bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to the Editor
Authors: Fallot Mary , Oski Frank A.
Published: December 2021

We wish to thank the writers for taking the time to reanalyze our report and point out that our data merely justify the statement that bottle-feeding increases the risk of hospitalization only among private patients. We hope that we will ultimately be able to have a sufficiently large population of clinic patients who are breast-fed in order to determine whether breast-feeding can be shown statistically to confer protection in this group as well.

We can assure Dr Margolis that a selection bias was not operative.
Hyperlipidemia Screening and Semmelweis Re-revisited
Authors: Holtzman Neil A.
Published: December 2021

Dietary modification can lower lipid levels in children, but will such modification, or therapeutic intervention, lower the probability of developing future coronary heart disease? The answer is still not in, as Dr Glueck well knows. "...diet-heart trials have not unequivocally proved or disproved the underlying hypothesis that cholesterol-lowering leads to reduced incidence of atherosclerotic disease." Moreover, "there is no evidence, either observational or experimental, that conclusively demonstrates a causative relationship between dietary fat per se and human and atherosclerotic disease."1

Faced with an unproved hypothesis pediatricians have four choices: (1) make no recommendation regarding diet changes; (2) Advocate a prudent diet to all families; (3) Screen for hypercholesterolemia and recommend diet changes and other measures to those with high levels; (4) Intervene, either by screening or by diet modification without screening, in only those children with a strong family history of coronary heart disease.
Aflatoxin and Reye's Syndrome: A Case Control Study
Authors: Nelson David B. , Kimbrough Renate , Landrigan Philip S. , Hayes A. Wallace , Yang George C. , Benanides Jeannette , Morens David M. , Morse Dale , Pollack Marjorie , Powell Kenneth E. , Sullivan-Bolyai John Z.
Published: December 2021

Aflatoxin levels were determined in serum and urine of 17 patients with Reye's syndrome and in control subjects. No significant difference in aflatoxin levels was found for the two groups. However, 23% of all persons studied had levels of aflatoxin indicative of recent exposure. Aflatoxin levels were associated with ingestion of cornmeal and corn bread but not peanut-containing products. This prevalence of aflatoxin may be of public health importance.
Prostaglandins in Human Milk
Authors: Reid Barbara , Smith Harilyn , Friedman Zvi
Published: December 2021

Levels of prostaglandin E2 and prostaglandin F2α were measured by radioimmunoassay in aliquots of foremilk and hindmilk obtained at different stages of lactation (colostrum, transitional, and mature milk) from six healthy nursing mothers who delivered at term. Immunoeactive prostaglandin E2 and prostaglandin F2α were detected in all fresh human milk samples, but not in cows' milk-based formulas. Further studies are necessary to investigate the role of these hormones in the physiologic function, the extrauterine adaptation, and the cytoprotective effect on the gastrointestinal tract in the breast-fed human infant.
An Explosive Outbreak of Mycoplasma pneumoniae Infection in a Summer Camp
Authors: Broome C. V. , LaVenture M. , Kaye H. S. , Davis A. T. , White H. , Plikaytis B. D. , Fraser D. W.
Published: December 2021

An outbreak of Mycoplasma pneumoniae infection occurred in the summer of 1978 in a boys' camp in northern Wisconsin and affected 139 of 196 persons (71%); 115 (59%) had laboratory evidence of infection. In 77% of the cases, onset of disease occurred within three weeks after arrival at camp, in contrast to the usually indolent spread of the disease. Attack rates decreased with increasing age. The sensitivity of serology for detecting M pneumoniae disease may have been as low as 79%. There was shorter duration of cough in those treated with erythromycin within four days after onset of symptoms.
Infant Botulism: Clinical Spectrum and Epidemiology
Authors: Thompson Joel A. , Glasgow Lowell A. , Warpinski James R. , Olson Christopher
Published: December 2021

Between 1977 and 1979, 12 cases of infant botulism were diagnosed in Utah, and 87 control patients (normal, nonbotulism neurologic disease, and nonbotulism systemic disease) were evaluated. Observations from these patients suggest an expanded clinical spectrum of infant botulism including asymptomatic carriers of organism; mild hypotonia and failure to thrive; typical cases with constipation, bulbar weakness, and hypotonia; and children with a picture compatible with sudden infant death syndrome. Clostridium botulinum was isolated from the stools of three normal control infants and nine control infants who had neurologic diseases that were clearly not infant botulism. These infants were termed "asymptomatic carriers" of the organism. The occurrence of the asymptomatic carrier state suggests that a diagnosis of infant botulism cannot be made on a basis of culture results alone, but must rest in historical documentation and physical confirmation of progressive bulbar and extremity weakness with ultimate complete resolution of symptoms and findings over a period of several months. A common set of environmental features characterizes the home environment of children with infant botulism and "asymptomatic carriers" and includes: nearby constructional or agricultural soil disruption, dusty and windy conditions, a high water table, and alkaline soil conditions.
Effect of Dietary Protein and Carbohydrate on Theophylline Metabolism in Children
Authors: Feldman Charles H. , Hutchinson Vincent E. , Pippenger Charles E. , Blumenfeld Thomas A. , Feldman Bernard R. , Davis William J.
Published: December 2021

