bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital Isolation and Precaution Guidelines
Authors: Gardner Pierce , Breton Sylvia , Carles Diana G.
Published: December 2021

Infections acquired in hospitals have been recognized as a significant cause of morbidity and mortality since before the era of Semmelweis and Lister. Hospital isolation and precaution procedures have evolved along highly individualistic lines depending on the facilities, patient population and the degree of concern regarding nosocomial infections at a particular hospital. In recent years, a number of valuable manuals which offer details of isolation and precaution techniques as well as recommendations for the hospital control of particular infectious diseases have become available. These include:

1. Public Health Service, U. S. Department of Health, Education and Welfare: Isolation Techniques Used in Hospitals. Washington, D.C.: U.S. Government Printing Office, 1970.

2. Report of the Committee on Infectious Diseases, ed. 16. Evanston, Illinois: American Academy of Pediatrics, 1970.

3. Infection Control in the Hospital, ed. 2. Chicago: American Hospital Association, 1970.

4. Benenson, A. S. (ed.): Control of Communicable Diseases in Man, ed. 11. New York: American Public Health Association, 1970.

5. Top, F. H. (ed.): Control of Infectious Diseases in General Hospitals. New York: American Public Health Association, 1967.

In an attempt to synthesize these recommendations into a more easily utilized form, the following alphabetical listing of diseases and conditions has been developed by members of the Infections Control Committee at the Children's Hospital Medical Center. It should be stressed that these are guidelines based on current understanding of the natural history and epidemiology of certain infections. In our hospital, modifications are frequently necessary due to heavy demand for the limited isolation facilities.
Accuracy of a Home Throat Culture Program: A Study of Parent Participation in Health Care
Authors: Katz Harvey P. , Clancy Robert R.
Published: December 2021

During the past four years, the Pediatric Department of the Columbia Medical Plan, a Johns Hopkins affiliated Health Maintenance Organization, has developed a home culture program in which parents are taught to obtain throat cultures from their children at home when symptoms appear, with a subsequent visit only if the culture is streptococcal-positive. This study was done to assess parents' accuracy by (1) a direct comparison of culture results between parents and health assistants at the clinic (group 1) and (2) an evaluation of children with negative cultures taken by parents at home, measured by the need for subsequent clinic visits (group 2). The attitudes of 70 participating families toward the program were also elicited. Families were selected on subjective criteria by the pediatric staff which instructed parents in technique and indications. Culturettes were taken home to be used as needed. Of 137 children in group 1, 24.8% were streptococcal-positive. Comparisons between health assistant and mother revealed agreement in 136 out of 137 specimens. In group 2, 28% of 100 children were streptococcal-positive; of those who were initially streptococcal-negative, 4.2% appeared within three weeks for an illness with a positive culture, compared to 4.7% in group 1. Two thirds of families felt our home culture approach improved medical care, and stated it reduced anxiety, decreased contagion, and eliminated unnecessary visits for children and their siblings. The data strongly suggest that a trained mother can play a major role in promptly and accurately identifying streptococcal throat infections without consulting a health care provider.
Minor Physical Anomalies and Neurologic Status in Hyperactive Boys
Authors: Quinn Patricia O. , Rapoport Judith L.
Published: December 2021

The "hyperactivity" syndrome or "minimal brain dysfunction" has received considerable attention from teachers, psychologists and pediatricians over the past decade. The varied symptoms of restlessness, irritability, short attention span, impulsivity, motor incoordination and perceptual-cognitive disability may be prevalent in from 4% to 10% of grade school children.

Several etiologic factors for this disorder have been proposed. In 1956 Rogers and Pasamanick found a higher rate of pregnancy complications for cases of behavior disorder compared to controls. Several replications of these findings have supported the postulate of a continuum of reproductive casualty in which disability varies with extent of damage. However, some recent studies of behavior disorders have not found a clear relationship among perinatal difficulties, neurologic signs, cognitive abnormalities and behavior problems.

The evidence for genetic transmission of hyperactivity has also been examined; family clustering and sib half-sib studies have supported a genetic model. In addition, parents of hyperactive children have been noted to have a higher incidence of psychiatric disturbances not seen in their adoptive counterparts.

The heterogeneity of this population and the variety of the theoretical models for the condition suggest that further clinical subclassification for hyperactive children is needed.

In 1960 Daryn, examining 86 children with "diffuse brain damage," noted the frequent occurrence of minor physical anomalies for this group. Waldrop used the presence of minor physical anomalies to predict hyperactive behavior in a nursery school population. Waidrop and co-workers have reported four replications of this study with preschool populations, children with speech and hearing disorders, and an elementary school population. Rosenberg and Weller found that high ratings of minor physical anomalies were associated with school failure for an unselected population of 99 first-grade children.
Recovery From Disseminated Candidiasis in a Premature Neonate
Authors: Hill Harry R. , Mitchell Thomas G. , Matsen John M. , Quie Paul G.
Published: December 2021

The management of candidemia in neonates is difficult since even transient episodes of fungal septicemia may lead to widespread tissue invasion and multiple secondary complications.1-8 The patient reported here was a premature neonate receiving parenteral hyperalimentation and broad spectrum antibiotic therapy when Candida septicemia developed. The septicemia was followed by Candida arthritis, osteomyelitis, meningitis, endophthalmitis and pyelonephritis. Initial treatment with 5-fluorocytosine rapidly resulted in the emergence of resistant organisms, but prolonged therapy with a combination of amphotericin B and 5-fluorocytosine brought about a satisfactory clinical response and reversed the destructive changes observed in the eyes, bones and joints. Four months after discontinuation of antifungal therapy, the patient had a recurrence of Candida ophthalmic infection which responded to another course of amphotericin B.

