bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma Creatinine Levels in Low-Birth-Weight Infants During the First Three Months of Life
Authors: Stonestreet Barbara S. , Oh William
Published: December 2021

In clinical practice, the plasma creatinine level is often used as an indicator of renal function. Plasma creatinine values have been reported in persons from 1 to 20 years of age1; however, the value in low-birth-weight infants during the first three months of life has not been established. With an increasing number of survivors in this group of infants, the appropriate management of fluid and electrolyte balance during the neonatal period often requires plasma creatinine levels as an indicator of renal function. In the course of various renal functional studies, our laboratory has accumulated data on plasma creatinine levels in a group of clinically stable, low-birth-weight infants during the first three months of life; these data are the subject of this report.
WILL THE STETHOSCOPE EVER COME INTO GENERAL USE IN CLINICAL MEDICINE? A STRONGLY NEGATIVE VIEW EXPRESSED IN 1821
Authors: C. T. E.
Published: December 2021

Sir John Forbes (1787-1861) in the preface to the first edition of his translation of Laënnec's De l'ausculation médiate, published in 1821, was guilty of one of the most famous false prophecies in medicine.1 He wrote of the newly invented stethoscope:

That it [the stethoscope] will ever come into general use, notwithstanding its value, I am extremely doubtful; because its beneficial application requires much time, and gives a good deal of trouble both to the patient and the practitioner; and because its whole hue and character is foreign, and opposed to all our habits and associations. It must be confessed that there is something even ludicrous in the picture of a grave physician formally listening through a long tube applied to the patient's thorax, as if the disease within were a living being that could communicate its condition to the sense without. Besides, there is in this method a sort of bold claim and pretension to certainty and precision of diagnosis, which cannot, at first sight, but be somewhat startling to a mind deeply versed in the knowledge and uncertainties of our art, and to the calm and cautious habits of philosophising to which the English physician is accustomed. On all these accounts, and others that might be mentioned, I conclude, that the new method will only in a few cases be speedily adopted, and never generally.2

This paragraph was omitted from subsequent editions.
Use of Codeine-and Dextromethorphan-Containing Cough Syrups in Pediatrics
Authors:   Committee on Drugs
Published: December 2021

In making decisions regarding the use of centrally acting antitussives, the practitioner must first consider the indications for the use of any antitussive agent; then, the efficacy and safety of the available agents as compared to those of a nondrug, alternative course of therapy must be considered. As stated in an editorial in the British Medical Journal,1 "the fact that a patient has a cough does not indicate that he needs treatment for it." Nevertheless, we acknowledge the traditional, frequent prescribing and self-administration of antitussive products and the almost placebo nature of many of them. Indications and Contraindications Coughs may be considered reflex responses to mechanical or chemical irritation of the tracheobronchial tree that are mediated by a brainstem "cough center." Thus, coughing serves the beneficial functions of clearing airways of obstructing or irritating material and warning against noxious substances in inspired air.2

In pathologic states (e.g., asthma, chronic obstructive pulmonary disease, chronic bronchitis, and cystic fibrosis), the cough reflex serves to maintain airway patency by clearing excessive secretions. Cough suppression in patients with these conditions may be not only counterproductive but also directly harmful. Clearing of secretions filling the tracheobronchial tree of these patients is essential to management.

In other diseases (e.g., influenza), coughing simply may be a response to inflammation of the respiratory epithelium; however, a truly "nonproductive" cough is unusual in infants and young children. Rarely, nonproductive coughing may be severe enough to cause emesis, exhaustion, and loss of sleep.

A cough is usually a mild symptom of the common cold, but even in this instance clearing of secretions is probably beneficial.
Mitigation of Cretinism by Breast-Feeding
Authors: Bode Hans Henning , Vanjonack William J. , Crawford John D.
Published: December 2021

An athyrotic infant had hypothyroidism at 1 year of age. He had grown at an above-average velocity until age 10 months when breast-feeding was discontinued, yet his bone age remained that of a newborn. These observations suggested that breast-feeding had attenuated hypothyroidism by providing significant quantities of thyroid hormones in the milk. To test this hypothesis, thyroxine (T4), 3,5,3'- triiodothyronine (T3, and 3,3',5'-triiodothyronine (reverse T3) were measured in breast milk samples collected serially from three months before to four months after delivery. Mean breast milk T4 content fell from 1.4 to 0.7 µg/dl within 48 hours after delivery, while T3 content rose from 136 to 286 ng/dl. Reverse T3 content remained unchanged. The shift in the T4/T3 ratio after delivery was observed in samples of all five donors; the highest postpartum T4 level was 1.1µg/dl and the highest postpartum T3 level was 405 ng/dl. It is concluded that breast-feeding may deliver sufficient thyroid hormones to the athyrotic infant to mitigate severe hypothyroidism and to prevent impaired neurological development.
Trisomy 21 in One of Twin Fetuses
Authors: Heller Richard H. , Palmer Lee S.
Published: December 2021