Theophylline metabolism can be altered by a variety of abnormal physiologic states as well as by exogenous factors. Adult studies demonstrate a significant influence of dietary composition on theophylline biotransformation. To examine this effect of diet, 14 children with bronchial asthma were studied during long-term theophylline administration. Each patient was maintained for 12 days on three separate diets with varying proportions of protein and carbohydrate and with constant calories and fat. Results showed significant differences in drug half-life and metabolic clearance rate parameters. Compared to the normal diet, high protein diet markedly decreased the half-life, and high carbohydrate diet greatly prolonged it (P < .001). Multiple regression analysis demonstrated these differences to correlate only with the dietary alterations. Adverse reactions and blood chemistry abnormalities were not detected during any test period. These findings firmly establish that nutritional factors exert a significant influence on theophylline pharmacokinetics in children.
Congenital Tuberculosis: Critical Reappraisal of Clinical Findings and Diagnostic Procedures
Authors: Hageman Joseph , Shulman Stanford , Schreiber Michael , Luck Susan , Yogev Ram
Published: December 2021

The recent pattern of immigration from Indochina and Latin America to the United States suggests that tuberculosis will remain a significant public health problem. Two infants recently seen with probable congenital tuberculosis prompted critical evaluation of the 24 cases of congenital tuberculosis reported in the English literature since the introduction of isoniazid in 1952. Failure to thrive, jaundice, and central nervous system involvement, all reported in previous reviews and textbooks to be very common, were unusual presenting manifestations. In contrast, hepatomegaly, a finding not mentioned in the recent literature, was common. Diagnostic procedures previously underutilized but found in this review to be useful included liver biopsy, biopsy of skin lesions when present, and cultures of gastric aspirates. Factors which enable differentiation of congenital from early postnatally acquired tuberculosis include (1) the presence of known maternal tuberculosis at delivery, (2) whether infant and mother were separated from birth until the onset of illness, and (3) whether other tuberculous exposure of the infant can be determined. Insufficient data prevent recommendation of a preferred regimen of drugs in addition to isoniazid for the treatment of congenital tuberculosis. However, the responses of our patients suggest that streptomycin can be omitted without hazard. Information regarding the long-term prognosis of survivors is lacking, but early diagnosis and institution of appropriate therapy has markedly decreased the mortality of this previously fatal disorder.
Neonatal Mercury Vapor Exposure in an Infant Incubator
Authors: McLaughlin John F. , Telzrow Robert W. , Scott Celia Mae
Published: December 2021

A healthy newborn infant acquired a substantial body burden of mercury by inhaling mercury vapor originating from a broken mercury expansion switch in the heating unit of an infant incubator. Highly toxic mercury vapor is produced in quantity by heating otherwise harmless metallic mercury. Switches and thermometers that contain mercury should be removed from infant incubators.
Evaluation of Short-Term Antibiotic Therapy in Children with Uncomplicated Urinary Tract Infections
Authors: McCracken George H. , Ginsburg Charles M. , Namasonthi V. , Petruska Mary
Published: December 2021

This study was designed to determine whether serum C-reactive protein (CRP) concentrations could be used to identify children with uncomplicated lower urinary tract infection who would respond favorably to short-term antibiotic therapy. A one-day or ten-day regimen of cefadroxil (30 mg/kg/day in two divided doses) was assigned randomly to 80 children who had acute urinary tract infection and CRP concentrations <28 µg/ml (CRP-negative group). Ten days of cefadroxil therapy was used to treat 44 children with urinary tract infection and CRP values ≥28 µg/ml (CRP-positive group). The clinical and laboratory characteristics of the children in the two CRP-negative therapy groups were similar to, but different from those of children with CRP-positive infections. Recurrent infections occurred significantly more often at four to five days after completion of therapy in CRP-negative children who received one day (44.4%) compared to ten days (20%) of cefadroxil therapy (P < .05). When data from this study were combined with those from our previously published investigation of short-term antibiotic therapy in CRP-negative children, a significantly larger percentage of recurrences was documented immediately after one or four days of antibiotics (79%) compared to recurrences after the standard ten-day regimen (4l%). Additionally, the total rate of recurrent infections for all children in both studies was significantly larger in those who received short-term therapy (48%) as opposed to conventional therapy (34%). These data indicate that short-term antibiotic therapy is less effective than the conventional ten-day regimen in children with CRP-negative urinary tract infection.
Motor Vehicle Occupant Injuries in Noncrash Events
Authors: Agran Phyllis F.
Published: December 2021

Data on injuries sustained by child occupants in motor vehicles occurring in noncrash events are generally unrecorded. This study was undertaken to ascertain the occurrence of medically confirmed injuries sustained by child occupants in motor vehicles as a result of noncrash events. Seventy-nine children were seen in the emergency room for evaluation of injuries that they incurred as occupants in motor vehicle incidents over a period of 18 months. The majority of injuries occurred in crash events. However, 18 (23%) were injured in noncrash events. These events included sudden stops, swerves, turns, and movement of an unrestrained child within the vehicle. The mechanism of injury was either ejection from the vehicle or impact with an interior area of the vehicle. In five of the 18 cases safety restraint use could not be established. Of the 13 cases in which information was obtained, no child was restrained. Although the injuries were predominately minor (Abbreviated Injury Scale (AIS) 1), two children sustained moderate injury (AIS 2), and one child sustained severe injury (AIS 3). These results need to be confirmed by a larger study and if confirmed, the additional hazard of injury from noncrash events should be incorporated into health education messages that currently place primary emphasis on the potential for injury in crash events.
Retinopathy of Prematurity: An Estimate of Vision Loss in the United States—1979
Authors: Phelps Dale L.
Published: December 2021