CASE REPORT

The patient was a 1,928-gm infant born to a 33-year-old primagravida at approximately 32 weeks' gestation. The infant, who was delivered by cesarean section because of placenta previa, required intubation and resuscitation in the delivery room. Because of persistent respiratory distress and periods of apnea, the patient was transferred to the University of Minnesota Neonatal Intensive Care Unit at approximately 12 hours of age. Severe hyaline membrane disease necessitated the use of respiratory therapy, and an umbilical artery catheter was inserted to monitor blood gases.

On the fifth hospital day, apnea, acidosis, and questionable pneumatosis intestinalis observed on an abdominal x-ray prompted the institution and continuance of penicillin and kanamycin therapy, although blood, urine and cerebrospinal fluid cultures remained sterile. Hyperalimentation through the umbilical arterial catheter was started on the sixth hospital day.
Neonatal Islet Cell Adenoma: Case Report and Literature Review
Authors: Fischer Gerald W. , Vazquez Angel M. , Buist Neil R. M. , Campbell John R. , McCarty Eugene , Egan Edmund T.
Published: December 2021

Islet cell adenomata are uncommon in children, although more than 50 cases have been reported.1-3 Of these, only about a dozen cases were in the newborn period.4-12 For this reason we report here another case and provide a brief review of this disorder in the neonatal period.

CASE REPORT

A male infant was born April 14, 1972, after an uncomplicated pregnancy and a spontaneous term delivery. Birth weight was 4.2 kg. The one- and five-minute Apgar scores were 9 and 10, respectively.

Attacks of sweating and cyanosis associated with severe hypoglycemia (blood glucose <10 mg/100 ml) were first noted at 24 hours of age. These persisted despite repeated glucose administration and in the face of continuous intravenous glucose infusion (25 gm/kg/24 hr) and intravenous hydrocortisone (10 mg/kg/24 hr). After some days on oral glucose, 30 gm/kg/24 hr, the symptoms were ameliorated and the steroids were then discontinued. The child was discharged 15 days after birth on frequent oral feedings, although normoglycemia could not be maintained.

Two days after discharge, seizures and lethargy prompted readmission. An intravenous glucose tolerance test and a glucagon tolerance test were performed; the results are shown in Table I. Other studies included normal blood electrolytes, calcium, and BUN. Plasma cortisol was 6µg/100 ml. During this admission, the severe hypoglycemia persisted and treatment with prednisone (2 mg/kg/day) for one week followed by a trial of diazoxide (10 mg/kg/day) for seven days produced no obvious benefit (Table I).

At 6 weeks of age, the patient developed cardiac failure while still receiving 10 mg/kg/day of diazoxide and was transferred to the University of Oregon Medical School.
Letter to the Editor
Authors: Snyderman Selma E. , Sansaricq Claude , Norton Patricia M. , Phansalkar S. V.
Published: December 2021

We were gratified to see our experience with the effectiveness of oral neomycin therapy in reducing the levels of MMA in methylmalonic acidemia confirmed by Duran, Bakker, Wadman and van Sprang, and were, of course, distressed to learn of any possible untoward effect in their small patient. We should like to point out, however, that the acidosis of neomycin therapy reported by Asatoor is mild, and is a function of the loss of extra bicarbonate in a more voluminous stool.
O2 Content and Pao2
Authors: Mair Douglas D.
Published: December 2021

The April 1973 issue of Pediatrics contained a Letter to the Editor from Gerald B. Merenstein, M.D. In his letter, Dr. Merenstein was guilty of a fundamental error in the understanding of the mechanism of oxygen uptake by the tissues. Because this misconception is not uncommon, I believe that the topic deserves comment.

Dr. Merenstein compared systemic arterial oxygen content of two neonates in a hypothetical example (he referred to oxygen content as oxygen capacity, but this error is relatively unimportant). His illustration was as follows:
Index-Handbook of Ototoxic Agents 1966-1971, by E. Louisa Worthington, Lois F. Lunin, Miriam Heath, and Francis I. Catlin. Baltimore and London: The Johns Hopkins Press, 1973, 637 pp., $22.50
Authors: Jaffe Burton
Published: December 2021

This index-handbook is written to alert the physician about the potential ototoxic dangers of new drugs as well as to stress the special conditions which enhance the ototoxicity of old and established drugs. No prior compilation of these facts has been published; so this handbook fills an important gap in medical communication.

