bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to Editor
Authors: Scanlon John W.
Published: December 2021

Serum bile acid measurements are not routinely performed in our laboratory and we are not aware of normative values for preterm infants. Thus we must make do with more arcane liver function tests to monitor hepatic normality. The absence of neurologic toxicity in our small patients was documented on serial observation's of their performance on the Brazelton scale (modified for prematures).
Infant Car Seat Safety
Authors: Simmons Jean
Published: December 2021

As president of California Strolee, Inc, I am writing in response to the article in your December issue (Pediatrics 64:848, 1979) entitled, "Children's Car Seat Restraints: When Top-Tether Straps are Ignored, Are the Restraints Safe?" by Quentin McDonald. To say we were shocked that a prestigious scientific journal such as yours would print such a biased, irresponsible and self-serving document is truly an understatement.

First and foremost, let us set the record straight. The tests cited in the article were commissioned by the Bobby Mac Company (a small manufacturer of infant restraint systems).
Role of Exchange Transfusion in the Treatment of Severe Septicemia
Authors: Vain Nestor E. , Mazlumian Jorge R. , Swarner O. Ward , Cha Chul C.
Published: December 2021

Ten critically ill newborn infants presenting with documented septicemia were treated with antibiotics and supportive measures that included assisted ventilation, large blood transfusions and other volume expanders, sodium bicarbonate, and vasoactive drugs. Upon failure of the above treatment to improve the infants' rapidly deteriorating condition and the development of sclerema, exchange transfusions with fresh whole blood were performed and repeated up to four times. Seven of the ten infants showed immediate improvement and ultimately survived. IgM and IgA rose consistently with exchange transfusions. We postulate that these infants improved following exchange transfusion as the result of the removal of endotoxins, improvement of perfusion and of tissue oxygenation, decrease of hemorrhagic complications, and enhancement of the humoral and cellular inflammatory response. The development of sclerema in septicemic newborn infants continues to be an ominous sign despite the use of antibiotics and supportive measures. Our data suggest that exchange transfusions decrease the mortality of this group of critically ill infants.
Wilms Tumor in Five Cousins
Authors: Cordero José F. , Li Frederick P. , Holmes Lewis B. , Gerald Park S.
Published: December 2021

Wilms tumor developed in five cousins in a family. Two with bilateral tumors have died, but three with unilateral lesions have survived. None of the patients had associated chromosome defects, aniridia, hemihypertrophy, or other anomalies. The pattern of Wilms tumor in the family is consistent with several postulated mechanisms of inheritance of the neoplasm, and shows that relatives within affected families may be at risk.
Outcome of Symptomatic Congenital Cytomegalovirus Infection: Results of Long-Term Longitudinal Follow-up
Authors: Pass Robert F. , Stagno Sergio , Myers Gary J. , Alford Charles A.
Published: December 2021

Thirty-four patients with congenital cytomegalovirus infection who were symptomatic as newborns were followed in a special clinic providing periodic medical and visual examinations as well as psychometric testing and audiometry. All patients had symptoms of congenital infection by 2 weeks of age, and 31 of 34 had virus isolated from urine within the first month of life. Age at latest follow-up varied from 9 months to 14 years with a mean of about 4 years. Ten patients died and 23 surviving patients had adequate follow-up examinations; all but two had evidence of central nervous system or auditory handicaps. Microcephaly was present in 16 (70%), mental retardation in 14 (61%), hearing loss in seven (30%), neuromuscular disorders in eight (35%), and chorioretinitis or optic atrophy in five (22%). Children with symptomatic congenital cytomegalovirus infection are at very high risk for handicaps that will significantly impair development.
Unusual Eye Abnormalities Associated with Congenital Cytomegalovirus Infection
Authors: Frenkel Lawrence D. , Keys Marshall P. , Hefferen Stephen J. , Rola-Pleszczynski Marek , Bellanti Joseph A.
Published: December 2021

Seven children with congenital cytomegalovirus infection demonstrated a higher than expected incidence of "rare" ophthalmological abnormalities, including anophthalmia and Peters' anomaly. These data suggest that appropriate investigation for evidence of cytomegalovirus infection should be instituted in any child with congenital ocular defects.
Development of Adverse Sequelae in Children Born with Subclinical Congenital Toxoplasma Infection
Authors: Wilson Christopher B. , Remington Jack S. , Stagno Sergio , Reynolds David W.
Published: December 2021

Most infants born with congenital Toxoplasma infection are asymptomatic in the newborn period, and therefore their infection is not recognized. We performed follow-up evaluations on 24 such children. The mean age of these children at last examination was 8.5 years. In group I (13 children), the diagnosis was made prospectively. In group II (11 children), no symptoms or signs were noted in the newborn period and the diagnosis was made only after the first sign developed. Eighty-five percent of the children in group I and all of the children in group II have developed chorioretinitis. In group I, three children (23%) have unilateral blindness; in group II, three children (27%) and five children (45%) have unilateral and bilateral blindness, respectively. One child (8%) in group I and two children (18%) in group II developed severe, permanent neurologic sequelae after they initially presented with eye disease. Two of the children in each group are now retarded (IQ score range, 36 to 62). Six of the children in group I who were tested sequentially have had lower IQ scores (mean change from 97 to 74) on repeat tests performed an average of 5.5 years later. Less severe neurologic, intellectual, and audiologic deficits were observed in other children in each group. Treatment of some children may have had a beneficial effect on their outcome.
Pre-participation Sports Assessment
Authors: Garrick James G. , Smith Nathan J.
Published: December 2021