The number of infants blinded from retinopathy of prematurity in the United States in 1979 is estimated to be 546, based on birth-weight-specific published survival statistics and ROP incidence data. Approximately 2,100 infants will be affected by cicatricial disease annually. A simple formula is presented that permits estimation of incidence data based on other regional data. It is suggested that increased attention be focused on this old enemy in order to document its incidence worldwide and to learn more about its prevention and treatment.
Ivory Tower Expense Calculations
Authors: Lighter Donald E.
Published: December 2021

The economic analysis of the residents' outpatient practice at Thomas Jefferson University Hospital (Pediatrics 66:91, 1980) piqued my interest, because I am firmly in favor of housestaff becoming better versed in the financial vicissitudes of private practice. I respectfully would like to offer a few suggestions that I feel would make the study more valid and provide a better teaching model for residents.

First, the program should stand on its own financial merits, and the hospital subsidies should be excluded in the economic analysis of self-sufficiency.
Letters to the Editor
Authors: Weiss Jeffrey C. , De Jong Allan R.
Published: December 2021

We read Dr Lighter's letter with interest and thank him for the helpful suggestions regarding accounting methods.

Our analysis reflects the nature of our educational model in a university setting, which cannot always be compared to a private practice. We cannot compete with the hospital laboratory and cannot charge for immunizations (we get vaccines free from the Philadelphia Health Department). In addition, patient fees, which are determined by the hospital administration, are much lower than those of practicing pediatricians.
Letters to the Editor
Authors: Turkel Susan Beckwitt
Published: December 2021

We wish to thank Drs Valaes and Gellis for their comments on our paper, in general, we agree with them. We have just completed the second half of our study of the same matched infants with and without kernicterus at autopsy, in which we addressed the neuropathologic changes observed in both groups of infants. Our findings support the conclusions of Valaes and Gellis and emphasize that kernicterus may not always be "the definitive evidence of bilirubin toxicity," as has been previously thought.
Relative Importance of Bacteremia and Viremia in the Course of Acute Fevers of Unknown Origin in Outpatient Children
Authors: Murray D. L. , Zonana J. , Seidel J. S. , Yoshimori R. N. , Imagawa D. T. , St Geme J. W.
Published: December 2021

During a 12-month period 80 children >3 months of age seen at an emergency room with acute fevers ≥39.7 C (103.5 F) and no localizing signs of infection were studied using blood and buffy coat cultures to isolate bacteria and viruses. Bacteremia was identified in three children (3.8%): two with Streptococcus pneumoniae and one with Neisseria meningitidis. Two children with viremia were identified: both isolates were ECHO virus, types 11 and 21, respectively. Fifty-eight of the study children (72%) were seen again in 24 to 48 hours and 27/58 (46%) were afebrile and completely well. No differences in sex, age, or initial WBC count existed among those children who returned afebrile and well and those with either localized disease or those persistently febrile.
REGISTRY OF PEPTIC ULCERS
Authors: Tudor Robert B. Tudor B.
Published: December 2021

The Registry of Peptic Ulcers in Children which publishes a yearly review plus reviews of the Zollinger-Effison Syndrome, Surgical Summary, and a Summary of Stress Ulcer literature would like to have reports of childhood peptic ulcers, either primary ulcers or secondary ulcers, which you see and which you have not reported in the literature.
Neonatal Polycythemia: II. Plasma, Blood, and Red Cell Volume Estimates in Relation to Hematocrit Levels and Quality of Intrauterine Growth
Authors: Brans Yves W. , Shannon Donna L. , Ramamurthy Rajam S.
Published: December 2021

Volumes of plasma (PV), blood (BV), and red cells (RCV) were estimated within 32 hours of birth in 39 neonates with normal growth, 14 neonates with intrauterine growth retardation, and 20 neonates with macrosomia. Total PV, BV, and RCV increased linearly with birth weight and were unaffected by deviation in the quality of fetal growth. In proportion to body weight, PV/kg, BV/kg, and RCV/kg correlated neither with birth weight nor with the quality of intrauterine growth. Neonates with umbilical vein hematocrit (UV Hct) levels 51% to 60%, 61% to 65%, and 66% to 77% had progressively lower, but not statistically different, mean PV/kg (38.1 ± 4.49, 37.6 ± 5.41, and 34.8 ± 5.16 ml/kg, respectively). On the other hand, they had progressively higher mean BV/kg (90 ± 10.1 vs 101 ± 13.7 ml/kg, P < .002, and vs 110 ± 19.0 ml/kg, P < .001). They also had progressively higher mean RCV/kg (52 ± 7.4, 64 ± 8.7, and 75 ± 16.4 ml/kg, P < .001). Although PV/kg did not correlate with UV Hct, both BV/kg and RCV/kg increased linearly with increasing UV Hct (r = .58 and r = .79, respectively). Volume estimates were repeated after partial exchange transfusion in 29 neonates. Mean UV Hct decreased from 63 ± 5.9% preexchange to 51 ± 5.2% postexchange (P < .001), mean PV increased from 37.7 ± 5.56 to 47.6 ± 7.99 ml/kg (P < .001) and mean RCV decreased from 67 ± 16.5 to 51 ± 12.3 ml/kg (P < .001). Despite precautions to keep the partial exchange isovolemic, mean BV decreased from 105 ± 18.7 to 98 ± 18.0 ml/kg (P = .001) and the mean PV increase (10 ml/kg) was less than the mean RCV decrease (16 ml/kg). These data suggest that neonates with polycythemia have normal PV but their RCV and BV are elevated in direct proportion to UV Hct. "Isovolemic" partial exchange transfusion decreases UV Hct, RCV, and BV and increases PV.
Simultaneous Recovery of β-Lactamase-Negative and β-Lactamase-Positive Haemophilus influenzae Type b from Cerebrospinal Fluid of a Neonate
Authors: Stewardson-Krieger Prudence , Naidu Shrinivas
Published: December 2021