The Information Center for Hearing, Speech, and Disorders of Human Communication is engaged in information transfer, and this handbook has "the purpose of collecting, analyzing, and repackaging detailed information, experimental and clinical, concerning the effects of ototoxic agents on the auditory and vestibular system."
The Fetus & Newly Born Infant: Influences of the prenatal environment, by Roger E. Stevenson, M.D. Saint Louis: The C. V. Mosby Company, 1973, 391 pp., $30.25
Authors: Chernick Victor
Published: December 2021

This excellent book represents what must have been a tremendous effort by Dr. Stevenson. His objective, clearly stated in the preface, was to "catalogue forces in the maternally imposed environment that can penetrate the protective mechanisms available to the fetus and significantly alter the outcome of pregnancy." This objective has been amply realized in a critical review of important topics. The author clearly points out areas where scientific evidence, in contrast to testimony, is available and provides the appropriate reference material.
Perinatal Effects of Chemical Pollutants: Suggested Studies
Authors: Battaglia Frederick C.
Published: December 2021

Research in obstetrics is developing much more rapidly than most pediatricians appreciate. The impetus comes in part from various methods to test placental function as well as to identify drugs for induction or prevention of labor.

The onset of labor at the 28th week, or in any event prematurely, is one area that ought to be studied for a possible relationship to chemical pollutants. If one looks at the onset of labor-in part triggered by the pituitary-adrenal axis of the fetus but also in part by enzyme systems related to the synthesis of prostaglandins in the uterine mucosa (which trigger uterine contractions)-one can see ways of blocking enzymes that would channel certain fatty acids to prostaglandins.

In regard to the relationship between placental growth and fetal growth, it has become clear in animals such as the sheep-where implantation sites are grossly obvious before pregnancy (40-50 in each uterine horn)-that some animals use only 20 and others use all. The animals using all sites have larger placentas and larger babies, whereas those using fewer implantation sites have smaller total trophoblasts and smaller infants at term. What determines this selection of implantation sites? The effect of pollutants could be measured as to selection of implantation sites, and on the fertility of sperm as it relates to cervical mucus. Also, one might examine the concentration of various substances in oocytes. The selective concentration of chemicals in reproductive secretions and tissues could have a marked effect upon reproduction and should be studied.

The importance of events during the second trimester of pregnancy should be emphasized.
Scleredema and Carditis: Report of a Case and Review of the Literature
Authors: Yogman Michael , Echeverria Peter
Published: December 2021

Scleredema is a rare connective tissue disease "characterized by firm nonpitting edema, usually affecting the face, neck, scalp, conjunctivae, and thorax, occasionally the arms and more rarely the legs, sparing the hands and feet."1 The etiology is unknown but often follows a streptococcal infection. Systemic manifestations of the disease have been described,2 and cardiac involvement has been present in some of these patients (Table 1).3-6 The purpose of this report is to describe a child with scleredema and carditis and to review this association.

CASE REPORT

A 14-year-old retarded white boy was in good health until six weeks prior to admission when he developed pharyngitis and an upper respiratory tract infection.
Comment on Russell-Silver Syndrome
Authors: Severi Francesca , Colombo A. , Pasquali F. , Burgio G. R.
Published: December 2021

Szalay1 discusses the definition of Russell-Silver syndrome and tabulates some cases with chromosomal anomalies reported in the literature. We have recently observed a 3-year and 7-month-old boy in whom the diagnosis of Silver-Russell syndrome was based on the presence of small size at birth (birth weight, 1,950 gm) despite being born at term, triangular shape of the face, turned down corners of the mouth, increased curve of fifth fingers, syndactylism of the toes, a café au lait area of the skin, asymmetry of the legs and feet, and marked retarded skeletal age.
Renal Abnormalities in the Russell-Silver Syndrome
Authors: Spirer Z. , Soferman R. , Bogair N.
Published: December 2021

Haslam et al.,1 reporting abnormal excretory urograms or cystograms in four of six children with the Russell-Silver syndrome (RSS), stress the importance of thorough urological examination of RSS cases. In a recent review of 100 cases of hemihypertrophy,2 which is one feature of the RSS, similar urinary excretory defects are mentioned.

We present a typical case of RSS with a urinary malformation resembling that of Haslam's case 2.

CASE REPORT

K.T., a male infant 1 month of age and admitted to our hospital because of sudden dyspnea, is the third child of healthy Oriental Jews.
Pregnancy, Birth and Family Planning, by Alan F. Guttmacher, M.D. New York: New American Library, Signet Books, 1973, 392 pp., $1.50 (paperbound)
Authors: Smith Clement A.
Published: December 2021

First published in 1937, this book has been repeatedly extended, revised, and re-issued under new titles. In his brief Foreword, the author writes: "Pregnancy, Birth and Family Planning is the latest child of this rather extended book-bearing succession. To be sure it resembles its siblings, but there are striking differences, largely modernizations. The decade since 1962 has witnessed some remarkable advances-some scientific, others socio-medical-in Obstetrics." These advances, and the solid principles of obstetrics upon which they are based, are presented here with just the right mixture of authority and familiarity for the lay-but always inquisitive -audience addressed.
Regulation of Amino Acid Metabolism in Mammals, by Bernard Schepartz, Ph.D. Philadelphia/London/Toronto: W. B. Saunders Company, 1973, 205 pp., $9.50
Authors: Levy Harvey L.
Published: December 2021

During the past few years there has been published an increasing number of books reviewing the subject of amino acid metabolism. With a few notable exceptions, these books have been repetitious, have had no innovative central themes, and, consequently, have contained little information not already available.