Both the detection of twins and the successful execution of a double amniocentesis pose significant technical problems in prenatal diagnosis. A case is reported in which one of twin fetuses had trisomy 21 and the other was chromosomally normal. Following counseling, the family chose to continue the pregnancy. At term, the mother was delivered of a healthy infant and a severely macerated fetus with stigmata suggestive of Down's syndrome.
Neonatal Death: Reflections for Physicians
Authors: Elliott Barbara A. , Hein Herman A.
Published: December 2021

When an infant dies, a bereaved family is left to face the same mourning processes as any grieving family. However, recent reports indicate that these families often experience the process with more intensity and for a longer duration. Cullberg states that one third of the mothers in his study developed pathological mourning after one to two years. American fathers, as Kennell and Klaus2 point out, often react with overactivity and never completely resolve their grief. Blank3 explains that siblings with extended grief reactions are among the reasons for the development of her Early Crises Consultation Service. Clearly, the physician in contact with such a family has a role to play in their continuing recovery.

The purpose of this article is to focus on the physician's role as counselor to a family following neonatal loss. Our personal experience and a review of the literature form the basis for specific recommendations regarding the physician's role. (B.A.E. recently experienced the loss of twin newborn sons at 7 and 8 days of life. A coxsackievirus B2 septicemia was suspected as the cause of death in each case. H.A.H. is the neonatologist who counseled the family after the twins' death.) The various phases of mourning are described and recommendations for counseling are given at appropriate intervals.

The article is presented from the viewpoint of an intact, extended family that is interacting in the grieving process. We recognize that single parents and parents separated from relatives and friends may go through a more extended process. The skill of a caring physician is especially essential under these circumstances when support is minimal, and more frequent visits than recommended here may be required.
Childhood Cancer: Parental Discord and Divorce
Authors: Lansky Shirley B. , Cairns Nancy U. , Hassanein Ruth , Wehr Jean , Lowman James T.
Published: December 2021

Parents of 191 children who were treated for cancer over a seven-year period completed and returned a questionnaire concerning marital status. Contrary to the prediction of a high divorce rate among these families, the study found a person-year divorce rate of 1.19%. This is slightly lower than the 2.03% person-year divorce rate among married couples with children in the states of Kansas and Missouri. The Arnold sign indicator analysis of the Minnesota multiphasic personality inventory was used to measure marital stress in 38 intact couples whose children were treated for cancer. The study sample experienced more stress than a comparison group of 23 couples who had hemophilic children. Both of these populations had more stress than a normal standardization group but less than a standardization group of marriage counselees.
Behcet's Disease Presenting as Chronic Aphthous Stomatitis in a Child
Authors: Mundy Thomas Maxwell , Miller John J.
Published: December 2021

Behcet's disease is a chronic, recurrent, inflammatory disease of unknown cause that involves mucous surfaces, skin, eyes, joints, and the CNS. Although not reported in the pediatric literature, some cases start in childhood. This report describes a child whose chronic oral and genital ulcers preceded recognition of her gastrointestinal tract, eye, and CNS disease for nine years. The current knowledge of Behcet's disease in children is discussed.
TEACHING THINKING
Authors: Adams V.
Published: December 2021

Once they've learned how expert thinkers think, how do scientists teach what they've learned to novices? Certainly not by lecturing. "During a lecture," said Robert E. Sparks of Washington University in St. Louis, Mo., "the only mind working at reasonable efficiency is that of the lecturer." That is why cognitive scientists require students to take an active part in learning how to think. "The origins of this ‘new’ view are quite old," Dr. Lochhead observed, and he quoted Galileo: "You cannot teach a man anything; you can only help him to find it within himself."
Some Guidelines for Uses of Hypnotherapy in Pediatrics
Authors: Olness Karen , Gardner G. Gail
Published: December 2021

Hypnotherapy has many uses in pediatrics, and its value, not only as an adjunct but also as a primary therapy for certain conditions, justifies its inclusion in pediatric training programs. Suggestion and expectation have long been related to therapeutic outcomes in medicine, but not all physicians know how to apply them constructively and systematically in communication with patients. In pediatrics there is a tendency to overlook opportunities in which hypnosis might be the treatment of choice.

Because children engage in imagination and fantasy easily without the cognitive inhibitions of adults, they are able to use hypnosis more readily than adults. More research into the imaginative skills of children may facilitate understanding of learning mechanisms and make it possible for professionals to prevent the loss of the natural imaginative capacities in children and, therefore, enhance the ability of mature members of society to use these skills.