A case of Haemophilus influenzae type b meningitis in a neonate from whom both a β-lactamase-negative and a β-lactamase-positive strain were isolated simultaneously is reported. Both bacteriology laboratory technicians and clinicians should be aware of this phenomenon when performing sensitivity tests on H influenzae isolates or treating patients with serious H influenzae infection.
Amino Acids as Substrates in Children with Growth Hormone Deficiency and Hypoglycemia
Authors: LaFranchi Stephen , Buist Neil R. M. , Jhaveri Banoo , Klevit Harvey
Published: December 2021

In order to investigate the role of amino acid (AA) substrates in the hypoglycemia associated with human growth hormone (hGH) deficiency, we measured 12-hour fasting blood glucose and total quantitative AA concentrations in 11 children with hGH deficiency during three study periods: (1) before hGH replacement; (2) after 12 months of hGH treatment; and (3) after discontinuation of hGH for three months. The results were compared to studies in 16 control subjects. Fasting blood glucose concentrations were significantly (P < .05) lower in the hGH-deficient children prior to hGH treatment as compared to the control subjects (67.0 ± 5.3 vs 80.7 ± 5.3 mg/100 ml, X ± SE). Fasting total serum AA concentrations were similar in the patients and in the control subjects; however, after 12 months of hGH replacement, there was a significant (P < .01) elevation of serum AA (2,750 ± 170 vs 2,283 µmoles/liter). Fasting serum concentrations of alanine, glycine, arginine, and tryptophan were also significantly elevated (P < .01) with hGH treatment; ornithine, tyrosine, lysine, methionine, and phenylalanine showed lesser elevations (P < .05), whereas threonine decreased significantly (P < .01). The fasting hypoglycemia seen with isolated hGH deficiency is not an AA substrate-limited disorder. The finding of increased concentrations of AA with hGH replacement suggests increased retention of nitrogen and synthesis of AA or a decreased requirement of AA for gluconeogenesis due to availability of other substrates.
INFANT BOTULISM IN CALIFORNIA–1980 SUMMARY
Authors: M. E. K.
Published: December 2021

1980 was a record year for infant botulism in California in several respects; the most hospitalized cases (30); the oldest case yet documented (8½ months); the longest and costliest hospitalization (8 months and $300,000); the first occurrence, sequentially in twins (dizygotic) and, finally, the first death of a hospitalized baby since 1977. These 30 patients represent one third of all cases of infant botulism hospitalized in California in the five years since infant botulism was first recognized in 1976.

Age at onset ranged from 4 to 37 weeks; 20 cases (67%) were male; 24 (80%) were white, 6 (20%) Hispanic; and (this year) none were Asian or black. Fifteen cases were caused by type A toxin and 15 by type B toxin. Cases occurred in every calendar month except January and November; half the cases had onset in August, September, and October. Ten percent of cases (3/30) ingested honey before onset of illness, and when tested, honey specimens fed to these patients were culture negative for Clostridium botulinum.

The 30 California patients in 1980 represent almost half of the 65 cases hospitalized nationally for the year. The reasons for the marked increase of the State's infant botulism in 1980 are the subject of continuing investigation by the Infant Botulism Research Unit of the State Department of Health Services.
Mild ‘Punishment’ Works
Authors: Farber Jon Matthew
Published: December 2021

There has been much written about the evils of corporal punishment, including two editorials in Pediatrics,1,2 yet the practice continues. The reason is that, quite simply, the procedure works. To choose an extreme example that I do not condone, if one gave an electric shock to a child every time he talked back, he would stop doing it. What then, is so wrong about corporal punishment? The authors mention the important points: the dangers of physical injury; teaching that might makes right; not teaching appropriate behavior, etc.
Diet and Hyperactivity
Authors: Crook William G.
Published: December 2021

I read with great interest the article by Stare and associates entitled, "Diet and Hyperactivity: Is There a Relationship?" (Pediatrics 66:521, 1980). I agree with their statements, "Hyperactivity will continue to be a frustrating problem until research resolves the questions of its cause or causes and develops an effective treatment .... The reality is that we still have a great deal to learn about this condition."

However, I disagree strongly with the last sentence of their article which stated, "... it appears now that diet plays, at most, a very minor role."
Letters to the Editor
Authors: Stare Fredrick J.
Published: December 2021

There is nothing in our paper referred to by Dr Campbell that indicates or implies that it is "the final word on the ineffectiveness of the Feingold diet." All we wrote was that "The reality is that we still have a great deal to learn about this condition (hyperkinesis) ... it appears now that diet plays at most, a very minor role." That doesn't sound to me like "the final word"!

