bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid Eye Movement Sleep, Apnea, and Cardiac Slowing Influenced by Phenobarbital Administration in the Neonate
Authors: Gabriel M. , Albani M.
Published: December 2021

Polygraphic recordings were performed in seven preterm infants who had been given phenobarbital (phenobarbitone) to evaluate its effect on neonatal sleep behavior and on the incidence of neurogenic apnea and/or bradycardia. The amount of active sleep, as well as the incidence of apnea and/or cardiac slowing occurring predominantly in active sleep, were decreased at therapeutic serum levels of phenobarbital. With declining serum drug levels, active sleep showed a rebound effect; at the same time, apnea and/or cardiac slowing relapsed. Thus, our previously proposed neurophysiologic concept that neonatal apnea is facilitated by active sleep-inhibitory brain mechanisms seems to be confirmed.
Times of First Void and First Stool in 500 Newborns
Authors: Clark David A.
Published: December 2021

The times of the first stool and the first void were recorded for 500 infants. The population studied was defined in terms of gestational age,maternal premedication, and mode of delivery. The results are presented in tabular form by time segments with term, preterm, and postterm infants treated separately.
Urinary Tract Infection in Childhood
Authors: Rapkin Richard H.
Published: December 2021

The physician interested in primary care must recognize his responsibility in correctly diagnosing and properly treating children with urinary tract infections (UTIs). Despite some recent reviews,1,3 physicians may be confused and unsure of themselves in this area. They have been told by pathologists that chronic pyelonephritis is not usually due to UTI,4 that screening for UTI in females is5 (is not6) valuable, that aggressive urologic evaluation is of questionable importance,7-9. that there is danger in overdiagnosis3 (underdiagnosis2), and that the prognosis of UTI is unknown.5 What can the clinician do to help (and not inadvertently harm) his patient in the face of such controversy? One possible approach is to present the areas of controversy and to allow each practitioner the opportunity to draw his own conclusions. The following review is intended as a discussion of the problems presented by children with UTI and a statement of one physician's principles of management.

INCIDENCE

The incidence of UTI varies with age. The only careful prospective studies that have been done have assessed the prevalence (number positive at one point in time) of asymptomatic bacteriuria (ABU). The frequency of symptomatic UTI is less than ABU at each age, but precise data are not available. Estimates are that as many as 50% of patients with ABU may have had previous symptomatic UTI.10 In premature newborns, the prevalence of ABU is approximately 3%11; in term infants, 1%11; in the age group 1 to 5 years, 1%12; and in the school-age child,1.5%.6.13-16 Except for the
It Will Be in 1979
Authors: WEGMAN MYRON E.
Published: December 2021

Dr. Borgenicht's comment underlines a basic difficulty in utilizing and interpreting data from official records. The cause of death specified by a physician on the death certificate is tabulated by state and national authorities in accordance with the International Classification of Diseases,Adapted (ICDA) now administered by the World Health Organization. In neither the seventh revision, adopted in 1955, nor the eighth revision, adopted in 1965, was there any specific heading for sudden infant death
Office Records Are Useful!
Authors: MARGOLIS CARMI Z.
Published: December 2021

To the Editor:

Long and Rogers (Pediatrics 56:295, August 1975) report important data that indicate an imperfect correlation between performance and recording by pediatric practitioners of procedures necessary for adequate management of suspected streptococcal pharyngitis. The authors conclude that office records have limited value for evaluation of health care. However, although this conclusion seems valid for the records studied, at least for suspected streptococcal pharyngitis, two other conclusions supported by the data may be more
A Different Opinion
Authors: MURPHY F. GERTRUDE HURLEY
Published: December 2021

To the Editor:

The “AAP Code of Ethics for the Use of Fetuses and Fetal Material for Research” (Pediatrics 56:304, August 1975), albeit arrived at after diligent effort on the part of its authors, is not acceptable to this pediatrician or to a growing body of aroused pediatricians.

I object to the task force recommendation regarding “research on the fetus in utero (where delivery of a previable fetus is not contemplated).” Despite informed consent, do
The Task Force Replies
Authors: SPARLING DAVID
Published: December 2021

Dr. Hurley Murphy's comment on the report of the Task Force on Pediatric Research, Informed Consent and Medical Ethics represents the opinion of a number of informed physicians. The report however, as Dr. Hurley Murphy indicates, was arrived at after considerable effort, research, and soul-searching. It is believed that it represents a sound basis for decision making at this time. This does not mean that it was intended to be cast in stone, inviolate, for
Academic Assumptions Annoy Practitioner
Authors: GROSSMAN ELMER R.
Published: December 2021

To the Editor:

The letters on the danger of Actifed-C (Pediatrics 57:164, January 1976) exemplify an academic assumption of superior knowledge that annoys me no end. Drs. Ivey and Kattwinkel assert that “there is no condition in infancy for which codeine would be indicated.” I infer from this that they have never been called upon to relieve the pain of otitis media or a burn or a fracture-all occasionally known to befall infants, nor have
Potential Hazard of Therapy for Reye's Syndrome With Urea Cycle Intermediates
Authors: GLASGOW ALLEN NI.
Published: December 2021

To the Editor:

In the December 1975 issue (Pediatrics 56:1081, 1975), Thaler presents a working hypothesis of the pathogenesis of Reye's syndrome. Included in the report is a section on therapeutic implications, where it is suggested that ornithine, arginine, or citrulline might be a specific treatment for this disorder. However, this treatment potentially could make the hyperammonemia worse.1 Therefore, I would like to point out several difficulties with the hypothesis and review the potential hazard
Dr. Barness Replies
Authors: BARNESS LEWIS A.
Published: December 2021

Dr. Ainbender et al. are correct in questioning the clinical evidence indicating that human milk provides protection from necrotizing enterocolitis.

