bluuebunny/crossref_metadata_2025 huggingface dataset:
Amikacin Pharmacokinetics in the Therapy of Childhood Urinary Tract Infection
Authors: Khan Abdul J. , Evans Hugh E. , Jhaveri Ramesh , Chang Chia T. , Hochstein Lisa
Published: December 2021

Amikacin, a new aminoglycoside antibiotic with a spectrum similar to that of gentamicin, has been used mainly in adults. This report summarizes the first use of this drug in children with urinary tract infection. Organisms were eradicated in all cases and recurrent infection occurred in one half after one week. No evidence of ototoxicity or nephrotoxicity was found. Four children developed transient elevation of serum glutamic oxaloacetic transaminase. Serum level (17 µg/ml) of the drug at one hour and its urinary excretion in six hours (60% of the dose) was comparable to those of adults. This antibiotic is potentially valuable and has thus far not shown major toxicity when given for up to 11 days in patients with normal renal and liver functions.
THE POWER OF MATERNAL IMPRESSION CAUSES THE ALLEGED FATHER'S NAME TO APPEAR IN LEGIBLE LETTERS IN HIS INFANT SON'S RIGHT EYE (1817)
Authors: C. T. E.
Published: December 2021

During the 19th century the question of maternal impressions was still unresolved. A curious example of the putative power of this phenomenon is given below. A similar instance was reported about 1825 by Dr. Munro of Edinburgh who frequently exhibited a child in whose eyes many persons imagined they could read the name and age of his father.

A young woman in Galloway [Scotland] having proved with child, laid the same to a respectable man of the name John Woods, who denied being the father of the same, and persisted in his denial saying that he would never acknowledge the child unless his name was written at full length on its face; and he accordingly gave his solemn oath before the court to that effect. This made so much impression on the mind of the young woman, who was present, that his name and person remained constantly in her mind's eye, and when the child was born, the name of the father appeared in legible letters in the child's eye, the name of "JOHN WOODS," on the right eye, and "BORN 1817" on the left eye. When John Woods, the alleged father, came to know this circumstance, he instantly absconded and has not since been heard of.

This wonderful child has now arrived in this city [Edinburgh], and has been inspected by the Professors and other learned Faculties of this city, and pronounced to be a most wonderful phenomenon of nature, and an astonishing dispensation of Providence in pointing out the truth against the wicked and perjured ways of men.
Pneumoesophagus as a Sign of H Type Tracheoesophageal Fistula
Authors: Smith Wilbur L. , Franken E. A. , Smith John A.
Published: December 2021

Two patients with H type tracheoesophageal fistulae demonstrated prominent pneumoesophagus and gaseous distention of the bowel after endotracheal intubation and positive-pressure ventilation. This report discusses the pathophysiology of these events and emphasizes the significance of these findings.
Methylphenidate Dosage
Authors: Millichap J. Gordon
Published: December 2021

The adverse reaction to a single 40-mg dose of methylphenidate in a 38-kg child reported by Sleator1 is unusual and resembles a response that I have observed in a milder form and reported previously in one child who received a daily dose of 40 mg administered in two equal divided amounts.2 This patient had difficulty in speaking and in moving his lips and tongue, associated with twitching movements of the face. Drug administration was continued in a lower dosage because hyperactivity was affected, and the untoward reactions were relieved.
Intravenous Lipid and Growth in Small Premature Infants
Authors: Malan Atties F. , Higgs S. C. , Heese H. De V.
Published: December 2021

The article by Cashore et al.1 reporting on nutritional supplements in infants weighing less than 1,500 gm at birth is most interesting. It is remarkably similar to a study carried out in Cape Town involving 86 infants.2 Both studies used parenteral lipid, protein hydrolysate, and glucose. The lipid (Intralipid, 10%) and protein hydrolysate (Amigen) were identical solutions. The purpose of this letter is to point out that comparable growth rates were achieved in both studies.
Dr. Rumack Replies
Authors: Rumack Barry H.
Published: December 2021

Dr. Little raises an interesting point which will have to be the object of further investigation. While the clinical course is similar in some respects, it may be difficult to pin down the diagnosis of acetaminophen poisoning. By the time the hepatic failure of acetaminophen toxicity occurs, little if any of the drug is on board for laboratory detection. Further, during the prodrome of Reye's syndrome, fever may be treated with therapeutic doses of acetaminophen.
BLADDER CONTROL AND ENURESIS. Edited by I. Kolvin, R.C. Mackeith, and S. R. Meadow. Philadelphia, JB Lippincott Co, $29.50; 328 pp
Authors: Friedman David B.
Published: December 2021

Bladder Control and Enuresis is described on its jacket as "a comprehensible review of enuresis." The book derives from a colloquium on "Recent Advances in Knowledge of Bladder Control in Children," held under the auspices of the Department of Psychological Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, England. The editors have selected certain topics and asked individuals to provide papers presenting a fusion of their own ideas and those put forward at the colloquium. The result is an important contribution to the field of developmental pediatrics.
Dr. Kendig Replies
Authors: Kendig Edwin L.
Published: December 2021

The technical aspects of tuberculin testing are extremely important. Not only must the tuberculin test be applied properly, but the reaction must be read and measured accurately.1 Two personal experiences should suffice as examples.