The paper by Goldberg et al (Pediatrics 66:736, 1980) is of interest to the primary care physician in documenting not only what may be one approach to the often demanding and frustrating problem of large numbers of pre-participation health examinations, but most particularly in reporting what is found in a large number of such examinations when performed on high school boy and girl athletes. The physician may not appreciate that there are as many as 7 million high school students involved in interscholastic sports programs each year; potentially all are candidates for this type of health evaluation.

If the pre-participation sports examination is to be effective and economically realistic, its goals must be precisely defined.
Transillumination—A Technical Note
Authors: Donn Steven M. , Kuhns Lawrence R. , Roloff Dietrich W.
Published: December 2021

Transillumination has become a standard diagnostic tool in the neonatal intensive care unit. Most centers now

See Images in the PEF File

utilize a fiberoptic light probe such as the Mini-Light or Omni-Source light (Med General, Minneapolis) for transillumination. We have used this device for several years and have noticed that over time there is a continual loss of fiberoptic bundles, which gradually diminishes the overall intensity of the light. This may not be visually apparent until a significant number of contiguous fibers have broken (Fig 1).
Can the Physician Diagnose Hyperactivity in the Office?
Authors: Sleator Esther K. , Ullmann Rina K.
Published: December 2021

Office diagnosis of hyperactivity can present a problem to the pediatrician because only about 20% of the potential patients show hyperactive behavior during office examination. Exclusion of the children who appear normal in the physician's office can eliminate from medical treatment a large number of patients for whom treatment is appropriate. Eighty percent of the children ultimately accepted into the project on the basis of home and school reports showed exemplary behavior and no sign of hyperactivity in the office. Nonetheless, at a three-year follow-up, these children were rated the same as those who were obviously hyperactive in the presence of the pediatrician. The groups appeared no different on school grade, teachers' ratings of classroom behavior, amount of stimulant medication prescribed, or duration of drug treatment. The reported outcome data indicate that the physician can have confidence in historical information from the parents combined with current teacher reports as reliable aids in the diagnostic process with hyperactive children.
The Feeding of Solids Debate
Authors: Ganelin Robert S.
Published: December 2021

I find the statement of the Committee on Nutrition in the June issue (Pediatrics 65:1178, 1980) disconcerting. I recognize that it addresses an issue (feeding of solids) about which definitive judgements are impossible and for which rigidity is unrealistic and unnecessary. However, the Committee, I feel, has arrived at conclusions which are not harmonious with the background information it provides.

Throughout the commentary the statement is made that solid foods should be introduced between 4 and 6 months of age.
On Growing New Neurons: Are Early Intervention Programs Effective
Authors: Ferry Peggy C.
Published: December 2021

In recent years, there has been an exponential proliferation of developmental stimulation programs for environmentally deprived and neurologically handicapped children.1 Premature infants in neonatal intensive care units are being cuddled, patted, stroked with vibrators, and rocked in water beds and motorized hammocks. They are exposed to flashing lights, dangling birds and toys, and piped-in heartbeat sounds and music ("This Old Man"). Infants and preschoolers with neurologic disorders roll on beach balls in special "infant classrooms," on "therapeutic playgrounds," and in "creative play centers." We have home-based, parent-oriented programs; home-based child-oriented programs; center-based, child-oriented programs; and, logically, center-based, parent/child-oriented ones. Older children with learning disabilities practice walking on balance beams to improve their gross motor skills and learning abilities. The age of children at entry, the nature of their handicaps, the type and duration of intervention, the materials used, and the qualifications of teachers and therapists all vary in a flood of new programs. "Infant stim" and developmental therapy programs now represent a major industry in our country, employing thousands of personnel (infant therapists, child development specialists, movement therapists, physical and occupational therapists, early child educators, parent trainers, home teachers, and aides).

Without intending to promise normal brain development, personnel in many of these programs convey to parents the message that stimulation and intervention will, in effect, grow new brain cells. Sensory integration therapy, for example, reportedly "enhances the organization of brain mechanisms and neural integration."2 Vestibular impairment is treated by providing "a bombardment of stimulation through the many different vestibular receptors activating synapses and increasing the number of impulses converging on neurons."
The Pediatrician's Orientation to Infant Stimulation Programs
Authors: Browder J. Albert
Published: December 2021

A statement for pediatricians concerning the very popular and widely touted infant stimulation programs is past due in view of the rapid development of these services in the past decade. At present most communities have infants and young children involved in early education programs. As long ago as 1974, interest in these early educational interventions led to a national conference sponsored by the President's Committee on Mental Retardation and the Association for Childhood Education International.1 It was apparent at the time of the national conference that most of the programs functioned outside of health delivery systems. The literature dealing with delivery models and research on their effects are in nonpediatric literature. Therefore, pediatricians are generally unfamiliar with the several types of programs that have evolved and their advantages and disadvantages. In this issue Denhoff,2 on behalf of the American Academy of Pediatrics Committee on Children with Handicaps, reviews the state of the art in infant stimulation programs, especially those for biologically impaired infants and/or those considered at high risk.