We would be very interested in seeing their publication, which apparently is in conflict with many others, e.g., those of Gyorgy1 and Winberg and Wessner,2 regarding gastrointestinal bacterial flora.
Patriotic Eyes
Authors: FRAZIER CLAUDE A.
Published: December 2021

To the Editor:

Seeing children in my allergy practice and with the bicentennial year in the back of my mind, I thought this syndrome appropriate: “patriotic eyes”—red, white, and blue. “Patriotic eyes” are readily identified by the red conjunctiva, white sclera, and blue circles under the eyes.

This represents a common enough allergic condition, “allergic shiners.” The discussion of this syndrome presented in my book Parents' Guide to Allergy in Children (Double-day) follows:“dark puffy
Pro Spanking
Authors: SCHREIN DANIEL D.
Published: December 2021

To the Editor:

In response to Dr. Ris on spanking by the school officials(Pediatrics 57:293, February 1976), I wish to offer the following observations.

1. Spanking need not be a form of violence.

2. At certain ages, prior to the age of reason, physical force is the most effective mode of reprimand.

3. Children must learn that society, starting with the family and school,will take whatever steps are necessary to obtain compliance with
Is Adult Immunization More Appropriate Than Immunization of Infants?
Authors: SIEBER OTTO F. , FULGINITI VINCENT A.
Published: December 2021

To the Editor:

The report of Weibel et al. (Pediatrics 56:380, September 1975)concerning long-term antibody levels after monovalent or combined measles,mumps, and rubella virus vaccines presents numerous observations, but leaves one of the more interesting ones incompletely explored.

Of particular interest to us is an apparent disparity in levels of rubella antibody five years after rubella immunization of seronegative children and adult women. Among 74 children followed up for duration and level of
The Task Force Replies
Authors: THOMPSON HUGH C.
Published: December 2021

The Ad Hoc Task Force on Circumcision did not advocate the abandonment of circumcision. It did state that there is no “absolute medical indication for routine circumcision of the newborn.” It also advocated prenatal discussion of circumcision with the prospective parents so that truly informed consent could be given if the decision was to perform the procedure.
A Way of Handling Circumcisions and Consent Forms
Authors: FEEHAN EDWARD B.
Published: December 2021

To the Editor:

One would have to be an ostrich not to run across controversies about whether circumcision in infancy is indicated or not. One would also have to be an ostrich not to run across discussions of informed consent. Three years ago I attended a conference in Palm Springs at which Henry Kempe recommended getting a permit whenever kanamycin was to be used. It seems he had to go out into the wilds of
Periosteal Reaction Due to Foreign Body-Induced Inflammation of Soft Tissue
Authors: Kleiman Martin B. , Elfenbein Dianne S. , Wolf Ellen L. , Hemphill Michael , Kurlinski J. Parker
Published: December 2021

Bone lesions resulting from embedded plant thorns or wooden splinters have been reported,1-7 though rarely. Despite the fact that the majority of cases have occurred in children, no description appears in the English pediatric literature. We have recently seen a child with an osteomyelitis-like lesion in whom, after a considerable delay in diagnosis, an embedded wood fragment was found. A search of the literature revealed a striking similarity in the presenting signs and symptoms of our patient to those described, prompting this report and literature review.

CASE REPORT

A 12-year-old boy was admitted to the pediatric service with a two-week history of swelling and erythema of the dorsum of the left foot.
RESEARCHING
Authors: Barzun J. ,   Student
Published: December 2021

The private reasons for "researching" are . . . plain: it is the shortest path to promotion and prestige; it frees the able young from drudgery and often entails paid travel. For an organization man to be "put on research" is the same as for a horse to be put out to grass-no stated hours or set duties. The very essence of research is that no precise result can be specified. The sense of privilege and of exceptional status that comes with research also obtains in the academic world to which it is native. It explains the popularity of honors work in colleges. It is a cause of the flight from teaching in universities-and of the many other flights to meetings and conferences across the world. The motive is not laziness or cynicism, any more than it is a passion for knowledge. Rather, it is a desire to escape the boredom of ordinary non-work. The flight is not so much from classroom study or from teaching as such, or from executive responsibility in a business or government office; it is from an excess of people, paper, confusion, conferring, and frustration.

