bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Oxygen Permeability in Premature Infants
Authors: Versmold Hans T. , Holzmann Mathäus , Linderkamp Otwin , Riegel Klaus P.
Published: December 2021

While 24 newborn infants (ages, 2 to 48 hours; gestational ages, 24 to 42 weeks) breathed various concentrations of oxygen, the PO2 values on their unheated skin surface were measured by an unheated microcathode electrode for transcutaneous PO2 monitoring. In infants with arterial PO2 values in the range of 50 to 100 torr and with similar skin temperatures, the mean surface PO2 of unheated skin was inversely related to birth weight: 27.2 torr in infants weighing less than 1,500 gm, 14.3 torr in infants weighing 1,500 to 2,500 gm, and 2.9 torr in infants weighing more than 2,500 gm. In the smallest infants, the skin surface PO2 was significantly related to arterial P02: it was about one third of arterial PO2 as estimated by a second electrode for transcutaneous PO2 monitoring heated to 44°C. Phototherapy, crying, or blood transfusion increased the surface P02 of unheated skin, but not the tcPO2 measured at 44°C. These findings suggest that blood flow to the skin in excess of its metabolic needs due to immature control of cutaneous circulation, along with low resistance to oxygen diffusion, determines the high oxygen permeability of skin in premature infants.
Evaluation of the Growth Hormone Exercise Test in Normal and Growth Hormone-Deficient Children
Authors: Eisenstein Evelyn , Plotnick Leslie , Lanes Roberto , Lee Peter A. , Migeon Claude J. , Kowarski A. Avinoam
Published: December 2021

A group of 168 short but otherwise normal children (group A) and 25 children deficient in growth hormone (GH) (group B) were studied with an exercise stimulation test to determine the expected error of this method. In group A, 125 (74.4%) had maximum GH responses greater than 15 ng/ml, 23 (13.7%) had responses between 10 and 15 ng/ml, and 20 (11.9%) had responses less than 10 ng/ml. The mean ± SD values were 8.4 ± 0.4 ng/ml at 0 time, 26.3 ± 15.0 at 20 minutes, and 10.7 ± 8.3 at 40 minutes. The mean maximum response was 27.7 ± 14.3 ng/ml. In group B, 22 (88%) had maximum responses less than 10 ng/ml and 3 (12%) had responses between 10 and 15 ng/ml. Patients with maximum responses less than 10 ng/ml have a high probability of being GH-deficient, whereas patients with responses between 10 and 15 ng/ml are less likely to be GH-deficient. No patients with responses greater than 15 ng/ml were GH-deficient.
Growth Deceleration Patterns in Children With Constitutional Short Stature: An Aid to Diagnosis
Authors: Horner James M. , Thorsson Arni V. , Hintz Raymond L.
Published: December 2021

A retrospective study of 263 children referred for evaluation of short stature revealed that 149 (56.7%) had constitutional short stature (CSS). A typical pattern of growth was observed in these children. As exemplified by 12 children who had complete serial growth measurements, exaggerated growth deceleration first became apparent between 3 and 6 months of age, was greatest in the first two years of life, and resulted in these children falling more than 2 SDs below the mean for height by 3 years of age. After 3 years of age, the growth rate of these children with CSS was essentially the same as that of normal children, and they ran parallel to the growth curve though below the third percentile. The importance of serial measurements and the growth chart is emphasized, and recommendations are made for the evaluation of short stature or abnormal growth deceleration in the first three years of life. Awareness of this typical pattern of growth in children without disease may aid the pediatrician in his evaluation of short stature and allow for watchful waiting when results of screening tests are normal.
Increased Lead Burden in Children of Battery Workers: Asymptomatic Exposure Resulting From Contaminated Work Clothing
Authors: Dolcourt Jack L. , Hamrick Harvey J. , O'Tuama Lorcan A. , Wooten Jane , Barker Edward L.
Published: December 2021

Lead transmitted into the home via contaminated parental work clothing was the probable source of excessive lead exposure among 69% of 58 children whose mothers worked in a battery factory in Raleigh, North Carolina, Blood lead levels were highest in children less than 3 years old, and declined with age. All children were asymptomatic, and all had normal findings on physical examinations. Dust samples from the homes of children with the greatest lead burden demonstrated gross contamination of the home environment. Although maternal employment was short, young children spent a significant portion of their lives exposed to lead. Certain parental occupations can subject children to considerable risk from lead exposure.
Urinary Tract Infection in the Infant: The Unsuspected Diagnosis
Authors: Berger Michael , Warren Michael M. , Hayden C. Keith
Published: December 2021

Urinary tract infection (UTI) in childhood is surpassed only by the usual fevers and upper respiratory tract infections in its frequency of occurrence,1 yet a high index of suspicion, aggsiveesive treatment, and conscientious follow-up is not common.2 Although most infants with UTI have few residua, others require urinary tract diversion and still others develop end-stage renal disease.1

Perhaps the reason that UTIs are often overlooked in children is because of the emphasis that is put on flank pain, dysuria, or frequency as signs of UTI, with little regard to the age variables associated with these symptoms. However, nonspecific symptoms such as jaundice, anorexia, vomiting, failure to thrive, enuresis, and abdominal pain may signal UTI in a young child.1
Are Mental Health Teams Necessary in Cardiac Clinics?
Authors: Sissman Norman J.
Published: December 2021