One evening a pediatrician was called to his office to see a patient of one of his associates. The child had a minor respiratory infection, but in the course of the examination a red papule was noted on the volar surface of one forearm.
Charles A. Janeway
Authors: H. R. J.
Published: December 2021

Charles A. Janeway, Thomas Morgan Rotch Jr. Professor Emeritus of Pediatrics, Harvard Medical School, was honored by Janeway Day, May 12, 1976, at the Children's Hospital Medical Center, Boston. The Blackfan Lecture, that day, was delivered by Dr. Janeway's close international friend, Professor Bo Vahlquist, and is published elsewhere in this issue. As a small tribute to a great leader in American pediatrics who continues an active career in retirement, we are pleased to publish commentaries on various but not all portions of "Charlie's" many careers. The more remarkable, in that they were all carried out at the same time!
Dr. Janeway and the University Center for the Health Sciences in Yaounde, Cameroon
Authors: Joseph Stephen C.
Published: December 2021

Beginning as a cooperative venture between the government of Cameroon and the World Health Organization in the late 1960's, the University Center for the Health Sciences (UCHS) in Yaounde was developed as a prototype institution for multiprofessional health education and training, intended to be responsive to the health problems of contemporary Africa.1

Cameroon, a country not atypical of sub-Saharan Africa, is characterized by subsistence agriculture, rural and increasing urban poverty, scarcities of trained manpower, fiscal, and logistic resources, rapid population growth, and pervasive high morbidity and mortality patterns emphasizing the interactions between early childhood malnutrition and infectious and parasitic disease.
Parental Visiting of Sick Infants: The Effect of Living at Home Prior to Hospitalization
Authors: Lampe John , Trause Mary Anne , Kennell John
Published: December 2021

Several studies have suggested the importance of keeping mother and infant together during the early post-partum period for the development of the mother-infant bond.1,2 Mother-infant contact soon after birth has been shown to have far-reaching consequences with effects demonstrable in mother-to-child speech at 2 years3 and affecting IQ in premature infants at 42 months.4 Prematurity and neonatal illness may separate the mother and infant and change the quality of their contact. After these separations there is a significant increase in the incidence of child abuse and failure to thrive in the absence of organic cause.5,6

The frequency of parental visiting was studied to determine the effects of a short period of care at home and the presence of a visible congenital anomaly on parent-to-infant attachment.
Optimism or pessimism for the victim of child abuse?
Authors: Cupoli J. Michael , Newberger Eli H.
Published: December 2021

The Contribution Of Elmer To Our Knowledge Of Child Abuse1 Brings Into Focus The Limited State Of Our Understanding Of The Long-Term Effects Of The Problem. We Know Too Little About The Impact Of Abuse On Children, And The Findings Of The Study Suggest That We Must Attend To The Social And Familial Circumstances Which Equally Affected The Outcomes Of Cases And Controls. The Study Concludes "That The Effects On Child Development Of Lower-Class Membership May Be As Powerful As Abuse."

Other Reports Of The Developmental Sequelae Of Child Abuse Have Emphasized A Range Of Physical, Emotional, Social, And Cognitive Pathology.2-7
Neonatal Thermography
Authors: Pomerance Jeffrey J. , Lieberman Ricardo L. , Ukrainski Christinia T.
Published: December 2021

Anterior and posterior view thermograms were recorded in 37 neonates. Studies were performed under a radiant heater servocontrolled to an abdominal skin temperature of 36.0 C. Heart, liver, and kidneys, being highly vascular structures, were detected as "warm" areas on the body surface. A longitudinal study of an infant with a patent ductus arteriosus and congestive heart failure demonstrated a generally cooler chest following a decrease in pulmonary artery blood flow accomplished by ductal ligation. Another infant demonstrated a unilateral warm area posteriorly over the left flank. At autopsy the right kidney and its vasculature were found to be moderately hypoplastic. Thermography may prove to be a simple noninvasive tool for routine screening in the neonate of highly vascular internal organs. Thermographic detection of renal malformation may offer considerable potential.
Recurring Digital Fibrous Tumors of Childhood: A Review
Authors: Beckett James H. , Jacobs Alvin H.
Published: December 2021

Two new cases that conform to the clinical and histopathological features of recurring digital fibrous tumor of childhood, described by Reye in 1965, are reported. This tumor, which is considered a distinct entity among the juvenile fibromatoses, characteristically presents in infancy and early childhood, involves only the digits, recurs frequently following surgical excision without metastatic spread, and demonstrates the distinct histopathological finding of intracytoplasmic inclusion bodies within proliferated fibroblasts. This tumor is reviewed with reference to clinical features, histopathology, etiological considerations, and management.
In Reply: A Question Regarding Validity of Questionnaire for Follow-up
Authors: Hein Herman A. , Ferguson Norma , Christopher M. Christina
Published: December 2021

We agree with the statement that "A direct follow-up assessment by team members would serve to more clearly document these findings and provide a far more valid comparison," but unfortunately time constraints made this type of a follow-up assessment prohibitive. The period of time required for us to complete a direct assessment would be something in the range of 18 months to two years. For this reason we chose to do the follow-up by a questionnaire, although the limits of this technique are obvious to all.
Photodistribution of Viral Exanthems
Authors: Cupoli J. Michael
Published: December 2021

I was asked to see an 8-year-old girl with a vesicular rash which on first observation appeared to be smallpox (variola), as all the lesions were at the same stage of development. In fact, the sheet-like distribution was confined to the back, and the abdomen and face had the typical appearance of chickenpox (varicella).

