bluuebunny/crossref_metadata_2025 huggingface dataset:
EVALUATION OF MEAT IN THE INFANT DIET
Authors: JACOBS HOWARD M. , GEORGE GEORGE S.
Published: December 2021

A commercially prepared lean meat was fed to young infants as a supplement to a diet already adequate in all food factors.

In those infants first fed meat under 2 months of age, there was improvement in physical growth as determined by weight and height measurements. The same group demonstrated an improvement in hemoglobin levels; the elimination of the physiologic drop in total protein levels of the serum, with a prompt sustained rise in values, the greater part of which was composed of the globulin fraction.

In those infants first fed meat after 2 months of age, there was a slight improvement in average weight gain, but no significant difference was noted in other body measurements, total protein, albumin or globulin fractions, or hemoglobin levels.

Illness rates for the two years of the study demonstrated a 40% lower morbidity rate in the meat-fed group as compared to the control group.

In striving for the optimum in infant nutrition protein requirements should be evaluated both quantitatively and qualitatively.
ADRENOCORTICOTROPHIC HORMONE (ACTH) THERAPY OF THE NEPHROTIC SYNDROME IN CHILDREN
Authors: METCOFF JACK , RANCE CHARLES P. , KELSEY WESTON M. , NAKASONE NOBUYUKI , JANEWAY CHARLES A.
Published: December 2021

The clinical and physiologic features characterizing the administration of 56 courses of ACTH therapy to 45 children with the nephrotic syndrome have been reviewed.

The intramuscular administration of ACTH in daily doses of 150 to 200 mg./sq.m./ 24 hours for at least 8 and usually 10 days resulted in complete diuresis in 38 of 47 (81%) such courses, in 68% of all courses, and in 34 of 45 (75%) patients treated. Approximately 50% of the patients undergoing diuresis have maintained clinical remissions of three months or longer. Twelve of 16 such patients have been in clinical remission for over 6 months; 6 of these, for over 12 months. Induced diuresis and remission were associated with considerable improvement in renal function, particularly glomerular filtration rate and filtration fraction. Some diminution of proteinuria and increased serum protein levels were observed after diuresis, and serum cholesterol fell toward normal levels. Rather consistent but minimal changes in serum electrolyte patterns were noted. An increase of 2 to 4 mM/1. in Na, slight alkalosis and a fall in serum K were usual responses.

ACTH therapy of the nephrotic syndrome in children may be hazardous. Four patients died as a result of complications associated with therapy. The principal complications were infection, severe hypertension and hypotonicity of the extracellular fluid. Prompt recognition and treatment of these disorders with immediate withdrawal of ACTH therapy required constant vigilance and careful supervision. For this reason, this method of treatment is not considered to he a safe outpatient procedure.

The mechanisms responsible for diuresis and remission induced by ACTH therapy are not yet clear. Adequate dosage, normal diet without salt restriction but without added or excessive salt, and possibly a limited period of reduced renal function appear to favor diuresis. Neither the age of the patient nor the (chronologic) duration of disease appear to influence the outcome in children.

Although ACTH therapy may not effect a cure, it does appear to alter the course favorably in a relatively significant number of patients treated, and therefore at the present time appears to be the treatment of choice for the active phase of the nephrotic syndrome in children. A preventive or curative agent is still to be found.
PSYCHOSOMATIC STUDY OF INFANTILE ECZEMA
Authors: ROSENTHAL MAURICE J.
Published: December 2021

Comparisons of findings in interviews with the mothers of 25 infants with infantile eczema and of 18 control cases revealed that in a significantly higher proportion among the eczema cases the mother tended to let the baby cry without picking it up unless there was some obvious physical discomfort present in the infant. This was taken to indicate that most eczematous infants received inadequate caressing and cuddling. (Spitz, in an independent investigation, came to a similar conclusion.) While the study was designed to test the possibility of a quantitative lack of maternal-child physical contact (which was demonstrated), the study did not rule out the possibility that qualitative aspects of the contacts were also significant.

The lack of cuddling and caressing of the child was found to result most commonly from an attitude on the part of the mother of wishing to be free from being burdened with the care and responsibility of raising a child. These mothers would generally try to justify their infant-rearing practices by saying that they did not wish "to spoil" their babies. In a smaller group of mothers it seemed likely that their relative lack of caressing was due to physical fatigue or weakness.

The lack of cuddling and caressing in most of the cases studied was felt to be an important factor in causing the eczema. However, other factors such as constitutional predisposition and allergy were possibly equally important. Certain therapeutic suggestions were made on the basis of the hypothesis.
USE OF I131-LABELED PROTEIN IN THE STUDY OF PROTEIN DIGESTION AND ABSORPTION IN CHILDREN WITH AND WITHOUT CYSTIC FIBROSIS OF THE PANCREAS
Authors: LAVIK PAUL S. , MATTHEWS LEROY W. , BUCKALOO G. W. , LEMM FRANCES J. , SPECTOR SAMUEL , FRIEDELL HYMER L.
Published: December 2021

A method is described for evaluating protein digestion and absorption by measuring the fecal excretion of isotope after the administration of a test meal of I131-labeled protein. Application of this method to 10 children without gastrointestinal disase and to five with cystic fibrosis of the pancreas revealed the following:

1. Less than 6% of the ingested isotope was excreted in the feces of the "control" subjects.

2. A 10 to 40% (av. 22.5%) fecal excretion of the ingested isotope occurred in the children with cystic fibrosis of the pancreas.

