bluuebunny/crossref_metadata_2025 huggingface dataset:
Parental Use of "Positive Contact" in Child-Rearing: Its Relationship to Child Behavior Patterns and Other Variables
Authors: Chamberlin Robert W.
Published: December 2021

In an investigation of child-rearing styles maternal use of "positive contact" was measured by asking the mother how often she played with the child, praised the child, and the like, and combining the responses into a score. Home observations on a sample of families revealed that mothers scoring above the mean used fewer communications in the form of directives and "unmodified power" and more communication in the form of praise and social conversation than mothers scoring below the mean.

The mother's use of positive contact was related to her educational level, the birth order of the child and number of children in the family, the father's use of positive contact, and to a friendly outgoing pattern of child behavior. There was no relation to the mother's use of physical punishment, her protectiveness, her tendency to comply with the child's demands, or her child-rearing ideology and other attitudes.

Child care workers are in a strategic position to educate parents about the importance of this kind of contact, especially with later-born children in large families.
Epileptiform Activity in the Electroencephalogram Induced by Lithium Carbonate
Authors: Brumback Roger A. , Weinberg Warren A. , Herjanic Barbara L.
Published: December 2021

Lithium salts have been used in the prophylaxis of manic-depressive disease in adults, in the treatment of episodic behavior disturbances in children, and recently in the treatment of thyrotoxicosis. Side effects of therapy with lithium salts have been frequent at toxic blood levels (1.5 mEq/liter) but rare at therapeutic blood levels (0.8 to 1.5 mEq/liter).

This report describes the development of paroxysmal electroencephalographic abnormalities in a child under treatment with lithium carbonate for a behavior disturbance. Such paroxysmal activity has not been described previously during lithium carbonate therapy.

[see pdf for fiure]

CASE REPORT

This white boy was the 2,920-gm product of a normal pregnancy, labor, and repeat Cesarean section delivery in a 39-year-old gravida 2 woman.

[see pdf for figure]
Previously Reported Unrecognized MLNS
Authors: Stechenberg Barbara W. , Keating James P.
Published: December 2021

In the September 1974 issue of Pediatrics, Kawasaki et al.1 described the clinical manifestations of acute febrile mucocutaneous lymph node syndrome (MLNS), and Yanagisawa et al.2 described a patient with MLNS who died of aneurysmal dilatation and bilateral obstruction of the coronary arteries. In an editorial in the same issue, Fetterman and Hashida3 suggested that the syndrome had not been recognized in the continental United States. Such a case may have been described but not recognized as a case of MLNS.
A Hypothesis About Late Walkers
Authors: Greene Geoffrey E.
Published: December 2021

Dr. Beargie, in his interesting comments on babies late to walk, concluded that this motor delay occurs because the children were kept in a crib and were unable to practice walking. He noted, however, that these children come from "a home that does not have central heating . . . [and] is heated by a coal stove . . .[and] the crib is placed near the heating stove."

When carbon is completely oxidized it will yield carbon dioxide and water.
Lysine Malabsorption Syndrome: A New Type of Transport Defect
Authors: Omura Kiyoshi , Yamanaka Nobuko , Higami Shinobu , Matsuoka Osamu , Fujimoto Akie , Issiki Gen , Tada Keiya
Published: December 2021

A 21-month-old girl with physical and mental retardation is described. She excreted an increased amount of lysine in urine but no excessive quantities of arginine, ornithine, or cystine. Serum level of lysine was found to be low but the levels of the other amino acids were within normal limits. The endogenous renal clearance rates of amino acids showed a marked high value of lysine and normal values of the other dibasic amino acids. Oral loading test of amino acids revealed an impaired absorption of lysine and normal absorption of arginine, ornithine, and cystine in the intestine. These results indicate a specific defect in transport of lysine in the intestine as well as in the renal tubule.
GM3 Gangliosidosis: A Novel Human Sphingolipodystrophy
Authors: Maclaren Noel K. , Max Stephen R. , Cornblath Marvin , Brady Roscoe O. , Ozand Pinar T. , Campbell James , Rennels Margaret , Mergner Wolfgang J. , Garcia Julio H.
Published: December 2021

A male infant of nonconsanguinous Jewish parents had clinical features of pseudo-Hurler's syndrome. A maternal uncle with similar features had previously died at 2½ months of age.

Following death at 3½ months of age, analysis of the patient's brain and liver revealed increased amounts of ganglioside GM3, a virtual absence of higher ganglioside homologues (GM2, GM1, GD1a, and GT1), and a deficiency of the biosynthetic enzyme, UDP-Gal NAc:GM3, N-acetylgalactosaminyl-transferase.