Research affords the further pleasure of any specialism, that is, a comfortable monopoly, the emotional protection of "my subject": an adroit researcher manages to have a field as nearly as possible to himself. Society favoring an infinite division of labor, it is the mark of the second-rate to generalize, as it is of the depraved to popularize. But specialism need not mean solitary confinement.
ABRAHAM JACOBI ON JUVENILE DIABETES MELLITUS-1896
Authors: C. T. E.
Published: December 2021

Abraham Jacobi (1830-1919) was the first in the United States to specialize in the teaching of pediatrics. In 1862 he founded the first pediatric clinic in New York City. Probably no other pediatrician in America had a greater influence than Jacobi on the development of American pediatrics. This is how Jacobi treated juvenile diabetes mellitus 80 years ago and 26 years before Banting and Best had isolated insulin.

... The disease runs a more rapid course in infants and children than in adults, and terminates more readily in coma and death. Therefore the treatment must be enforced. Fortunately, the young, with very rare exceptions, are apt to live on milk mostly. Thus less difficulties are encountered in them than in adults. For these also milk, skimmed or not, forms a principal and beneficial part of their nutriment. The medicinal treatment of the young requires some modifications. The facility with which cerebral symptoms ("coma") are developed, renders the persistent use of alkalies advisable (mineral waters), and forbids the use of opium. lodoform, which I have seen to render fair service in adults, in daily doses of from ten to twenty grains internally, is seldom tolerated by the young, even in proportionately small doses. Arsenic may be given in increasing doses a long time, the bromide as well as other preparations, one drop and more of Fowler's solution [potassium arsenite], largely diluted, after meals, three times daily, the dose to be increased gradually until doses of from two to four drops are taken.
FRANÇOIS MAURICEAU ON TEETHING
Authors: C. T. E.
Published: December 2021

François Mauriceau (1637-1709) was the leading obstetrician of his day. His remarks on teething in his Traité des Maladies des Femmes Grosses et Accouchées (1668), a book that established obstetrics as a science, show that he was ahead of many of his contemporaries in rejecting centuries of superstitions; he even had the boldness, according to G. F. Still (The History of Paediatrics, Oxford, England, Oxford University Press, 1931), to deny any special virtue to hare's brain.

The child may it self be helpful if they give it a little stick of Liquorice to champ or a little end of a small new wax-candle, which is very good to soften the Gum: There is ordinarily made use of a Silver Coral, furnished with small Bells, to divert the Child from the pain it then feels. Sometimes instead of Coral they put a Wolfs [sic] tooth in. One must not however believe that these things have any peculiar property, as many Women imagine; but if they are helpful in this case it is because of their solidity, evenness and smoothness; for the Child rubbing his Gums with it to ease the Itching which it feels there, doth by degrees diminish the thickness of them, and so they are at length insensibly cut by the Teeth which are under. If these things do no good because the gums are either too hard or too thick, that the Child may not suffer so much nor, by reason of the great pain, fall into those accidents above mentioned, let the Gums be cut with a Lancet where the teeth are ready; Nurses use to do it with their nails but 'tis better to be done with a Lancet because 'tis not painful.
Dr. Jacobson Replies
Authors: Jacobson Jay A.
Published: December 2021

Dr. Marks has misconstrued the point of our article. Although we agree with him that data on the national prevalence of ampicillin-resistant Haemophilus influenzae type b would be valuable, we feel that the significance of the problem is clear from the wide geographic distribution, the potential virulence of the organism, and continuing reports that it may represent up to 10% of strains of H. influenzae type b isolated within particular institutions.1

Discussion of therapy seems quite appropriate in a report detailing the emergence of an organism resistant to standard treatment.
Why Wasn't Radionuclide Diagnosis of Bleeding Meckel's Diverticulum Mentioned?
Authors: Schussheim Arnold , Moskowitz Gerard , Levy Lester
Published: December 2021

The article on pediatric nuclear medicine by the Committee on Radiology of the American Academy of Pediatrics (Pediatrics 58:459, September 1976) had as its intention to update "the expanding role that radionuclide techniques have in the management of pediatric patients." It also noted the ideal properties of technetium 99m for imaging. It did not, however, include any mention of its use in the preoperative diagnosis of bleeding Meckel's diverticulum in children.

Rectal bleeding in children due to Meckel's diverticulum is not uncommon, it is often massive, and the failure of standard techniques to make this diagnosis is well known.
Urethral Meatal Stenosis in Males
Authors:   Committee From the Urology Section, Belman A. Barry , Filmer B. Bruce , Immergut Mark A. , Schoenberg Harry W.
Published: December 2021

The Section on Urology of the American Academy of Pediatrics has charged this committee with the task of evaluating the status of the question of meatal stenosis in boys (excluding those with hypospadias). The objective information on the subject is limited; however, our conclusions, based on review of available literature and the committee's deliberations, are as follows.