However, reading the preface to this monograph evoked a good bit of excitement. For here was a book that would attempt to discuss mammalian amino acid metabolism not in the conventional manner of listing pathways but in terms of regulatory mechanisms and integration into the whole organism.
DR. JEAN ASTRUC ON MORBUS PEDICULARIS AND THE LOUSE WITH FOUR TESTICLES
Authors: C. T. E.
Published: December 2021

In 1746 an English edition of lectures on diseases of children given by Dr. Jean Astruc (1684-1766) was published anonymously in England. The preface describes it as "preferable to anything written on the present subject." This may be an overstatement, but the book was certainly in advance of most that had been written before, and of some that were written later.1

Part of the chapter on Phthiriasis or Morbus Pedicularis is given below.

Though this subject is very nauseous and disagreeable to the physician, yet he should not be ignorant thereof, nor neglect its treatment, being very troublesome, and even dangerous, to children. It may happen to all, but it is more frequently observable in dirty, neglected infants. Some authors report, that they have seen infinite numbers of lice on all parts of the body; that they not only appeared on its surface, but also betwixt the cuticula and cutis, forming whitish superficial tumours. This kind of Pthiriasis I never observed: but have frequently seen it in the head, especially of those who are infected with a scabies, tinea, or crusta lactea, of that part....

The origin of Pediculi the moderns justly derive from eggs; from the axiom, omne animale ex oco, is true in this case. These eggs in the head are small, round, and whitish tumours or vesicles, fixed to the roots of the hair. The vermin have distinct males and females, and are not hermaphrodites, as several authors have imagined. The males have four testicles.
Congenital Porencephaly
Authors: Nixon George W. , Johns Richard E. , Myers Garth G.
Published: December 2021

Congenital porencephaly originates early in fet al development as a component of diffuse cerebral malformation. In infancy the patients have clinical manifestations of local or generalized cerebral disease. Convulsions, delaved growth and development and focal motor deficits are the most common clinical findings. Skull films, transillumination and brain scanning are useful methods of examination. Intracranial pneumography is the definitive means of diagbnosis.

Roentgen studies in unilateral cases demonstrate characteristic changes. This pattern consists of ipsilateral calvarial enlargement and thinning, bilateral ventricular dilatation and contralateral shift of midline structures. Other anomalies of the cerebrum and meninges are often demonstrated on roentgen studies.

The prognosis in these patients is guarded. Significant mental and motor retardation occurred in nearly all cases.
Acrodermatitis Enteropathica, With Pathologic Findings in Jejunum and Skin
Authors: Rayhanzadeh Syrus , Dantzig Paul
Published: December 2021

A 37-month-old black boy with an illness diagnosed as acrodermatitis enteropathica at 2 months of age had normal tryptophan metabolism. Results of direct and indirect immunofluorescence studies were negative. A biopsy of the jejunum revealed edema and superficial ulceration of the mucosa. Electron microscopy of the skin revealed virus-like particles in the epidermal cells. Marked clinical improvement occurred with diiodohydroxyquin therapy.
Optic Atrophy Following Treatment With Diiodohydroxyquin
Authors: Pittman Fred E. , Westphal Milton C.
Published: December 2021

Permanent severe bilateral optic atrophy was detected in a 3½-year-old white child with an unusual type of colitis following oral administration of diiodohydroxyquin, 1,950 mg daily for eight weeks, given as nonspecific treatment of diarrhea. Neurological examination four weeks after the appearance of partial blindness revealed no abnormalities other than optic atrophy. Examination three years later showed persistence of the optic atrophy and the presence of nystagmus on extreme lateral gaze. Because of strong evidence suggesting dose-related neurotoxicity associated with use of the chemically similar drug, iodochlorhydroxyquin, it was thought that this child's optic atrophy was caused by the large amount of diiodohydroxyquin he received. The presence of active inflammatory bowel disease in association with pharmacologically delayed colonic emptying may have enhanced colonic absorption of the drug, thereby contributing to its neurotoxicity.
Hand nebulizers and asthma therapy in children and adolescents
Authors: Bierman C. Warren , Pierson William E.
Published: December 2021

Should pressurized bronchodilator hand nebulizers be prescribed for routine treatment of asthma in children and adolescents? There has been considerable controversy about pressurized hand nebulizers since they were introduced into clinical medicine about 15 years ago. Proponents point to convenience, prompt relief of symptoms, and the advantage of a drug-delivery system which administers medication directly to the lungs. Others cite the danger of permitting the patient to determine his dosage of such a potent bronchodilator drug which may be packaged to deliver up to 600 dosages of medication per cartridge. Another danger is the psychological dependence which frequently results in a high abuse rate and the substitution of a nebulizer for effective oral bronchodilator therapy.
Annual Summary of Vital Statistics—1973
Authors: Wegman Myron E.
Published: December 2021