Since the biochemical findings denote a novel state of ganglioside deficiency, clinical findings emphasizing points of distinction from other causes of pseudo-Hurler's syndrome are presented.
Rapid Diagnosis of Iron Deficiency by Measurement of Free Erythrocyte Porphyrins and Hemoglobin: The FEP/Hemoglobin Ratio
Authors: Piomelli Sergio , Brickman Anthony , Carlos Edwina
Published: December 2021

The concentration of free erythrocyte porphyrins (FEP) and of hemoglobin can be measured on blood samples spotted on filter paper. The FEP/hemoglobin ratio in iron deficiency increases exponentially with a decrease of both transferrin saturation and hemoglobin level. The FEP/hemoglobin is an indicator of impaired heme synthesis. In small children an elevation of the FEP/hemoglobin ratio is a better indicator of iron-deficiency anemia than low transferrin saturation. The FEP/hemoglobin ratio is normal in thalassemia trait and renal anemia but it may be elevated in sickle-cell anemia. Measurement of FEP and hemoglobin on filter paper provides a useful diagnostic tool for the diagnosis of iron deficiency, of anemia, and (in populations at risk) of lead intoxication.
Apneic Spells and Sleep States in Preterm Infants
Authors: Gabriel M. , Albani M. , Schulte F. J.
Published: December 2021

The incidence of apneic spells during different sleep states, active sleep, quiet sleep, and undifferentiated sleep was determined in eight preterm infants of 30 to 35 weeks' conceptional age, by means of a polygraphic recording technique. They were free of perinatal and postnatal complications other than apnea. During their active or rapid eye movement (REM) sleep they showed significantly more apneic episodes which were also longer lasting and they were accompanied by bradycardia of a greater severity. The organization of the immature nervous system with a preponderance of inhibitory synaptic connections and the additional inhibition of spinal motoneurons during REM sleep are likely to be the cause of apneic spells in otherwise "normal" preterm infants.
Guidelines for Health Screening
Authors: Thorpe Helene S.
Published: December 2021

The symposium "Screening in Child Health Care"1 supplements the recently distributed 205-page guide prepared by the American Academy of Pediatrics.2 The latter is designed to assist public officials and health personnel in every state to plan and implement the screening component of the Early and Periodic Screening Diagnosis and Treatment Program (EPSDT).3 The guide contains suggestions which, based on past experience, are likely to be considered minimal standards by state officials. Only procedures or tests specified in the guide are likely to be reimbursed.
Questions Safety of Ultrasound
Authors: Scheidt Peter C.
Published: December 2021

In the report on ultrasonography in children, the Committee on Radiology of the American Academy of Pediatrics states flatly that, "There is no radiation hazard."1 Technically this is correct since ultrasound is acoustic energy and not electromagnetic radiation. However, this dismissal of possible radiation hazards gives an impression of established safety, which appears to be unwarranted by existing research.

To date, with the levels of energy currently used for diagnostic ultrasound there are no known adverse effects in humans; but there are reasons to believe that it is too early to conclude that the use of diagnostic ultrasound is free of hazards, particularly with regard to the exposure of the fetus and infant.
Danger of Actifed-C
Authors: Ivey Hallam H. , Kattwinkel John
Published: December 2021

Recently it was brought to our attention that the Physicians' Desk Reference contains potentially dangerous recommendations concerning the dosage of Actifed-C.1 Each 5 cc of Actifed-C contains 10 mg of codeine phosphate. Dosage recommendations include "infants and children up to six–½ teaspoonful" four times daily.

In our opinion, there is no condition in infancy for which codeine would be indicated. However, the currently recommended dosage of codeine for cough suppression in any child is 1 mg/kg/day.2
Cardiovascular Malformations Associated With Tracheoesophageal Fistula and Esophageal Atresia
Authors: Greenwood Ronald D. , Rosenthal Amnon
Published: December 2021

Cardiovascular malformations were present in 48 of 326 (14.7%) patients with tracheoesophageal fistula. The most common cardiac lesion was ventricular septal defect. When tracheoesophageal fistula or esophageal atresia was associated with other gastrointestinal anomalies, tetralogy of Fallot and atrial septal defect were very frequent; when skeletal anomalies were present, the cardiac malformations were usually complex. The hospital mortality in infants with tracheoesophageal fistula and cardiovascular malformations is 79% in contrast to 23% for infants without cardiac abnormalities.
Dr. Murray et al. Reply
Authors: Murray Andrew B. , Hardwick D. F. , Pirie G. E. , Fraser B. M.
Published: December 2021

We agree with Drs. Leifer and Wittig that adrenergic aerosols, properly administered, are an aid to some asthmatics and should not be denied to them. Nonetheless, these inhalers do appear to be dangerous if they are overused, and this is particularly so of the ones that contain isoproterenol.

The suspicion of Greenberg and Pines that large doses of inhaled isoproterenol aerosol cause fatal cardiac arrythmia in some asthmatics seems justified. The increase in death rate in England was highest in the 10- to 14-year age group.
Remaining Sequelae With Modern Perinatal Care
Authors: Sabel K.-G. , Olegård R. , Victorin L.
Published: December 2021

The incidence of major sequelae—cerebral palsy (CP), psychomotor retardation (PMR), sensorineural hearing defect, and acquired hydrocephalus—has been studied retrospectively in a nonselected population of 6,500 3-year-old children born in 1969 and 1970 at one Swedish hospital and treated uniformly according to the principles of modern perinatology. The total incidence of these four types of handicaps was 3.5 per 1,000 when children with congenital malformation syndromes, chromosomal aberrations, verified congenital viral infections, or toxoplasmosis were excluded. The incidence of CP was 1.2 per 1,000. Extreme immaturity, traumatic delivery, postnatal asphyxia, and hyperbilirubinemia were found to be relatively small factors as causes of sequelae in this population. Babies showing various degrees of intrauterine malnutrition were found to be the major remaining group at risk for PMR and/or CP, two thirds of children with these handicaps being recruited from the 16% of newborns with birthweights more than 1 SD below normal in relation to gestational age. The most important further gains can probably be made by earlier intrauterine diagnosis of these cases, induced termination of pregnancy in selected cases, and further studies on the perinatal treatment and adaptation of these infants.
Hyperinsulinism in Infancy: Diagnosis by Demonstration of Abnormal Response to Fasting Hypoglycemia
Authors: Stanley Charles A. , Baker Lester
Published: December 2021