It was discovered that the patient and her brother (unrelated sibling by adoption) had both had a two-day prodrome, then had gone to the beach where they acquired a mild sunburn.
He Wonders
Authors: Lechelt Ronald K.
Published: December 2021

After reading the lengthy responses to the article on circumcision, I wish to make a suggestion: All letters regarding this weighty matter to be accepted by the editor and published must state the status of the author's penis.

My impression is that we would find that those of us in favor were circumcised as infants and probably subconsciously believe our parents were correct. Those who were "denied" this as infants now need to relieve their parents of this onerous burden. (Fiend?)
CYSTOURETHROGRAPHY: A RADIOGRAPHIC ATLAS. Edited by Marjorie Hertz. Amsterdam, Excerpta Medica, 1973, $44.20; 300 pp
Authors: Silverman Fredric N.
Published: December 2021

The volume is divided into three parts: the first is a general consideration of the subject, and the second and third parts show, primarily in atlas form, the author's experience with cystourethrography in children and in adults. There is a good bibliography and an effective index. The author initially discusses and illustrates radiologic anatomy and physiology of the bladder and urethra and describes in considerable detail techniques of examination. In the former, the author discards urethral shape in the female patient as an indication of pathologic change and considers all the variations which have previously been ascribed to meatal stenosis as normal variation.
Vesicoureteral Reflux in the Primate: II. Maturation of the Ureterovesical Junction
Authors: Roberts James A. , Riopelle Arthur J.
Published: December 2021

Infant rhesus monkeys frequently show vesicoureteral reflux unlike adults. We studied monkeys born of mothers who had been on normal or protein-deficient diets. Protein deficiency may influence the time that reflux continues, but this was not statistically proved.

Reflux disappears over time. The time was influenced by when the pregnancy was initiated and the maturity of the infant.

Maturation as measured by skeletal maturity scores correlated well with the time of reflux, but growth as measured by birth weight did not.

Vesicoureteral reflux in the monkey is frequent, but maturation of the ureterovesical junction occurs by age 3 years and reflux disappears.
Ampicillin Rashes
Authors: Sokoloff Burton
Published: December 2021

Ampicillin is generally considered the drug of choice in the treatment of otitis media in children under age 5.1 For this and other reasons it has become a frequently prescribed and yet still effective drug. The maculopapular rash that often accompanies its use is well known. My personal experience shows (disturbingly) that an increasing number of pediatricians are erroneously considering this benign rash as an allergic reaction not only to ampicillin but to penicillin as well.
PEDIATRIC NEUROPATHOLOGY. By Joseph F. Smith. New York, McGraw-Hill Book Co, 1974, $12.95; 266 pp
Authors: Gilles Floyd H.
Published: December 2021

In tackling the abnormalities of development of this most complicated of structures, Smith has done a service to his colleagues by collating literature, pointing out major adverse events during the growth of the brain, and giving examples of abnormality of developing brain derived from his own extensive experience. In this volume he has presented briefly some of the classic concepts of neuropathology as applied to the developing brain to satisfy his goal of giving this information in a concise form.
The Respiratory Mechanism of Aerosol Inhalation in the Treatment of Partial Airway Obstruction
Authors: Sasaki Clarence T. , Suzuki Masafumi
Published: December 2021

There is a sensory system within the mucosa of the nose and supraglottic larynx that appears to be both mechanosensitive and chemosensitive. Our data suggest that the respiratory modification produced by microaerosol inhalation represents a mechanoreceptor rather than chemoreceptor response. Furthermore, the sensitivity of this reflex system appears age-dependent, the data indicating a more active response early in life.

From a clinical perspective, it is postulated that aerosol inhalation reflexly alters the pattern of breathing, resulting in improved respiratory flow rates during partial upper airway obstruction. The mechanism of a favorable clinical response to mist inhalation has not been previously appreciated in this context.
Soy Protein Intolerance: Four Patients With Concomitant Cow's Milk Intolerance
Authors: Whitington Peter F. , Gibson Richard
Published: December 2021

An infrequently encountered and poorly understood infantile disorder is gastrointestinal soy protein intolerance. Four patients who had intractable diarrhea of infancy and who failed to thrive were tested by oral challenge with soy protein isolate and were found to have soy protein intolerance. All four exhibited concomitant sensitivity to cow's milk protein. The response to challenge with soy protein included diarrhea, vomiting, hypotension, lethargy, and fever. These symptomns were immediate, of short duration, and occurred with each subsequent challenge dose. No patient exhibited cutaneous, pulmonary, or hematologic evidence of allergy although it was prominent in their families. A diet devoid of intact soy and cow's milk protein allowed symptomatic recovery and rapid weight gain. Oral disodium cromoglycate therapy was ineffective in one trial. Soy protein intolerance should be suspected in infants with diarrhea resistant to therapy with soy based formulas.
Nursing Bottle Caries
Authors: Shelton Preston G. , Berkowitz Robert J. , Forrester Donald J.
Published: December 2021