National data for this article, as in previous reports,1 are drawn principally from the Monthly Vital Statistics Report,2,3 published by the National Center for Health Statistics. The international data come chiefly from the United Nations Demographic Yearbook4 and the quarterly, Population and Vital Statistics,5 both published by the Statistical Office of the United Nations. These are official government reports, but the provisional data sometimes omit significant factors related to the World Health Organization definition of a live birth and an infant death. In such instances, data from World Health Organization Reports6 or direct communications from ministries of health7 have been substituted.
The Need To Be Attentive to What Mothers Say
Authors: C. T. E.
Published: December 2021

Dr. James B. Harrison, a successful mid-19th century English practitioner, advised a young practitioner to be attentive to what mothers say as follows:

I was once called to see a child which had been crying very much, and was shown a minute spot upon it, which even required careful examination to distinguish. This I did not attach much importance to, but I was afterwards told that a blackened fragment of a needle was ultimately drawn out from it. This shows how careful one ought to be where children are concerned who cannot describe their feelings. It is a good rule always to be very attentive to what mothers say; for, however foolish they are in their way of treatment, you may rely on it that they are good observers where their own children are concerned. They are full of prejudices, conceits, and absurdities, but still they are no bad observers; and let me tell you never to neglect to notice what they say. If you do, you will assuredly some day repent not having given more notice to their tales.1
Insensible Water Loss in Preterm Infants: Changes With Postnatal Development and Non-ionizing Radiant Energy
Authors: Wu. Paul Y. K. , Hodgman Joan E.
Published: December 2021

Insensible water loss (IWL) was measured by an Electronic Potter Baby Scale in 170 healthy preterm infants, with birthweights ranging from 800 to 2,000 gm, who were appropriate for gestational age. IWL was found to increase with decreasing birth weight, i.e., from a mean of 0.7 ml/kg/hr in infants weighing 1,751 to 2,000 gm to 2.67 ml/kg/hr in infants weighing < 1,000 gm. This correlation between IWL and birthweight was high (r = 0.91; P = < 0.001). In infants < 1,500 gm, IWL decreased with postnatal age while in infants > 1,500 gm, IWL increased in the second week and was stable in the third and fourth weeks. Exposure to non-ionizing radiant energy from three radiant heat warmers was found to increase IWL by 50% to 190% depending on the maturity of the infant and the type of warmers. Phototherapy was associated with a twofold to threefold increase in IWL, which can be minimized by careful temperature control of the infant. The magnitude of increase in IWL in response to exposure to non-ionizing radiant energy, both from radiant heat warmers and phototherapy was greater in infants with birthweight > 1,500 gm than in infants < 1,500 gm.
Relationship Between Dose and Apparent Volume of Distribution of Salicylate in Children
Authors: Levy Gerhard , Yaffe Sumner J.
Published: December 2021

The apparent volume of distribution (Vd) of salicylate was determined in 11 children, 4 months to 16 years old, who had ingested from about 36 to over 340 mg of salicylic acid (mainly as aspirin) per kilogram of body weight. Vd was calculated from the amount of salicylate in the body at a given time (as determined by the amount of total salicylates excreted in the urine and, where applicable, removed in peritoneal dialysis fluid after that time) and the concentration of salicylate in the plasma at the same time. This method of calculation is ideal for the nonlinearly eliminated salicylic acid and does not require any assumptions with respect to the nature of the pharmacokinetic model for salicylate distribution. The Vd for salicylate in the children ranged from 162 to 345 ml/kg and was larger at the higher doses. Plots of salicylate concentration in plasma versus amount of drug in the body were usually linear for a given patient, showing that Vd remained relatively constant over the time course of elimination of the drug in the patients studied. This indicates that a given plasma salicylate concentration in children who have ingested large doses reflects a larger amount of salicylate in the body than the same plasma concentration in children who ingested smaller doses of the drug. These observations help to rationalize and emphasize the usefulness of the Done nomogram (which involves estimation of the theoretical zero time plasma salicylate concentration by back extrapolation) for assessing the severity of salicylate intoxication.
Improved Prognosis for Infants of Very Low Birthweight
Authors: Stewart Ann L. , Reynolds E. O. R.
Published: December 2021

Following the introduction of a program of intensive care for infants of very low birthweight, 197 infants who weighed 1,500 gm or less at birth were cared for in the Neonatal Unit of University College Hospital, London, in the five years from 1966 to 1970. During this period, the neonatal survival rate for infants weighing 501 to 1,000 gm was 23% and for those weighing 1,001 to 1,500 gm was 69%. The principal immediate cause of death was hypoxia around the time of birth or hyaline membrane disease. Ninety-five of the 98 surviving children, aged 2 years 10 months to 7 years 10 months (mean, 5 years 2 months) were followed up. They all had repeated physical examinations and developmental assessments. Sixty-five of the older children also had IQ tests. The results showed that 86 (90.5%) of the children had no detectable handicap, 4 (4.2%) had physical handicaps only, and S (5.3%) had mental handicaps, including two children with physical handicaps. The incidence of handicap was very much greater among infants presumed to have been severely hypoxic than among the remaining infants.