The metabolic adaptation to fasting in infants with hyperinsulinism was examined to see whether a characteristic abnormality could be found that would aid in the diagnosis of this disorder. Seven infants under 1 year of age with hyperinsulinism were studied; 7 control infants of similar age and 12 children with ketotic hypoglycemia served as contrast groups. At the time of hypoglycemia, four of the seven infants with hyperinsulinism did not have elevated levels of insulin. However, levels of β-hydroxybutyrate were significantly lower in the infants with hyperinsulinism than in the control and ketotic hypoglycemic groups. Levels of free fatty acids were also lower in the infants with hyperinsulinism. Expected levels and normal limits for β-hydroxybutyrate, insulin, and free fatty acids when plasma glucose is below 40 mg/100 ml were estimated by combining the control and ketotic hypoglycemic groups. Using these values as standards, the diagnosis of hyperinsulinism can be made by evaluation of the response to fasting hypoglycemia. The application of this approach is illustrated by three case examples.
The Coexistence of Cystic Fibrosis and Celiac Disease
Authors: Katz Aubrey J. , Falchuk Z. Myron , Shwachman Harry
Published: December 2021

Two patients with cystic fibrosis (CF) who subsequently developed celiac disease (CD) are described. Since organ culture of intestinal mucosa has been used to establish an in vitro model for the study of CD, we utilized this opportunity to determine whether duodenal mucosa obtained from each of these two patients and their immediate families differed in its organ culture behavior from mucosa obtained from patients with CD alone. Additionally, as specific HL-A types are associated with CD, we used HL-A typing to determine whether the two patients with CF-CD differed genetically from patients with CD alone. One of our patients was HL-A8, the most common type associated with CD; the other was HL-A12, as are many of the non-HL-A8 celiac patients. The response in organ culture of the mucosa of these two patients was the same as the response in organ culture of the mucosa from patients with CD alone. These and other data suggest that CD occurring in patients with CF is no different than CD occurring alone.
Fetal Lung Lecithin Metabolism in the Glucose-Intolerant Rhesus Monkey Pregnancy
Authors: Epstein Michael F. , Farrell Phillip M. , Chez Ronald A.
Published: December 2021

Fetal lung lecithin metabolism was examined in rhesus monkey gestations complicated by glucose intolerance secondary to maternal streptozotocin (STZ) administration. Fetuses of STZ-treated mothers were delivered at 85% to 89% of term and were compared to two control groups of fetuses from normal pregnancies—one group age-matched to the STZ pregnancies, and the other composed of fetuses delivered in the final 10% of gestation. In the glucose-intolerant pregnancies, two measures of fetal lung lecithin biosynthesis—the amniotic fluid lecithin-to-sphingomyelin (L/S) ratio and the rate of 14C-choline incorporation into lecithin in fetal lung slices—were significantly greater than in age-matched normal gestations and were similar to results in late-gestation controls. However, lung lecithin concentrations in the glucose-intolerant group were comparable to the age-matched controls, and both were significantly less than in the late-gestation controls. Since the gestational age, mode of delivery, and fetal acid-base status were the same in the age-matched groups, we conclude that these changes in fetal lung lecithin metabolism are due to the effects of maternal glucose intolerance.
Vitamin D Toxicity After Dieting in Hypoparathyroidism
Authors: Connors Matthew H. , Sheikholislam Bagher M. , Irias Julian J.
Published: December 2021

Attempts at management of idiopathic hypoparathyroidism with vitamin D have led to various reports of resistance to therapy,1 different responses to vitamin D preparations,2 and unexplained toxicity.3 We report a patient with idiopathic hypoparathyroidism who was persistently hypocalcemic during ten months of treatment with vitamin D, 150,000 units/day. After voluntary weight reduction he became hypercalcemic on the same dose of vitamin D. We believe that the toxicity in this instance was due to release of stored vitamin D into the circulation.

CASE REPORT

The patient was referred to the hospital at 12½ years of age because of intracranial calcifications noted on roentgenograms obtained for the evaluation of sinusitis.
Hospital Utilization by Children
Authors: North A. Frederick
Published: December 2021

There is little support from available data for the hypothesis that better pediatric care is keeping children out of hospitals. The available data suggest that the observed reduction in hospital utilization by children is largely the result of the changed age distribution of the child population of the United States. Slight reductions in age-specific utilization rates appear to be entirely the result of reduced average length of stay in the hospital following admission which were not offset by slightly increasing admission rates.