Feeding habits affect dental health and ultimately the total health of young children. There is mounting concern among pediatric dentists about the increased incidence of nursing bottle caries in patients younger than 3 years old. Nursing bottle caries, nursing bottle syndrome, or bottle-propping caries are synonymous terms for a devastating condition that may render young children dental cripples. Typically, the primary maxillary incisors are affected most severely. The primary first molars are second in frequency; the most remarkable finding is that the mandibular incisors are seldom involved (Fig. 1 and 2). This is thought to be related to the protective effect of the tongue during suckling.
Roentgenographically Visible Fatty Liver in Cystic Fibrosis
Authors: Gibson Burney , Levin Daniel , Currarino Guido , Weinberg Arthur
Published: December 2021

Fatty infiltration of the liver of sufficient severity to become detectable by roentgenographic examination is an uncommon observation. Only eight cases have been reported1 and another eight have been mentioned in the literature.2,3 Six of these patients had cystic fibrosis. During the past two years we have observed three similar cases of fatty liver diagnosed roentgenographically. All three patients had cystic fibrosis and a grossly fatty liver was confirmed at autopsy. This apparent high incidence of cystic fibrosis and roentgenographically visible fatty liver prompted us to evaluate this relationship further by reviewing the initial roentgenogram of all patients with cystic fibrosis who were admitted to the Children's Medical Center during the past five years.

See table in the PDF file
Circumcision and Obstructive Renal Disease
Authors: Linshaw Michael A.
Published: December 2021

I would like to change the emphasis of one statement by the Committee on Fetus and Newborn in the summary report on circumcision that appeared in the October 1975 issue (p. 610). In the section on surgical risks and aftermaths, the report states that "meatal stenosis is seldom, if ever, associated with hydronephrosis or other objective evidence of urinary tract obstruction...." A practicing physician who reads this might dismiss meatal stenosis as having little clinical significance and could possibly overlook this complication.
BIRTH DEFECTS: MODERN APPROACHES TO DIAGNOSIS AND PREVENTION (Proceedings of the Fourth International Conference, Vienna, September 2-8, 1973). Edited by Arno G. Motulsky and W. Lenz. Amsterdam, Excerpta Medica, 1974, $40.40
Authors: Woolley Paul V.
Published: December 2021

The final plenary grouping, entitled Modern Approaches to Diagnosis and Prevention, could stand by itself as a monograph. There are four articles covering prenatal diagnosis and three updating data on current screening programs, including a progress report upon what has been to me one of the most dramatic epidemiologic approaches to voluntary control of genetic disease-the Baltimore-Washington detection program for Tay-Sachs heterozygotes. Essays on genetic counseling by two outstanding scholars, C. O. Carter and J. H. Edwards, conclude this section. The final paragraph of Dr. Edwards' essay might well be engrossed in red, illuminated, and hung upon the office wall of those undertaking any form of counseling: "genetic counseling and foetal selection are unlikely to have much effect on the frequency of the underlying determinants of disease, and must be justified on grounds of private, rather than public, benefit. An extension of either activity into the field of normal variation may have serious consequences at the population level and can confer little benefit at the private level."

During my reading of this book I was tempted on several occasions to make trite reference to Orwell and Huxley, or at least to the contemporary dictum of informed consent. In the end this proved completely unnecessary, since the final contribution before Professor Lenz' summary is an excellent essay by Arno Motulsky on the ethical issues of birth defects. This should be required reading for all students of genetics or medicine, and-above all-for those workers in the information media who compose or reconstruct learned pontifications.
The Lack of Effects of Phototherapy on Neonatal Oxygen Dissociation Curves and Hemoglobin Concentration in Vivo
Authors: Chandler Barry D. , Cashore William J. , Monin Pierre J. P. , Oh William
Published: December 2021

Phototherapy has been shown to cause hemolysis of fetal red cells and a shift to the right in the neonatal oxygen dissociation curve (ΔP50) in vitro. To determine if these parameters act similarly in vivo, we have studied 16 icteric infants before and after phototherapy and compared them with eight control infants studied at birth and at 3 days of age, measuring the change in P50, 2,3-diphosphoglycerate (2,3-DPG), serum bilirubin, the percent of bilirubin/albumin saturation, and the hemoglobin concentration in the two groups.