Neither Harvard's Department of Nutrition nor the American Council on Science and Health is my institution, though I am active in both.
Letters to the Editor
Authors: Baron Michael A. , Fink Howard D.
Published: December 2021

We agree completely with Dr Mangravite'ss comments and have been advising parents as he suggests.

Implicit in Mangravite's remarks is the observation that a single test is no more reliable for diagnosis than is any single historical datum or physical sign. The constant exercise of clinical judgment and careful follow-up of patients is therefore essential and can prevent excessive reliance on "blood tests." It should be kept in mind that young infants are at especially high risk for bacteremia; that this risk varies directly with temperature and inversely with age: and that one or many of the risk factors for bacteremia may be absent in culture-proven bacteremia.
Prader-Willi Syndrome
Authors: Barol Daniel H.
Published: December 2021

It was my impression that Crnic et al (Pediatrics 66: 787, 1980) posited a causal relationship between uncontrolled obesity and the severity of mental deficit in Prader-Willi syndrome.

Possibly I overlooked either a key proof or a quiet disclaimer, but it seems equally possible, from my reading of their intriguing report, that the observed correlation is altogether noncausal, ie, that greater controllability of weight and higher IQ may simply be twin attributes of "mild" disease, or conversely that lower IQ and lower amenability to weight control may be co-features of more severe disease.
Round Table Discussion
Authors: PIERCE MILA , DAVIDSOHN I. , POTTER EDITH , SCOTT WILLIAM J. , SNOW JAMES B.
Published: December 2021

Chairman Pierce: I wish to emphasize that your participation in the discussion is cordially invited. It is the desire of the Program Committee that the Round Table provide an opportunity for all of us to share our experience. The specialists whom we have invited to join us and who are well known to us have kindly indicated their willingness to take part in the discussion. Dr. I. Davidsohn is the attending hematologist at Mt. Sinai Hospital; Dr. Edith Potter is the pathologist at Chicago Lying-in Hospital. The subject for discussion this morning will be limited to a discussion of acute hemolytic anemia of the newborn, or erythroblastosis fetalis—hematologic and pathologic aspects of the disease. All the hemolytic anemias have certain common characteristics. Erythrocytes are destroyed, anemia follows, hepatic function is disturbed by anoxia, and further impaired by the demand for the excretion of excessive quantities of blood pigment. Bilirubinemia follows. The hematopoietic centers compensate for blood destruction by delivery of reticulated erythrocytes or normoblasts to the blood and extramedullary erythropoiesis may result. In the acute hemolytic anemias this chain of events is initiated by a plasma factor while the cells themselves are normal. The plasma factor may be (1) an antibody; (2) a toxin of bacterial or spirochetal origin; (3) a chemical, or (4) a hormone. In the chronic types of hemolytic anemias there is often a familial or racial abnormality of the erythrocytes which predisposes it to the hemolytic effects of a plasma factor. Examples of hemolytic anemia resulting from these various causes are seen in the newborn. (1) Erythroblastosis fetalis or hemolytic disease of the newborn is due to the antigen antibody reaction caused by incompatibility of blood groups of mother and baby; (2) hemolytic anemia due to bacterial toxin may result from sepsis, bronchopneumonia or congenital lues; (3) in congenital hemolytic icterus, the splenic or hormonal factor together with erythrocytes which are spheroids rather than discs in the cause of the anemia.
Azarcón por Empacho—Another Cause of Lead Toxicity
Authors: Bose Aruna , Vashistha Krishan , O'Loughlin Bernard J.
Published: December 2021

A new source of toxic lead ingestion has been identified roentgenologically in Mexican-American children and adults. Azarcón is an orange powder that contains 86% to 95% lead tetroxide (Pb3O4. At least three children have been treated with this substance by folk healers for relief of abdominal symptoms. Other Hispanic medical folklores may include this toxic "remedy."
Positive Pressure Hand Ventilation: Potential Errors in Estimating Inflation Pressures
Authors: BIZZLE TERRY L. , KOTAS ROBERT V.
Published: December 2021

Despite increasing electronic sophistication in the design of mechanical ventilators, there has been persistent dependence on hand bagging in acute neonatal respiratory failure. Hand ventilation continues to be clinically useful in preparation for the application of the mechanical ventilator and to support airway suctioning.1 High inflation peak pressures can lead to the development of pulmonary air leaks; therefore, the use of a pressure manometer with neonatal hand bag ventilation equipment is widely recommended.2,3 Although no manufacturer currently markets a pressure manometer designed exclusively for use with neonatal hand ventilation equipment, many neonatal intensive care centers currently use diaphragm-type manometers for this purpose.
Sanctity of Life or Quality of Life?
Authors: SINGER PETER
Published: December 2021

The ethical outlook that holds human life to be sacrosanct—I shall call it the "sanctity-of-life view"—is under attack. The first major blow to the sanctity of life view was the spreading acceptance of abortion throughout the Western world. Supporters of the sanctity-of-life view have pointed out that some premature babies are less developed than some of the fetuses that are killed in late abortions. They add, very plausibly, that the location of the fetus/infant—inside or outside the womb—cannot make a crucial difference to its moral status. Allowing abortions, especially these late abortions, therefore does seem to breach our defense of the allegedly universal sanctity of innocent human life.
Value of Child Maltreatment Tests
Authors: PASCOE JOHN M.
Published: December 2021