Etiology

Meatitis, an inflammation generally secondary to ammoniacal diaper irritation, has been cited as the underlying cause of secondary meatal stenosis.1 The lack of protection by the foreskin in the circumcised male is thought to correlate with an increased incidence of meatitis. Meatal narrowing has been noted to occur more commonly in the circumcised male.1,2 The formation of a ventral lip of tissue is characteristic of secondary meatal narrowing and may cause deflection of the urinary stream upward. Campbell, however, suggested that congenital meatal stenosis is the underlying cause of meatitis,3 whereas Allen and Summers believe meatitis can be either the cause or the effect of meatal stenosis.2 Other factors which have been stated to influence the development of secondary meatal stenosis include abrasions and diet.2

Incidence and Measurement

Calibration of the urethral meatus by Allen et al.4 demonstrated that 9% of newborn boys have a meatus tight to 4F which the authors consider to be congenital meatal stenosis. In a later article the same authors reported the results of visual inspection in a group of 1,800 boys, ages 6 to 10 years. Thirty-two percent were considered to have a "pinpoint meatus."
Treatment of Status Asthmaticus in Children With High Doses and Conventional Doses of Methylprednisolone
Authors: Harfi Harb , Hanissian Aram S. , Crawford Lloyd V.
Published: December 2021

Twenty-one children who were admitted to the hospital with status asthmaticus were assigned randomly to one of two groups. Children in group A received methylprednisolone sodium succinate intravenously, 30 mg/sq m every six hours (conventional dose), and those in group B received methylprednisolone sodium succinate intravenously 300 mg/sq m every six hours, until they were no longer wheezing, or for a maximum of four days. There were no significant differences in the outcome between the two groups. We conclude that there is no extra advantage in giving massive doses of corticosteroids over conventional doses in the treatment of severe asthma attacks.
Late Effect of Nocturnal Mist Tent Therapy Related to the Severity of Airway Obstruction in Children With Cystic Fibrosis
Authors: Bureau Michel A. , McDougall Dianne M. , Beaudry Pierre H. , Belmonte Mimi M.
Published: December 2021

To evaluate the long-term effect of nocturnal mist tent therapy on the progression of airway obstruction in children with cystic fibrosis (CF) of varying severity, two matched groups each consisting of 24 children with CF were studied during 18 months on mist tent therapy and 18 months off therapy. The progression in airway obstruction was measured by change in serial measurements of maximal midexpiratory flow (MMEF), from which a regression equation of MMEF against time was obtained for each individual. Changes in MMEF value with or without therapy were compared in patients matched for severity of disease as indicated by initial MMEF values.

For the group as a whole no differences were found in the progression of the airway obstruction whether the patients received mist tent therapy or not. This therapy failed to benefit any of the groups of children with CF who had early, moderate, or advanced airway obstruction as judged from their initial MMEF value.

It is concluded that nocturnal mist tent therapy neither decreases airway obstruction nor prevents its progression in children with CF.
A CHRONIC AND IRREVERSIBLE DISEASE
Authors: Brodeur Paul ,   Student
Published: December 2021

For by demonstrating that inert chlorofluorocarbons, instead of vanishing harmlessly into thin air, can scar the ozone layer Rowland and Molina have shown us that we may well have succeeded in inflicting a chronic and irreversible disease upon the atmosphere, which is the very lung of the earth. For better or for worse, however, they have also provided us with a valuable lesson in the crucial necessity of testing potentially harmful substances-before putting them on the market-for their consequences both in the environment and upon human beings who will come in contact with them.
Congenital Hypertrophic Pyloric Stenosis: The Role of Gastrin Reevaluated
Authors: Werlin Steven L. , Grand Richard J. , Drum David E.
Published: December 2021

In order to evaluate the potential role of gastrin in the etiology of pyloric stenosis, serum gastrin levels were measured in cord blood of affected infants, matched controls, and mothers of both. No differences were identified when values from infants with pyloric stenosis were compared with those from control infants. Mean cord serum gastrin levels of the infants were significantly greater than the mean maternal gastrin levels. The data effectively dismiss the possibility that elevated serum gastrin concentration in mother or infant at the time of delivery can be implicated as a cause of pyloric stenosis.
Granulopoiesis in Chronic Myeloproliferative Disorders in Children
Authors: Crist William M. , Ragab Abdel , Moreno Hernan , Pereira Fabio , Foster John C.
Published: December 2021

Four children with chronic myeloproliferative disorders (three with Philadelphia [Ph1] chromosome-positive chronic myelogenous leukemia [CML]) were studied with soft agar culture at diagnosis (before therapy) in an attempt to define abnormalities in granulopoiesis. The three patients with CML had elevated peripheral blood colony-forming cells (CFCs) and/or normal or decreased bone marrow CFCs (in those studied). Colony-stimulating activity (CSA) was markedly decreased or absent at diagnosis in all three. Maturation of myeloid cells within the colonies in agar was normal, indicating that no block in myeloid maturation was present. These findings are in general agreement with results previously reported in untreated adults with Ph1 chromosome-positive CML and further define the similarity with the adult form of the disease.