Following phototherapy, in the icteric infants there was a shift to the right in the O2 dissociation curve of + 1.7 mm Hg, a rise in 2,3-DPG of 2.26 µmol/gm Hb, a fall in serum bilirubin of 4.3 mg/100 ml, a decrease in percent bilirubin/albumin saturation of 12.4%, and a drop in hemoglobin of 1.1 gm/100 ml. The control group showed a ΔP50 of + 2.0 mm Hg, a rise in 2,3-DPG of 3.67 µmol/gm Hb, an increase in serum bilirubin of 3.2 mg/100 ml, an increase in percent bilirubin/albumin saturation of 9.3%, and a fall in hemoglobin of 0.3 gm/100 ml. Significant differences between the groups were seen only in the changes in bilirubin concentration and percent bilirubin/albunmin saturation. The magnitude of changes in P50, 2,3-DPG, and hemoglobin concentration was similar in the phototherapy and control groups and was related to the expected changes with reference to postnatal age. These results suggest that phototherapy in vivo neither affects fetal erythrocytic affinity for oxygen nor causes hemolysis.
Neonatal Radial Artery Puncture: A Teaching Simulator
Authors: Schreiner Richard L. , Gresham Edwin L. , Gosling Craig G. , Escobedo Marilyn B.
Published: December 2021

Respiratory diseases of the newborn continue to be major contributors to neonatal mortality and morbidity. When caring for a sick newborn who requires supplemental oxygen or when evaluating an infant with cyanosis, it is imperative to determine the arterial partial pressure of oxygen (PO2) to prevent the damage that may result from either hypoxia or hyperoxia.

See image in the PDF file

The technical difficulties encountered when monitoring arterial blood gases in newborns, especially in small premature infants, are well known. Possible sites of blood sampling include: (1) radial, brachial, temporal, dorsal pedal, and posterior tibial arteries; (2) umbilical arteries; and (3) capillaries ("arterialized"). "Capillary" or "arterialized" samples are satisfactory for determination of PCO2 and pH but are probably inadequate for accurate PO2 values.
The answer is no
Authors: Korsch Barbara M.
Published: December 2021

Can we identify a group of children at age 2 who are at high risk for emotional disturbance and behavioral problems at school age? In Dr. Chamberlin's careful observations of a group of children (p. 971), no behaviors were documented at age 2 that were strong predictors of these children's adaptation to the school situation two or three years later. There were not even any strong relationships noticed between early and later behaviors within the home setting, or between observations made in the home and in school at approximately the same time! These findings are extremely important and should be heeded by all those involved in planning programs for mental health intervention targeted at high risk populations.
BIOMEDICAL RESEARCH PAYS OFF
Authors: Comroe J. H. , Dripps R. D.
Published: December 2021

Our analysis showed . . . 41% of all work judged to be essential for later clinical advance was not clinically oriented at the time it was done. The scientists responsible for these key articles sought knowledge for the sake of knowledge. . . . Our data show that clinical advance requires different types of research and development and not one to the exclusion of the other. . . . Our data compel us to conclude (1) that a generous portion of the nation's biomedical research dollar should be used to identify and then provide long term support for creative scientists whose main goal is to learn how living organisms function, without regard to the immediate relation of their research to specific human diseases; and (2) that basic research, as we have defined it, pays off in terms of key discoveries almost twice as handsomely as other types of research and development combined.
Twelve Years' Experience With Bronchopulmonary Dysplasia
Authors: Edwards David K. , Dyer Wayne M. , Northway William H.
Published: December 2021

A retrospective study of 299 successive infants who were ventilated for respiratory distress syndrome (RDS) showed that 62 (21%) developed radiographic stage IV bronchopulmonary dysplasia (BPD). The largest, most mature, and least ill infants tended to survive without developing BPD; the smallest, least mature, and most ill infants tended to die without developing BPD. The patients who developed BPD tended to be intermediate in terms of weight, maturity, and severity of disease; they required longer exposures to elevated oxygen and assisted ventilation than patients who did not develop BPD. The data suggest that in addition to varying individual susceptibility (primarily degree of immaturity and initial severity of disease), elevated oxygen is more important than mechanical ventilation in the pathogenesis of BPD.
CHARLES DICKENS'S DESCRIPTION OF HIS VISIT TO A FREE SCHOOL IN CINCINNATI IN 1842
Authors: C. T. E.
Published: December 2021

Charles Dickens (1812-1870) was among the first of several English writers who visited the United States during the 1840s and 1850s. The description below of his visit to a free school in Cincinnati was included in his American Notes which Dickens wrote in 1842 upon completion of his six months' visit to our country.

Cincinnati is honorably famous for its free schools, of which it has so many that no person's child among its population can, by possibility, want the means of education, which are extended, upon an average, to four thousand pupils annually. I was only present in one of these establishments during the hours of instruction. In the boy's department, which was full of little urchins (varying in their ages, I should say, from six years old to ten or twelve), the master offered to institute an extemporary examination of the pupils in algebra; a proposal which, as I was by no means confident of my ability to detect mistakes in that science, I declined with some alarm. In the girl's school, reading was proposed; and as I felt tolerably equal to that art, I expressed my willingness to hear a class. Books were distributed accordingly, and some half dozen girls relieved each other in reading paragraphs from English history. But it seemed to be a dry compilation, infinitely above their powers; and when they had blundered through three or four dreary passages concerning the treaty of Amiens, and other thrilling topics of the same nature (obviously without comprehending ten words), I expressed myself quite satisfied.
Continuous Airway Pressure Breathing With the Head-Box in the Newborn Lamb: Effects on Regional Blood Flows
Authors: Gabriele G. , Rosenfeld C. R. , Fixler D. E. , Wheeler J. M.
Published: December 2021