Those responsible for planning hospital facilities for children should not base predictions for future needs on the apparent trend to lower hospitalization rates for children. Unless further data establish that such trends are real, rather than a manifestation of changed demography, planners will be most prudent if they estimate future needs by applying current age-specific rates to future age-specific population projections.
Congenital Posterolateral Defect in the Right Side of the Diaphragm
Authors: Blank Eugene , Campbell John R.
Published: December 2021

The infant born with a posterolateral defect in the right side of the diaphragm may appear normal at birth. His abdominal viscera may be normally located; the right side of the diaphragm may seem to be intact. Later, part of the liver may herniate. As it does, it displaces the lower part of the right lung, and hepatic flexure follows into a high posterior position in the right upper quadrant of the abdomen. Rarely, obstruction of portal and hepatic venous flow at the hernial ring may cause liquid to accumulate in the right side of the chest. At any time the liver may resume its interrupted passage.
Modification of Umbilical Plastic Clamp To Secure Nasopharyngeal Prongs Used To Administer CPAP
Authors: Bonta Bedford W. , Warshaw Joseph B.
Published: December 2021

Since the introduction of continuous positive airway pressure (CPAP) via endotracheal tube by Gregory et al.1 in 1971, several alternate methods of delivering CPAP without the need for endotracheal intubation have been suggested, including the use of nasopharyngeal prongs.2 A major peoblem, however, in delivering CPAP either by endotracheal tube or by nasal prongs has been that of securing the endotracheal tube (or prongs) in place. Recently, Cussel et al.3 have suggested the use of a Hollister plastic clamp adapted for this use. We have used this method successfully for securing endotracheal tubes in place and recently have modified the clamp to secure nasal prongs used to deliver "benign" CPAP without the need for endotracheal intubation in selected patients.
Hypoglycorrhachia in Pediatric Patients
Authors: Silver Ted S. , Todd James K.
Published: December 2021

Hypoglycorrhachia (abnormally low cerebrospinal fluid glucose content) eludes exact numerical definition, largely because of the dynamic equilibrium between blood and CSF glucose. A group of 181 pediatric patients with a CSF glucose less than 50 mg/100 ml or a CSF/blood glucose ratio less than 0.50 were studied. Hypoglycorrhachia was present in patients with bacterial meningitis, aseptic meningitis, meningeal carcinomatosis, subarachnoid hemmorrhage, and hypoglycemia. Markedly diminished CSF glucose values were seen primarily in patients with bacterial meningitis. Higher CSF/blood glucose ratios predominated in those with hypoglycemia and neonates with low-normal bloo sugars.

Following bacterial meningitis and hypoglycemia, aseptic meningitis (including five children with documented enterovirus meningitis and one with documented mumps meningitis) was the third most common cause of hypoglycorrhachia in children. When readily available, positive CSF viral cultures may allow early cessation of antibiotic therapy in two types of patients with meningitis and hypoglycorrhachia: (1) those receiving previous recent antibiotic therapy, and (2) those with CSF findings more typical of a bacterial meningitis.
Fitness in the Preschool Child
Authors: Thornton Melvin L. , Eng Gloria D. , Flynn Thomas G. , Kennell John H. , Mcleod Robert N. , Shaffer Thomas E. , Strong William B. , Tower John C. , Smith Nathan J. , Bell Jack , Burkett Lucille
Published: December 2021

Achieving fitness is a way of life, not a fad or a brief change in one's way of doing things. And, an early start is imperative. A flaw in our present system of health care is the emphasis on evaluation of anatomic or organic soundness and the presence or absence of disease–with less regard for the quality of physiologic function. In other words, dynamic performance is frequently ignored after the organic condition has been determined. An infant or child may well be regarded as healthy with the proper immunizations and absence of disease. But, is he/she able to meet daily tasks, recreational activities, and unforeseen emergencies with vigor and enthusiasm and without undue fatigue? Is he/she making adequate use of the musculoskeletal and cardiopulmonary systems?

Lack of encouragement to exercise in early life is reflected in the National Adult Physical Fitness Survey conducted by the President's Council on Physical Fitness in 1972. This study showed that 45% of all adult Americans do not engage in physical activity for the purpose of exercise. However, 63% of these nonexercisers said they believed they had enough exercise; only 57% of those who exercised regularly thought they did enough of it.

Normal growth and development in infancy should assure physical fitness for ordinary and even strenuous physical tasks because of innate, powerful drives toward functional development at this period of life. The infant who naturally strives for motor fitness can be on the way to a lifetime of improving physical fitness. The preschool child who characteristically uses his large muscles during many hours of the day is continuing a self-imposed program of physical fitness.
Defective Polymorphonuclear Leukocyte Chemotaxis and Bactericidal Capacity in a Boy With Recurrent Pyogenic Infections
Authors: Chusid Michael J. , Gallin John I. , Dale David C. , Fauci Anthony S. , Wolff Sheldon M.
Published: December 2021

A 13-year-old boy with a history of recurrent pyogenic infections had abnormalities of polymorphonuclear leukocyte (PMN) function which probably accounted for his susceptibility to infection. PMN phagocytosis and nitroblue tetrazolium dye reduction were normal but glucose 14C oxidation was abnormally increased in resting cells. The patient's PMNs possessed decreased bactericidal activity against Staphylococcus aureus and Escherichia coli. Also documented were decreased PMN chemotactic activity and leukocyte accumulation in Rebuck skin windows. PMN random motility, PMN bone marrow reserve, PMN kinetics, lymphocyte blastogenesis, and delayed cutaneous hypersensitivity were normal. This patient represents another of the growing number of distinct granulocytopathies currently being recognized which may result in increased susceptibility to infection.
Pharmacokinetics of Theophylline in Children With Asthma
Authors: Ellis Elliot F. , Koysooko Renu , Levy Gerhard
Published: December 2021