3. A 50% decrease in the fecal excretion of isotope resulted in 2 of 4 children with cystic fibrosis of the pancreas when pancreatin was fed with the test meal.

4. One patient with cystic fibrosis of the pancreas, who after receiving pancreatin still excreted 40% or more of the ingested isotope in the feces, excreted only 8% when the test was repeated with prehydrolyzed protein.
Adult Height in Growth Hormone Deficiency: Historical Perspective and Examples From the National Cooperative Growth Study
Authors: Frindik J. Paul , Baptista Joyce
Published: December 2021

There are few historical data on final or adult heights after the completion of long-term growth hormone (GH) therapy in children with GH deficiency (GHD). Adult height has been defined as that achieved at chronologic ages ranging from 18 to 30 years, at bone ages ≥13 years (girls) and ≥15 years (boys), at growth velocities ≤1 to 2 cm per 6 to 12 months, at the “cessation of growth,” at “1 year after the completion of pubertal development,” and that at which patients are either “satisfied with their height” or have attained an “accept adult stature.”

Without GH treatment, children with GHD have a mean adult height standard deviation score of −4.7 (range, −6.1 to −3.9). After treatment, the standard deviation score range from −4.7 to −1.2 (pituitary GH [pitGH] 2–4 times a week) and from −1.4 to −0.5 (recombinant human [rhGH] GH 3 times a week to daily) in women and from −3.6 to −1.1 (pitGH) and from −1.3 to −0.7 (rhGH) in men. Because there is no uniformly applied definition of adult height, comparisons are difficult, but historical data suggest that posttreatment heights are greater with rhGH than with pitGH.

Using the National Cooperative Growth Study database, we found that the criteria used to define adult height affected the apparent outcome. When chronologic age ≥20 years for men and ≥18 years for women was the only criterion, 27% of patients grew ≥5 cm after having reached this age. Adding the requirement of advanced puberty before adult height could be considered to have been attained reduced the proportion of those who later grew ≥5 cm to <10%, but also decreased the number of patients available for analysis. A combination of criteria for adult height (chronologic and bone age ≥16 years for boys and ≥14 years for girls plus advanced puberty plus growth rate of <2 cm per year) left only 1% of patients with later growth of ≥5 cm.
The Impact of a Brief Intervention on Maternal Smoking Behavior
Authors: Groner Judith A. , Ahijevych Karen , Grossman Lindsey K. , Rich Leslie N.
Published: December 2021

Objective.

To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than 1) mothers receiving routine smoking cessation advice or 2) a control group.

Design.

Randomized, controlled trial.

Setting.

Primary care center in a large urban children's hospital.

Intervention.

Four hundred seventy-nine mothers were randomly assigned to a smoking cessation intervention either aimed at their child's health or their own health, or to a control group receiving safety information.

Outcome Measures.

Smoking status, stage of change, cigarettes/day, location smoking occurred, and knowledge of ETS effects.

Results.

Complete data (baseline and both follow-ups) were available for 166 subjects. There was no impact of group assignment on the quit rate, cigarettes/day, or stage of change. The Child Health Group intervention had a sustained effect on location where smoking reportedly occurred (usually outside) and on improved knowledge of ETS effects.

Conclusions.

Further research is needed to devise more effective methods of using the pediatric health care setting to influence adult smoking behaviors.
Shared Vision: Concordance Among Fathers, Mothers, and Pediatricians About Unmet Needs of Children With Chronic Health Conditions
Authors: Perrin Ellen C. , Lewkowicz Corinne , Young Martin H.
Published: December 2021

Objective.

These analyses were undertaken to investigate the number and types of services and assistance believed to be useful to children with a chronic health condition and their families. The perspective of mothers, fathers, and primary care physicians were sought separately and compared.

Methods.

Families that include at least 1 child with a chronic health condition were selected from pediatric practices in Central Massachusetts. All 3 respondents completed a questionnaire describing their own perspective of current needs and of the severity of the child's condition. The 3 perspectives are compared statistically and areas of agreement/disagreement are described.

Results.

Mothers, fathers, and physicians described children's and families' needs with a surprising degree of concordance. On the other hand, pediatricians identified fewer needs, despite rating the severity of children's illnesses as greater than did parents. Mothers and fathers agreed substantially about the level of severity of their child's condition and about their unmet needs.

Conclusions.

It is important that pediatric practice systems include effective mechanisms to assess parents' opinions regarding the unmet needs of their child/family in the face of a child with a chronic health condition. Without input from families, pediatricians are aware of only some of the needs that parents identify. Pediatrics 2000;105:277–285;children, chronic health condition.
A Systematic Review of Treatments for Infant Colic
Authors: Garrison Michelle M. , Christakis Dimitri A.
Published: December 2021

Objective:

To conduct a systematic review of rigorously evaluated treatments for infant colic.