Although Kupst et al. acknowledge some of the limitations of their study of the role that mental health teams can play in helping parents cope with the diagnosis of congenital heart defects in their children, they seem to have ignored some of the broader implications of their work

Most conspicuously omitted from consideration is the obvious influence on reactions to visiting a pediatric cardiac clinic for the first time (or at any time, for that matter) of the idividual differences on one or both parts of the doctor-patient dyad.
Pharmacologic Evaluation of Orally Administered Antibiotics in Infants and Children: Effect of Feeding on Bioavailability
Authors: McCracken George H. , Ginsburg Charles M. , Clahsen Joan C. , Thomas Marion L.
Published: December 2021

The clinical pharmacology of orally administered antibiotics was investigated in 106 infants and children. The antibiotic suspensions studied were ampicillin, cephalexin, erythromycin estolate, erythromycin ethylsuccinate, penicillin G, and penicillin V. The feeding status of the patients was evaluated in relation to the concentrations of drugs in serum, saliva, and tears. Peak concentrations and area-under-the-curve values of cephalexin, penicillin V, and penicillin G were reduced 40% to 60% in patients given milk and drug concurrently. Absorption was enhanced when erythromycin ethylsuccinate was given with milk. After administration of both erythromycin formulations, penicillin V and ampicillin, salivary concentrations exceeded the minimal inhibitory concentrations for most pneumococci and group A streptococci and for many meningococci. The clinical implications of these pharmacokinetic data are discussed.
Improved Student Learning of Infant Growth and Development
Authors: Stillman Paula L. , Ruggill Jane S. , Sabers Darrell
Published: December 2021

All physicians who care for children require a knowledge of normal growth and development in order to detect and interpret abnormalities. Yet traditional instruction tends to focus on the ill child and rarely provides students the opportunity to follow up the cases of healthy children over a prolonged period of time. A new course was developed that enabled students to observe the longitudinal development of a normal infant from birth to age 16 months. At the completion of the course, a multiple-choice examination covering developmental concepts from birth to age 6 years was administered to the students who participated in this course (experimental group) and to two comparison Groups. The experimental group scored substantially higher than both comparison groups on items covering birth to age 18 months. The program offers an opportunity for medical students to observe the longitudinal development of a normal infant and appears complementary to other instructional methods.
Skull Roentgenography of Infants and Children With Convulsive Disorders
Authors:   Committee on Radiology
Published: December 2021

Routine skull roentgenograms are not necessary in patients with well-documented, simple, febrile convulsions. In patients with recurrent, nonfebrile seizures, the need for roentgenographic examination should be determined after a detailed history and neurologic examination, pertinent laboratory evaluation, and electroencephalography. With the exception of perhaps unusual circumstances (e.g., posttraumatic seizures, a course suggesting a progressive neurologic syndrome, and increased intracranial pressure), skull roentgenograms are not an emergency procedure in childhood epilepsy and may be obtained whenever indicated in the course of a diagnostic workup. Focal seizures, abnormal findings on neurologic examination, persistent seizures despite anticonvulsant therapy, psychomotor epilepsy, infantile spasms, a history suggesting a deteriorating clinical condition, and suspicion of intracranial hypertension are situations in which skull roentgenography may be informative. Children with these conditions should be given consideration on an individual basis.
Should we put catheters in the umbilical artery?
Authors: Tooley William H. , Myerberg David Z.
Published: December 2021

A catheter inserted in the umbilical artery with its tip in the aorta provides a convenient means for obtaining arterial blood samples, measuring pressure, and infusing fluids and drugs. Although these catheters often seem necessary to guide the treatment of newborn infants who have cardiopulmonary disease, they are dangerous. They are associated with thrombi, emboli, and infection. Their presence provokes vascular constriction and invites the infusion of vasoactive substances. Some catheter complications can be catastrophic. Recent reports include cases of hypertension,1 paraplegia,2 and septic osteoarthritis.3 In the past two years we have seen gangrene of a foot, a leg, and the lower half of the body.
Home Monitoring: A Huge Problem
Authors: Weinstein Stanley E. , Blenninger Christine , D'Antonio Michel , Routt Georgh , Boshak Sandy
Published: December 2021

Recently the American Academy of Pediatrics Task Force on Prolonged Apnea concluded that apneic spells may be manageable at home (Pediatrics 61:651, April 1978). This was a change from the position taken in 1975, which limited the use of home monitors to research projects. Such a change was bound to produce a variety of opinions, some of which were reported in the same issue of Pediatrics. Many questions have been raised with far too few answers.
All That Is Green Is Not PKU
Authors: Lee Raymond
Published: December 2021

Tests for phenylketonuria (PKU) using 10% ferric chloride solution dropped on wet diapers are done frequently. Recently, I have found a number of false-positive PKU tests, as have my colleagues. Some of these false-positive tests show up as green spots that appear immediately. On further investigation, we found that false-positive tests were occurring in infants who wore disposable diapers marketed by Montgomery Ward, Sears Roebuck, and Co-Op. We tested unused diapers of the above brands and found that they too give false-positive test results.
Further Observations on Noise Levels in Infant Incubators
Authors: Bess Fred H. , Peek Barbara Finlayson , Chapman Judy J.
Published: December 2021