The pharmacokinetics of theophylline following intravenous injection of aminophylline, 4 mg/kg of body weight, were determined in 30 children with asthma and in 6 normal adult volunteers. The average total clearance of theophylline was 87 ml/hr/kg in the children and 57 ml/hr/kg in the adults. The biologic half-life of theophylline in the children ranged from 1.42 to 7.85 hours, reflecting mainly pronounced interindividual differences in the elimination rate constant of the drug. There was no significant difference between the children and adults with respect to the distribution rate constants and apparent volumes of distribution of theophylline, but the elimination rate constant of the drug was considerably higher in children than in adults. Thus, children eliminate theophylline more rapidly on the average than do adults and also show pronounced interindividual differences in the elimination of the drug. Compared to adults, children tend to require relatively larger amounts of theophylline per day and the doses may have to be given at shorter intervals of time.
What Is the Current Incidence of RLF?
Authors: Akeson Nancy , Bonapart Benjamin
Published: December 2021

It occurs to us that your readers would be interested in some information which we have concerning the occurrence of retrolental fibroplasia (RLF) in recent years.

Preschool blind children in northern California are served by the Variety Club Blind Babies Foundation. The State of California Educational Services for Preschool Blind serves southern California. Our combined programs are currently serving 63 children with RLF in the state of California. These children are distributed by birth date as follows: 4 in 1970, 8 in 1971, 12 in 1972, 12 in 1973, 17 in 1974, and 10 in 1975.
HUMAN RIGHTS IN HEALTH. Ciba Foundation Symposium 23 (new series). New York, American Elsevier, 1974, $16.24; 304 pp
Authors: Fost Norman
Published: December 2021

If one judges this book by its title, it is a totally inadequate and disappointing treatment of the complex subject of "rights" in health care. If one judges it by its content, however, it is a stimulating and useful primer on the basic requirements for achieving health for the 70% of the world's people who live in the developing countries.

The book is a collection of papers presented at a 1973 CIBA Symposium on the practical aspects of providing four basic needs–food, water, access to fertility control, and protection from communicable disease–to the poor and deprived.
Subscribers' opinions about Pediatrics
Authors: Haggerty Robert J.
Published: December 2021

In a presidential election year everyone is familiar with opinion polls. Pediatrics has joined the crowd and commissioned a poll to learn the opinions of its readers. In doing this we recognize the many problems associated with polling: questions of reliability and validity; the acknowledgment that polls measure attitudes and not behavior; and, most important, editors—like presidents—should lead and not merely follow opinions. But modern methods of polling are able to determine the beliefs of a large group by asking questions of only a small sample if that sample is scientifically selected. The editors believe that readers' opinions are important in planning the future content of Pediatrics and therefore authorized this poll to provide "detailed information about the reader of the publication and his/her attitude toward Pediatrics, so that decisions can be made for future directions of the publication."
Relationship of Passive Cigarette-Smoking to Sudden Infant Death Syndrome
Authors: Bergman Abraham B. , Wiesner Lisa A.
Published: December 2021

The smoking habits of 56 families who lost babies to the sudden infant death syndrome (SIDS) were compared to those of 86 control families. A higher proportion of SIDS mothers smoked both during pregnancy (61% vs. 42%) and after their babies were born (59% vs. 37%). SIDS mother also smoked a significantly greater number of cigarettes than controls. Exposure to cigarette smoke ("passive smoking") appears to enhance the risk of SIDS for reasons not known.
Familial Aggregation of Blood Pressures of Newborn Infants and Their Mothers
Authors: Lee Yhu-Hsiung , Rosner Bernard , Gould Jeffrey B. , Lowe Ernest W. , Kass Edward H.
Published: December 2021

The blood pressures and pulse rates of 257 normal full-term infants and their mothers were measured two to four days after birth. Birthweight was correlated with systolic (P = .038), but not with diastolic blood pressure. Infants who were asleep had significantly lower systolic and diastolic blood pressure than infants who were awake (P < .001). Sex, body length, and feedings did not appear to influence infant's blood pressure nor did the anesthesia given to the mothers. Maternal diastolic pressure correlated with infant's diastolic pressure (regression coefficient, .128) (P < .01), whereas for systolic pressure the regression coefficient between maternal and infant pressure was .085 (P = NS). The aggregation between the diastolic blood pressures of infants and mothers was not influenced by birthweight, age of the mother, or medication administered to the mother. The pulse rates of black infants were significantly higher than those of white infants (P < .002). There was correlation between the pulse rates and blood pressures in infants.
The Paradoxical Effect of Adrenergic and Methylxanthine Drugs in Cystic Fibrosis
Authors: Shapiro Gail G. , Bamman Jacquelyn , Kanarek Paula , Bierman C. Warren
Published: December 2021

This study examined the effect of aerosolized isoproterenol and oral theophylline on pulmonary function in cystic fibrosis (CF) to determine how often these drugs are beneficial and whether there is a correlation between response to isoproterenol and response to oral theophylline.

After obtaining baseline pulmonary function tests before and after isoproterenol aerosol, 12 patients with CF were put on a double-blind trial of high-dosage theophylline (10 mg/kg three times per day) or placebo for four weeks and were then switched to the alternate regimen for the next four weeks. Patients had weekly evaluations of pulmonary function and plasma theophylline determinations.

Gastrointestinal side effects were common with theophylline. The responses to aerosolized bronchodilators were inconsistent from week to week. After aerosolized bronchodilator, five of 12 patients had an average increase of 10% or more in FEF45%-55% and FEFT70%-80%. While taking oral theophylline, five patients had a 10% or more decrease in FEF45%-55% and six patients had a decrease in FEF70%-80%.