One Ph1 chromosome-negative patient with a clinically similar chronic myeloproliferative disorder was studied and had similarly elevated peripheral blood CFCs. She had normal CSA with a similarly high WBC count. This finding was unexpected and suggests that, unlike the patients with CML, her monocytes were capable of elaborating CSA. This difference might prove helpful in the classification of this type of disorder in cases where the Ph1 chromosome abnormality is not present.
Where have all the celiacs gone?
Authors: Lloyd-Still John D.
Published: December 2021

Celiac disease is now a rare diagnosis in the United States. The incidence of celiac disease varies from 1 in 6,500 in Sweden1 to 1 in 890 in Switzerland.2 At the Melbourne Children's Hospital in Australia, Townley3 reported seeing 90 new patients with celiac disease in a four-year interval, with an almost equal incidence of newly diagnosed cases of celiac and cystic fibrosis per year. At the Children's Memorial Hospital in Chicago we now see 20 new cases of cystic fibrosis compared to three new celiac cases per year, despite performing intestinal biopsies in all suspected cases of celiac disease.
Educating Postpartum Women About Car Restraints
Authors: Reisinger Keith S.
Published: December 2021

I found disturbing the methodology, treatment of data, and the unjustified assumptions in Allen and Bergman's article on the outcome of educating postpartum women about car restraints for their infants (Pediatrics 58:323, September 1976).

The authors base their estimate of outcome on the results of a questionnaire administered six weeks after delivery. However, in discussing outcome, they repeatedly refer to "use" (of infant care restraints) rather than reported use. While referring to Pless et al.,1 Allen and Bergman failed to mention that Pless et al. found a significant difference between reported auto safety practices and observed behavior.
Investigation of New Drugs in Neonates: A Problem?
Authors: White Robert D.
Published: December 2021

Pediatricians who care for infants in intensive care nurseries seem destined to repeat their mistakes of years gone by. Even though the tragedies of the gray baby syndrome and retrolental fibroplasia are fresh in our minds, neonates continue to be exposed to drugs whose efficacy and safety are unproven and whose pharmacology in newborns is virtually unknown. Hundreds or thousands of infants have been exposed to tolazoline, dopamine, indomethacin, and aminophylline, to name a few, yet we have no more information about any of these drugs than we did about chloramphenicol in the days when it was being used for infants with prolonged rupture of membranes.
Noise Pollution
Authors: Hursey Francis X. , Powers William E.
Published: December 2021

The potentially dangerous results of infant exposure to high-intensity and/or high-frequency sound have been well documented.1-3 The Occupational Safety and Health Act of 1970 (OSHA) is the only federal standard establishing noise level limits. The OSHA allows an exposure of 90 dB on the "A" scale (90dB[A]) for eight hours for a working adult. The American Academy of Pediatrics' Committee on Fetus and Newborn has recommended 75 dB(A) as the maximum sound level permitted in the nursery and inside incubators.
OPHTHALMOLOGISTS' BLIND SPOT
Authors:   Student
Published: December 2021

[A blind person has poignantly summarized] his impression of ophthalmologists' attitudes toward patients who are becoming blind: "We are interested in vision but have little interest in blindness."

In one of Shakespeare's most horrifying scenes, Lear's monstrous daughter Regan, having just incited Cornwell into tearing old Gloucester's eyes from their sockets, commands her servants, "Go thrust him out at gates, and let him smell his way to Dover" [King Lear, iii. 7.92-2]....

Assuredly, no ophthalmologist would be anything but appalled at the prospect of bidding a nearly blind patient to "smell his way to Dover." Yet, from what [has been reported] about the paucity of help. . .received from the professionals in coping with blindness, the effect is much the same. . . .

Some years ago my son, a victim of congenital glaucoma, received expert surgical treatment at a major New England medical center, but when he was ready to learn how to see with what vision remained, the response of staff ophthalmologists ranged from bored indifference to crude and insensitive (and unhelpful) improvisation.

Dealing with one of nature's most isolated and self-contained organs, ophthalmologists—perhaps more than their brethren in other specialties—can be forgiven for not seeing "the person for the eyes." One hopes that they will take [these] observations to heart.
Early Detection of Wilms' Tumor in a Child with Hemihypertnophy and Ovarian Cysts
Authors: Tolchin Deborah , Koenigsberg Mordecai , Santorineou Maria
Published: December 2021

There have been many reports of the association between hemihypertrophy and intraabdominal masses, including Wilms' tumor, hepatoma, and adrenal cortical neoplasias.1 The present report describes a patient with segmental hemihypertrophy, multiple ovarian cysts, and bilateral Wilms' tumor and suggests a screening regimen for patients with hemihypertrophy.

CASE REPORT

The patient was a 9 lb 14 oz product of a term pregnancy, who was well until a mass filling the entire right side of the abdomen was discovered on routine examination at 4 months of age. Intravenous pyelogram (IVP) confirmed a large prerenal mass which on ultrasound was felt to be an ovarian cyst.
What Should Blood Pressure Be in Healthy Children?
Authors: McCrory Wallace W.
Published: December 2021

In a recent commentary,1 Adams and Landaw propose the novel concept that normally growing children need not have an associated progressive increase in blood pressure (BP).