The purpose of this study was to conduct an acoustic analysis of incubator noise under two conditions: when the incubator was associated with different types of life-support equipment; and when impulse noise was created by striking the side of the incubator or by opening and closing the doors of the storage unit. It was found that the life-support equipment increased the overall noise levels of incubators by as much as 15 to 20 dB. Much of this increased energy was in the high frequency region. Impulse signals created by striking the side of the incubator ranged from 130 to 140 dB. A representative impulse for opening the incubator was 92.8 dB, whereas closing the door produced a peak amplitude of 114 dB.
Noncompliance in Children With Renal Transplants
Authors: Korsch Barbara M. , Fine Richard N. , Negrete Vida Francis
Published: December 2021

In the article "Noncompliance in Children With Renal Transplants" by Korsch et al (Pediatrics 61:872, June 1978), Fig 1 and 2 are reserved. The bar graph showing the distribution of results on the Piers-Harris Seif-Esteen Scale should be Fig 1, and the bar graph showing the distribution of results on the California Test of Personality should be Fig. 2.
Mitral Valve Prolapse Syndrome in Children With Duchenne's Progressive Muscular Dystrophy
Authors: Sanyal Shyamal K. , Leung Richard K. F. , Tierney Ralph C. , Gilmartin Richard , Pitner Samuel
Published: December 2021

Myocardial function was evaluated prospectively by noninvasive methods in 20 boys with clinical, biochemical, muscle biopsy, and electromyographic evideuce of Duchenne's progressive muscular dystrophy, Auscultatory evidence of a nonejection systolic click suggested mitral valve prolapse (MVP) syndrome in seven patients. Phonocardiography disclosed that the click was mid-systolic ill four patients and early in three. Echocardiographic features consistent with this diagnosis were identifled in all seven patients and in an additional four. One of these had an apical pansystolic murmur, suggestive of mitral regurgitation. whereas in the other three, prolapse of the mitral valve was ‘silent."

Echocardiographic findings included an abrupt midsystolic, posterior motion (greater than 3 mm beyond the CD line) in five patients. multiple sequence echoes in six, and posterior coaptation of the mitral valve near the left atrial wall in six. The feature most characteristic of MVP syndrome was a smooth, pansystolic, anteriorly concave (hammocklike) posterior motion deviating more than 3 mm beyond the CD line. Among the remaining nine patients who did not have echocardiographic evidence of prolapsing mitral valve, none had an early, middle or late nonejection systolic click or a heart murmur, although four patients in this group had moderate to severe scoliosis.

These observations document the occurrence of MVP syndrome in children with Duchenne's muscular dystrophy and indicate that its prevalence is high. We speculate that prolapse of the mitral valve in these patients is an expression of the underlying cardiomyopathy characteristic of Duchenne's muscular dystrophy rather than an isolated, dystrophic involvement of the mitral valve leaflets.
Muscular Form of Glycogenosis Type II (Pompe's Disease)
Authors: Tanaka Kazuhiko , Shimazu Shinichiro , Oya Noriaki , Tomisawa Munehiko , Kusunoki Tomoichi , Soyama Kokichi , Ono Etsuko
Published: December 2021

An 11-year-old boy who was previously thought to have progressive muscular dystrophy was studied biochemically, and histologically. He was seen initially with an amyotonic syndrome with no clinical evidence of heart disease. Light and histochemical examination showed vacuolar degeneration and abnormal accumulation of glycogen in the muscular fibers. Electron microscopy showed aggregates of glycogen granules surrounded by a well-defined membrane, as in previously reported cases of type II glycogenosis. Enzyniatic study disclosed that acid α-glucosidase was deficient in muscle, liver, and heart tissue, although neutral cs-glucosidase was present within normal ranges. Measurement of acid and neutral α-gtucosidase activity in muscle from the patient and his sisters and in urine from them and their parents indicated that his sisters are heteroz gotes and his parents probably are heterozygotes. The disease was transmitted as an autosomal-recessive trait.
Chemotherapy: A Successful Application in Abdominal Fibromatosis
Authors: Hutchinson Raymond J. , Norris Donald G. , Schnaufer Louise
Published: December 2021

The fibromatoses constitute a group of disorders denoted by a variety of classifying terms and characterized by fibroblastic proliferation with deposition of collagen and reticulin.1 The biologic behavior of these tumors is such that local proliferation with invasion of adjacent normal tissues occurs frequently. However, metastasis, if it ever occurs, is a rare event.1-3 Recommended treatment for fibromatosis has been largely surgical, allowing wide local margins to prevent recurrence.3-4 Such surgery, however, may not always be possible when the mass is nonresectable. Radiaction therapy is acquiring a recognized role in the management of fibromatosis,2-5 but its use is also limited by tumor location and potential toxicity to normal tissues.
International Year of the Child Activities in Europe
Authors: Wagner Marsden
Published: December 2021