In addition to reduction of specific symptoms through hypnotherapy, children benefit by the sense of mastery which they acquire, a sense which is surely needed to overcome the feelings of hopelessness, loss of control, and depression induced by many diagnostic and therapeutic procedures in medicine.
Urinary Tract Infections in Girls: Age at Onset and Urinary Tract Abnormalities
Authors: Monahan Michael , Resnick Jack S.
Published: December 2021

Urinary tract infection in children is a common problem confronting pediatricians, family practitioners, and urologists. The prevalence of this problem for the general population under the age of 14 years has been found by Kunin1 to be 0.4% for boys and 1.2% for girls. The question of which patients require a complete radiologic evaluation (intravenous pyelogram [IVP] and voiding cystourethrogram [VCUG]) has been classically embalmed in controversy and confusion. Some authors have advocated investigating all children with a bacteriologically proven infection,2 while most others have recommended investigations after the first infection in boys and after the second infection in girls.3-5
Enteroviral meningitis: A reappraisal
Authors: Lepow Martha L.
Published: December 2021

During the first half of this century, poliomyelitis was the most prevalent epidemic acute nonbacterial CNS disease. Indeed, the paralytic consequences were so severe and costly that scientific efforts were directed toward disease control through immunization for several decades. The absence of susceptible animal species apart from primates limited epidemiologic and preventive endeavors.

A spectrum of illness presumed to be due to poliomyelitis virus was recognized. In a given epidemic, there were always persons with acute CNS illnesses characterized by fever, headache with signs of meningeal irritation, and pleocytosis in the CSF who did not become paralyzed. In some outbreaks, little or no paralytic disease was identified.
Patterning treatment for retarded children
Authors: Fremont Albert C. , Halpern Daniel , Merrill Robert E. , Taft Lawrence T.
Published: December 2021

It is likely that many pediatricians and other physicians are confused and frustrated by the actions and statements of pressure groups, by the news in the daily press, and particularly by the lack of informative data in regard to various treatment regimens which are advocated for all sorts and conditions of handicapped children. Particularly, the various points of view and controversies which have surrounded the socalled patterning regimens have frequently been sources of confusion rather than enlightenment.

Against this background, the study by Sparrow and Zigler published in this issue of Pediatrics (p. 137) is especially refreshing and welcome.
Evaluation of Programs Designed To Increase the Protection of Infants in Cars
Authors: Reisinger Keith S. , Williams Allan F.
Published: December 2021

Three in-hospital educational programs for postpartum women, designed to increase the crash protection of infants in cars, were evaluated in comparison to a group that received no education. The programs consisted of (1) literature, plus making infant carriers readily accessible and convenient to purchase; (2) literature, plus a personal discussion, plus making infant carriers readily accessible and convenient to purchase; and (3) literature, plus the offer of a free infant carrier. The programs increased the extent to which infant carriers were used to transport babies in cars, but had little or no effect on the key outcome measure: use of infant carriers fastened by the car seat belt so that crash protection is provided. Rates of such use were low in all groups. It is concluded that ways of providing increased crash protection to infant and child travelers in addition to use of restraint systems requiring the active, voluntary cooperation of parents must be encouraged. "Passive" (automatic) protection techniques, such as air bags and vehicle interior modifications, have great potential in this regard.
Chromosome Damage in Infants and Children After Cardiac Catheterization and Angiocardiography
Authors: Adams Forrest H. , Norman Amos , Bass Doris , Oku George
Published: December 2021

Current diagnostic cardiac studies in infants and children result in longer x-ray exposure times and in more angiocardiograms per patient. Blood samples removed before and immediately after such studies in 20 infants and children have shown chromosome damage in all. The damage was equal to an in vitro absorbed dose in the range of 20 to 50 rads. Since the effect was considerably greater than that calculated from the x-ray exposure dose to the patient, it is concluded that the damage is mainly due to the contrast agent used in angiocardiography. Long-term follow-up studies on such patients are indicated.
Child Psychiatric Consultation in Pediatrics
Authors: Lewis Melvin
Published: December 2021

The results of a three-month study of the incidence of child psychiatric consultation requests in three different locations (emergency room, primary care center, and pediatric wards) within a pediatric service in a teaching hospital are reported here. Future trends and roles for child psychiatry and pediatric collaboration are discussed.
ABO Hemolytic Disease: A Comparative Study of Clinical Severity and Delayed Anemia
Authors: Kanto William P. , Marino Brenda , Godwin Anita S. , Bunyapen Chantrapa
Published: December 2021

The hospital and clinic records of 230 neonates with ABO hemolytic disease (HD) were reviewed. There was no significant difference in clinical severity between AO-HD and BO-HD as measured by (1) number of neonates with hyperbilinibinemia and/ or those requiring exchange transfusion; (2) hemoglobin concentration; (3) reticulocyte count; (4) bilirubin concentration; and (5) incidence of anemia after discharge from the hospital. There was no difference in the hemoglobin concentrations measured at between four and eight weeks of age in 39 control infants and infants with either AO-HD or BO-HD who did not require an exchange transfusion. Our data do not indicate a clinical difference in the severity of AO-HD and BO-HD. Infants with ABO-HD who do not require exchange transfusion and/or phototherapy and whose hemoglobin concentration at discharge is > 15 gm/dl do not need a hemoglobin measurement before 6 weeks of age.
Sexual Abuse, Another Hidden Pediatric Problem: The 1977 C. Anderson Aldrich Lecture
Authors: Kempe C. Henry
Published: December 2021

Each week we find among our pediatric-adolescent patients, among youngsters at the Kennedy Child Development Center, and among the children seen at our child psychiatric service, increasing numbers of sexually abused children whose presenting chief complaint is nonspecific.