We conclude that intensive care can both increase the chance of survival for infants of very low birthweight amid reduce the incidence of serious handicap in survivors.
Breast-Feeding: Second Thoughts
Authors: Gerrard John W.
Published: December 2021

A number of studies have shown that breast-feeding not only supplies the infant with nourishment but gives him immunologic protection against infection as well. Breast-fed infants are less likely to develop respiratory and gastrointestinal infections and allergic reactions. Infants slowly develop their own immunologic defenses in the months after birth, and breast-feeding is a hygienic, gradual method of protection during the transition to immunologic independence. Best protection is achieved when the infant receives breast milk alone for, at least, the first six months of life. Pediatricians should be aware that this is particularly important in areas where contamination of cow's milk and other foods is likely and where medical facilities are inadequate.
Hydranencephaly Following Elevated Hematocrit Values in a Newly Born Infant
Authors: Koffler Herbert , Keenan William J. , Sutherland James M.
Published: December 2021

A newly born infant with a hematocrit value of 78% was subsequently found to have hydranencephaly. Polycythemia produces hyperviscosity which, in turn, resuts in decreased tissue perfusion. It is possible that compromised cerebral circulation produced brain ischemia with consequent massive destruction of cerebral tissue.
Early Post-Transplant Function of 33 Machine-Preserved Human Cadaveric Kidneys in Children
Authors: Moore Thomas C. , Fine Richard N. , Asch Morris J. , Berne Thomas V. , English Thomas S.
Published: December 2021

Thirty-three of 254 machine-preserved and transplanted human cadaveric kidneys were transplanted into children 16 years of age and younger (13%). Early post-transplant function was classified as F (immediate and continuing good function), FAR (immediate good function, then accelerated rejection), SF (slow initial function), and NF (nonfunction). Early function other than F for machine-preserved kidneys of good quality from perfusion data was considered likely to be due to recipient presensitization to donor transplant antigens.

The incidence of F during first transplants of good quality was 78% for recipients 12 and under, 63% for recipients 13 to 16, and 42% for adult recipients. The incidence of F for second and third transplants for these age groups was 80%, 50%, and 21%. The predictability error of antibody-against-the-panel assays (10% or more) with respect to early transplant function of other than F class was 47% (4 of 9) for recipients 16 and younger and 17% (7 of 42) for adult recipients of first, second, and third transplants. Shorter pretransplant durations of hemodialysis and the frequent use of high functional capacity adult-donor kidneys for small pediatric-age recipients are suggested as major factors contributing to these recipient-age-related early post-transplant function responses.
To Be Alive
Authors: Mumford LEWIS , Moore H. T. , Deutsch K. W.
Published: December 2021

If appetites are ready, food will follow. To be alive means clear eyes and a good digestion: a readiness to risk one's neck or lose one's sleep: a willingness to work at anything one needs for bread or knowledge from catching fish to measuring an atom's dance: the will to be incorporated with others in a family, union, shop or city, and yet to keep one's proper self intact. A life well-keyed will find its way with equal ease about a landscape or a library. To be a man at all means sharing in the modes of life that men have found a help to sheer existence or to ecstasy.
Concepts of School Health Programs
Authors: Burnett Robert D. , Bell Leo S. , Frank Donald J. , Goldstein Paul S. , Haverty J Rhodes , Kahn Lawrence , Silver Henry K. , Rinker Andrew , Lagozzino Daniel A. , Eldredge L. L. , Poncher John R. , Rogers Kenneth D. , Schell Norman B. , Shackleford E. C. , Sia Calvin C. J. , Smull Ned
Published: December 2021

School health programs have traditionally included health education, health services, and healthful school living. As a concept of school medicine has appeared, there has developed a specialized area of medical practice that is concerned with the identification, observation, and management of special health problems in the school setting. Increasing emphasis has been placed on identifying high-risk groups of children with potential learning problems, making proper referrals early, and developing a closer liaison between various medical, educational, and psychosocial personnel involved with the individual child's optimal performance in school.

The child's primary physician, the school physician or medical consultant, and the school nurse make up the basic school health team. In the ideal school health program, this team works collaboratively with parents, teachers, and other school and health personnel who may include dental professionals, psychologists, speech and hearing specialists, counselors, social workers, mental health specialists, health educators, and others.

The physician practicing school medicine must know the scientific basis and technique of various school health screening tests and examinations. He must know the general provisions of laws and regulations governing school health; functions and appropriate involvement of school personnel, such as the psychologist, guidance counselors, special teachers, and social workers; identification and appropriate management of school-related emotional and learning problems; and the identification and special needs of handicapped children in school. He must know standards for the school physical environment and develop effective administrative and record-keeping practices. He must understand desirable employee health practices and programs, organize emergency plans for the school, and recommend safe athletic practices and equipment.
Ampicillin-Resistant Strains of Hemophilus influenzae type B
Authors: Katz Samuel , Klein Jerome O. , Yow Martha D. , Barrett Fred F. , Feldman Roger S. , Fleming Peter , Overturf Gary , Wehrle Paul F. , Wilfert Catherine
Published: December 2021

Strains of Hemophilus influenzae type b highly resistant in vitro to ampicillin have been reported from several widely separated locations in the United States since December 1973.1-4 These strains were isolated from children with meningitis and the clinical course corroborated the in vitro susceptibility results. Until the importance of these resistant strains can be ascertained, hospital laboratories are urged to test clinical isolates of H. influenzae type b for susceptibility to ampicillin, and physicians must reconsider the treatment of patients with severe disease due to this organism.