Continuous airway pressure delivered by a head-box is an accepted means of treating clinical hyaline membrane disease. To investigate hemodynamic alterations resulting from its use, eight newborn lambs, 1 to 6 days of age, were studied at 6 and 11 mm Hg of positive pressure, while spontaneously breathing room air. Organ blood flows and cardiac output were measured with 25 µ-diameter radioactive microspheres. Heart rate, left ventricular pressure, and arterial blood gases did not change during the study. Jugular venous pressures increased from 6.4 mm Hg to 18.6 and 24.2 mm Hg at 6 and 11 mm Hg, respectively (P < .005). Cardiac output decreased approximately 20% at either intrachamber pressure setting. Renal blood flow fell 21% at 11 mm Hg. No significant changes in blood flow were found in the brain, gastrointestinal tract, spleen, heart, or liver when compared to control flows. Of particular interest was the finding of a 28% reduction in ocular blood flow at 6 mm Hg and 52% at 11 mm Hg. From these results, we conclude that substantial cardiovascular alterations may occur during the application of head-box continuous airway pressure breathing, including a significant reduction in ocular blood flow.
Effect of Exchange Transfusion on Bilirubin Binding
Authors: Valaes Timos , Hyte Marilyn
Published: December 2021

The bilirubin titration point-the lowest bilirubin concentration at which loosely bound bilirubin could be demonstrated by Sephadex gel filtration-was determined in samples collected before, during, and on completion of 17 exchange transfusions as well as in the discarded and donor blood. The bilirubin titration point expressed either as bilirubin concentration or as bilirubin/albumin molar ratio failed to be increased by the exchange transfusion and, in each case at the end of the procedure, the titration point was below the expected level, assuming that the donor albumin was going to retain its binding properties in the infant's circulation. The bilirubin titration point was also depressed in the discarded blood, and the depression was inversely related to the amount of bilirubin removed by the exchange transfusion (expressed as mg/kg of body weight/mg of initial bilirubin concentration). These results are interpreted as an indication that interfering substances are responsible for the decreased binding of bilirubin in newborn, particularly preterm, infants. In practical terms the criteria for a repeat exchange transfusion should be the same as for the initial one, as no change in the bilirubin binding properties of the serum is likely to occur following exchange transfusion.
Hemoglobin-Oxygen Equilibrium in Cystic Fibrosis
Authors: Rosenthal Amnon , Khaw Kon Taik , Shwachman Harry
Published: December 2021

A study of 35 patients with cystic fibrosis demonstrated that increasing severity of pulmonary involvement was associated with a mild but definite increase in erythrocyte 2,3-diphosphoglycerate (2,3-DPG) and a decrease in hemoglobin affinity for oxygen. The predominant regulators of 2,3-DPG were blood pH, cardiac output, and systemic oxygen transport. No significant relationship was observed between erythrocyte 2,3-DPG content and arterial oxygen tension. Hypophosphatemia may have prevented a greater increase in erythrocyte 2,3-DPG content. The inadequate increase in 2,3-DPG and consequent insufficient change in hemoglobin-oxygen affinity, coupled with an insufficient compensatory erythrocytic response, may adversely affect tissue oxygenation in patients with severe cystic fibrosis.
Sjögren's Syndrome in Children
Authors: Athreya Balu H. , Norman Michael E. , Myers Allen R. , South Mary Ann
Published: December 2021

Sjögren's syndrome is a relatively uncommon condition in the pediatric age group. The clinical and immunological features of this disease in childhood have not been adequately described in the literature. Herein, we present details of the clinical features and results of laboratory investigations including minor salivary gland biopsy, parotid scintigraphy, and renal biopsy on two children with Sjögren's syndrome associated with systemic lupus erythematosus.
Skateboard Safety
Authors: Rudisch Gloria A. , Palfrey Judith S.
Published: December 2021

Homemade skateboards have been a passion of children for many years. Formerly these were relatively slow-moving, clumsy objects which children sat or kneeled on for scooting along on sidewalks. Recently, manufactured, high-speed, sleek versions intended for standing "Snoopy" fashion and zooming downhill have been marketed with great success. Serious accidents directly related to skateboards are appearing in such numbers among the school-aged children in Brookline, Massachusetts, that we feel it important to report the hazards of this new product.
The Role of Tocopherol in Oxygen-Induced Retinopathy: Kitten Model
Authors: Phelps Dale L. , Rosenbaum Arthur L.
Published: December 2021

The effect of tocopherol (vitalnin E) on oxygen-induced retinopathy was studied in 75 kittens following the development of a 12-point scoring system to quantitate the degree of retinopathy seen at three weeks. The tocopherol was found to be beneficial when given daily from the day of birth (P < .0001) with oxygen exposures of two to three days (79% F1O2) beginning on day 3. Caution is urged in applying these data to humans because (1) hepatosplenomegaly was noted in the treated animals, and (2) the kitten model of oxygen-induced retinopathy is not entirely satisfactory,
Incest: Review and Clinical Experience
Authors: Nakashima Ida I. , Zakus Gloria E.
Published: December 2021

In diagnosing incest, a high index of suspicion is of the greatest importance. Given the reluctance of professionals to consider this possibility and the unwillingness of the family to reveal its pathology, incest becomes doubly difficult to identify.