The nonspecific symptoms I have described may be the only clues we physicians have that we may be dealing with sexual abuse. One requires sensitive attention to the patient, good listening, taking time, and always going beyond the presenting "chief complaint."

The runaway who is simply asked "Why did you run away?" will say, "I had afight with my folks." The next question is "What was your fight about?" The answer, "I was out late." Most professionals stop right there, but that's where we should all start. We simply have to know more. One needs to lead up to the relationships with the child's mother and father, and then one finally has to ask some direct questions, in as kind a way as possible, in order to give the child permission to relate his/her loneliness, shame, and fears.

Sexual abuse should always be viewed from a developmental point of view, and it is the point of each child's development which determines the ultimate impact that sexual abuse has. Early and decisive intervention, rescue, and supportive therapy work well, even if the family is not reunited. The child deserves a chance at therapy just as much as if there were any other insult to development.

Pediatricians routinely try to find children who have hearing and speech problems. Should we not be equally open and ready, intellectually and emotionally, for the condition of incest, which is the last taboo?

Thank you for allowing me to share with you this hour honoring the late Dr. Aldrich. I hope that I have done him honor.
The burned-out missionary
Authors: Work Henry H.
Published: December 2021

In a recent commentary in response to Anders' article,2 Rothenberg pointed out that

individuals who have chosen pediatrics for any of these reasons [comfort with children rather than adults, need to be in control of patients, or reacting against basic dislike and discomfort with children] are obviously not going to be interested in becoming very involved in psychosocial and behavioral issues, since such involvement would inevitably lead to their being confronted with their own motivations for going into the field.

These comments endeavor to extend the truth expressed in his words to the on-going issue of pediatric comfort and discomfort in dealing with patients, in this case parents.
Fetal Growth Retardation: Femurs, Fontanels, and Follow-up
Authors: Philip Alistair G.S.
Published: December 2021

Sixty-three term newborn infants with fetal growth retardation were evaluated within three days of birth. They were classified by length and head circumference. In group 1, both length and head circumference were less than the tenth percentile; in group 2, either length or head circumference was less than the tenth percentile; and in group 3, both length and head circumference were greater than the tenth percentile. Ponderal index (weight/length ratio), anterior fontanel size, and amount of epiphyseal ossification were also determined. Significantly lower birth weights and decreased ossification were found when groups 1 or 2 were compared separately with group 3.

These differences were most marked when the weight/length ratio was less than 2.25. When the ponderal index was less than 2.0, epiphyseal ossification was usually absent (suggesting a chronic process). Epiphyseal ossification was positively correlated with birth weight and length but was unrelated to anterior fontanel size. Ossification was more often absent in males than in females. There was a negative (inverse) correlation between birth weight and anterior fontanel size.

Follow-up of 32 of these infants at age 1 year showed marked individual variations, but there were significant differences in incremental linear growth between groups 1 and 3, a finding which supports results of animal studies showing that catch-up growth may be related to skeletal immaturity. Physical measurements at birth in the individual baby with fetal growth retardation do not reliably predict subsequent growth.
Congenital Vesicular Eruption Caused by Haemophilus influenzae Type b
Authors: Halal Fahed , Delorme Laurent , Brazeau Michel , Ahronheim Gerald
Published: December 2021

We report a case of perinatal infection that we believe is the first documented report of a congenital vesicular eruption due to Haemophilus influenzae type b and the second report of puerperal sepsis with this organism.

A vesicular eruption was noted at birth on an infant delivered at 37 weeks following 34 hours' premature rupture of membranes. Gram-negative rods were seen on Gram stain of vesicular fluid, and H. influenzae type b grew on cultures of vesicular fluid. The mother sustained postpartum septicemia with the same organism. Amnionitis and funisitis were demonstrated histologically. Results of all viral studies were negative. Infant and mother did well with antibiotic therapy.
Neonatal Osteomyelitis
Authors: Fox Lavinia , Sprunt Katherine
Published: December 2021

To evaluate current conservative therapy and document the existence of a recent shift in etiologic agents, we reviewed the records of 45 infants who developed osteomyelitis within the first ten weeks of life and who were admitted to Babies Hospital (New York) from 1951 through 1976. Emphasis was placed on characteristics and course of the disease, etiologic agents, therapy, and outcome. Illness was diagnosed within the first two weeks of life in 34 of the 45 infants (73%). Only six had been delivered normally after normal pregnancy and led a normal life before development of osteomyelitis. Infected sites were distinctive in frequency of involvement of multiple foci (21), of facial bones (10), and of joints contiguous to infected tong bones (22 of 29). Conservative therapy (nonsurgical) seems reasonable for the majority of patients. Of particular interest is documentation of a shift from Staphylococcus aurens as predominant etioloic agent before 1965 to β-hemolytic streptococci, commonly group B, from 1965 through 1976. Data collected from the literature of the 1930s indicate that such shifts have occurred before.
Diskitis: A Prospective Diagnostic Analysis
Authors: Fischer Gerald W. , Popich Gregory A. , Sullivan Daniel E. , Mayfield Gerald , Mazat Bruce A. , Patterson Peter H.
Published: December 2021