It is important to realize that there are two different types of children involved, and that each group's needs are quite different. The first type are children in whom environmental factors are the major events leading to concern for mental development. This so-called cultural-socially deprived group is felt by many to constitute the majority of the borderline and mildly retarded children. They are by far the largest group of handicapped in our school systems. The second type are the biologically impaired, ie, children with brain damage, sensory deficits, or physical impairments; they are a very heterogeneous group.
A Discussion of Early Intervention for Infants with Down Syndrome
Authors: Bricker Diane , Carlson Laurel , Schwarz Robert
Published: December 2021

Recently, a physician-colleague brought to our attention an article entitled, "Early Intervention for Infants with Down Syndrome: A Controlled Trial," by Piper and Pless.1 Although it is encouraging to find that these investigators are exploring the parameters of early intervention with handicapped infants, some of their conclusions are of concern and have prompted the formulation of a response. In particular, we would like to discuss this article's findings in relation to (1) existing efficacy data that suggest early intervention with young handicapped children may be effective; and (2) methodologic weaknesses in the research design employed by Piper and Pless.

A critical problem currently confronting the field of early intervention is the evaluation of the effectiveness of early programming for handicapped infants and their families. Major impediments to the documentation of program effects include the unsuitability of existing instrumentation for assessing the progress of handicapped infants and the scarcity of feasible evaluation research designs.2,3 To complicate matters further, randomly assigned control or untreated groups for comparison are rarely possible. Ethical concerns surrounding the withholding of services from infants assigned to control groups, coupled with recent state and federal mandates calling for the provision of educatinal services for all handicapped children of school age and permissive programming for the preschool child, are collectively operating to reduce and eventually eliminate available handicapped infants and children who might serve as non-intervention control subjects.4

Despite the design limitations associated with research involving young handicapped children, efficacy findings based on descriptive and quasi-experimental methodology do exist.
Tuberculosis in Pregnancy with Fatal Congenital Infection
Authors: Myers Joseph P. , Perlstein Paul H. , Light Irwin J. , Towbin Richard B. , Dincsoy Hosoon P. , Dincsoy Mehmet Y.
Published: December 2021

An unusual case of miliary tuberculosis which presented as fever and a tubo-ovarian abscess in a postpartum patient is described. Fatal congenital tuberculosis was also diagnosed in the mother's premature infant. The difficulties encountered in diagnosing the tuberculosis in these patients are summarized, and the need for early recognition and therapy is emphasized. Epidemiologic follow-up of the premature infant's exposed contacts was thorough and revealed no new cases of tuberculosis among the infants or the personnel who were exposed to the infected baby.
The Axial Mesodermal Dysplasia Spectrum
Authors: Russell Laura J. , Weaver David D. , Bull Marilyn J.
Published: December 2021

Features of both the Goldenhar and the caudal regression syndromes were found in the patient described. A search of the literature revealed two other patients having both conditions. However, a number of other individuals have been reported with Goldenhar or related syndromes who have malformations in the caudal region or, conversely, who have the caudal regression syndrome and possess cranial anomalies. Possible explanations for the commonality of malformations seen in these syndromes are presented and discussed. It is suggested that the term, "axial mesodermal dysplasia spectrum" be used in patients manifesting this overlap to emphasize the importance of searching for the other malformations seen in this spectrum of anomalies.
Hyperventilation Syndrome in Children and Adolescents: Long-Term Follow-up
Authors: Herman Stephen P. , Stickler Gunnar B. , Lucas Alexander R.
Published: December 2021

Records of 34 hyperventilating children aged 18 years or younger seen at the Mayo Clinic over a 25-year period were reviewed. Five different clinical subtypes were identified. Evaluation and treatment varied considerably. At follow-up, 40% were still hyperventilating as adults, and many had signs and symptoms of chronic anxiety. Hyperventilation in childhood can be a signal that the child is experiencing severe anxiety, which may persist into adulthood.
Scoliosis Screening: Results of a Community Project
Authors: Gore Donald R. , Passehl Rosalyn , Sepic Susan , Dalton Anthony
Published: December 2021

From 1973 to 1977, 7,642 girls and 751 boys were screened for spinal deformity in a Wisconsin County with a population of approximately 100,000. Of 243 girls and 30 boys found to have scoliosis, 155 girls and 13 boys had curves 10 degrees or greater. The most common location and curve direction was right thoracic; 98% of those with scoliosis were classified as idiopathic. Eighteen girls required treatment when initially seen: ten with a Milwaukee brace and eight with spine fusion. Of those not treated and followed for six months or longer, 24 girls and one boy had a decrease in their curve of at least 5 degrees, and 21 girls and one boy had an increase in their curve of at least 5 degrees. Determination of which curves would progress was unpredictable and identification of progression was possible only by repeated examinations.
Factors Influencing Pediatric Interns' Relationships with Dying Children and Their Parents
Authors: Sahler Olle Jane Z. , McAnarney Elizabeth R. , Friedman Stanford B.
Published: December 2021