Methods.

Online bibliographic databases were searched for the term “colic” in articles classified as clinical trials or randomized controlled trials and conducted in infants. Reference lists from review articles, meta-analyses, and the selected articles were also reviewed for potential studies. The abstracts or full-text articles of 57 relevant studies were examined, of which 22 met the selection criteria. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study methods, intervention studied, outcomes measured, and results.

Results.

Four of the interventions studied had data of adequate quality and statistically significant numbers needed to treat (NNT): hypoallergenic diet (NNT = 6), soy formula (NNT = 2), reduced stimulation (NNT = 2), and herbal tea (NNT = 3).

Conclusions.

There are some effective therapies for infant colic, but additional rigorous studies of existing and alternative therapies are needed.
Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities
Authors:   Committee on Child Abuse and Neglect
Published: December 2021

In most cases, when a healthy infant younger than 1 year dies suddenly and unexpectedly, the cause is sudden infant death syndrome (SIDS). SIDS is more common than infanticide. Parents of SIDS victims typically are anxious to provide unlimited information to professionals involved in death investigation or research. They also want and deserve to be approached in a nonaccusatory manner. This statement provides professionals with information and guidelines to avoid distressing or stigmatizing families of SIDS victims while allowing accumulation of appropriate evidence in potential cases of death by infanticide.
EFFECT OF MAGNESIUM SULFATE ON RENAL DYNAMICS IN ACUTE GLOMERULONEPHRITIS IN CHILDREN
Authors: HARRIS JEROME S. , DEMARIA WILLIAM J. A.
Published: December 2021

Renal function was determined in children before and during the intravenous administration of MgSO4. These studies were performed on normal children and on children with acute nephritis; in the latter, both during the acute hypertensive phase of the disease and during convalescence 1 to 3 weeks later. Glomerular filtration rates and effective RPF were markedly subnormal during the hypertensive stage and increased toward normal during convalescence. The intravenous administration of MgSO4 caused marked rises in GFR and in effective RPF when given during the hypertensive stage. Magnesium produced smaller rises in effective RPF but no changes in GFR when given during convalescence. Changes in renal function were not caused by Mg in normal children.

The implications of these findings are discussed with reference to the treatment and pathophysiology of acute nephritis. It is suggested that renal vasospasm is present in children with acute glomerulonephritis and that adequate therapy with MgSO4 relaxes this vasospasm.
IDIOPATHIC CELIAC DISEASE
Authors: ANDERSEN DOROTHY H. , DI SANT'AGNES PAUL A.
Published: December 2021

The acute phase of idiopathic celiac disease was studied in 58 patients. The criteria for selection of these cases are stated.

The frequency and severity of gastrointestinal symptoms in siblings and other relatives appeared to exceed expectation unless the disease is familial.

In the majority of patients studied, symptoms began before the age of 6 months, in 14 at birth. Vomiting was a frequent prodromal symptom. Breast feeding for more than two months was shown to delay the onset of diarrhea. The early onset of symptoms in the present series is believed to be related to the prevalence of formula feeding from early infancy in New York City at present.

Severe retardation in growth of the skull was common and occurred at an earlier age than retardation in height. This, at times, led to disproportion between measurements for total body length and head circumference. Ultimate head measurements were normal.

The following laboratory procedures were performed in the patients under consideration and their results recorded: pancreatic trypsin and amylase estimation on duodenal drainage, glucose tolerance tests, fecal fat determination, total serum protein, serum carotene and vitamin A levels and vitamin A absorption test. The diagnostic usefulness of these procedures is discussed.

Various diseases of infancy which may lead to an erroneous diagnosis of idiopathic celiac disease are discussed.
INCIDENCE OF GROSS VISUAL DEFECTS DUE TO RETROLENTAL FIBROPLASIA
Authors: SCHLESINGER EDWARD R. , MCCAFFREY ISABEL
Published: December 2021

A study was made of the incidence of gross visual impairment due to retrolental fibroplasia among infants born to residents of New York State, exclusive of New York City, in 1948 and 1949, whose birth certificates indicated birth weights of less than 2000 gm. and who survived to the age of 4 months. Information was obtained regarding 3377 infants or 92.1% of the 3667 in the group described.

A total of 50 cases with gross visual defects due to retrolental fibroplasia, or an over-all incidence rate of 1.5%, was found. The incidence rates decreased from 15.9% in the birth weight group under 1000 gm. to 4.3% in 1000-1499 gm. group, and 0.7% in the 1500 to 1999 gm. group. The infants reported to have the shortest period of gestation were found to have the highest incidence, the rate in the group with a period of gestation under seven months being 7.6% as compared with a rate of 0.3% in the group whose gestation period was reported as eight months or more.

Although the numbers are small and the measure of gestation as reported on the birth certificate is open to question, the incidence of the condition within each birth weight group was found to be inversely related to the length of gestation. In the 1000-1499 gm. birth weight group, for example, an incidence rate of 7.0% was found among the infants with recorded periods of gestation of less than seven months, as contrasted with a rate of 1.9% among those eight months or more.