In a three-year prospective analysis of nine patients with suspected diskitis, seven were confirmed as having diskitis, one had sacroiliac septic arthritis, and one had Guillain-Barré syndrome. The mean age of the patients was 3.3 years, and four of the seven were girls. Routine lumbar spine roentgenograms were not diagnostic for three to eight weeks. Nuclear imaging procedures, however, produced abnormal scans in all nine studies. Technetium Tc 99m diphosphonate scans were abnormal within seven days of symptoms, gallium citrate Ga 67 scans within 14 days. Scans were abnormal on seven occasions when standard roentgenograms were not diagnostic. The diskitis patients had low-grade fever (seven), irritability (six), and leg or hip complaints (six). Early, rapid diagnosis is critical with this disease because some cases have been misdiagnosed as meningitis, appendicitis, or septic arthritis. Four of the seven patients had evidence of viral disease, white β-hemolytic streptococci and anaerobic diphtheroids were isolated from two disk space aspirates. Spica casts were used in six patients to encourage immobilization, antibiotics in two, and one patient received no specific therapy. All patients recovered regardless of therapy.

The present study is the first known prospective study of diskitis. The data thus far collected suggest that this disease is more common than previously recognized and that with the use of radiopharmaceuticals, cases previously missed may now be accurately diagnosed as diskitis. Pediatricians are urged to consider this diagnosis in any child with fever, irritability, and vague abdominal, leg, or back complaints whose origin is not identified.
Pyogenic Hepatic Abscess in Infancy and Childhood
Authors: Chusid Michael J.
Published: December 2021

Five cases of childhood pyogenic hepatic abscess at Milwaukee Children's Hospital and 61 cases in the literature were reviewed. Hepatic abscess occurred most often in infants who had sepsis or umbilical infection. Cases in older children were associated with underlying host defense defects, particularly chronic granulomatous disease (CGD) and leukemia.

Common clinical findings were fever, abdominal pain, and hepatomegaly. Radionuclide scan was useful in diagnosis of lesions larger than 2 cm. Small or microscopic lesions were diagnosed at autopsy. Staphylococcus aureus was the most common etiologic agent. Mortality in all evaluable cases was 27% in patients with CGD and 42% in those without CGD. Open drainage and appropriate antibiotic therapy is the treatment of choice and should lower the mortality of this infection.
Thrombocytopenic Purpura Related to Rubella Infection
Authors: Özsoylu Sinasi , Kanra Güler , Savaş Gülersu
Published: December 2021

Serologic studies for rubella (hemagglutination inhibition and complement fixation changes) were carried out at two-week intervals in 15 patients with acute idiopathic thrombocytopenic purpura and in age-matched controls in the same season during a small rubella epidemic. Hemagglutination inhibition, sucrose density gradient for hemagglutination inhibition, and complement fixation titer changes implicated recent rubella infection as an etiologic factor in five of the 15 patients.
Microangiopathic Hemolytic Anemia and Thrombocytopenia in a Neonate Associated With a Large Placental Chorioangioma
Authors: Bauer Charles R. , Fojaco Rita M. , Bancalari Eduardo , Fernandez-Rocha Luis
Published: December 2021

The case of an infant born in association with a large chorioangioma of the placenta is presented. The maternal complications of polyhydramnios, preeclampsia, and premature labor are those described in the "syndrome" of a chorioangioma. The immediate neonatal course was unusually complicated by severe microangiopathic anemia with persistent thrombocytopenia and hemolysis which required three exchange blood transfusions. The relationship between the neonatal complications and the placental tumor is discussed in terms of possible pathophysiologic mechanism.
Financial Compensation for Evaluation and Therapy of Children With Developmental Disabilities
Authors:   Committee on Children With Handicaps
Published: December 2021

A developmental disability is defined as an abnormality beginning in fetal life or early childhood which precludes or significantly impedes normal physical and/or mental development. Included in this definition are mental retardation, cerebral palsy, and other neurologically handicapping conditions, deafness, speech disorders, blindness, mental illness, autism, and disorders of comprehension or effective use of language.

Diagnosis and therapy of a developmental disability frequently require efforts of many disciplines (i.e., medicine, occupational and physical therapy, psychology, nursing, social service, speech pathology, and audiology). It is essential that appropriate financial compensation be provided by third-party payers for the services performed by all these disciplines. Non-physicians should receive compensation from thirdparty payers only if the diagnostic and theticapeuic measures are prescribed by a physician.