Events and feelings immediately surrounding the deaths of children in the hospital were investigated in order to identify factors that might influence a house officer's ability to relate in a personally satisfying way to dying children and their parents. Open-ended interviews with the involved interns and their supervising residents were conducted within 36 hours of the deaths of 31 hospitalized children to gain insight into the reactions and responses of new physicians managing terminally ill patients. Interns' relationships with children who were fatally ill appeared to be influenced by two factors: the child's age and the child's neurologic status. The interns' relationships with parents reflected their attitudes toward the children but were also affected by the duration of the illness, especially in instances when the patients were comatose or severely impaired. Senior medical staff awareness of the age and responsiveness of dying patients and the duration of their illness can help to provide case-specific guidance and support to the interns. Such support may help prevent that excessive distancing or overinvolvement that can impair the interns' abilities to provide optimal emotional support to patients, the families, or themselves.
Precocious Puberty and Hypothalamic Hamartoma
Authors: Hochman Hillel I. , Judge David M. , Reichlin Seymour
Published: December 2021

A 3-year old boy with true precocious puberty and hamartoma of the hypothalamus is described. Preliminary diagnosis was established by the presence of unusually advanced puberty and skeletal age without other evidence of central nervous system dysfunction, elevated blood gonadotropin and testosterone concentrations, and positive computed tomography scans. Pneumoencephalography further delineated the tumor. Hypothalamic-pituitary-gonadal and adrenal functions were studied. Release of gonadotropins after the injection of synthetic luteinizing hormone-releasing hormone and the suppression of luteinizing hormone and of testosterone by oral fluoxymesterone were comparable to maximal responses of normal men. The diagnosis was confirmed by histologic and electron microscopic study of an excised portion of the tumor. Immunofluorescence studies indicated the presence of luteinizing hormone-releasing hormone in the hamartona and radioimmunoassays detected thyroid-stimulating hormone-releasing hormone and somatostatin. The hamartoma resembles an autonomously functioning accessory hypothalamus. The ectopic neuroendocrine pathways, however, are responsive to hormonal stimulation and feedback. The clinical, endocrinologic, and pathologic features of published cases of precocius puberty and hypothalamic hamartoma are reviewed. Advanced or rapidly progressive true precocious puberty in the very young with elevated concentrations of blood gonadotropins and gonadal steroids and positive pneumoencephalography appear to be characteristic.
Management of Pituitary-Adrenal Suppression Secondary to Corticosteroid Therapy
Authors: Chamberlin Patricia , Meyer Walter J.
Published: December 2021

Withdrawal of steroid medications from patients who have been receiving them for management of chronic disease carries the risk of certain serious complications. An understanding of adrenal physiology, coupled with a rational plan for evaluating the individual patient, when necessary, and for protecting against certain stressful situations, should obviate the occurrence of acute adrenal insufficiency.
1980 Update: The Recent Trend in Breast-feeding
Authors: Martinez Gilbert A. , Nalezienski John P.
Published: December 2021

This study presents results of surveys conducted on a continuous basis over a period of years to determine the trend in the incidence of breast-feeding. Questionnaires were mailed to large samples of mothers, representative of the national distribution of births, asking them what type of milk they fed their infants over a period of time. Demographic characteristics of mothers who breast-fed were also obtained. From 1955 to 1971, there was a progressive decline in breast-feeding, followed by a resurgence of its incidence through 1979. Not only are more mothers breast-feeding, more are continuing to do so for a longer period of time throughout the months of their infants' most rapid growth and high nutritional requirements. It is also apparent that the increased incidence of breast-feeding has not been limited to higher income, better educated mothers.
Varicella Hepatitis Without Neurologic Symptoms or Findings
Authors: Ey John L. , Smith Sandra M. , Fulginiti Vincent A.
Published: December 2021

Varicella hepatitis has been reported frequently in immunocompromised patients and occasionally in adults with varicella pneumonia and/or systemic involvement. However, hepatitis is not generally known to occur in otherwise uncomplicated varicella. Six children are described who had typical varicella in association with transient elevation of liver enzymes. No CNS abnormalities were noted, and all recovered uneventfully. Such patients have previously been described as representing stage I of Reye's syndrome. The authors postulate that hepatitis complicating varicella may well represent a distinct entity which bears no relationship to Reye's syndrome.
Counseling Families Who Have a Child with a Severe Congenital Anomaly
Authors: Fost Norman
Published: December 2021

The birth of an infant with a major congenital malformation is experienced by the family as a calamity. Parents have an urgent need for compassionate and skilled attention, and a long-term need for counseling to help them adapt to the crisis. The difficult ethical and legal implications of such cases further complicate the doctor's ability to care for the patient and family. Potential conflicts of interest have recently led to the use of voluntary consultation by hospital committees, or obligatory involvement by the courts.
Mixed Connective Tissue Disease in Children and Adolescents
Authors: Oetgen William J. , Boice John A. , Lawless Oliver J.
Published: December 2021