The fertile fields of southern Poland roll past my window as I begin to write this summary of International Year of the Child (IYC) activities for 1979 in Europe. There are 50 pediatricians on the bus, traveling from a meeting in Cracow of the Association for Paediatric Education in Europe to a meeting in Warsaw of the Association for Medical Education in Europe. It occurs to me that the events of this particular week present in several ways a microcosm of the factors lying behind the directions that the development of the IYC activities in Europe are taking. The medical school in Cracow recently celebrated its 600th anniversary (a pediatric chair was established in 1864)—an illustration of long tradition in human services in Europe.
Roentgenographic Follow-Up of Acute Pneumonia in Children
Authors: Grossman Lindsey K. , Wald Ellen R. , Nair Prasanna , Papiez Joseph
Published: December 2021

The need for follow-up roentgenograms documenting complete clearing of pulmonary infiltrates in the pediatric patient with acute pneumonia was studied prospectively. Seventy of 129 children enrolled in the study had a repeat roentgenogram within three to four weeks after initial diagnosis. Twenty percent of this group had residual pulmonary infiltrates. Of the two thirds of those who returned for a second follow-up roentgenogram, the infiltrates had cleared completely within three months. Routine repeat chest roentgenograms may not be necessary unless there is clinical evidence of persistent respiratory difficulty or failure to thrive.
A TEACHING TOOL
Authors: Mason Edward A.
Published: December 2021

THAT OUR CHILDREN MAY NOT DIE. 60 minutes, color, 1978, by Joyce Chopra for Ford Foundation, 320 E. 43rd Street, New York, NY 10017.

Nigeria has one of the highest death rates for young children and in some sections of that country "half of the children never reach their fifth birthdays." These are the opening comments in a film with Prof. O. Ransome-Kuti, head of pediatrics at the Institute of Child Health, University of Lagos. Realizing that more was necessary for good maternal and child health than modern facilities in the capital, he has embarked on developing clinics, field stations, and community health activities in areas throughout the country. This film illustrates many of the preventive efforts being launched in well child care, sanitation, nutrition, immunization, and child spacing in suburban, rural, and village settings. Its focus is on the training of health workers drawn from the area where they will serve and given skills for preventive and some simple curative procedures. Much use is made of role play and drama as well as on-the-job training.

Nurse clinicians provide total care, diagnosing and treating most children in some areas by following a set of carefully developed standing orders. Other distinctive practices include prepackaged drugs and mothers carrying their babies' health records. Many questions are stimulated and the film will have value far beyond its primary intended audience in Nigeria. For those involved in international maternal and child health, it is an excellent introduction and training aid. It will also be useful in training paraprofessionals, even in the United States, because it covers key issues in mobilizing community participation in improved health care.
Amniotic Fluid Microviscosity Determined by Fluorescence Polarization: Methodology and Relation to Gestational Age
Authors: Stark Raymond I. , Blumenfeld Thomas A. , George John D. , Freda Vincent J. , James L. Stanley
Published: December 2021

The fluorescence polarization of 116 amniotic fluid specimens obtained from 22 isoimmunized pregnant women was determined. The degree of fluorescence polarization of amniotic fluid provides an index of microvisocity in lipid aggregates that is dependent on the lecithin-to-sphingomyelin ratio and the degree of saturation of fatty acid side chains. We confirmed the reproducibility of the measurement of amniotic fluid microviscosity (coefficient of variation, 2.0%). The measurements are not effected by bilirubin concentration or amniotic fluid dilution. The pattern of change of amniotic fluid microviscosity during gestation parallels the expected development of the surfactant system. Amniotic fluid microviscosity is high during early gestation and abruptly and sequentially decreases between the 28th and 36th week of gestation. Since the measurements are an accurate reflection of the biochemical properties of amniotic fluid lipids and parallel the development of the surfactant system, we conclude that amniotic fluid microviscosity may well serve as an indicator of the process of fetal lung maturation.
Munchausen Syndrome by Proxy: Definition of Factitious Bleeding in An Infant by 51Cr Labeling of Erythrocytes
Authors: Kurlandsky Lawrence , Lukoff Jonathan Y. , Zinkham William H. , Brody Judith P. , Kessler Richard W.
Published: December 2021

The Munchausen syndrome by proxy is a phenomenon in which symptoms of a disease are fabricated by some person other than the patient. This report describes an 8-week-old infant with repetitive bleeding episodes, presumably originating from the upper respiratory tract. Extensive investigations, including angiography, several endoscopies under general anesthesia, and reinfusion of the infant's red cells labeled with 51Cr followed by pulmonary and upper airway scanning, failed to reveal the source of bleeding. Within two weeks after initiation of the 51Cr studies, radioactivity of facial blood from two separate bleeding episodes did not exceed background counts. Soimultaneous examination of the infant's capillary blood, however, showed moderate to marked radioactivity. The Rh subtype of the facial blood was cc, whereas the infant's type was Cc. These findings indicated that the facial blood was factitious in origin. No further "bleeding" occurred after this information was presented to the parents. This case represents an unusual example of the Munchausen syndrome by proxy. Awareness of this entity can prevent potentially harmful investigations. Documenting its occurrence and sharing the information with parents in a nonaccusatory manner may prevent future harm to the patient.
CMV AND INFANTILE SPASMS
Authors: Riikonen R.
Published: December 2021