We conclude that there was no concorrdance between response to isoproterenol and theophylline, and that adrenergic and methylxanthine drugs must be used with caution in patients with CF.
Pulmonary Valvular Dysfunction in Children With Ventriculovenous Shunts for Hydrocephalus: A Previously Reported Complication
Authors: Silver Walter
Published: December 2021

In the article by Hougen et a!.,1 pulmonary insufficiency was described as a previously unreported complication. It was, in fact. reported by us in Chest (59:344, 1971). Of further hemodynamic interest in our case was the finding of tricuspid stenosis resulting from the catheter.
Inheritance of Cryptorchidism
Authors: Rezvani Iraj , Rettig Kenneth R. , DiGeorge Angelo M.
Published: December 2021

The majority of instances of undescended testes occur sporadically, but cryptorchidism in more than one member of a family is not rare in our experience despite the paucity of published reports. Occurrence of cryptorchidism among siblings has been reported by several investigators.1-3 Charny and Wolgin described left-sided undescended testes in a father and his two sons4; Scorer and Farrington also have observed several instances where both father and son have had cryptorchidism.5 The genetics and hereditary pattern of isolated cryptorchidism is not clear at this time, although many genetic syndromes associated with cryptorchidism are known.6
UNDERSTANDING CHILDREN, By Richard A. Gardner, M.D. New York, Jason Aronson, Inc, 1973, $10.00; 258 pp
Authors: Aug Robert G.
Published: December 2021

Here comes yet another book offering expert professional advice on child-rearing to the bay parent, adding to the superabundance of such books published in recent years. Dr. Gardner's book is valid, clearly written, and as complete as the current state of our knowledge will allow. (Completeness/incompleteness is a special problem in any advice on child-rearing, and hence an important quality in looks on the subject.) At any rate, there are many other recent books in this field with much to recommend them, so why another one?
Tularemia: An Unappreciated Cause of Exudative Pharyngitis
Authors: Tyson Hugh K.
Published: December 2021

A boy with a persistent febrile illness accompanied by exudative pharyngitis found to be due to tularemia is described. The role of tularemia as a cause of exudative pharyngitis is discussed.
Phosphaturia in Thalassemia
Authors: Lapatsanis P. , Sbyrakis S. , Vretos C. , Karaklis A. , Doxiadis S.
Published: December 2021

Thirteen phosphorus balances were performed in four thalassemic children aged 6 to 10 years. No correlation was found between phosphorus intake and serum level or between phosphorus intake and net absorption. There was a positive correlation among daily phosphorus intake, net absorption, and 24-hour urinary excretion. The 24-hour urinary excretion level was higher than net absorption, indicating that these children have normal phosphorus absorption but abnormally high renal phosphaturia, which leads to a deficiency of phosphorus. A strongly positive correlation was found between values for hemoglobin and serum alkaline phosphatase. In the thalassemic patients with hemoglobin levels ≥7.5 gm/100 ml, the serum alkaline phosphatase values were ≥15 King-Armstrong units, suggesting normal osteoblast function.
Energy Dose for Ventricular Defibrillation of Children
Authors: Gutgesell Howard P. , Tacker Willis A. , Geddes Leslie A. , Davis Joyce S. , Lie J. T. , McNamara Dan G.
Published: December 2021

Transthoracic direct current shock is the recommended treatment for ventricular fibrillation in children as in adults. To determine the appropriate energy dose, data were collected from 71 defibrillation attempts in 27 children. Sixty-three of the 71 shocks (89%) were successful in terminating fibrillation. Fifty-seven shocks were within 10 watt-seconds (w-sec) above or below an energy dose of 2 w-sec/kg of body weight. Fifty-two (91%) of these were effective and five (9%) were ineffective. In every case, fibrillation was ultimately terminated by a shock of 4 w-sec/kg or less.

The results of these studies suggest that an energy dose of 2 w-sec/kg (or approximately 1 w-sec/lb) is adequate to defibrillate most children weighing under 50 kg. We currently use 2 w-sec/kg and double the energy dose if the first defibrillation attempt is unsuccessful.
Dr. Stein Replies
Authors: Stein Israel M.
Published: December 2021

We wish to apologize if we have offended our academic colleagues at the University of Washington School of Medicine. I find, however, the harsh tone of their criticism unjustified.

We have received numerous inquiries for reprints of the article and requests for information regarding the availability of this technique for both investigational and clinical use. As a consequence, to save on expenses, we elected to include a one-page statement of pertinent data with each reprint. Furthermore, the expense of providing reprints, we believe, justifies the annotation "Compliments of."
TORCHES
Authors: Brumback Roger A.
Published: December 2021

In the July 1975 issue, Fuerst1 suggested that the acronym for the common congenital infections be changed from TORCH to STORCH in order to include another important congenital infection, syphilis. I would like to recommend an acronym used by some pediatricians to designate the pentad of congenital infections: TORCHES (TOxoplasmosis Rubella Cytomegalovirus HErpes Syphilis). Substituting TORCHES as the acronym for the common congenital infections may be more readily accepted and recognized by pediatricians familiar with the older acronym.
Computerized tomography: Dilemma of health care technology
Authors: Fineberg H. V.
Published: December 2021