Since the recognition of mixed connective tissue disease in 1972, a small number of pediatric and adolescent patients with this disorder have been described in detail. Four additional patients, two male and two female, are reported in this study. Age range at onset of symptoms was 11 to 18 years. All had arthritis or arthralgia, cervical lymphadenopathy, and hypergammaglobulinemia. Skin rashes and restrictive pulmonary disease were present in three; Raynaud phenomenon, skeletal myopathy, elevation of serum IgE, and neurologic abnormalities were present in two of the four patients. One patient had cardiomyopathy which was progressive over three years. Renal function was normal in all four patients. Most manifestations of the disease in these patients appeared to respond to variable doses of corticosteroids. A review of 234 reported patients with mixed connective tissue disease, including 50 pediatric patients, suggests a higher prevalence of renal and cardiac disease in affected children and adolescents. A multicenter cooperative study of patients with mixed connective tissue disease is strongly recommended to determine the natural history and the effects of therapeutic interventions in this disease.
Psychosocial Functioning of Children with Cystic Fibrosis
Authors: Drotar Dennis , Doershuk Carl F. , Stern Robert C. , Boat Thomas F. , Boyer William , Matthews Leroy
Published: December 2021

The adjustment of children with cystic fibrosis as rated by parents and teachers was compared to that of physically healthy siblings, normal children, and other chronically ill children. The findings indicated that children with cystic fibrosis achieved an age-adequate level of adjustment at home and school. Adjustment was largely unrelated to the severity of cystic fibrosis. As a group, chronically ill children had less adequate adjustment as rated by parents. However, severe adjustment problems were relatively rare. These findings are consistent with a growing body of literature which suggests that children with cystic fibrosis can cope reasonably well with life tasks and that emotional disturbance is not an inevitable consequence of the disease. Future studies of the cystic fibrosis population should study factors which differentiate adjusted from maladjusted children.
ABRAHAM JACOBI ON THE ESTABLISHMENT OF SYSTEMATIC INSTRUCTION IN THE DISEASES OF CHILDHOOD IN THE UNITED STATES
Authors: C. T. E.
Published: December 2021

As a specialty, pediatrics, or "pediatry" or "pedology," as it was called in the nineteenth century, was introduced to America by Abraham Jacobi (1830-1919).1

He wrote:

There never was any systematic instruction in the diseases of children, by a teacher appointed for that branch of medicine exclusively, until (in 1860) I established a weekly children's clinic in the New York Medical College, at that time on East Thirteenth Street. That was the first of its kind in the United States. When the college ceased to exist (in 1865) I established a children's clinic in the University Medical College and in 1870 in the [Columbia] College of Physicians and Surgeons. In both these institutions, as also in the Bellevue Hospital Medical College, such clinics have existed since, and a number of the medical schools of the country have imitated the example.

In them, a single hour weekly, during the regular courses of the winter, is given to the student of medicine for the special study of the diseases of children, who will, in his future practice, form the majority of his patients. In the course of four so-called years, which the legislatures of our States pronounce sufficient for the attainment of all medical knowledge required for the welfare of a country, the student is pressed very hard for time. There are a number of branches which he is taught to deem worth his while and attention, by being told that he will be examined in them before obtaining his diploma; but the diseases of children are not now among these.
Cardiac Manifestations of Rocky Mountain Spotted Fever
Authors: Marin-Garcia José , Gooch W. M. , Coury Daniel L.
Published: December 2021

An increasing incidence of Rocky Mountain spotted fever is being noted across the United States. From 1955 to 1978 80 children with this disease were seen in a children's hospital. Autopsies were performed in six of the nine fatal cases, and cardiac lesions were seen in each. Multifocal myocarditis with petechiae was present in four cases, and in two of them there were areas of myocardial necrosis. In four of the necropsied cases there were electrocardiographic changes and cardiac enlargement on chest roentgenogram. Among survivors five patients manifested at least one cardiac abnormality. ST-T changes were noted in two patients, atrioventricular conduction disturbance in two, and severe left ventricular hypertrophy in one patient. Cardiomegaly was observed in three patients, and one had severe cardiac failure that responded to medical management. Cardiac involvement is frequently present in Rocky Mountain spotted fever, and close observation seems to be warranted.
Hygienic Care in Uncircumcised Infants
Authors: Osborn Lucy M. , Metcalf Thomas J. , Mariani E. Marc
Published: December 2021

A written questionnaire was used to determine the advice pediatricians give concerning hygienic care of uncircumcised infants. A telephone survey was conducted in which new mothers were asked what they had been told about genital hygiene and how they were caring for their infants. Pediatricians' advice concerning hygiene in uncircumcised infants varied greatly. Most counseled mothers to retract the foreskin and clean the child, but few (22%) knew when this could be readily accomplished. None of the mothers of uncircumcised children had been told when the foreskin could be expected to retract, and only half had been given any advice concerning hygiene. Mothers of infants whose foreskins had been manipulated by physicians felt this practice was traumatic. Both this and the stress of caring for their infants without adequate instruction caused 40% of the mothers to state they would choose to have the next child circumcised. Recommendations for hygienic care of uncircumcised infants are given.
Cerebral Infarction Associated with Mycoplasma pneumoniae
Authors: Parker Pamela , Puck Jennifer , Fernandez Fabio
Published: December 2021