At the Children's Hospital, University of Helsinki, 205 children with infantile spasms who were born between 1960 and 1976 were studied in a search for the factors responsible. In 11 children (5%) the infantile spasms were possibly associated with cytomegalovirus (CMV) infection. The number may actually have been considerably higher, as no systematic search was made for CMV, especially in the early years. In four of the 11 children, the infection was probably congenital, and was the most likely cause of the spasms. One of the remaining seven children had congenital toxoplasmosis and the simultaneous CMV infection was probably also congenital. The children with congenital CMV infection exhibited severe clinical symptoms in the neonatal period or in early infancy. Two frequent symptoms were persistent tremor and meningoencephalitis. Later, all five children were severely mentally retarded and had spastic tetraplegia and small heads; three of them had optic atrophy and were blind. In the other six children, the CMV infection was probably acquired, the clinical symptoms being less severe, and the spasms may have been caused by another factor. In two of the 11 cases, immunosuppressive therapy (ACTH treatment generally given for infantile spasms) seems to have caused a fulminant CMV infection. Two children with CMV infection still show signs of a slow virus infection in the central nervous system many years later.
Disseminated Intravascular Coagulation With Trauma: Treatment With Exchange Transfusion
Authors: Sarnaik Ashok P. , Stringer Kenneth D. , Jewell Patrick F. , Sarnaik Sharada A. , Ravindranath Y.
Published: December 2021

Disseminated intravascular coagulation (DIC) may complicate hypovolemic shock secondary to trauma.1 Treatment with heparin in such cases is contraindicated because of the risk of bleeding at the site of trauma. Replacement therapy with clotting factors and platelets alone may be inadequate2 or result in volume overload in the presence of compromised renal function. We describe here a patient with multiple intraabdominal traumatic injuries whose severe bleeding diathesis secondary to DIC was successfully treated with exchange transfusion.

CASE REPORT

A 10-month-old black boy weighing 10 kg was brought to Children's Hospital of Michigan, Detroit with a history of grunting for three hours and "not feeling well" for three weeks.
An Unusual Etiology of Urticaria
Authors: Tinkelman David G. , Tinkelman Carl L.
Published: December 2021

Urticaria, while a very common disorder in pediatrics, is infrequent, if not rare, in the practice of dental medicine. Generally, once hives occur, trying to determine the etiology proves to be very difficult. In fact, some authors suggest that up to 75% of cases go undiagnosed. However, in some of these undiagnosed cases, the cause may literally be under the patient's nose. In this report, we describe a case of urticaria in a child following the application of orthodontic bands.

CASE REPORT

A 14-year-old white girl, previously in good health, was referred for evaluation and treatment of her chronic urticaria.
Measles Vaccination
Authors: Halsey Neal A. , Schubert Warren , Nieburg Phillip , Preblud Stephen R. , Hinman Alan R.
Published: December 2021

In November 1976, the US Public Health Service Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics Committee on Infectious Diseases (Red Book Committee) agreed that the recommended age for routine administration of measles vaccine should be changed to 15 months.1,2 In May 1978, the Immunization Division of the Center for Disease Control conducted an informal survey of public clinics and pediatricians with regard to the administration of measles vaccine. One hundred forty-nine directors of public clinics and 195 private pediatricians actively involved in vaccinating children were contacted by telephone and read a questionnaire by personnel from state health departments.
Periodic Breathing in Infants With Near-Miss Sudden Infant Death Syndrome
Authors: Kelly Dorothy H. , Shannon Daniel C.
Published: December 2021

Twelve-hour nocturnal home recordings of respiration and heart rates were obtained during sleep in 32 infants with near-miss sudden infant death syndrome (SIDS) and in 32 control infants, and the recordings were analyzed for periodic breathing. An episode of periodic breathing was defined as three or more apneic pauses of three or more seconds. The duration of respirations interrupting the pauses was 20 seconds or less. Analysis revealed a statistically significant difference (P < .001) between the two groups, using criteria of percent of periodic breathing episodes, number of periodic breathing episodes/100 min of recorded sleep time, average duration of all episodes, and duration of the longest episode of periodic breathiflg. It is concluded that periodic breathing is present in excessive amounts during sleep in infants with near-miss sudden infant death svndrome.
Strychnine Therapy in Nonketotic Hyperglycinemia
Authors: Arneson Dora , Ch'ien Lawrence T. , Chance Philip , Wilroy R. Sidney
Published: December 2021

Nonketotic hyperglycinemia is an inborn error of metabolism resulting from a defect in the glycine cleavage enzyme system. It is characterized biochemically by elevated concentrations of glycine in blood, spinal fluid, and urine. Previous therapies which have been directed toward reducing the glycine concentration in plasma and CSF have not been successful in preventing neurological deterioration, which may be the result of the role of glycine as an inhibitory neurotransmitter. Strychnine treatment was initiated because it is a specific antagonist of glycine at postsynaptic membranes. The patient reported here has shown clinical and EEG improvement while taking strychnine in conjunction with sodium benzoate.
Age, Sex, and Season of Onset of Juvenile Diabetes in Different Geographic Areas
Authors: Fleegler Francene M. , Rogers Kenneth D. , Drash Allan , Rosenbloom Arlan L. , Travis Luther B. , Court John M.
Published: December 2021