There was no statistical difference in the incidence of the condition in the group of infants for whom one or more major complications of the mother's pregnancy was reported when compared with the group of infants on whose birth certificates the statement appeared that no such complication occurred. Among infants weighing less than 1500 gm. at birth, a statistically significant variation in the incidence of the condition was found in different regions of the State. The incidence rate, adjusted for differences in weight distribution was found to be 1.7% in males and 1.2% in females. The incidence rate among infants born to mothers under 30 years of age was 1.3%, which is not significantly different from the rate of 1.9% among the infants born to mothers 30 years of age or more.
NIC/Q 2000: Establishing Habits for Improvement in Neonatal Intensive Care Units
Authors: Horbar Jeffrey D. , Plsek Paul E. , Leahy Kathy
Published: December 2021

Objectives. The Vermont Oxford Network is a group of health professionals who are committed to improving the quality and safety of medical care for newborn infants and their families. Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was the second in a series of multiorganization improvement collaboratives organized and administered by the Vermont Oxford Network. The objective of this collaborative was to make measurable improvements in the quality and safety of neonatal intensive care, develop new tools and resources for improvement specific to the neonatal intensive care unit setting, evaluate improvement progress, and disseminate the learning.

Methods. The 34 centers that participated in NIC/Q 2000 learned and applied 4 key habits for improvement: the habit for change, the habit for evidence-based practice, the habit for systems thinking, and the habit for collaborative learning. A plan-do-study-act method of rapid-cycle improvement was an integral part of the habit for change. Multidisciplinary teams from the participating centers worked closely together in face-to-face meetings, conference calls, and dedicated e-mail listservs under the guidance of trained facilitators and expert faculty. Focus groups formed around specific improvement topics used critical appraisal of the published literature, detailed process analysis, benchmarking, and round-robin site visits to identify potentially better practices (PBPs).

Results. The focus groups developed a total of 51 PBPs. Each focus group has developed a “resource kit” summarizing its work. Many of these PBPs have been tested and implemented at the participating centers using rapid-cycle improvement. The PBPs and descriptions of individual center PDSA cycles are available to participants on NICQ.org, the dedicated Internet site for the collaborative.

Conclusions. Collaborative quality improvement based on the 4 key habits can assist multidisciplinary neonatal intensive care unit teams in identifying, testing, and successfully implementing change.
Using Economic Information in a Quality Improvement Collaborative
Authors: Rogowski Jeannette
Published: December 2021

This article provides an overview of neonatal intensive care unit treatment costs for hospitals that participated in the Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) quality improvement collaborative and discusses how economic information can be used in quality improvement efforts. Detailed information on neonatal intensive care unit treatment costs is presented for 29 hospitals that participated in the NIC/Q 2000 collaborative. The sample consists of 6797 very low birth weight infants (1500 g or less at birth) with admission dates between January 1, 1997, and December 31, 1998. Information on median treatment cost per infant, ancillary costs, accommodation costs, length of stay, and cost per day is presented. In addition, ancillary costs are further disaggregated into those for respiratory therapy, laboratory, radiology, pharmacy, and all other ancillary services. The role of level of care and other factors that influence treatment costs are then explored.
Implementation of Potentially Better Practices for the Prevention of Brain Hemorrhage and Ischemic Brain Injury in Very Low Birth Weight Infants
Authors: McLendon Debra , Check Jennifer , Carteaux Patricia , Michael Laura , Moehring Jim , Secrest Joel W. , Clark Sue E. , Cohen Howard , Klein Sharon A. , Boyle Diane , George Jeffrey A. , Okuno-Jones Susan , Buchanan Debora S. , McKinley Pam , Whitfield Jonathan M.
Published: December 2021

Objective. Using an evidence-based approach, a Vermont Oxford Network focus group whose goal was to reduce brain injury developed and implemented a number of potentially better practices. Each center approached implementation of the practices differently. Reducing the incidence of intraventricular hemorrhage and periventricular leukomalacia are important for improving long-term outcomes for low birth weight infants.

Methods. Implementation approaches for some but not all of the practices at the various centers are discussed. The practices reviewed include optimal peripartum management, such as resuscitation, avoidance of hypothermia, optimal surfactant delivery, early neonatal management by the most experienced providers, and measures to minimize pain and stress. Additional practices include maintenance of neutral head positioning, fluid volume therapy for hypotension, indomethacin prophylaxis, ventilator management, avoidance of routine suctioning, and limiting the use of sodium bicarbonate and postnatal dexamethasone.

Results. Approaches to implementation were center specific, and results vary. Although some practices were easier to implement than others, communication, education, and leadership were critical to the process.