To the Editor.—

Rosenberg et al1 have made a commendable attempt to define early markers of maltreated children. Their effort demonstrates how difficult it is to develop an instrument to identify families with complicated, low-prevalence psychosocial disease. The sensitivity and positive predictive value of such assessment tools are usually very low. This example is no exception. The sensitivity of a test is defined as the "test positivies" in patients with the disease (eg, abused children in the sample who are unkempt and abnormally parented in the emergency room) divided by all the patients with the disease (all abused children in the sample).2
Parental Information and Circumcision: Another Look
Authors: LAND JACK A. , POLICASTRO ANTHONY M.
Published: December 2021

To the Editor.—

We found "The Role of Parental Information in the Incidence of Circumcision" (Pediatrics 1982;70:597-598) to be most interesting. At Malcolm Grow USAF Medical Center, Andrews Air Force Base, Maryland, we performed a similar study. Pregnant women, followed by the obstetrical service, were given appointments to attend, with their husbands, a four-hour general counseling session during their eighth month of pregnancy. During the session, circumcision was discussed in such depth that it constituted informed consent. Women who did not attend the session received no structured informed consent.
Febrile Children
Authors: MCCARTHY PAUL L. , CICCHETTI DOMENIC V.
Published: December 2021

In Reply.—

A high percentage (87%) of the 55 ill-appearing (scale score >10) febrile children in our study1 had at least one laboratory test performed; a lesser percentage (45%) of the 110 well-appearing (scale score ≤10) febrile children had at least one laboratory study performed. Nearly half (47%) of the total laboratory studies performed, however, were performed on well-appearing febrile children.

Despite a nearly equal number of total laboratory studies in well- and in ill-appearing febrile children, only three of 23 abnormal test results (p 805, table 2) occurred in well appearing children.
Effect of Inhaled Beclomethasone Dipropionate on Hypothalamic-Pituitary-Adrenal Axis Function in Children with Asthma
Authors: Goldstein David E. , König Peter
Published: December 2021

The hypothalamic-pituitary-adrenal axis was investigated in 15 asthmatic children treated with inhaled beclomethasone dipropionate (mean 490 µg/day) and 11 asthmatic control subjects receiving no corticosteroid therapy. Measurements of 24-h urinary free cortisol and 17 hydroxy corticosteroids, serum cortisol, response to ACTH, and the oral metyrapone test showed no significant difference between the two groups. All the patients' results were within normal limits, and carbohydrate metabolism, as shown by blood glucose and hemoglobin A1c, was not affected by beclomethasone therapy. Thus, in the above dose, inhaled beclomethasone does not cause suppression of the hypothalamic--pituitary-adrenal axis.
Bacterial Infection and Splenic Reticuloendothelial Function in Children with Hemoglobin SC Disease
Authors: Buchanan George R. , Smith Susan J. , Holtkamp Christine A. , Fuseler John P.
Published: December 2021

Although the epidemiology and pathophysiology of serious bacterial infection in homozygous sickle cell anemia (SS disease) have become increasingly well understood, information about infection risk and splenic reticuloendothelial function in hemoglobin SC disease is quite limited. Therefore, the type and frequency of invasive bacterial disease were examined in 51 children with SC disease followed for 370 person-years and splenic function was assessed in 31 patients by quantitation of pitted erythrocytes. Seven serious bacterial infections occurred in four of the patients, five due to Streptococcus pneumoniae and two to Haemophilus influenzae. A primary focus of infection was present in all episodes, none of which proved fatal. Although 30 episodes of pneumonia or chest syndrome occurred in 20 of the patients, a bacterial etiology was proven in only three instances. Splenic function was usually impaired, with a mean pit count of 7.1% ± 8.2% (range 0% to 22.9%). This is significantly greater than normal, but less than pit counts in patients with SS disease or asplenic subjects. Children with SC disease may have a greater risk of bacterial infection than normal children, but their infection rate is not nearly as high as that in patients with SS disease.
Haemophilus influenzae Type b Brain Abscess Complicating Meningitis: Case Report
Authors: Feldman William E. , Schwartz James
Published: December 2021

A 7-month-old child developed β-lactamase negative Haemophilus influenzae type b meningitis which was treated with parenteral ampicillin and chloramphenicol for two days and ampicillin for eight additional days. She was readmitted two days after discharge on the 14th day after the initial hospitalization because of a suspected relapse of meningitis. Cultures of CSF and blood yielded no growth, and therapy with ampicillin and chloramphenicol was discontinued after three days. After discharge, her fontanel became full and a large, right, frontoparietal brain abscess was found on her third admission on day 25. Pus from the abscess yielded β-lactamase negative H influenzae type b but CSF and blood yielded no growth. The abscess resolved after needle aspiration of pus and 4 weeks of therapy with ampicillin and chloramphenicol. It is speculated that this rare complication of H influenzae meningitis arose from a focal infection in an area of brain necrosis that resulted from the initial meningitis.
Massive Clonidine Ingestion with Hypertension in a 9-Month-Old Infant
Authors: Yagupsky Pablo , Gorodischer Rafael
Published: December 2021