Computerized tomography (CT) is a remarkable technological triumph whose significance has been likened to the development of the X-ray itself. The CT scanner projects a narrow beam of X-rays across the head or body and uses a computer to convert sequential readings of tissue X-ray absorption into a cross-sectional view of the anatomical part examined. A CT scan entails radiation doses which are comparable to those from conventional X-ray studies, but is capable of distinguishing smaller differences in tissue radio-density. The only significant operational disadvantage to CT is the need for the subject to remain motionless during the time required for the scan, which often necessitates sedation or general anesthesia in restless children and infants.
Child Health Across Boundaries
Authors: Vahlquist Bo
Published: December 2021

It is indeed a great privilege to have been invited to give this Memorial Lecture. I was not fortunate enough to know Dr. Kenneth D. Blackfan personally. When he died in 1939 I had just started my training in pediatrics and it was to be another decade until I first visited Boston. But from what I have read and heard, I know that Dr. Blackfan was a very remarkable person, a pioneer in his field who played a decisive role in building up during the 1920's and 1930's what is today the great Children's Hospital Medical Center. He thus left a permanent legacy to the development of pediatrics, not only in Boston, but also throughout the world.

It is fortunate for a Center like this one to have continuity in leadership of great excellence. The whole program today is a testimony to what Professor Charles A. Janeway has meant in this respect. For many of us it is a mystery how one person has been able, over such a long period of time, to shoulder both the responsibilities of being professor of pediatrics and physician-in-chief of the Children's Hospital Medical Center and at the same time being involved in so many other extremely important national and international tasks, including engagement in Third World problems. For a good many years Professor Janeway was Chairman of the Executive Committee of the International Pediatric Association and he remains one of the Board members of the International Children's Center in Paris. It is especially in these two latter capacities that I have learned to know, admire and, indeed, like so many, acquire great affection for this truly remarkable person.
Evaluation of Neonatal Intracranial Hemorrhage by Computerized Tomography
Authors: Krishnamoorthy K. S. , Fernandez R. A. , Momose K. J. , DeLong G. R. , Moylan Fergus M. B. , Todres I. David , Shannon Daniel C.
Published: December 2021

Computerized tomographic (CT) brain scan was performed on 28 infants with unexplained cardiorespiratory and neurologic deterioration and bloody lumbar cerebrospinal spinal fluid. Fourteen of 20 with intraventricular hemorrhage (IVH) died; the six infants with lesser degrees of IVH survived. Significant subarachnoid hemorrhage (SAH) was demonstrable in three infants and three had negative scans despite bloody CSF. We have found that CT scans provide useful information about the size and extent of neonatal IVH and distinguishes it from SAH. It also confirms the diagnosis of post-hemorrhagic hydrocephalus in these infants. Continued use of the CT scan will help us to understand the natural history and the effects of neonatal intracranial hemorrhage among the survivors of intensive care.
Computerized Axial Tomography in Clinical Pediatrics
Authors: McCullough David C. , Kufta Conrad , Axelbaum Stewart P. , Schellinger Dieter
Published: December 2021

Computerized axial tomography (CAT), a noninvasive radiologic method, provides a new dimension in screening and diagnosis of intracranial pathology. Evaluation of 725 scans in infants and children demonstrates that CAT may be performed with negligible risk, although sedation and restraint are essential to the successful performance of studies in children under 6 years of age. CAT is the preferred initial diagnostic method in suspected hydrocephalus and is accurate in the detection and precise localization of brain tumors. The management of hydrocephalus and brain tumors has been significantly altered by the availability of CAT. Few invasive neuroradiologic procedures are required and pneumography is especially curtailed. Serial scanning is the best available method of monitoring ventricular alterations in hydrocephalus, tumor size during radiotherapy or chemotherapy, and postoperative recurrence of benign neoplasms. Complex intracranial anomalies are detectable with computerized tomography, but complete definition of pathology often requires angiography and air studies. Limited clinical experience in detecting neonatal intraventricular hemorrhage suggests that CAT will be a valuable tool for future investigations of that problem.
Sympathetic Pupillary Activity in Infants
Authors: Laor Netanel , Korczyn Amos D. , Nemet Pinchas
Published: December 2021

In an attempt to learn the contribution of the sympathetic system to smaller pupillary size in infants, pupillary responses were tested to agents acting on this system in 12 infants and 23 young adults. Phenylephrine dilated the pupils of both groups by the same ratio, with infants' pupils reaching a lesser diameter. The responses to cocaine and hydroxyamphetamine were lower in children.

It is concluded that in the first months of life the postganglionic sympathetic nerve releases less norepinephrine. This may be due to a lower number of sympathetic neurons. The post-synaptic apparatus may not be fully developed in infants.
Pulmonary Pseudocysts in the Newborn Infant
Authors: Harris Howard
Published: December 2021

Five neonates who developed a pulmonary pseudocyst are reported. All infants had clinical hyaline membrane disease and were treated with continuous distending airway pressure. The pseudocysts developed between 39 hours and 7 days of age. In all but one pulmonary interstitial emphysema preceded or occurred together with the development of the pseudocyst. All babies went on to complete clinical recovery without surgical intervention. Radiologic documentation of the spontaneous resolution of the pseudocyst was obtained in three infants and occurred over three days, five days, and three months, respectively.
Reye's Syndrome: Relapses and Neurological Sequelae
Authors: van Caillie Micheline , Morin Claude L. , Roy Claude C. , Geoffroy Guy , McLaughlin Bernadette
Published: December 2021