Conclusions. The quality improvement multidisciplinary approach is a useful tool for finding ways to reduce the incidence of intraventricular hemorrhage and periventricular leukomalacia.
Lead
Authors: Bellinger David C.
Published: December 2021

Children differ from adults in the relative importance of lead sources and pathways, lead metabolism, and the toxicities expressed. The central nervous system effects of lead on children seem not to be reversible. Periods of enhanced vulnerability within childhood have not consistently been identified. The period of greatest vulnerability might be endpoint specific, perhaps accounting for the failure to identify a coherent “behavioral signature” for lead toxicity. The bases for the substantial individual variability in vulnerability to lead are uncertain, although they might include genetic polymorphisms and contextual factors. The current Centers for Disease Control and Prevention screening guideline of 10 μg/dL is a risk management tool and should not be interpreted as a threshold for toxicity. No threshold has been identified, and some data are consistent with effects well below 10. Historically, most studies have concentrated on neurocognitive effects of lead, but higher exposures have recently been associated with morbidities such as antisocial behavior and delinquency. Studies of lead toxicity in experimental animal models are critical to the interpretation of nonexperimental human studies, particularly in addressing the likelihood that associations observed in the latter studies can be attributed to residual confounding. Animal models are also helpful in investigating the behavioral and neurobiological mechanisms of the functional deficits observed in lead-exposed humans. Studies of adults who have been exposed to lead are of limited use in understanding childhood lead toxicity because developmental and acquired lead exposure differ in terms of the maturity of the organs affected, the presumed mechanisms of toxicity, and the forms in which toxicities are expressed.
Teeth
Authors: Billings Ronald J. , Berkowitz Robert J. , Watson Gene
Published: December 2021

Common environmental chemicals, drugs, or physical agents can adversely affect human teeth during their embryonic development and after their eruption into the oral cavity. One of the more common elemental toxicants is lead. Teeth are known to accumulate lead during their development. Both animal and human studies have shown that teeth with high lead levels are generally more susceptible to dental caries. Similarly, although inorganic fluorides have long been recognized for their potential to prevent dental caries, exposure to excessive amounts of fluoride when enamel is forming often leads to a type of enamel hypoplasia referred to as dental fluorosis or mottled enamel. Teratogenic agents, such as tetracyclines, a class of antibiotic drugs commonly administered to infants and children, will often result in the discoloration of tooth enamel when prescribed during tooth development. It has recently been suggested that childhood exposure to passive smoking increases the risk for dental caries. Environmental tobacco smoke has previously been linked to periodontal disease in adults. However, this is the first report of an association between passive tobacco smoke and increased susceptibility to dental caries. Last, an often-overlooked source of damage to teeth among all age groups after their eruption into the oral cavity is physical trauma from a variety of sources, especially sports-related injuries. Epidemiologic data suggest that up to one third of all dental injuries are sports related.
Environmental Causes of Human Congenital Malformations: The Pediatrician’s Role in Dealing With These Complex Clinical Problems Caused by a Multiplicity of Environmental and Genetic Factors
Authors: Brent Robert L.
Published: December 2021

There have been amazing advances in embryology, teratology, reproductive biology, genetics, and epidemiology in the past 50 years that have provided scientists and clinicians with a better perspective on the causes of congenital malformations. We still cannot provide the families of children with malformations a definitive diagnosis and cause in every instance. The purpose of this article is to inform pediatricians about environmental drugs, chemicals, and physical agents that have been documented to produce congenital malformations and reproductive effects and to indicate that the multitude of teratogenic agents account for only a small proportion of malformations. The most common known cause is genetic, but the largest group, unfortunately, is unknown. There are a number of important clinical rules that are important for clinicians to use when determining the cause of their patient’s congenital malformations: No teratogenic agent should be described qualitatively as a teratogen, because a teratogenic exposure includes not only the agent but also the dose and the time in pregnancy when the exposure has to occur.Even agents that have been demonstrated to result in malformations cannot produce every type of malformation. Known teratogens may be presumptively implicated by the spectrum of malformations that they produce. It is easier to exclude an agent as a cause of birth defects than to conclude definitively that it was responsible for birth defects, because of the existence of genocopies of some teratogenic syndromes.When evaluating the risk of exposures, the dose is a crucial component in determining the risk. Teratogenic agents follow a toxicologic dose-response curve. This means that each teratogen has a threshold dose below which there is no risk of teratogenesis, no matter when in pregnancy the exposure occurred.The evaluation of a child with congenital malformations cannot be performed adequately unless it is approached with the same scholarship and intensity as the evaluation of any other complicated medical problem.Each physician must recognize the consequences of providing erroneous reproductive risks to pregnant women who are exposed to drugs and chemicals during pregnancy or alleging that a child’s malformations are attributable to an environmental agent without performing a complete and scholarly evaluation.Unfortunately, clinical teratology and clinical genetics is not emphasized in medical school and residency education programs, but pediatricians have a multitude of educational aids to assist them in their evaluations, which includes consultations with clinical teratologists and geneticists, the medical literature, and the OMIM web site.
Applicability of the Principles of Developmental Pharmacology to the Study of Environmental Toxicants
Authors: McCarver D. Gail
Published: December 2021