In a pediatric setting the victim of incest may be the young girl who presents with a variety of physical or psychosomatic or behavioral complaints. Her family may appear to be stable and well functioning, or they may have many problems obvious to the community because of their acting-out. In either situation, family dynamics may reveal an inadequate sexual relationship between the parents, condoning of the incest by the mother, and denial of this behavior by all individual members who fear exposure and resultant family disintegration.

Incest arises as a symptom of severely distorted family relationships and can inflict considerable psychological damage on the child involved in this pathological triangle. This is particularly true when the girl is an adolescent. For these reasons, professionals who deal with children need to have a heightened awareness of the possibility of incest so it can be identified and reported to the appropriate authorities, and intervention instituted.
Fisher's Syndrome in Children
Authors: Marks Harold G. , Augustyn Phillip , Allen Richard J.
Published: December 2021

Fisher's syndrome is characterized by ophthalmoplegia, ataxia, and areflexia. The clinical course is usually benign with complete recovery. We report a case that developed following a bee sting and review the literature of Fisher's syndrome in children. Its history, pathogenesis, and relationship to Guillain-Barré syndrome are also discussed.
Apnea Monitor Failure in Infants With Upper Airway Obstruction
Authors: Warburton David , Stark Ann R. , Taeusch H. William
Published: December 2021

Obstruction of the upper airway in infants may be associated with continued respiratory efforts without air entering the lungs.1-4 Our clinical experience has led us to suspect that some apnea monitors in current use are unable to differentiate between these ineffective respiratory efforts and true breathing. To document this deficiency of apnea monitors, we examined the response of two types of apnea monitors to respiratory movements during upper airway obstruction.

SUBJECTS AND METHODS

Five healthy full-term infants were studied during the first three days of life, and two premature infants in stable condition (birth weight, 1.32 kg and 1.30 kg; gestational age, 32 weeks) were studied at 25 days of age when they no longer had apnea associated with bradycardia in the nursery.
Nursing Bottle Caries
Authors: Richardson Barbara D. , Cleaton-Jones Peter E.
Published: December 2021

The report of Shelton et al. on nursing bottle caries (Pediatrics 59:777, May 1977), which was described as a "devastating condition that may render young children dental cripples," was of great interest to us. We have recently made a study of dental caries and sucrose intake in a series of South African black and white preschool children. The condition so lucidly described by the above workers is identical to the labial caries noted in the canine and incisor teeth in our groups.1 In children under 3 years, the prevalence of labial caries in a black rural group of 109 children was 12.8%; this proportion was not significantly greater than found in 122 white urban children, namely, 9.8%.
The Heimlich Maneuver as an Aid in Endotracheal Intubation of Neonates
Authors: Milstein Jay M. , Goetzman Boyd W.
Published: December 2021

Neonates with acute respiratory failure and certain other clinical conditions may require emergency endotracheal intubation. During the procedure, one periodically encounters laryngospasm with the vocal cords tightly apposed to each other, resisting passage of the endotracheal tube. We have encountered four such neonates during the past 12 months. Two neonates suffered from severe birth asphyxia and required intubation in the delivery room. A third infant was intubated because of progressive hypoxemia and hypercarbia secondary to hyaline membrane disease, and the fourth was intubated for an elective surgical procedure. A brief period of forced expiration produced by a depression of the sternum, a modification of the Heimlich maneuver,1 opened the vocal cords, enabling a smooth, relatively atraumatic intubation in all four infants.
WINSTON CHURCHILL'S POIGNANT DESCRIPTION OF THE DEATH OF HIS NANNY
Authors: C. T. E.
Published: December 2021

Winston Churchill's nanny, Mrs. Everest, was engaged by the Randolph Churchills very soon after Winston was born in 1874. The depth of his love for Mrs. Everest and hers for him is shown in this passage from his My Early Life.

I travelled up to London to see her. She lived with her sister's family in North London. She knew she was in danger, but her only anxiety was for me. There had been a heavy shower of rain. My jacket was wet. When she felt it with her hands she was greatly alarmed for fear I should catch cold. The jacket had to be taken off and thoroughly dried before she was calm again. Her only desire was to see my brother Jack, and this unhappily could not be arranged. I set out for London to get a good specialist; and the two doctors consulted together upon the case, which was one of peritonitis. I had to return to Aldershot by the midnight train for a very early morning parade. As soon as it was over I returned to her bedside. She still knew me, but she gradually became unconscious. Death came very easily to her. She had lived such an innocent and loving life of service to others and held such a simple faith, that she had no fears at all, and did not seem to mind very much. She had been my dearest and most intimate friend during the whole of the twenty years I had lived.
Are Blood Gas Machines Safe for Use in the Intensive Care Nursery?
Authors: Hughes Walter T. , Cox Frederick
Published: December 2021

The article by Rapkin (Pediatrics 57:239, February 1976) describing a small epidemic of Pseudomonas cepacia infection in an intensive care nursery adds further support to the germ theory of Pasteur, Koch, Lister, and others, which ascribes to the concept that microorganisms cause disease. Indeed, even the observations of Semmelweis1 deserve second thoughts. Rapkin's excellent piece of detective work and the appropriate action taken are commendable. His summation that "Both professional and nonprofessional hospital personnel failed to oversee the appropriateness of handling of patient care materials" could perhaps be reiterated by many of us.
Pupillary Size in Infants
Authors: Romano Paul E.
Published: December 2021

Congratulations to Dr. Laor et al. on their study "Sympathetic Pupillary Activity in Infants" (Pediatrics 59:195, February 1977), which concludes that one cause for a relatively miotic pupil in newborns is that "in the first months of life the postganglionic sympathetic nerve releases less norepinephrine ... [which] may be due to a lower number of sympathetic neurons."