Age, sex, and estimated time of onset of insulin-dependent diabetes were determined for children in Pittsburgh (N = 673), Gainesville (N = 976), Galveston (N = 741), and Melbourne (N = 851). The US cities had a decrease in new cases during the summer and peak incidence in January through April. In Melbourne, monthly trends were reversed: there were more cases during May through August. In US cities, but not in Melbourne, children less than 6 years old showed a greater variation by season than children 6 years old and older. Observations of the same fall and winter onset (in different calendar months) of insulindependent diabetes in Australia and the United States, and exaggeration of seasonal differences in young US children, suggest that onset of insulin-dependent diabetes is associated with seasonally varying viral diseases. Mumps and rubella infections do not seem to be responsible for much of the seasonal variation. Seasonal peaks of mumps and rubella are later than those observed for insulin-dependent diabetes, and immunization with live mumps and rubella viruses has not been associated with changes in incidence of insulin-dependent diabetes. An increase in disease incidence in boys over girls below age 6 years and in girls over boys at ages 6 through 11 years was consistently observed but not explained.
Localization and Therapy of Urinary Tract Infections of Childhood
Authors: Wientzen Raoul L. , McCracken George H. , Petruska Mary L. , Swinson Susan G. , Kaijser Bertil , Hanson Lars A.
Published: December 2021

One hundred four patients with 124 episodes of urinary tract infection were studied. Serum C-reactive protein (CRP) was determined on diagnosis of each patient. Children with a CRP equal to or greater than 30 µg/ml (CRP-pos) differed significantly from those with values less than 30 µ/ml (CRP-neg) in age, clinical presentation, K type of Escherichia coli causing disease, frequency or radiographic abnormalities, and presence of antibody coating of bacteria in the urinary sediment. E coli K1 strains caused disease significantly more often in CRP-pos than in CRP-neg patients, and children with K1 infections were younger than those with non-K1 infections. The antibody-coated bacteria test was neither sensitive nor specific for localization of infection in pediatric patients. Determination of K1 antibody concentrations in serum and urine of E coli K1-infected children provided data supporting the measurement of CRP as one means of localizing urinary tract infections. Patients with CRP-neg infections were treated as successfully with four days of antimicrobial therapy as with ten days.
Califano's Body Counts
Authors: Bergman Abraham B.
Published: December 2021

We are attempting to increase our coverage of important policy issues in child health. The recent ruling on immunization goals for federally funded health centers is such an issue. The articles and commentaries in this issue of Pediatrics speak to the problem. Our "political pediatrician," Abraham B. Bergman, MD, has highlighted the problem in a way that will not bore you!

It is hard to conceive that such an "apple pie issue" as immunizing children would become controversial, but such thinking fails to reckon with the involvement of Joseph A. Califano, secretary of the Department of Health, Education and Welfare (HEW).
Letter To The Editor
Authors: Halkin H.
Published: December 2021

Excessive serum digoxin concentrations do not establish the diagnosis of digitalis intoxication but certainly mark the subgroup of digitalis-treated patients who are at high risk of intoxication. True, seven of ten infants tolerated high serum concentrations without adverse effect, but intoxication was nonetheless highly prevalent (30%) among these infants.

The choice of the 2 ng/ml level was not arbitrary but rather represents the well-established lower limit of the toxic range in adults. Our findings support the statement that it is of the same significance in the agc group studied.
The Alice in Wonderland Syndrome in Juvenile Migraine
Authors: Golden Gerald S.
Published: December 2021

Two children are reported who had recurrent attacks of impairment of time sense, body image, and visual analysis of the environment. These occurred with a clear state of consciousness and in the absence of any evidence of an encephalitic process, seizures, drug ingestion, or psychiatric illness. Both children had recurrent headaches; one was clearly migrainous. There was a family history of migraine in both cases. These children represent examples of the Alice in Wonderland syndrome in juvenile migraine.
Effect of Supine and Prone Positions on Arterial Oxygen Tension in the Preterm Infant
Authors: Martin Richard J. , Herrell Nancy , Rubin Dov , Fanaroff Avroy
Published: December 2021

To determine the optimal position for the preterm infant, arterial oxygen tension (Pao2) was monitored in 16 preterm infants by the transcutaneous method with the infants in both supine and prone positions. When the infants were prone, Pao2 rose by a mean of 7.4 mm Hg (P < .001), an increase of 15%. In those infants with residual cardiopulmonary disease, a 25% increase was noted. The higher Pao2 in the prone position was accompanied by a significant decrease in the amount of time the chest wall moved asynchronously. This improved oxygenation in the prone position appears to be the result of enhanced ventilation/ perfusion ratios and not merely secondary to an alteration in sleep state with positioning of the infant. These findings may have important implications in the management of preterm infants requiring neonatal intensive care.
THE ISOLATED PROFESSIONS
Authors: Belknap R. L. , Kuhns R.
Published: December 2021

Professions used to be called mysteries, and certain skills must necessarily remain esoteric. But this practical training in a profession surprisingly seldom entails ideas and methods that are inexplicable, ineffable, or beyond the grasp of a genuinely educated layman. True experts seek ways to communicate. Psuedoexperts rely on the secrecy of their data for their place in society, claiming that disclosure of their secret lore would make them helpless, when actually it might only show them to be useless. . . .