Noting that the National Heart, Lung and Blood Institute Task Force graphs to be used for plotting of pressure during growth and maturation show a continual increase of BP levels with age, they state that "Any implication that this is a healthy phenomenon associated with the aging process . . . is unjustified."2 To support this concept they cite data from studies in unacculturated tribes (ie, the Yanomamo Indians) showing that mean BP levels of these indians aged 0 to 50+, except for a slight increase from ages 0 to 9 years to 10 to 19 years, show no increase with age; this pattern is unlike that found in the United States and other Western cultures.
Historical Controls
Authors: Farewell V. T.
Published: December 2021

The use of concurrent controls in clinical trials has been advocated for a considerable period of time and by a large number of researchers. Nevertheless, the nature of clinical investigations appears to lead to continuing interest in the use of historical controls. The two opposing views are enunciated in papers by Byar et al1 and Gehan and Freireich.2

When a clinical trial is viewed as a scientific experiment, the use of concurrent controls, and especially randomized concurrent controls, is to be preferred based on long-standing principles of experimental design. There is little doubt that the ethics of clinical experimentation rightly impose constraints on what might otherwise be viewed as ideal experimental design.
Cerebral Blood Flow Velocity in the Human Newborn: The Value of Its Determination
Authors: Volpe Joseph J. , Perlman Jeffrey M. , Hill Alan , McMenamin Joseph B.
Published: December 2021

An ultrasonic technique based on measurement of the Doppler frequency shift produced by the movement of red blood cells in an insonated vessel has been useful for measurement of cerebral blood flow velocity in the newborn. When the transducer is applied to the anterior fontanel, flow velocity in each anterior cerebral artery can be determined noninvasively. Reliable application ofthe technique requires utilization of both the audible and visible signals produced by the instrument. Experience and awareness of the anatomy are also important in interpretation.

Serial measurements of cerebral blood flow velocity have provided useful information concerning changes in the cerebral circulation under important

neonatal circumstances. Examples of the latter include PDA, pneumothorax, hydrocephalus, and hyperviscosity. Most of the changes in the cerebral circulation appear to reflect directly systemic hemodynamic changes. This relation between cerebral and systemic hemodynamic events is compatible with other observations, indicating that in the human newborn—particularly the infant most at risk for hypoxic-ischemic and/or hemorrhagic brain injury—the cerebral circulation is pressure passive. Indeed, the changes in the cerebral circulation observed so far with the Doppler technique may have important implications for the genesis of neonatal ischemic and hemorrhagic brain injury.
Neonatal Polycythemia
Authors: Shohat Mordechai , Merlob Paul , Reisner Salomon H.
Published: December 2021

The article by Ramamurthy and Brans (Pediatrics 68:168, 1981) on the criteria for diagnosis and treatment of neonatal polycythemia was most interesting. Their conclusions that there are considerable and unpredictable differences between capillary, peripheral, venous, and umbilical venous hematocrit levels in the same neonate might be of much importance in deciding on which neonate to treat. It might be justified, as they suggested, in performing an umbilical vein hematocrit and blood vincosity determination before deciding whether to continue with a partial exchange transfusion in an infant with a venous hematocrit of 65% or greater.
Letter to the Editor
Authors: Hauger Sarmistha B.
Published: December 2021

I find the report by Nudelman et al of this 11-week-old infant with group B streptococcal extremity cellulitis interesting in several aspects.

First, this report is an important addition to our knowledge of the clinical manifestations of group B Streptococcus (GBS) infections. The negative blood culture in the face of a positive aspirate culture is surprising in that given the child's presentation with irritability and fever, one would have expected the infant to be septic.
Drug Therapy for Ambulatory Pediatric Patients in 1979
Authors: Kennedy Dianne L. , Forbes Mary B.
Published: December 2021

Little data are available on the use of drugs in children on an outpatient basis. Therefore, the present study investigated national patterns in the prescribing of drugs for children by office-based physicians during 1979, in order to describe the most commonly encountered pediatric drug therapies. The data are presented as descriptive norms of drug therapy by office-based physicians in two pediatric subgroups, 0 to 2 years old and 3 to 9 years old. Anti-infective drugs and cough and cold preparations accounted for approximately 50% of drugs used. Tetracycline and its congeners continue to be used in pediatric patients. Despite apparent advantages of amoxicillin, ampicillin is still widely used.
BILIRUBIN TROUBLE IS WORLDWIDE
Authors: Little George
Published: December 2021

In a small regional survey of direct spectrophotometric methods and a larger Australian and New Zealand survey of paediatric bilirubin analyses, the overall performance of both groups was unsatisfactory with an unacceptable high interlaboratory variation. This inter-laboratory variation was reduced significantly by the use of a spectrophotometric method with a common standard of methyl orange.

The Australian and New Zealand survey also examined the "state of the art" for the measurement of conjugated bilirubin and showed that laboratories could not adequately measure conjugated bilirubin.
FIRST NAMES
Authors:   Student
Published: December 2021

. . . since children themselves have nothing to do with what they are named, their names reveal to us their parents—their sublimations, hopes; those who think of names as the accumulation of capital; who from a narrow living room seek an exotic and alien land; who living in a present without a past, hope, by surrounding themselves with its utterances, to revive one.
Maternal Diabetes and Neonatal Macrosomia I. Postpartum Maternal Hemoglobin A1c Levels and Neonatal Hypoglycemia
Authors: Brans Yves W. , Huff Robert W. , Shannon Donna L. , Hunter Mary Ann
Published: December 2021