The antihypertensive drug clonidine has a double and antagonistic effect on arterial blood pressure. As a result of activation of peripheral α-adrenergic receptors, it causes a transient increase in blood pressure; by a central action it decreases sympathetic tone which results in sustained bradycardia and hypotension. Both central and peripheral effects are experimentally blocked by tolazoline, an α-adrenergic blocking agent. The toxic symptoms seen in clonidine poisoning are usually produced by the central effect. A case of severe clonidine poisoning in a 9-month-old infant is reported. The clinical picture included coma, miosis, apneic spells, bradycardia, and hypertension. Rapid and complete recovery was obtained with supportive treatment that included assisted ventilation. No adrenergic blockers or antihypertensive drugs were given. Use of tolazoline in cases of clonidine overdose in children remains controversial. Supportive measures alone may be adequate for even the most severe cases.
Infant Maltreatment: Caretaker-Infant Interaction and Developmental Consequences at Different Levels of Parenting Failure
Authors: Dietrich Kim N. , Starr Raymond H. , Weisfeld Glenn E.
Published: December 2021

A total of 53 mother-infant dyads, divided into five diagnostic groups (nonaccidental trauma combined with failure-to-thrive, nonaccidental trauma combined with iron-deficiency anemia, nonaccidental trauma only, neglect only, and normal control subjects) were observed during a feeding session. Qualitative differences were found in the relational characteristics of dyads in which multiple forms of maltreatment existed. Developmental examinations revealed that infants subjected to severe abuse and neglect were significantly retarded in their mental and motor development compared with the remaining index and control groups. The results were interpreted to suggest that relational disturbances are at the core of the problem of infant maltreatment and that on the basis of interactional symptomatology, two broadly different clinical conditions have been identified.
Transfusion-Acquired Plasmodium malariae Infection in Two Premature Infants
Authors: PICCOLI D. A. , PERLMAN S. , EPHROS M.
Published: December 2021

Several diseases can be transmitted to infants via transfusion. The risk of acquiring an infection via transfusion is greatly increased in sick premature infants because they receive frequent transfusions. The full-term infant is not fully competent immunologically,15 and the premature infant is even less able to deal with infection.6,15 Ideally, the transfusion of infected blood, especially into immunoincompetent recipients, should not occur. However, because screening for malaria in nonendemic regions is not practical, physicians caring for sick premature babies should consider transfusion-acquired malaria as a possible cause of illness, especially when there is no response to antibacterial therapy.
Eikosiphobia
Authors: COHEN MARK L.
Published: December 2021

To the Editor.—

Watchko and Oski1 deserve commendation for dramatizing the bilirubin dilemma with reason and style. Their alert anonymous resident no doubt has read Lucey's startling commentary2 which calls into serious question our understanding of this problem.

This scene has value that goes well beyond the newborn's jaundiced eye. Countless variations can be imagined: phenobarbital for seizures, antihistamines for stuffy ears, CBCs and chest films for surgery. As residents, we were aware of the well-known "Rule of 3, 7, 10, or 14" which states that: "The length of treatment for any positive culture is directly proportional to who's on service this month."
The Silent Patent Ductus Arteriosus
Authors: ELLISON R. CURTIS , PECKHAM GEORGE J. , LANG PETER , TALNER NORMAN S. , LERER TRUDY S. , LIN LILLIAN , DOOLEY KENNETH J. , NADAS ALEXANDER S.
Published: December 2021

In Reply.—

We appreciate the comments of Kashani, Swensson and Merritt. We are cognizant of the pioneering work done through the years at the University of California at San Diego in relation to the management of respiratory distress syndrome (RDS).

The multicenter trial1 established diagnostic criteria for patent ductus arteriosus (PDA) in 1978. In view of the unknown toxicity of indomethacin at that time, high specificity rather than maximum sensitivity was of prime concern. We wanted to enroll in our trial only those infants in whom the degree of ductal shunting was leading to sufficient cardiopulmonary compromise to cause a threat to the infant and to warrant the use of a potentially toxic drug or surgery.
Efficacy of Penicillin Prophylaxis
Authors: KAPLAN EDWARD L.
Published: December 2021

To the Editor.—

I read with interest the article by Hess and colleagues.1 The objectives of that study, to determine the incidence of postextraction bacteremia and to evaluate the efficacy of antibiotic prophylaxis, are worthy although not novel.

The authors point out, in assessing the "efficacy of penicillin prophylaxis as recommended by the American Heart Association to prevent the onset of bacterial endocarditis," that "the results of our study indicate that transient postextraction bacteremia can occur in patients receiving parenteral penicillin prophylaxis recommended by the American Heart Association."
Right Atrial Thrombus and Superior Vena Cava Syndrome in a Child
Authors: Graham LeRoy , Gumbiner Carl H.
Published: December 2021

Complications of central venous catheterization are well described. They include right atrial thrombosis and superior vena cava syndrome resulting from impaired venous drainage. Such complications are normally observed while the catheter is in place. They are often transient, resolving upon catheter removal. A patient with recurrent signs of superior vena caval obstruction 1½ years after removal of the central venous catheter is described. The obstruction was determined to be intermittent and functionally related to elevated cardiac output due, in turn, to anemia. This patient was also found to have a calcific right atrial thrombus which was not obstructive.
Protest Views of Singer
Authors: BONGIOVANNI ALFRED M.
Published: December 2021

To the Editor.—

The commentary by Singer1 must not go unchallenged. This member of the American Academy of Pediatrics takes exception to this statement, and he in no way espouses "religious mumbo-jumbo" which Singer applies to his possible opponents. Nor does this writer espouse the application of heroic measures to the preservation of human life under all circumstances. There is such latitude in Singer's discussion that "quality of life" can mean almost anything.