An 8-year-old girl with a cerebral infarction and pneumonia developed the acute hemiparesis associated with clinical and serologic evidence of Mycoplasma pneumonia infection. Mycoplasma complement fixation titers increased from 1:1,024 on the tenth day of illness to 1:>16,384 at three weeks and subsequently decreased to 1:512 at seven weeks. Total resolution of her facial weakness, hemiparesis, dysphagia and dysarthria occurred by eight weeks.
Cerebrospinal Fluid Concentrations of Aqueous Procaine Penicillin G in the Neonate
Authors: Speer Michael E. , Mason Edward O. , Scharnberg John T.
Published: December 2021

Simultaneous serum and CSF samples were obtained following the intramuscular administration of 50,000 units/kg of aqueous procaine penicillin G in 25 neonates. Penicillin activity was detected in the sera and CSF of all patients. Peak serum levels were noted at four hours (mean ± SEM, 17.1 ± 6.3 µg/ml). Peak CSF levels were noted at 12 hours (0.70 ± 0.35 µg/ml). The serum level at 24 hours was 2.1 ± 0.98 µg/ml (range, 0.2 to 5.8 µg/ml); the CSF level at 24 hours was 0.12 ± 0.05 µg/ml (range, 0.03 to 0.27 µg/ml). These results demonstrate that spirocheticidal levels (≥0.03 µg/ml) are achieved for at least 24 hours in the CSF following the intramuscular administration of aqueous procaine penicillin G in neonates.
Serum Thymic Hormone Activity and Cell-Mediated Immunity in Healthy Neonates, Preterm Infants, and Small-for-Gestational Age Infants
Authors: Chandra R. K.
Published: December 2021

Groups of healthy, small-for-gestational age (SGA) and preterm appropriate-for-gestational age (AGA) infants were studied at birth, 1 month, 3 months, and 12 months of age. Serum thymic hormone (TH) activity was assayed, the number of T lymphocytes in the peripheral blood was counted, and in vitro lymphocyte stimulation responses to phytohemagglutinin (PHA) were evaluated. TH activity was decreased in 1-month-old SGA infants. T cells were reduced in all low birth weight infants; the number reverted to normal by 3 months of age in preterm AGA infants, whereas it remained low for at least 12 months in the SGA group. Lymphocyte stimulation response was decreased in low birth weight infants; the extent of depression paralleled reduction in T lymphocyte number. These observations indicate that cell-mediated immunity is impaired in low birth weight newborns and reduced TH activity may be one of the pathogenetic factors involved. Persistent depression of immunocompetence may underlie the increased susceptibility of SGA infants to infection-related morbidity and mortality.
Soft Tissue Infection Associated with Haemophilus aphrophilus
Authors: White Christopher B. , Lampe Richard M. , Copeland Randolph L. , Morrison Robert E.
Published: December 2021

Haemophilus aphrophilus is an uncommon cause of human infection. Brain abscess, 1-5 endocarditis, 2,5-8 abdominal wound infections, 5-9 and infections associated with the oropharynx2,5 are the most commonly reported presentations in children (Table). The presentation and management of a child who developed a soft tissue infection of the leg associated with H aphrophilus are presented.

CASE REPORT

A 12-year-old boy struck an opponent's mouth with his right knee while playing soccer. No obvious wound was noted. Four days later, the soft tissue about his knee became red, swollen, and tender. The bursa and joint were not involved. Incision and drainage of the subcutaneous abscess near the right knee was accomplished.
Letters to the Editor
Authors: Kauffman Ralph E.
Published: December 2021

The Committee on Drugs did not categorically recommend against the use of naloxone to reverse the effects of maternally administered narcotic analgesics. However, the Committee did recommend that naloxone not be used during the second stage of labor, but be reserved for administration directly to infants, who are significantly depressed and have a high probability of being narcotized, as an adjunct to standard resuscitation efforts.

The recommendation against administration of naloxone to the mother just prior to delivery was developed and published jointly by the American Academy of Pediatrics Committee on Drugs and the American College of Obstetrics and Gynecology after careful review of recent literature and some unpublished data.
Increased Cholesterol and Decreased Fluidity of Red Cell Membranes (Spur Cell Anemia) in Progressive Intrahepatic Cholestasis
Authors: Balistreri William F. , Leslie Mary H. , Cooper Richard A.
Published: December 2021