The most effective care for developmentally disabled persons necessitates coordination, staffing, and follow-up efforts. Physicians must receive third-party compensation for these efforts as well as for counseling and visits to schools on behalf of these patients. Such activities are all appropriate extensoins of the physician's primary care role in the diagnosis and management of developmental disabilities in children.
Surface Morphology of Polyvinyl Chloride and Silicone Elastomer Umbilical Artery Catheters by Scanning Electron Microscopy
Authors: Clawson C. C. , Boros Stephen J.
Published: December 2021

The surface features of a new siliconmer elastomer umbilical artery catheter have been defined by scanning electron microscopy and compared with those of a standard polyvinyl chloride catheter. Little difference was noted in the surfaces of the catheter materials themselves, but the radiopaque material used to render the catheters visible by x-ray resulted in a considerable difference in the overall smoothness. The polyvinyl chloride catheter's marker was in the form of a wide, rough band extending the length of the tubing whereas the marker particles of the silicone elastomer were dispersed, more uniform in size, and resulted in less overall irregularity of the surface.
Age-Dependent Closure of the Patent Ductus Arteriosus by Indomethacin
Authors: McCarthy Jeane S. , Zies Leonor G. , Gelband Henry
Published: December 2021

Indomethacin has been shown to be effective in closing a patent ductus arteriosus (PDA) in small premature infants. However, the age range over which this therapy is effective remains undetermined. Eighteen infants ranging in age from 4 to 45 days were studied. All had auscultatory and clinical findings indicative of PDA. Seventeen had roentgenographic evidence of cardiomegly and/or increased pulmonary vascular markings, and eight had ECG evidence of ventricular hypertrophy. Indomethacin was administered to most patients in two doses of 0.1 to 0.3 mg/kg 24 hours apart. In eight of 12 patients, 3 week of age or younger, the PDA closed after indomethacin therapy. Two patients had a decrease in the intensity of murmur and improvement of congestive heart failure after treatment, but the PDA did not close completely. Only patients 33 weeks of age (actual age) or younger responded to indomethacin therapy with complete ductal closure. The condition of patients 34 to 36 weeks of age improved but there was not complete closure; in patients older than 36 weeks there was no response. The data suggest an age-related mechanism for PDA closure and that treatment with indomethacin before 33 weeks of age is probably required. A role for prostaglandin in ductal patency is postulated.
Control of Nosocomial Respiratory Syncytial Viral Infections
Authors: Hall Caroline Breese , Geiman Joyce M. , Douglas R. Gordon , Meagher Mary Pat
Published: December 2021

We evaluated methods to control the spread of respiratory syncytial virus (RSV) on our infants' ward during a community outbreak of RSV infection. Methods included isolation and cohorting of infected infants, strict handwashing, use of gowns, and the cohorting of staff to the ill infants. Of 123 infants studied, 36 were admitted with RSV infections. Of the remaining 87 contact infants, eight (19%) acquired nosocomial RSV disease. Three of the eight developed pneumonia and one died. Of the 43 staff members, 24 (56%) became infected and 82% were symptomatic. Four acquired repeated infections within weeks of the initial infection. Studies a year previously had revealed that 45% of contact infants and 42% of the staff had acquired nosocomial RSV infections. Thus, the employed procedures appeared to have decreased the transmission of RSV to infants but not to the staff. Staff may continue to be infected by large droplets from close contact with ill infants or by self-inoculation of contaminated secretions.
Early Development of Children with Sex Chromosome Aberrations
Authors: Haka-lkse Katerina , Stewart Donald A. , Cripps Mary H.
Published: December 2021

A prospective study was made of 42 children who were found at birth to have sex chromosome aberrations. The mean developmental quotient of the XXY and XXX groups was in the dull-normal range, whereas developmental quotients of 3 XYY children were low normal. The commonest deficits were in language and gross motor skills, with highest incidence in the XXX group. Many of the children had behavior problems, but no specific pattern was associated with an individual chromosome aberration. The XXX group experienced a linear growth spurt after 4 years of age. With one exception there were only mild dysmorphic features, none of them specifically associated with any subgroup. Of 17 children followed up to school age, almost two thirds evidenced learning and/or behavior problems.

There was a high incidence of birth problems, particularly in XXX children (seven of ten), and of social problems, psychiatric illness and learning difficulties in their families. In 14 cases, the parent-child relationship was disturbed, resulting in behavior problems. These findings make it improbable that the children's generally poor developmental and behavioral performance were solely attributable to their chromosomal constitution.
Use of Prothrombin Complex Concentrates in Hemophiliacs with Inhibitors: Clinical and Laboratory Studies
Authors: Buchanan George R. , Kevy Sherwin V.
Published: December 2021

Nine patients with severe classic hemophilia and inhibitors against factor VIII were treated for 156 bleeding episodes with 503 infusions of Proplex, Konyne, or Auto-Factor IX, three preparations of prothrombin complex concentrates (PCCs). Approximately two thirds of the bleeding episodes were managed successfully. Although the prothrombin time (PT) and partial thromboplastin time (PTT) were shortened after most PCC infusions, there was no evidence of disseminated intravascular coagulation. The degree of shortening of PT or PTT was not related to the particular PCC preparation used, dose, or cessation of hemorrhage. All PCC preparations contained activated clotting factors, as manifested by their ability to shorten the PTT of normal plasma, factor-VIII-deficient plasma, and factor-IX-deficient plasma. Shortening, which was greater with Auto-Factor IX than with the other products, was inhibited partially by a factor IX antibody and blocked completely by prolonged incubation with plasma. Although the nature of the procoagulant material in PCCs is uncertain, these products are of proven benefit to hemophilic patients with high-titer inhibitors. Side effects have been minimal and inhibitor titers have not risen.
Sephadex Bilirubin Binding Test Yet To Be Shown Valid?
Authors: Poland Ronald L.
Published: December 2021