Within these isolated professions the patronizing attitude toward outsiders becomes increasingly hard to avoid. Specialization in recent decades has made the old divisions of knowledge and the old careers even narrower and more excluding, with a consequent reduction of the number of people with whom the specialist feels any solidarity. This intellectual fragmentation has made it virtually impossible for universities to function as social units. The misplaced emphasis on career training and the isolation of the professions have produced a pair of effects which every teacher has seen in class. The first effect emerges in all on a given subject because they are not experts on it. Such people are the destined victims of false experts. The second effect emerges in those students who believe that anything they say sincerely is true. Much modern school teaching encourages this belief out of a fear of discouraging the free flow of creativity. These two forms of mindlessness reflect one another. By neglecting their intellectual contact with the untrained majority of humanity, our experts have driven that majority into a dim realm where, as nonexperts, they cannot think, but only feel. . . .
School Health Experience Before and After Completion of Pediatric Training
Authors: Chilton Lance A.
Published: December 2021

A questionnaire regarding school health training and current school-based activities was completed by 116 of 141 young pediatricians practicing in four southwestern states. Responses indicated that few (22.4%) were exposed to school health during their residencies, although most (65.5%) are now providing some school health services. Those who had had school health training during residency are much more likely to be providing services than those who did not. Likewise, durimig their residencies, few received instruction in methods of health education, though many, led again by those who had appropriate residency experience, now participate in school health education programs. Residency programius should provide training in school health to improve the pluysician's comfort and efficiency in the roles he is presently asked to play, and to increase his involvement in this critically important area of pediatrics.
Hypoelectrolytemia and Metabolic Alkalosis in Infants With Cystic Fibrosis
Authors: Beckerman Robert C. , Taussig Lynn M.
Published: December 2021

The records of all children in the Tucson area diagnosed as having cystic fibrosis (CF) before the age of 12 months were reviewed to ascertain the prevalence of metabolic alkalosis as a major presenting manifestation of CF. Five of eleven infants (46%) in whom CF had been diagnosed between 1 and 12 months of age initially were seen with hypokalemia, hypochloremia, and metabolic alkalosis unassociated with marked dehydration, hyperpyrexia, or major pulmonary and/or gastrointestinal symptoms. Two infants had repeated episodes of metabolic alkalosis; for one of these infants, both episodes of metabolic alkalosis occurred before the diagnosis of CF. It is postulated that chronic loss of sweat electrolytes together with mild gastrointestinal or respiratory illness may predispose the infant with cystic fibrosis to a severe electrolyte and acid-base disturbance. The lack of shock and hyperpvrexia together with the apparent chronicity of electrolyte losses differentiates metabolic alkalosis from the heat prostration syndrome, a more acute complication of cystic fibrosis. Quantitative sweat testing should be part of the evaluation of any infant with unexplained metabolic alkalosis. Serum electrolytes should be assessed regularly in infants with cystic fibrosis during hot weather months.
Repeated Naloxone Administration for Morphine Overdose in a 1-Month-Old Infant
Authors: Gober Alan E. , Kearns Gregory L. , Yokel Robert A. , Danziger Larry
Published: December 2021

Repeated injections of naloxone hydrochloride, a pure narcotic antagonist, were administered to a 3,320-gm 4-week-old boy for treatment of an accidental morphine overdose. The infant received frequent naloxone hydrochloride injections (0.2 mg per injection) during the first 12 hours of therapy to reverse morphine-induced apnea, hypothermia, and flaccidity. A cumulative dose of 2.73 mg of naloxone hydrochloride (0.822 mg/kg) was administered over 27 hours without apparent adverse effect or evidence of toxicity.
Lactobezoar Formation Associated With High-Density Caloric Formula
Authors: Duritz Gilbert , Oltorf Charles
Published: December 2021

Two cases of lactobezoar formation were seen in premature low-birth-weight infants fed a 24 cal/oz formula fortified with medium-chain triglycerides and glucose polymers given by continuous nasogastric infusion. Medical management included cessation of oral feedings and increased hydration and led to a rapid dissolution of the problem. The use of this preparation in small low-birth-weight infants is not recommended as an initial formula, and it should only be used when oral feedings have been well tolerated in a growing premature infant.
Budd-Chiari Syndrome in Childhood Secondary to Inferior Vena Caval Obstruction
Authors: Taneja Arvind , Mitra S. K. , Moghe P. D. , Rao P. N. , Samanta N. , Kumar Lata
Published: December 2021

Budd-Chiari syndrome is an uncommon disease caused by an obstruction to hepatic venous outflow either at the level of the hepatic veins or in the hepatic part of the inferior vena cava. Clinically, it presents with ascites, abdominal pain, hepatomegaly, edema, and occasionally jaundice. The syndrome was first recognised by Lamboran1 in 1842 and later described by Budd2 in 1846 and Chiari3 in 1899. The syndrome is caused by obstruction to the hepatic veins. In the Fig 1. Photograph showing massive ascites and dilated superficial abdominal veins. majority of cases, the obstruction is ascribed to obliterative thrombophlebitis of unknown cause.4
Letters to the Editor
Authors: McCarthy Paul L. , Jekel James , Dolan Thomas F.
Published: December 2021

We appreciate Dr. Woodward's thoughtful comments. We agree that pediatricians should "observe children with elevated temperatures" and not just elevated acutephase reactants. In an article to be published soon,1 we have recommended that, in most instances, history and physical examination are sufficient to evaluate febrile children. In children at risk for more serious illness because of height of fever, age, or results of the history and physical examination, use of white blood count (WBC) and erythrocyte sedimentation rate (ESR) is, in our experience, helpful.
Guidelines for Deciding Care of Critically III or Dying Patients
Authors: Duff Raymond S.
Published: December 2021