Although nontherapeutic xenobiotics represent the vast majority of environmental exposures during childhood, study of these compounds in children has lagged behind drug studies. Some useful extrapolation can be made from the latter, however. An increased impetus for pediatric pharmacology studies resulted from evidence of shortcomings in algorithmic approaches to dosing and the recognition of differing efficacy and toxicity in children compared with adults. With some drugs, developmental differences resulted in increased toxicity or failed efficacy; however, in others, decreased toxicity has been demonstrated. Thus, pediatric patients may not be classified arbitrarily as a susceptible population but certainly a different one compared with adults. Better designed pediatric pharmacology studies use well-documented, nonlinear changes in body composition across childhood, as well as knowledge about the impact of physical growth, mediated by complex hormonal changes. Developmental differences in all components of drug disposition, including absorption, distribution, metabolism, and excretion, have been characterized. Of these, the ontogeny of metabolism, particularly tissue-specific metabolism, is the most complex. Many knowledge gaps persist within developmental pharmacology; however, recent Food and Drug Administration regulatory action likely will ensure continued accumulation of pediatric therapeutic data. Although these data can provide important a priori information for improved environmental study design, evaluation-specific toxicant disposition by pediatric patients is clearly needed.
Pediatric Pharmacokinetic Data: Implications for Environmental Risk Assessment for Children
Authors: Ginsberg Gary , Hattis Dale , Miller Richard , Sonawane Babasaheb
Published: December 2021

Pharmacology and toxicology share a common interest in pharmacokinetic data, especially as it is available in pediatric populations. These data have been critical to the clinical pharmacologist for many years in designing age-specific dosing regimens. Now they are being used increasingly by toxicologists to understand the ontogeny of physiologic parameters that may affect the metabolism and clearance of environmental toxicants. This article reviews a wide range of physiologic and metabolic factors that are present in utero and in early postnatal life and that can affect the internal dose of an absorbed chemical and its metabolites. It also presents a child/adult pharmacokinetic database that includes data for 45 therapeutic drugs organized into specific children’s age groupings and clearance pathways. Analysis of these data suggests that substantial child/adult differences in metabolism and clearance are likely for a variety of drugs and environmental chemicals in the early postnatal period. These results are also relevant to in utero exposures, where metabolic systems are even more immature, but exposures are greatly modified by the maternal system and placental metabolism. The implications of these child/adult differences for assessing children’s risks from environmental toxicants is discussed with special focus on physiologically based pharmacokinetic modeling strategies that could simulate children’s abilities to metabolize and eliminate chemicals at various developmental stages.
CONGENITAL LUNG CYSTS IN INFANTS
Authors: ALBERT HAROLD M. , POTTS WILLIS J.
Published: December 2021

The diagnosis and treatment of congenital lung cysts producing severe symptoms are discussed. The cases of six infants form the basis of this report. All had such severe dyspnea and cyanosis that emergency operations were necessary. All six infants made uneventful recoveries. The youngest child was five days old.
THE ROLE OF THE PULMONARY VASCULAR BED IN CONGENITAL HEART DISEASE
Authors: DAMMANN J. FRANCIS , MULLER WILLIAM H.
Published: December 2021

In the normal human being systemic blood pressure is maintained at a high level by means of the high resistance offered to the flow of blood by the smaller systemic arteries and arterioles. In contrast, pressure in the pulmonary circulation is maintained at a low level because of the relatively large size of the pulmonary vessels. In the fetal and newborn period pulmonary arteries resemble systemic arteries in that they have a small lumen and thick media. In this period pulmonary pressure and resistance are high. As these vessels gradually thin out and enlarge, resistance to pulmonary blood flow falls and consequently pulmonary blood pressure falls.

There is evidence to suggest that the fetal state of thick-walled, thin-lumened pulmonary arteries is retained in instances where the two circulations are joined, such as in patients with a single ventricle, large ventricular defect, aortic septal defect or large patent ductus arteriosus. As the patient grows, resistance to pulmonary blood flow may: (1) decrease. If the small pulmonary arteries develop normally and become thin-walled and large-lumened, pulmonary resistance will fall. More and more blood will be shunted into the lungs and the patient will develop the signs and symptoms of cardiac decompensation. (2) remain the same. If the small pulmonary arteries retain their fetal characteristics, pulmonary resistance will remain elevated. A balance between systemic and pulmonary blood flow will be maintained compatible with a relatively normal life. (3) increase. If, because of secondary intimal changes, the pulmonary arteries become thicker-walled and smaller-lumened, pulmonary resistance will increase. Progressively less blood will be shunted to the lungs and finally the shunt will reverse and become predominantly venous arterial. The patient will develop the signs and symptoms of pulmonary stenosis with increasing dyspnea and cyanosis.

Data from two groups of patients are presented to illustrate the importance of the pulmonary vascular bed. In the first group, early and severe symptoms of cardiac failure necessitated closure of a large patent ductus arteriosus early in life. The ductus was large, comparable to the size of the aorta, pressures from the aorta and pulmonary artery were similar and a study of the lung biopsies demonstrated that the lumens of the small pulmonary arteries were decreased in size and the media were abnormally thick. In each instance closure of the ductus resulted in a cure.