Pupil size is significantly larger in adulthood than infancy, whether pharmacologically dilated or not. However, neither these authors nor prior workers in this area mention what is probably the single most important reason for this change, the growth of the anterior segment of the eye.
When Should a Child Be in the Hospital?
Authors: Kafka H. L.
Published: December 2021

The answer to this question (Pediatrics 57:540, April 1976) I have frequently summarized to our residents and physicians in one sentence: The child needs to be admitted when home environment cannot provide circumstances granting improvement and recovery from an illness.

For the same reason, a child is ready for discharge when the services demanded for a child can be provided in the home environment.

I have forwarded Dr. North's article to our PSRO Committee as it seems to me the only reasonable approach to the problem.
Letter to the Editor
Authors: Fuld Gilbert L.
Published: December 2021

Dr. North's article in the section entitled "Pediatrics for the Clinician" has implications that are profoundly disturbing to a practicing pediatrician.

I disagree with several of his criteria. Although procedures requiring general anesthesia are best performed in a hospital, these patients do not necessarily require hospitalization. More significantly, I noted no allowance for admission when the major problem is not the severity of the illness itself, but the inability of the parent(s) to cope with the problem.
Dr. North Replies
Authors: North A. Frederick
Published: December 2021

Dr. Kafka has certainly captured the essence of what I tried to say in fewer words than I used. My criteria can be regarded as more detailed specification of his general principle. Dr. Fuld, Dr. Lathrop, and several others have questioned why "inability of parents to cope" was not considered as a separate criterion for "when should a child be in the hospital?" It should be a real and important factor in hospitalization decisions but, I would argue, not in itself be a criterion.
Multiple Vitamin Deficiencies in Association With Chronic Anticonvulsant Therapy
Authors: Klein Gordon L. , Florey James B. , Goller Vernon L. , Larese Ricci J. , Van Meter Quentin L.
Published: December 2021

Tolman et al. (Pediatrics 56:45, July 1975) and Crosley et al. (Pediatrics 56:52, July 1975) described rickets and osteomalacia complicating chronic anticonvulsant therapy. We recently cared for a 28-month-old black girl who not only developed the physical and roentgenographic stigmata of rickets while receiving long-term anticonvulsants, but who also demonstrated clinical evidence of cardiac beriberi and subclinical ascorbic acid deficiency.

The patient was receiving acceptable doses of phenobarbital, Dilantin, and Mysoline for infantile myoclonic seizures, was allegedly fed a full diet in the nursing home in which she was cared for, but did not receive vitamin supplementation.
Quality of Services to Children
Authors: Senn Milton J. E.
Published: December 2021

My recent experience in evaluating private and public institutions for the care and treatment of mentally retarded and emotionally disturbed children for the U.S. Department of Justice has demonstrated widespread abuses in programs dealing with such children.

Diagnoses of minimal brain damage, dyslexia, and mental retardation are made indiscriminately with a pseudoscientific assurance which permits children to be given medications inappropriately and in dangerous amounts. Drugs are used to control behavior which is often normative for the circumstances under which the children are being educated and reared.
Vioform Condemned
Authors: Hansson O.
Published: December 2021

I fully agree with Dr. Smith's concern about the use of ointments containing iodochlorhydroxyquin (clioquinol, Vioform) (Pediatrics 57:163, January 1976). In a child with generalized psoriasis locally treated with an iodochlorhydroxyquin ointment, 18.1 mg/100 ml of the conjugated (glucuronic acid ester) drug was found in the urine.1 After the first suspicion that iodochlorhydroxyquin could result in optic atrophy,2 several reports from different countries have appeared. Furthermore, the SMON (subacute myelo-optico neuropathy) catastrophe with thousands of victims in Japan has brutally shown the dangers of this drug.
Drs. McCarthy and Dolan Reply
Authors: McCarthy Paul L. , Dolan Thomas F.
Published: December 2021

We recognize that the cost of blood cultures in our institution is reasonable and reflects the frequent use we make of this diagnostic procedure.

Our data show that a repeated positive blood culture occurred more frequently in children who were not treated initially with antibiotics. We cannot agree that the child with, for example, pneumonia or otitis media who is started on a regimen of oral antibiotics and subsequently found to have a positive blood culture is not at increased risk.
Camphor Dangers
Authors: Rockoff Alan S.
Published: December 2021

A child was admitted to our hospital after ingesting Campho-Phenique, an over-the-counter preparation for the "treatment" of cold sores and fever blisters. Although the child remained well, we were appalled to discover that this innocuous-looking medicine, unadorned by a conspicuous warning or childproof cap, is potentially lethal in a dose of one or two teaspoons! It contains not one, but two potential poisons: 45 ml contains enough phenol to possibly kill a child, but 10 ml has enough camphor to do it first.