I will not belabor the many aspects of Singer's rhetoric but must make two points.
Pharyngeal Gonorrhea
Authors: RIS HANIA W.
Published: December 2021

To the Editor.—

The article, "Screening for Pharyngeal Gonorrhea in the Urban Teenager,"1 calls attention to the pharynx as an important site of infection and recommends routine culture of the pharynx in this population group.

Among 80 adolescents with gonorrhea, 15 (19%) had pharyngeal infection. Twelve patients had a positive culture from the pharynx alone and three patients had positive cultures from both pharynx and cervix.

It should be kept in mind that a single cervical culture is not infallible and even under optimal conditions in a research laboratory does not diagnose all infected females; 10% to 30% of infected patients will be missed.2
Pharyngeal Gonorrhea
Authors: CHACKO MIRIAM R.
Published: December 2021

In Reply.—

We agree with Ris' comments on the dependability of a single cervical culture for gonorrhea, and therefore it is possible that some of the 12 patients with pharyngeal gonorrhea alone had cervical infection as well. An alternative to taking a second cervical culture prior to treatment would be to take a cervical culture following treatment to ensure cure.

Regarding the prevalance of rectal gonorrhea in this study population,1 20% of the patients with gonorrhea had rectal gonorrhea and 19% had pharyngeal gonorrhea (our figure 1).
Histoplasmosis: A Reinterpretation
Authors: WEINBERG GEOFFREY A. , KLEIMAN MARTIN B.
Published: December 2021

In Reply.—

Prominent features of the serum sickness-like hypersensitivity reaction associated with cefaclor always include rashes, usually erythema multiforme, and occasionally arthritis.1 Joint involvement is usually symmetrical, often affecting fingers, ankles, and knees (K. Israel, MD, Lilly Research Laboratories, Indianapolis, personal communication). In a report of eight children receiving cefaclor for "persistent" otitis media, six had prior contact with the drug.1 Symptoms developed five to 19 days after beginning cefaclor therapy. Our patient had not previously received cefaclor.
A Prospective Study of the Impact of Home Monitoring on the Family
Authors: Wasserman Abby L.
Published: December 2021

Fourteen families whose infants required home monitoring for apnea were followed for approximately 5 years from the initial contact (1977). Each family received at least three psychiatric interviews and two follow-up contacts. Effects on the monitored infant, siblings, and parents were examined in open and semistructured interviews. At first follow-up (mean of 21 months after monitoring discontinuance), seven of 14 monitored children were characterized as spoiled by parents. By the second follow-up, 2½ years later, nine children showed speech, learning, and motor problems; five of these nine children had required resuscitation during their initial episode. Apnea severity was also related to both duration of monitoring and number of additional psychiatric interviews requested by parents or staff. Of 16 older siblings, 12 had psychological problems reported by their parents at first follow-up; these problems appeared to be largely resolved by the second follow-up, although three children were still having problems that caused parental concern. Monitoring, as well as the apnea itself, caused substantial distress manifested in depression, fatigue, and anxiety in many parents, particularly mothers. However, despite their considerable distress, none of the families discontinued monitoring prematurely. Results of the study indicated that the monitoring experience can be divided into four phases: doubt/acceptance, dependence/frustration, discontinuance, and late effects, with substantial differences in parents' responses occurring only in the last two phases.
Introduction to Recombinant DNA
Authors: Cederbaum Stephen D.
Published: December 2021

Seldom has a scientific or biomedical break-through evoked the awe, controversy, or sheer incredulity that has accompanied the developments in the field of recombinant DNA technology or more popularly, gene cloning and genetic engineering. Now little more than one generation after Avery, et al1 demonstrated that genes were encoded in DNA and Watson and Crick2 interpreted the structure of these molecules, genes are being cut, manipulated, and recombined to produce unprecedented new insights into genetics and molecular biology and the prospect of gene therapy. These developments have not occurred without anxiety to both scientists and laymen. At the moment, neither the most apocalyptic fears nor the most optimistic dreams appear to be imminent, although I believe that the dreams are closer to fulfillment than the fears.

Recombinant DNA technology is already having great impact in hematology, oncology, endocrinology, immunology, and infectious disease and will soon play an important role in other medical subspecialities as well. In none, however, will it have quite the same impact as in genetics because DNA is the material that genetics "is all about." The cloning and study of phenylalanine hydroxylase is one of the first instances in which this technology has important implications in the diseases traditionally classified as inborn errors of metabolism.

In order to understand and appreciate the presentation by Woo on phenylalanine hydroxylase as well as the many future papers that will play so vital a role in all of our professional lives, it is necessary to acquire the basic vocabulary of the field.
Parental Consent for Immunization
Authors: HALAC ELIAS , MEISLIN AARON G.
Published: December 2021

To the Editor.—

The New York Pediatric Society, a 50-year-old professional organization of practicing and academic physicians dedicated to the study and welfare of children, is submitting this letter, previously sent to the Academy offices, in the interest of stimulating further discussion of the question of parental consent for routine immunizations. We have reviewed the March 1983 report on DTP (diphtheria, pertussis, tetanus), DT, and TD immunizations provided by the American Academy of Pediatrics, and wish to register our strong objection to the formal request/consent forms favored, or at least publicized by the Academy.