Progressive hemolytic anemia occurred in a 4½-year-old girl with familial intrahepatic cholestasis; a peripheral smear contained bizarre spiculated "spur" red cells. Analysis of this patient's fresh red cells revealed a 59% increase in cholesterol content with a normal phospholipid content and therefore an increase in the cholesterol /phospholipid molar ratio to 1.35 (normal = 0.92). A similar abnormality of lipid composition was present in serum lipoproteins. The lipid abnormality in red cell membranes was associated with a decrease in membrane fluidity, as assessed by the fluorescence polarization of the hydrophobic probe 1,6-diphenyl- 1,3,5-hexatriene. Following incubation with patient's plasma, normal cells acquired a spur-shaped morphology with an associated decrease in osmotic fragility and a 25% increase in cholesterol content. The patient's cells, during incubation with normal plasma, acquired morphologic features of spiculated spherocytes with an increase in osmotic fragility and a 21% decrease in cholesterol content. Chenodeoxycholate and lithocholate were present in markedly elevated concentrations in serum. These studies show that a process identical to spur cell anemia in alcoholic cirrhosis may accompany severe liver disease in children with intrahepatic cholestasis.
Differentiating Environmental from Disease-Related Fevers in the Term Newborn
Authors: Pomerance Jeffrey J. , Brand Richard J. , Meredith Janet L.
Published: December 2021

It is often difficult to differentiate environmental overheating from disease-related fever in the newborn. The purpose of this study was to establish the normal relationship between peripheral skin temperature and rectal temperature in normal newborn infants whose rectal temperatures were in the upper range of normal (99.0 to 99.6 F) and to compare it with that relationship in infants with fevers known to be disease related. Seventy -eight paired rectal and anterior mid-lower leg skin temperatures were obtained from 41 normal 2-day-old infants. Thirteen similar paired temperatures were measured in 13 full-term infants admitted from home with fever (>100.0 F). The rectal temperature-leg temperature (RT-LT) difference in the normal infants ranged between -1 and +4 F, with a mean of +1.14 F, whereas in the febrile infants it ranged between +5.7 and 12.9 F with a mean of 7.90 F. In febrile infants there was no trend in RT-LT difference as rectal temperatures rose whereas normal infants showed a tendency toward a decreasing RT-LT difference with increasing temperatures. When an RT-LT difference of +3 F is chosen as an arbitrary boundary between environmentally overheated infants and infants with disease-related fevers, it is estimated that 0.5% of infants with disease-related fevers would be incorrectly classified. The RT-LT difference adds an objective guideline for evaluation of temperature elevation in the full-term, appropriate for gestational age neonate.
Enterovirus 71 Infection: Report of an Outbreak with Two Cases of Paralysis and a Review of the Literature
Authors: Chonmaitree Tasnee , Menegus Marilyn A. , Schervish-Swierkosz Ella M. , Schwalenstocker Ellen
Published: December 2021

Enterovirus 71 (E-71) infection was first reported in 1974 in the United States; subsequent outbreaks breaks were reported in worldwide distribution. In the summer of 1977, we identified 12 patients, mostly children, with E-71 infection. The striking feature of this outbreak is the occurrence of two cases with polio-like paralytic disease. Other diseases associated with E-71 included aseptic meningitis, meningoencephalitis, respiratory disease, gastroenteritis, and hand-foot-mouth disease. The spectrum of illness observed in our community was compared to that seen in other outbreaks. It is suggested that the significance of E-71 lies in its neuropathogenic potential.
Determinants of Neurobehavioral Outcome in Low-Birth-Weight Infants
Authors: Lipper Evelyn , Lee Kwang-Sun , Gartner Lawrence M. , Grellong Bruce
Published: December 2021

The relative importance of (1) birth weight, gestational age, and head circumference at birth, and (2) appropriateness of birth weight and head circumference to gestational age in the predictability of neurobehavioral outcome was evaluated in 127 low-birth-weight infants at 7 months of age. Lower absolute birth weights, shorter gestational ages, and smaller head circumferences at birth correlated with poorer outcome (Bayley Scales of Infant Development and abnormal neurologic examination) at the corrected chronologic age of 7 months (r = .28 to .42, all P <.005). The incidence of low scores on the Mental Development Index and of severe neurologic deficit was significantly higher in small head circumference for gestational age infants than in appropriate head circumference for gestational age infants (both, P <.05). In the absence of small head circumference, small for gestational age infants had similar incidences of low Bayley scores and abnormal neurologic examinations as did appropriate for gestational age infants. These observations suggest that head circumference at birth may be the single most important variable for subsequent neurobehavioral outcome, and that both birth weight and gestational age may simply be markers of fetal head growth in their relationship to later outcome.
Progressive Sensory Loss in Familial Dysautonomia
Authors: Axelrod Felicia B. , Iyer Kamla , Fish Irving , Pearson John , Sein Mary Ellen , Spielholz Neil
Published: December 2021

Clinical variability in sensory impairment was demonstrated among 75 patients with familial dysautonomia. Older patients had a greater tendency toward increased dysfunction in pain sensation, joint position and Romberg's sign, and vibratory sense. Significant worsening with increased age was supported by retesting of 53 patients after a five-year interval. Sensory and motor axon loss were indicated by electrodiagnostic testing of peripheral nerves and abnormal cortical somatosensory evoked potentials. Familial dysautonomia is a hereditary disease with variable penetrance which involves both failure of intrauterine development of neurons and their postnatal maintenance.
Two-Dimensional Echocardiography for Catheter Location and Placement in Infants and Children
Authors: Perry Lowell W. , Galioto Frank M. , Blair Timothy , Shapiro Stephen R. , Ruckman Roger N. , Scott Lewis P.
Published: December 2021