In the second group the two circulations were joined by either a large ventricular defect or a single ventricle. Three patients were in cardiac failure due to excessive pulmonary blood flow. Pulmonary blood flow was decreased by the creation of pulmonary stenosis, the main pulmonary artery being narrowed 60 to 80%. The postoperative course in these three patients illustrates the value of the creation of pulmonary stenosis in instances where the two circulations are joined by a large communication between the ventricles or great vessels.
HYDROCEPHALUS TREATED BY ARACHNOID-URETEROSTOMY
Authors: MATSON DONALD D.
Published: December 2021

Parents of an infant with hydrocephalus are interested not in having their child kept alive but in giving it a chance for normal development. Therefore, once it is established that progressive hydrocephalus exists, temporizing measures and prolonged observation should be discouraged in favor of a definitive procedure which will immediately and continuously reduce spinal fluid pressure to within normal limits. This series of patients indicates that this objective can be accomplished by diversion of cerebrospinal fluid into the urinary tract. The complications of this procedure are three: (1) mechanical obstruction of the shunt, which has been seen in only a few cases and has always been remediable; (2) meningitis, which has occurred in 8 out of 50 patients postoperatively and has been fatal in 3; and (3) acute dehydration secondary to intercurrent infection because of unreplaced loss of fluid and electrolytes through the shunt, which has been fatal in 8 to 10 of these patients.

Thirty-three out of 50 patients with severe communicating hydrocephalus treated by arachnoid-ureterostomy are living, and of these 31 are satisfactory to excellent results to date. At least 24 of these children appear to be entirely asymptomatic with normal or close to normal mental and physical development at periods from a few months to over four years.
DIAGNOSIS AND TREATMENT OF PATENT DUCTUS ARTERIOSUS IN INFANCY
Authors: ADAMS PAUL , ADAMS FORREST H. , VARCO RICHARD L. , DAMMANN J. FRANCIS , MULLER WILLIAM H.
Published: December 2021

A large patent ductus arteriosus can produce obvious cardiac difficulty and death in infancy. The diagnosis of a patent ductus arteriosus in infancy can be difficult in the absence of a continuous murmur. In such instances special studies such as cardiac catheterization or retrograde aortography should be performed to establish the diagnosis.

Surgical closure of the patent ductus arteriosus can and should be performed in those infants with symptoms and findings of cardiac difficulty—dyspnea, cardiomegaly, murmur, and marked growth failure.

Data have been presented on 16 infants with patent ductus arteriosus in whom surgical closure of the patent ductus arteriosus was deemed necessary before 18 months of age.

Of the 16 infants, one died during surgery (6% mortality rate) and the remaining showed marked improvement following surgery. Postoperative rate of growth was variable in patients followed one year or less, consistently improved in those followed 1½ years or more.
PROBLEM OF DIFFERENTIAL DIAGNOSIS IN INFANTS WITH LARGE HEARTS AND INCREASED BLOOD FLOW TO THE LUNGS
Authors: FERENCZ CHARLOTTE , JOHNSON ARNOLD L. , GOLDBLOOM ALTON
Published: December 2021

This paper deals with the differential diagnosis of the cardiac lesion in infants who have enlargement of the heart associated with increased blood flow to the lungs, and in whom cyanosis is not a prominent feature. Some patients in this group have a patent ductus arteriosus in the absence of a typical continuous murmur, and these infants may urgently require the benefits of surgical therapy. Since the diagnosis can be established by aortography or heart catheterization, some criteria are required for the better selection of infants from this group in whom these investigations should be performed.

Twenty-five infants form the subject of this study. In 19 the diagnosis was confirmed at autopsy. Eight patients had a patent ductus, either as an isolated lesion or in association with other defects; 10 had ventricular septal defects with or without overriding of the aorta; 5 had anomalous pulmonary vein drainage; one had an ostium atrioventricular communis and in one there was a functional single ventricle.

Clinical, electrocardiographic and radiologic findings were analyzed. Important features which appear to favour the diagnosis of patent ductus arteriosus are full or collapsing pulses and a normal ECG or one showing evidence of combined ventricular hypertrophy. Suggestive, but of lesser importance, is the finding of an apical diastolic rumble and enlargement of the left atrium. All these findings may, however, be present in patients with other malformations, especially defects involving the ventricular septum.

Evidence of marked hypertrophy of the right atrium and right ventricle by electrocardiography and fluoroscopy renders the presence of patent ductus unlikely and is consistent with the diagnosis of anomalous drainage of pulmonary veins.
INTESTINAL OBSTRUCTION DUE TO ASCARIASIS
Authors: JENKINS MARGARET Q. , BEACH M. W.
Published: December 2021

Thirty-one patients with obstruction of the small intestine due to ascaris are discussed, with two deaths. These patients were seen during a five year period.

Treatment consisted of Wangensteen suction, parenteral fluids and small doses of hexylresorcinol crystoids without a laxative, given for several days, or of hetrazan®, 6 mg./kg, three times daily for one week.

