired oxygen. Lowering the inspired oxygen to 0.28 resulted in a reduction in Pao2 to 54 torr, an increase in calculated venous admixture to 47%, and an increase in RPEP/RVET to 0.36 (P <.001). Raising the inspired oxygen to 0.34 increased Pao2 to 72 torr but had no effect on RPEP/RVET. Calculated venous admixture decreased to 33% (P <.001). Myocardial contractility did not change with decrease in inspired oxygen but improved slightly with increase in inspired oxygen. These preliminary findings suggest that in infants with bronchopulmonary dysplasia the Pao2 should be kept > 55 torr and the RPEP/RVET < 0.35 to avoid the development of right heart failure.
Remission Rates of Children and Adolescents with Thyrotoxicosis Treated with Antithyroid Drugs
Authors: Collen Roberta J. , Landaw Elliot M. , Kaplan Solomon A. , Lippe Barbara M.
Published: December 2021

The clinical course of 65 children with hyperthyrodism in whom antithyroid medication was initiated has been reviewed retrospectively. Fifty-five patients received only this projected medical therapy with propylthiouracil or methimazole. Sustained remission in excess of one year following cessation of drugs occurred in 31 patients (56%). All but two achieved that remission within 4.5 years. Of the 31 patients, 24 have been followed-up for more than two years off medication with only one relapse. Twenty-four patients are still under medical therapy, 14 for longer than 4.5 years. By methods of life-table analysis, the data on all 65 patients gave an estimate of 25% remitting within the first two years and a median remission time of 4 to 4.5 years. These results suggest a continuing remission rate of 25% every two years for up to six years of follow-up. Analysis of presenting variables (assessment of age at onset of disease, sex, family history, initial laboratory data, gland size, and degree of exophthalmos) that might have distinguished which patients were likely to undergo remission was attempted. There were no clearly significant differences with any of these variables although several suggestive differences emerged. These included a tendency toward earlier remission in patients older than 13 years, in boys of any age, and in patients of any age or sex in whom initial triiodothyronine (T3 RIA) < was 645 ng/100 ml. An approach to long-term medical management is proposed.