The article by Valaes and Hyte (Pediatrics 59:881, June 1977) states that the "criteria for a repeat exchange transfusion should be the same as for the initial one, as no change in the bilirubin binding properties of the serum is likely to occur following exchange transfusion." They base their conclusion on bilirubin titration points obtained by Sephadex gel filtrations before, during, and after exchange transfusion in a diverse population of newborn infants, most of whom received adult albumin in one form or another prior to exchange transfusion.
PaO2 and Retrolental Fibroplasia
Authors: Ramenofsky Max L. , Leape Lucian L.
Published: December 2021

The general disappointment of Kinsey et al. with the results of a large, multicenter study of the relationship of PaO2 levels and retrolental fibroplasia (RLF) (Pediatrics 60:655, November 1977) is matched by the disappointment of the readers who had hoped to discover at last the "safe" level of PaO2 in infants to whom oxygen is being administered. Several reasons are given in the article and in subsequent discussions as to why the study failed to show any difference in PaO2 values between normal infants and those with RLF.
Where Do the Heaviest Children Come From? A Prospective Study of White Children From Birth to 5 Years of Age
Authors: Dine Mark S. , Gartside Peter S. , Glueck Charles J. , Rheines Larry , Greene Gail , Khoury Philip
Published: December 2021

A prospective follow-up study, from birth to age 5, of height, weight, and weight/height indices in 582 white children was carried out in a suburban private pediatric practice. The purpose of the study was to examine trends in height and weight over time, to evaluate any differences in measures of ponderosity between breast-fed and bottle-fed infants, and to locate the heaviest children at age 5. There were significant correlations between height, weight, the ratio of height to weight, the ponderal index (height/weight1,3), and the Quetelet index (weight/height2) achieved during the first year of life, and that attained at age 5 years. However, approximately 70% of the variance in weight and ponderosity indices at age 5 could not be accounted for by measurement of weight and ponderosity during the first year of life. Breast-fed and bottle-fed infants did not differ in weight and weight/height indices. There was a modest, but consistent, "tracking" pattern among children in the upper decile for weight and ponderosity at age 5 years in that 30% of them were also in the top decile for weight and ponderosity at age 6 months, and 30% to 40% were in the top decile at age 1 year. More than half of the variance in weight or indices of body proportion at age 5 is not accounted for by these variables in the first year of life, indicating limitations to the generalizability of the concept, that obese infants become obese children.
The Development of Preschool Children of Heroin-Addicted Mothers: A Controlled Study
Authors: Wilson Geraldine S. , McCreary Richard , Kean James , Baxter James C.
Published: December 2021

Disturbances of growth and behavior in infants and toddlers of women addicted to heroin during pregnancy have been reported in uncontrolled studies. In this study, 3to 6-year-old children of heroin-addicted mothers were compared to three other groups matched for age, race, sex, birth weight, and socioeconomic status. Heroin-exposed children weighed less and were shorter than those in the comparison groups; 14% had a head circumference below the third percentile. Heroin-exposed children were rated by parents as less well adjusted than control children and they differed significantly in perceptual measures and on subtests of the Illinois Test of Psycholinguistic Abilities and McCarthy Scales of Children's Abilities relating to the process of organization. These findings Suggest that chronic intrauterine exposure to heroin may affect growth and behavior as well as perceptual and learning processes in preschool children.
Fluoride Supplementation: Revised Dosage Schedule
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Forbes Gilbert B. , Nichols Buford L. , Roy Claude , Smith Nathan J. , Walker W. Allan , Winick Myron , Woodruff Calvin W. , Newburn Ernest
Published: December 2021

Since the previous Committee on Nutrition statement on fluoride was issued in 19721, the value of providing fluoride supplements to help prevent dental caries has been supported by a growing body of experimental evidence.2 This statement has been prepared to recommend a new dosage schedule that decreases the dosage of fluoride in infancy and that is better adjusted to the concentration of fluoride in the drinking water.

Health authorities agree that, in communities where the fluoride concentration of the water is suboptimal, the most effective and inexpensive means of reducing dental decay is by adjusting the community water supply to an optimal fluoride concentration. In the absence of a fluoridated central water supply, alternative means of fluoride supplementation should be used. Fluoride in tablets, drops, lozenges, or in combination with vitamins can serve this purpose and have been shown to be effective.2 However, the success of these forms of fluoride supplementation depends on whether parents are sufficiently motivated to supervise the regular, daily intake of fluoride supplements by their children from shortly after birth until about 16 years of age. It should be emphasized that fluoride administration is strictly supplemental; it is intended to increase fluoride intake in approximately the amount that would be obtained from fluids in optimally fluoridated communities. Fluoride intake is primarily from water and liquid foods made with fluoridated water. There is relatively little fluoride in most foods3-5; exceptions are certain seafoods.