Medical technology is usually beneficial in the care of sick or injured persons, sometimes dramatically so. However, since it is often intrusive, occasionally cruel, sometimes of little or no value, and almost always expensive, its use must be assessed critically, particularly in ICUs. Guidelines for doing this are proposed. To ensure the most caring approach to patient care and family support, the values and autonomy of patients and their families, one by one, are emphasized in all decision making and the roles of nurses and social workers as well as those of physicians are considered central. If these guidelines are used, many, perhaps most, of the ethical and legal issues and the problems of human relationships in ICUs will be resolved.
Chronic Diarrhea of Infancy: Nonbeta Islet Cell Hyperplasia
Authors: Ghishan F. K. , Soper R. T. , Nassif E. G. , Younoszai M. K.
Published: December 2021

The case of an infant who developed refractory watery diarrhea at the age of 2 weeks is described. Diarrhea was secretory in type, stool weight on no oral intake was 400 to 600 gm daily. A vasoactive intestinal peptide (VIP)-producing tumor was suspected. At the age of 7½ months an exploratory laparotomy revealed nonbeta islet cell hyperplasia of the pancreas. VIP levels were elevated in plasma and pancreatic tissue. After 95% pancreatectomy, plasma VIP level dropped to normal. Hypokalemia, described in adult patients with VIP-producing pancreatic tumors and refractory watery diarrhea, was not a significant problem in this infant. This is the first report on the association of refractory watery diarrhea with elevated levels of plasma VIP and pancreatic islet nonbeta cell hyperplasia in the pediatric age group.
Diagnosis of Neonatal Bacterial Infection: Hematologic and Pathologic Findings in Fatal and Nonfatal Cases
Authors: Squire Edward , Favara Blaise , Todd James
Published: December 2021

Consecutive newborn autopsy cases were divided into infected and noninfected groups on the basis of pathologic findings and cultures, and were compared to a concomitant consecutive group of neonatal survivors with proven bacterial sepsis. Newborns dying with bacterial infection often demonstrated leukopenia, neutropenia, and thrombocytopenia, usually associated with normal bone marrow cell production. Those with nonfatal sepsis frequently had neutrophiia with an increase in absolute band counts. Of infected newborns 80% showed one or more hematologic abnormalities as did 43% of newborns dying without bacterial infection. Of newborns dying with bacterial infection 13% had no hematologic abnormality. Blood cultures were negative in 18% (seven) of the infants dying with bacterial infection. Abnormalities of the white blood cell, differential and platelet counts are not invariably specific for bacterial infection nor do normal values adequately exclude it. Blood cultures may be negative in newborns dying with significant foci of bacterial infection.
Fatal Haemophilus influenzae Endocarditis Diagnosed by Echocardiography in an Infant
Authors: Laird W. Pennock , Nelson John D. , Weinberg Arthur C. , Huffines F. Douglas
Published: December 2021

A 1-year-old boy was admitted to the hospital with Haemophilus influenzae meningitis. On the second hospital day a heart murmur heard on admission seemed louder. No signs of congestive heart failure were present. An echocardiogram demonstrated a persistent echo-dense mass behind the anterior leaflet of the mitral valve. A presumptive diagnosis of endocarditis was made. After ten days of antibiotic treatment the child was considerably improved. Treatment was continued for endocarditis. Over the next several days the infant's condition deteriorated. On the 16th hospital day he died. Autopsy examination showed a large vegetation attached to the posterior mitral valve leaflet. Bacterial endocarditis caused by H influenzae is uncommon at any age and rare in children. Echocardiography provided a definitive diagnosis early in the hospital course of this patient.
Need for an Infant Intravenous Multiple Vitamin Preparation
Authors: Zenk Karin E. , Huxtable Robert F.
Published: December 2021

The only commercially available intravenous multiple vitamin with A and D, M.V.I., (Multi-Vitamin Infusion, USV Pharmaceutical Corp., Tuckahoe, NY) appears to have been formulated for use in adults, yet must be used for infants and children because of the lack of an alternative product. To provide the RDA of 400 IU of vitamin D with this fixed ratio preparation, a disproportionately high dose for infants of some vitamins must be given, while an insufficient amount of others is provided.
In Reply: Reader Points Out Error
Authors: Speck William T.
Published: December 2021

I wish to thank Dr. Fraser for pointing out the error in that portion of our paper dealing with bacterial interference.
Chronic Neuropathy Presenting as a Floppy Infant with Respiratory Distress
Authors: Moss Richard B. , Sriram Subramaniam , Kelts K. Alan , Forno L. S. , Lewiston Norman J.
Published: December 2021

Respiratory distress was the presenting feature in a 4-month-old male infant suffering from Déjérine-Sottas disease, an inherited sensory-motor polyneuropathy. This unusual but potentially benign disorder can be diagnosed upon peripheral nerve biopsy by noting extensive demyelination with "onion bulb" formation. Polyneuropathy should be considered in the differential diagnosis of infantile neuromuscular weakness including or solely involving bulbar and respiratory muscles.