Hemoglobin A1c (HgbA1c) levels were determined within 24 hours after delivery in 88 nondiabetic and 73 diabetic women belonging to White's classes A to D. Diet-controlled gestational diabetic women had mean (±SE) Hgb A1c levels similar to those of nondiabetics (5.8 ± 0.18% vs 5.7 ± 0.08%). Mean Hgb A1c levels were higher in insulin-requiring gestational (6.4 ± 0.20%, P < .05) and permanent (6.5 ± 0.27%, P < .05) diabetics than in nondiabetics. The proportions of subjects with levels above the normal range were also larger in the insulin-requiring groups. Mean Hgb A1c levels and the proportions of abnormally high levels were similar for mothers of macrosomic and of normally grown neonates in the nondiabetic as well as in the various diabetes groups. There was no correlation between maternal Hgb A1c level and neonatal birth weight, either real or relative. There were also no statistically significant differences in mean Hgb A1c levels between mothers of neonates with or without hypoglycemia within four hours of birth. Hgb A1c measurement did not permit differentiation between those mothers of macrosomic neonates who were diabetic and those who were not. In conclusion, although Hgb A1c level has been shown to reflect diabetic control, our data suggest that it may not be reliable as an indicator of fine tuning during the third trimester of pregnancy or as a predictor of the effects of diabetes on the fetus.
AN ELECTRICAL INFANT AS REPORTED IN 1870
Authors: C. T. E.
Published: December 2021

Nineteenth century medical literature abounds with strange pediatric case reports; none is more bizarre than the following, published in 1870 in the Boston Medical and Surgical Journal.

AN ELECTRICAL INFANT—There is a wonderful account in all the French papers of an outstanding baby just dead, at the age of ten months, at St Urbain, near Lyons. The strongest medical evidence is said to be given that the child was so highly endowed with electricity that all the persons in the same room with him received constant electric shocks. Its end was apparently painless, but accompanied by still more astounding manifestations. At the instant of death luminous effluvia proceeded, it is affirmed by the doctors, from the body of the child, which continued for several minutes after its decease. The case is supposed to be quite unprecedented in the world of science.
Varicella Zoster in Hospital Personnel: Skin Test Reactivity to Monitor Susceptibility
Authors: Steele Russell W. , Coleman Mary Ann , Fiser Martin , Bradsher Robert W.
Published: December 2021

An outbreak of chickenpox, involving three patients and one nurse on a pediatric ward, necessitated rapid identification of susceptible employees in conjunction with standard epidemiologic intervention in order to prevent spread to other high-risk patients. Of 46 hospital personnel 15 (33%) gave a negative or unknown history of prior disease. Response to a varicella-zoster skin test was compared with antibody determination as measured by fluorescent antibody to membrane antigen. Correlation of these two screening methods was absolute. Of 46 hospital personnel four (9%) were susceptible to infection (negative skin test and antibody < 1:4) requiring their removal from the ward. All those with positive histories for prior disease with the virus and 11/15 (73%) with negative or unknown histories were immune as indicated by both tests. A readily available varicella zoster skin test would be an extremely useful epidemiologic tool for screening hospital personnel.
Screening for Pharyngeal Gonorrhea in the Urban Teenager
Authors: Chacko Mariam R. , Phillips Sheridan , Jacobson Marc S.
Published: December 2021

A retrospective chart review assessed the occurrence of pharyngeal gonorrhea among 546 teenagers who attended a general adolescent clinic and were cultured for gonorrhea; they had been routinely cultured at three sites (cervix/urethra, rectum, and pharynx) regardless of their history of sexual practice. No record of specific sexual practice was available. This population was predominantly urban, black, and female; the age range was 11 to 22 years (mean = 16.5). The overall occurrence of gonorrhea was 14.7% (80/546). Pharyngeal gonorrhea was detected in 2.7% of the study population, representing 12 females and three males. Of the 80 patients with gonorrhea, 15% had only pharyngeal gonorrhea. History was available for 13/15 patients: none had pharyngeal symptoms. Approximately half were detected by routine screening at a family planning visit; the remainder had complaints related to sexually transmitted disease. The occurrence of pharyngeal gonorrhea is sufficiently high to merit study of the indications for pharyngeal culture of teenaged patients. Given the potential for disseminated infection and absence of information regarding the reliability of self-report, it currently appears appropriate to culture adolescents routinely for pharyngeal gonorrhea, regardless of stated sexual practice, whenever genital cultures are collected.
GROWING NUMBERS OF DISABLED
Authors:   Student
Published: December 2021

It has been estimated that during the period 1975-2000 the number of the disabled in the world will grow by about 200 million. According to another estimate, in 1970 there were some 60-70 million disabled children in the developing countries; if existing preventive measures were not applied and new ones developed, that number could be expected to grow to about 135-150 million in the year 2000. This may be compared with an estimated increase in the number of disabled children from 12 to 25 million in developed countries over the same period.