Twenty-two children aged 2 months to 11 years were seen at our institution from January 1970 to March 1975 with clinical, laboratory, and/or histological features consistent with the diagnosis of Reye's syndrome. There were three pairs of siblings. Severity of the illness ranged from relatively benign to rapidly fatal forms. Five received live attenuated vaccines within the three weeks prior to admission. Four relapsed 1 to 21 months after the initial episode, and in one there were multiple recurrences. Six developed major neurological sequelae. All patients graded levels IV and V by EEGs on admission subsequently died in contrast to none from grades 1 and 2. Peritoneal dialysis was carried out in the more severely affected patients. The procedure did not influence final outcome as predicted by the first EEG and is thought to be of limited value.
Atrial Fibrillation in Children
Authors: Radford Dorothy J. , Izukawa Teruo
Published: December 2021

Atrial fibrillation is rare in children. Previous reports associated it with severe rheumatic heart disease and a poor prognosis. This review is of the unique experience of 35 cases of atrial fibrillation in children in the past 22 years; 23 patients were boys. The age of onset ranged from 1 day to 19 years (average, 8 years).

Associated cardiac conditions were severe rheumatic mitral regurgitation (3 cases), cardiomyopathy (5), atrial tumors (2), infective endocarditis (1), paroxysmal atrial tachycardia of infants (4), idiopathic paroxysmal atrial fibrillation (1), Marfan's syndrome with mitral regurgitation (1), endocardial fibroelastosis (1), and structural congenital heart malformations (17). Surgical correction of congenital heart lesions was directly related to the development of atrial fibrillation in 14. Varying arrhythmias of the sick-sinus syndrome were observed in five children. The atrial fibrillation was paroxysmal or transient in 21 patients and persistent in 14.

Treatment depended on the underlying condition. Digoxin was used in all cases and cardioversion attempted in ten; no patient was given anticoagulants. Three children had cerebral emboli, with residual defects. Eighteen patients are known to be alive, 13 are dead, and 4 are lost to follow-up.

Atrial fibrillation in childhood is an indication for complete investigation of the patient and for the institution of treatment appropriate to the underlying disease.
Cerebral Abscess in Children Secondary to Esophageal Dilatation
Authors: Leahy W. R. , Toyka K. V. , FischBeck K. H.
Published: December 2021

Brain abscess is known to occur (1) as hematogenous or metastatic abscesses in normal individuals, (2) in children with cyanotic congenital heart disease,1,2 (3) secondary to sinus or mastoid infection,3-5 and (4) secondary to trauma.

The following report of brain abscess in three children undergoing dilatation of the esophagus should alert the clinician to undertake a careful evaluation in any child developing neurologic dysfunction while undergoing esophageal dilatation.

CASE REPORTS Case 1

A 4-month-old infant with congenital esophageal atresia had retrograde bougienage performed monthly. At the age of 2 months, after one of the dilatations, the child had had an episode of "suspected meningitis," but returned to normal within three days without therapy.
The Value of Phenobarbital in the Child Who Has Had a Single Febrile Seizure: A Controlled Prospective Study
Authors: Wolf Sheldon M. , Carr Andrew , Davis David C. , Davidson Sherwood , Dale Earle P. , Forsythe Alan , Goldenberg Erwin D. , Hanson Rebecca , Lulejian Gary A. , Nelson Marilyn A. , Treitman Paul , Weinstein Anita
Published: December 2021

A group of 355 children who were seen after a first febrile convulsion at the Kaiser Foundation Hospitals in Southern California from 1970 to 1975 were randomly assigned to three treatment groups—daily phenobarbital, "intermittent" phenobarbital given at the onset of fever, and no phenobarbital. We found that 42% had a relative with a febrile seizure and 16% a relative with an afebrile convulsion. 13% had seizures which were either lateralized or longer than ten minutes. Parents were unaware of the fever prior to the seizure in about 30% of the cases. In 81% the preseizure duration of fever was less than 24 hours. The mean follow-up was 28 months, with a range of 6 to 70 months.

There was no significant difference in the recurrence rate between children receiving "intermittent" as compared with no phenobarbital. The recurrence rate in children receiving daily phenobarbital was significantly decreased compared to either of the other two groups. Severe recurrent febrile seizures occurred in no children on daily phenobarbital and in 4.4% of the children receiving either intermittent or no phenobarbital. Parental resistance, compliance, and reversible hyperactivity were the main problems encountered with the continuous phenobarbital regimen.
A Single Growth Hormone Determination to Rule Out Growth Hormone Deficiency
Authors: Johanson Ann J. , Morris Gordon L.
Published: December 2021

Exercise is a known stimulus to growth hormone release1 and has been used effectively as a screening test for growth hormone deficiency.2,3

On the pediatric endocrine service at the University of Virginia, 87 exercise tests have been performed to determine growth hormone responses in 72 children and adolescents (74 tests), 2 to 19 years old, and 13 adults, 23 to 67 years old (Table I). Two children were tested twice. After at least four hours of fasting, blood was obtained for growth hormone determinations before and after 20 minutes of sustained, vigorous exercise to near exhaustion (rapid walking, running on inclined treadmill, or climbing stairs), and 20 minutes after cessation of exercise, modified according to Keenan et al.4