Obstruction was relieved and no evidence of toxicity occurred.
MITRAL COMMISSUROTOMY IN CHILDHOOD
Authors: LURIE PAUL R. , SHUMACKER HARRIS B.
Published: December 2021

Three patients, age 1-2, 14 and 15 years, presented symptoms of mitral stenosis to a disabling degree and were surgically relieved with dramatic effectiveness. These cases are reported, including catheterization data in two of the cases. The similarity of a very few cases of rheumatic heart disease in childhood to adult patients with mitral stenosis is pointed out. The criteria for selection of adult patients for mitral commissurotomy are equally applicable to children.
EFFECTS OF VITAMIN B12 AND AUREOMYCIN ON NITROGEN RETENTION IN INFANTS
Authors: KAYE ROBERT , CAUGHEY RONALD H. , MCCRORY WALLACE W.
Published: December 2021

The effects of vitamin B12 on weight, nitrogen and electrolyte balances were studied in six male infants. Three of the infants were offered nitrogen intakes of approximately 1.0 gm./kg./day, and the remaining three an intake of 0.1 gm./kg./ day.

The effects of aureomycin were studied by the same criteria in two of the infants on low nitrogen intakes.

The authors were unable to obtain unequivocal evidence that vitamin B12 exerts a nitrogen anabolic effect in infants maintained on constant intakes of high and low protein content.

Vitamin B12 administration to the subjects on a high protein intake resulted in an increased urinary nitrogen excretion which may be a reflection of an enhanced rate of conversion of protein into carbohydrate or fat.

Averages of the control and B12 period nitrogen retentions and weight gains in gm./kg./day were 0.235 and 11.8 for the high protein-fed subjects, and .011 and 2.4 for the low protein-fed subjects.

Aureomycin did not produce beneficial effects on weight or nitrogen retention, but rather showed a tendency to augment fecal nitrogen losses.

Appetite stimulation was noted in 2 of the 6 subjects given B12.

A nitrogen intake of 0.1 gm./kg./day derived from cow's milk protein approximates the minimum requirement for equilibrium in male infants under the conditions of this study.
ASSAY OF THE TRYPTIC ACTIVITY OF THE FECES OF THE NEWBORN INFANT, AT TERM OR PREMATURE
Authors: DE FILIPPI FELIPE , GIUSSANI AUGUSTO A. , RIVELIS LEA
Published: December 2021

The Shwachman test was carried out on 30 healthy newborn infants, including premature infants. The results were negative in 28 cases on the first day, but positive in all cases on the 4th. As it is known that normally the newborn infant, even when premature, possesses duodenal trypsin, the absence of same in the meconium indicates that it may be destroyed by intestinal stagnation. This means that the assay of fecal trypsin is of no use for the precocious diagnosis (within the four first days of life) of mucoviscidosis or cystic fibrosis of the pancreas.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: WEGMAN MYRON E.
Published: December 2021

UNDER this title Alan Moncrieff, Nuffield Professor of Child Health in the University of London, delivered the Newsholme Lectures in 1953. The series is now published in a slim volume by Oxford University Press and makes stimulating reading. Professor Moncrieff's experience and present position as physician-in-chief at The Hospital for Sick Children, Great Ormond Street, fit him particularly well for combination of curative, clinical thinking, with prevention.

Opening the series is an introduction setting the stage in the light of Sir Arthur Newsholme's works in an earlier generation. Newsholme said that the health of every individual is a social concern and responsibility, but he raised important practical questions. How much can we afford for health, or, more particularly, for child health? And we are getting value for our money? Does state interference, state control, state provision of benefits or whatever it is called remove a sense of parental responsibility?

Moncrieff examines the problem under four headings: Infant Welfare; School Health; The Deprived Child; Parental Responsibility and The State. Considering under the first the question of medical care for motherhood, Newsholme noted that maternity and child welfare work represented a practical escape from the pathological to the physiological in public health problems. Yet Moncrieff notes that even now maternity care as provided in Britain has not been up to what it should be.
TOTAL BODY CHLORIDE IN TUBERCULOUS MENINGITIS
Authors: CHEEK DONALD B.
Published: December 2021

Seven children with tuberculous meningitis have been studied. In the absence of fluid restriction and vomiting, hypotonic expansion of the extracellular fluid has been revealed. This draws attention to an alteration in water excretion. Metabolic alkalosis yields evidence of cell potassium depletion.

The serum chloride is no indication as to the status of total body chloride.
THE TREATMENT OF LEAD ENCEPHALOPATHY—A METHOD FOR THE REMOVAL OF LEAD DURING THE ACUTE STAGE
Authors: BESSMAN SAMUEL P. , RUBIN MARTIN , LEIKIN SANFORD
Published: December 2021

1. A theoretical basis for the use of the Calcium complex of ethylene diamine tetraacetic acid for the deleading of patients in the acute stage of lead poisoning is presented.

2. Of seven cases of lead encephalopathy treated with this agent, one expired soon after admission, and the others showed prompt clinical improvement.

3. Urinary excretion studies show that approximately 1.8 mg. of lead are excreted for each 500 mg. of CaEDTA administered under conditions calculated to realize the maximum efficiency of the therapy.

4. No signs of toxicity from CaEDTA were noted.

5. A general plan of therapy of lead encephalopathy with CaEDTA is presented.

6. It is too early to evaluate the effects of this form of treatment in minimizing brain damage from this disease.