Specific factors that may affect the future proportion of disabled persons in the world include: (1) changes in the age composition of the general population; (2) changes in the patterns of mortality and morbidity; (3) changes in the extent of health services; and (4) increase in urbanization and industrialization. It is generally accepted that unless major improvements in disability prevention are achieved, the proportion of the disabled will remain the same or show a slight increase in the next 20-30 years. But since the world population is expected to grow about 2 thousand million in this period, the absolute number of disabled persons will show a dramatic increase.
A Grain of Salt
Authors: Marcuse Edgar K.
Published: December 2021

An article in this issue of Pediatrics purporting to show the superiority of pediatricians' management of febrile children compared with that of their family practice colleagues deserves special scrutiny. Caveat lector!

Le Duc and Pless (Pediatrics 70:511, 1982) found that when managing acute febrile illness in apparently similar patient groups, residents in family practice obtained three times as many roentgenograms as did pediatric residents whereas pediatricians obtained five times as many cultures and ten times as many "strep screens" as did family practitioners.

Despite these dramatically different diagnostic approaches, the patients' therapy and subsequent courses were remarkably similar: 47% of pediatric patients were treated with antibiotics vs 43% of family practice patients; 92% of pediatric patients were well within six days vs 88% of family practice patients.
On Teaching Endotracheal Intubation
Authors: Katzman Gerald H.
Published: December 2021

Teaching endotracheal intubation to a large number of house staff, nurses, and respiratory therapists is often a difficult task. The difficulty is mainly in finding appropriate situations for practice while at the same time not compromising patient care.

The anesthetized kitten1 has been suggested as a good model for teaching intubation. Although practice on the kitten is useful, in my experience transference of the intubation skill to a clinical situation with a human neonate has been less than satisfactory.
Car Seats
Authors: Vandeman Philip R.
Published: December 2021

There is a great drive in process to encourage and even force parents to use safe car seats for their infants and children. This is a very worthwhile project, but I wish to question the reality orientation of those pediatricians who approach this endeavor with such optimistic enthusiasm. Good safe care seats cost $45 to $50 in today's market. Promotional material says "Cost should not be the deciding factor. Cheap or unapproved models may save money, but will not deliver the protection your child needs" (source: Michigan State Highway Safety Planning).
New Penny Is Not Expensive
Authors: Frye Thomas R.
Published: December 2021

I was intrigued by the article on the radiodensity of the new penny by Dorst and associates (Pediatrics 69:224, 1982). It is reassuring to know that we pediatric radiologists will continue to be able to find pennies in our little patients who inhale and ingest them.

Hidden in the next to the last paragraph is a fact which I think is even more important as the authors may have inadvertently stumbled on one of the true monetary crises of our government.
Skull Roentgenograms; Soft Conclusions
Authors: Groner Judith , Charney Evan
Published: December 2021

We are sure that the title of the lead article of the February 1982 issue, "Mild Head Trauma in Children: When Is a Roentgenogram Necessary" (Pediatrics 69:139, 1982), caught the attention of many readers as it did ours. This article, according to the authors, examined "the incidence and clinical significance (italics ours) of skull fractures in an unselected population of children... ." According to the abstract, the clinical criteria derived from the study are an attempt to "make efficient use of resources."
Letter to the Editor
Authors: Pauker Stephen G. , Leonidas John C. , Binkiewicz Anna , Scott R. Michael
Published: December 2021

We appreciate the thoughtful comments of Groner and Charney regarding the value of routine skull radiography in mild head trauma in children. They would be satisfied with less than perfect sensitivity in an algorithm designed to select children at high risk for fractures. If, as well may be the case, skull fractures are themselves poor predictors of clinical outcome, then one must raise an even more basic question—why try to detect skull fractures? Why use the presence of a fracture as a gold standard for performance?
BODY SOUNDS
Authors:   Student
Published: December 2021

The effects of the stethoscope on physicians were analogous to the effects of printing on Western culture. Print and the reproducible book had created a new private world for man. He could isolate himself with the book and ponder its messages. As the sociologist David Riesman comments: "As long as the spoken or sung word monopolized the symbolic environment, it is particularly impressive; but once books enter that environment it can never be quite the same again—books are, so to speak, the gunpowder of the mind. Books bring with them detachment and a critical attitude that is not possible in an oral tradition." Similarly, auscultation helped to create the objective physician, who could move away from involvement with the patient's experiences and sensations, to a more detached relation, less with the patient but more with the sounds from within the body. Undistracted by the motives and beliefs of the patient, the auscultator could make a diagnosis from sounds that he alone heard emanating from body organs, sounds that he believed to be objective, bias-free representations of the disease process.
Serial Studies of Circulating Immune Complexes in Poststreptococcal Glomerulonephritis
Authors: Lin Ching-Yuang
Published: December 2021

Levels of circulating immune complexes were determined in 30 children who suffered from acute poststreptococcal glomerulonephritis. The study was started in the acute phase of the disease and continued for one year. Raji cell radioimmune assay was used for the detection of immune complexes. The patients had significantly elevated levels of immune complexes during the acute phase, especially in the first three days after the onset of hematuria. Six months later the levels of immune complexes declined to slightly elevated levels, and nine months after the initial attack, no immune complexes were detectable. However, the patients who had persistent hematuria and proteinuria continued to have detectable immune complexes during this time.