Ampicillin disk sensitivity tests of H. influenzae isolates are satisfactory for screening purposes but strains that are of equivocal sensitivity or are resistant should also be tested by a quantitative method, such as the tube dilution or agar diffusion techniques. The appropriate methods for antibiotic susceptibility tests were reviewed recently in a weekly report of the Center for Disease control.5 If facilities for these tests are unavailable or if confirmation of test results is desired, the bacterial strains may be forwarded, via the State Public Health Laboratory, to the Center for Disease Control.

In areas where resistant strains have been recognized, initial therapy of children with documented or suspected severe infection due to H. infiuenzae type b, such as sepsis, meningitis, epiglottitis, arthritis, or cellulitis, should include an antimicrobial agent of known efficacy. Initial administration of penicillin G or ampicillin and chloramphenicol would seem appropriate at this time. The antimicrobial regimen should be reevaluated when the results of the bacterial isolation studies and antimicrobial sensitivity tests are available.
Chronic Pulmonary Insufficiency of Prematurity (CPIP)
Authors: Krauss Alfred N. , Klain David B. , Auld Peter A. M.
Published: December 2021

This report describes a syndrome of delayed respiratory distress occurring in premature infants usually under 1,250 gm at birth. Unlike hyaline membrane disease, this syndrome occurs after four to seven days in a previously healthy infant; also unlike hyaline membrane disease, it persists for two to four weeks. Chronic pulmonary insufficiency of prematurity (CPIP) carries a 10% to 20% mortality rate. The infants are frequently apneic, require supplemental oxygen, but lack the radiologic findings of hyaline membrane disease or bronchopulmonary dysplasia. When compared with nondistressed infants of similar birthweight, infants with CPIP demonstrate slowly progressive atelectasis, hypoxemia, and hypercapnia. Recovery is usually complete by 60 days of age. The importance of CPIP is that an awareness of its existence can eliminate a false sense of security, often communicated to anxious parents, during the four-to-seven-day grace period before its appearance is clinically obvious. The physiologic similarities between CPIP and hyaline membrane disease suggest that lack of surfactant may play a role in the pathogenesis of CPIP.
Pharmacologic Basis for the Treatment of Cardiac Arrhythmias
Authors: Gelband Henry , Rosen Michael R.
Published: December 2021

The treatment of many cardiac arrhythmias occurring in the pediatric population is often a perplexing therapeutic problem. An apparent increase in the incidence of these arrhythmias is occurring, probably for several reasons. Physicians have attained a greater awareness of the problem of cardiac arrhythmias in the young; diagnostic capabilities have been improved; and large numbers of patients with congenital cardiac malformations now undergo total surgical correction and experience postoperative cardiac arrhythmias.

The pharmacotherapy of cardiac arrhythmias in pediatric patients is determined by multiple factors. Probably foremost among these is the clinical efficacy of a given drug in the hands of an individual pediatrician; that is, his personal experience in antiarrhythmic therapy. Information and experience here are often limited, however, and in many instances the determining factor in selection and method of administration of a drug to the pediatric patient is its use in the treatment of arrhythmias in the adult. Additional requirements for the rational choice of the proper antiarrhythmic agent are (1) an accurate diagnosis of the cardiac arrhythmia; (2) a knowledge of the mechanism for initiation and maintenance of an arrhythmia; (3) an understanding of the electrophysiologic effects, pharmacologic properties and metabolism of the drugs available; and (4) the clinical status of the patient. Any electrolyte imbalance, concomitant drug therapy or organ system dysfunction may alter the absorption and metabolism of the drug.

In the past decade there has been a large increment in the literature concerning mechanisms underlying the occurrence of cardiac arrhythmias and their therapy. Our purpose in this review is to familiarize pediatricians with the electrophysiologic basis for arrhythmias, with the mechanisms of action of the commonly used antiarrhythmic drugs, and with their administration, metabolism, excretion and undesirable effects.
Endogenous and Exogenous Insulin Responses in Patients With Cystic Fibrosis
Authors: Wilmshurst Errol G. , Soeldner J. Stuart , Holsclaw Douglas S. , Kaufmann Robert L. , Shwachman Harry , Aoki Thomas T. , Gleason Ray E.
Published: December 2021

Eight male patients with cystic fibrosis, normal nutrition, normal physical activity, relatively mild pulmonary disease, no evidence of liver disease and no family history of diabetes mellitus underwent a series of carbohydrate tolerance tests in comparison with a group of 18 normal male subjects matched for age and body weight.

Compared with the normal group, the patients with cystic fibrosis had significantly impaired glucose tolerance and significantly lower serum immunoreactive insulin levels during oral and intravenous glucose tolerance tests; serum insulin levels were also significantly lower after intravenous administration of tolbutamide in the patients with cystic fibrosis, but the reduction in blood glucose concentration in each group was not significantly different. During an intravenous insulin test, the decrease in blood glucose concentration was the same for both groups, in spite of significantly lower serum insulin levels in the patients with cystic fibrosis. The percentage fall in plasma free fatty acids was at least as great in the patients with cystic fibrosis as in normals during the test procedures, while a significant decrease in plasma alpha-amino nitrogen after intravenously administered insulin was seen only in the patients with cystic fibrosis.