This paper presents our experience with two-dimensional echocardiography in the detection of 61 intravascular catheters or wires in a series of 39 infants and children. It was possible to identify intravascular wires as small as 0.5 mm in diameter and intravascular catheters as small as 0.9 mm in diameter. In no instance, was an intravascular catheter not detected. The twodimensional echocardiogram is demonstrated to be a tool to assist the physician in placement of intravascular catheters. In the catheterization laboratory, the two-dimensional echocardiogram is useful in determining catheter location, particularly in the presence of complex congenital defects. Two-dimensional echocardiographic guidance of catheters minimizes exposure to ionizing radiation.
Transient Nephromegaly Simulating Infantile Polycystic Disease of the Kidneys
Authors: Stapleton F. Bruder , Hilton Saskia , Wilcox John , Leopold George R.
Published: December 2021

The discovery of bilaterally enlarged kidneys near the time of birth often portends a poor prognosis for renal function. Important diagnostic considerations include obstructive uropathy, renal venous thromboses, Wilms'tumor, infantile polycystic kidney disease, and renal multicystic dysplasia. In this report, we describe a child in whom enlarged bilateral kidneys were noted during the first day of life and to whom a presumptive clinical diagnosis of infantile polycystic kidney disease was incorrectly assigned, primarily on the basis of the excretory urogram. By 6 weeks of age, however, the kidney size was normal, and at 2 years of age, the boy remains in good health with radiographically normal kidneys.

CASE REPORT
Plant Fiber Intake in the Pediatric Diet
Authors: Barness Lewis A. , Daliman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W. , Anderson Betty E. , White Philip L. , Egan Mary C. , Cheney Margaret , Roy Claude C. , Moore Melinda , Chopra Joginder , Brown Myrtle L. , Sarett Herbert P. , Fjellstedt Thorsten J. , Teply L. J. , Kennedy Eileen , Darby Wffliam J. , Lewy Peter , Tomarelli Rudolph M. , Benson John D. , Purvis George A. , Licari Jerome , Lockhart Haines B. , Saperstein Sidney
Published: December 2021

Dietary fiber has been defined as the part of material in foods impervious to the degradative enzymes of the human digestive tract. The dietary fiber of plants is comprised of carbohydrate compounds including cellulose, hemicellulose, pectin, gums, mucilages, and a noncarbohydrate substance, lignin. These substances, which form the structure of plants, are present in the cell walls of all parts including the leaf, stern, root, and seed.1 Animal tissue also contains indigestible substances.

Crude fiber and dietary fiber are not the same thing. Crude fiber refers to the residue left after strong acid and base hydrolysis of plant material. This process dissolves the pectin, gums, mucilages, and most of the hemicellulose and mainly is a measure of the cellulose and lignin content. Clearly, this method tends to underestimate the total amount of fiber in the food.1 Most food composition tables give only crude fiber values.

Current interest in fiber was stimulated by the suggestion that it might help to prevent certain diseases common in the United States, namely diverticular disease, cancer of the colon, irritable bowel syndrome, obesity, and coronary heart disease.2-4 African blacks in rural areas where the fiber intake was high rarely had these diseases; however, during the past 20 years as this population moved to the cities and adopted Western habits (including a Western diet), they began to suffer from the same "Western-type" diseases.

A high-fiber diet increases fecal bulk, produces softer, more frequent stools, and decreases transit time through the intestine.5 These factors may be responsible for the supposed beneficial effects of fiber.
Incidence of Respiratory Distress Syndrome Following Antenatal Betamethasone: Role of Sex, Type of Delivery, and Prolonged Rupture of Membranes
Authors: Papageorgiou Apostolos N. , Colle Eleanor , Farri-Kostopoulos Evangelia , Gelfand Morrie M.
Published: December 2021

Premature male infants have a higher incidence of respiratory distress syndrome (RDS) than female infants (male/female = 1.7:1.) With the demonstration that antenatal use of betamethasone significantly reduces the incidence of RDS, a proportional reduction or possibly a complete elimination of the discrepancy between the two sexes might be expected. The role that sex, type of delivery, and prolonged rupture of membranes (PROM) may play in the development of RDS was tested in a prospective study of RDS prevention with betamethasone. A full course of betamethasone, ie, 12 mg, 24 hours apart, was given antenatally to 94 infants of 27 to 34 weeks gestation. The incidence of RDS in male infants was 29.1% vs 8.6% in female infants (P < .02). The incidence of RDS among male babies delivered by cesarean section (30.3%) or vaginally (29.7%) was not statistically different, nor was there a difference between those with PROM > 24 hours (26.9%) and those without PROM (31.8%). The same was true of the incidence of RDS among female infants: cesarean section (14.2%) vs vaginal delivery (6.2%) and PROM > 24 hours (8%) vs (9.5%) without PROM. We conclude that: (1) Prevention of RDS with betamethasone is far more effective in female infants. The natural ratio of male/female of 1.7:1 becomes 3.4:1. (2) Once lung maturity has been achieved with betamethasone, the type of delivery plays no role in the development of RDS. (3) PROM does not add extra protection from RDS in the 27- to 34-week gestational age range.