These studies suggest that the carbohydrate intolerance of cystic fibrosis is consequent upon an impaired insulin response to glucose, but that this insulin deficiency is partly compensated for by increased peripheral tissue sensitivity to insulin.
Biliary atresia and the Kasai operation
Authors: Koop C. Everett
Published: December 2021

Biliary atresia has been the most disappointing lesion to treat among those congenital anomalies theoretically amenable to surgical correction. With a flurry of reports of a "new" or "Japanese" operation for biliary atresia with as high as 80% success if done early enough, it is important to review some aspects of the state of our knowledge.

The Japanese operation should properly be called the Kasai operation. It is not new; Dr. Mario Kasai had done his first successful operation before he was my resident 16 years ago. The patient is 17 years postoperative; I have seen him, and he is well.
Cystic Fibrosis: Comparison of Two Mucolytic Drugs for Inhalation Treatment (Acetylcysteine and Arginine Hydrochloride)
Authors: Dietzsch Hans-Joachim , Gottschalk Bodo , Heyne Klaus , Leupold Wolfgang , Wunderlich Peter
Published: December 2021

Clinical, bronchoscopic, spirographic, scintigraphic, and chemical analyses were done in 24 children with cystic fibrosis to assess the mucolytic effects of acetylcysteine inhalations versus L-arginine hydrochloride aerosols. The latter drug is less active than acetylcysteine and should not be used to treat children with cystic fibrosis.
Child Health Care in the United States: Expenditures and Extent of Coverage With Selected Comprehensive Services
Authors: Wallace Helen M. , Goldstein Hyman
Published: December 2021

This paper summarizes pertinent data on national health expenditures for children and youth. In fiscal year 1972, the average expenditure per child per year for health care from all sources in the United States was $ 147 for children and youth under 19 years of age, an amount 15% above that for the children and youth projects ($ 128 per child per year). The extent of coverage of children and youth, even those in high-priority groups, is still very restricted. Some implications are suggested for future planning for the use of existing funds currently available for the health care of children and youth.
CASE PRESENTATIONS
Authors: Dock William
Published: December 2021

I divide CPC's into the visceral and exanthematous. The latter is the amphitheater showpiece, usually one case. The former, and more important, is the weekly show in the morgue, where a brief summary, clinical diagnosis and display of gross lesions (fresh), with an occasional slide, nail down the anatomic diagnosis. This procedure is in almost complete decay, even in teaching centers. Ideally, each case is followed by brief summary of errors, of laboratory work irrelevent to case (a great deal in Cabot cases now), and of treatment not done promptly and effectively.
Teen-Agers Evaluate Their Own Health Care
Authors: McAnarney Elizabeth R. , Hagen Margaret A. , Adams Barbara H. , Friedman Stanford B.
Published: December 2021

Emphasis in the news media on health has provided the lay public with easier accessibility to information on health-related topics. Knowledgeable consumers are now demanding participation in decision-making affecting their own medical care.

Traditionally, health programs were planned and administered almost exclusively by the medical profession. However, a wide representation of consumers of the medical system now serve on health councils and planning boards. Another means of recipient participation in health planning is consumer evaluation of existing programs. One problem with this type of study is that adults generally respond favourably when asked about the medical care they have received.
Protein Advisory Group's Recommendations Deplored
Authors: Graham George G.
Published: December 2021

The April issue carried a thoughtful review of the possible untoward effects of milk drinking prepared by the Committee on Nutrition of the American Academy of pediatrics. It is regrettable, however, that the Committee chose to endorse the recommendations of the Protein Advisory Group of the United Nations.

Alarmist statements in the lay press are unfortunate and, to a great extent, untrue. I refer to the subject of "lactose intolerance": at present it does not represent a nutrition problem in this country.
Lettrt To The Editor
Authors: Holliday Malcolm A.
Published: December 2021

Dr. Graham argues that the Committee on Nutrition should not encourage the use of lactose-containing milk base formulas for the treatment of diarrhea. The Committee on Nutrition is aware of the prevalence of lactose intolerance under these conditions and appreciates the complications that may result. The Committee is also aware that lactose-free milk substitute formulas have become available commercially and under government contract development.

However, it is also clear that the lactose-free substitutes are not always available.
Lettrt To The Editor
Authors: Lawson Edward Earle
Published: December 2021

Dr. Thaler's letter raises several questions about our recent article1 which we are happy to have the opportunity to discuss. Unfortunately he has misread the sentence " familial neonatal hepatitis had significantly more serious morbidity and mortality than the sporadic disease, whether or not surgically treated." "Whether or not" refers to sporadic cases not familial cases and therefore our conclusion is justifled.

In regard to the type of illness occurring in the two families, there were indeed two distinct clinical courses, consistent with the heterogeneity of presentation and outcome of neonatal hepatitis.