Dosage

In establishing an optimal dosage regimen for fluoride supplements, the age of the child and the existing fluoride concentration in the water supply are the two major considerations.
Developmental Aspects of an Infant With Transient Moderate to Severe Hearing Impairment
Authors: Beratis Stavroula , Rubin Martha , Miller Robert T. , Galenson Eleanor , Rothstein Arnold
Published: December 2021

Very little is known about the effects of early deafness on later emotional and cognitive development, or about the span of time during which these effects may remain correctable. Adults who have had a profound or severe hearing impairment since infancy show a rather consistent pattern of personality development.1-3 A variety of behavioral deviations have been described in older children with congenital or early hearing impairment.3-5

There are very few observations, however, of the behavior of deaf children during their first two years of life. In this communication, we describe the behavior and some aspects of the development of a hearing-impaired infant during the period of moderate to severe hearing impairment (70 dB hearing loss) followed by resolution of hearing loss.
Albright's Syndrome Presenting as Thyrotoxicosis: Follow-up of a Case
Authors: Richton Samuel M. , Maclaren Noel K. , McLaughlin Judith V. , Raiti Salvatore
Published: December 2021

In 1937, Albright and colleagues1 reported a syndrome triad consisting of precocious puberty, cutaneous pigmentation, and polyostotic fibrous dysplasia of bones. More recently, a number of hormone excess endocrinopathies have been described as part of the syndrome, as reviewed by Hall and Warrick2 and DiGeorge.3 The reason for the autonomous functioning of diverse endocrine glands remains unknown.

In 1970, Levitsky et al1 reported in this journal a 7-month-old who at that early age had symptoms of severe thyrotoxicosis. The purpose of this report is to present a follow-up of this interesting patient, in whom there developed findings consistent with Albright's syndrome.
Increased Muscularity of the Pulmonary Circulation in Victims of Sudden Infant Death Syndrome
Authors: Williams Adrian , Vawter Gordon , Reid Lynne
Published: December 2021

It has recently become apparent that some victims of sudden infant death synclrome (SIDS) are chronically hypoxemic before death. In this study, the structural alterations in the pulmonary circulation of 15 victims of SIDS were examined using precise quantitative morphometric techniques applied to the injected and inflated lung. Increased muscularity of the pulmonary circulation has been demonstrated, as evidenced by the extension of muscle into arteries not usually muscularized during the first year of life, and by an increased thickness of the medial wall in some patients. This confirms the findings of Naeye and further justifies the shift of investigative efforts from the events immediately surrounding death to a search for chronic abnormalities.
Risk of Respiratory Distress Syndrome After Prenatal Dexamethasone Treatment
Authors: Taeusch H. William , Frigoletto Frederic , Kitzmiller John , Avery Mary Ellen , Hehre Ann , Fromm Barbara , Lawson Edward , Neff Raymond K.
Published: December 2021

A prospective double-blind randomized clinical trial was carried out to determine whether glucocorticoid treatment reduces the risk of respiratory distress syndrome (RDS) in prematurely born infants. There were 127 infants born to 122 mothers who received either steroid (dexamethasone phosphate) or placebo. No differences between groups occurred in risk factors for RDS (eg, prepartum asphyxia, male sex, cesarean section). When those who received a full course of dexamethasone therapy were compared with those who received placebo, a significant reduction was found in risk, severity, and deaths due to RDS. An increased incidence of infection in mothers treated with steroid was evident, particularly after premature rupture of membranes. We conclude that steroids are effective in reducing risk of RDS, but safer and more efficacious approaches for the prevention of RDS should be sought.
l-Glutaric Acidemia: Investigation of a Patient and His Family
Authors: Whelan Donald T. , Hill Robert , Ryan Eamonn D. , Spate Marilyn
Published: December 2021

A 5-month-old infant had an unusual combination of clinical signs and symptoms. These consisted of irritability, dystonia, lack of head control, grimacing, opisthotonos, choreoathetoid movements, delayed development, and severe metabolic acidosis. Metabolic investigation by gas-liquid chromatography/mass spectrometry detected urinary organic acids. This confirmed the diagnosis of l-glutaric aciduria.

The concentration of l-glutaric acid in the patient's plasma was 2.5 mg/dl (normal range, 0 to 0.1 mg/dl), and in the patient's urine was 4.6 mg/mg of creatinine (normal range, 0 to 0.05 mg/mg of creatinine),) but the concentration was not elevated in the plasma and urine of the infant's parents nor of two other family members.

No glutaryl-CoA dehvdrogenase activity was found in leukocytes taken from the patient. Three of the four family members, including the parents, demonstrated 38%, 42%, and 42% activity, respectively, compared with the activity of normal controls. These findings are consistent with an autosomal recessive disorder involving the Metabolism of ghitaryl-CoA to crotonyl-CoA.

Dietary restriction was instituted on two separate occasions. First, a low protein diet of 1.6 gm/kg of body weight per day was given, then a low lysine intake of 50 mg/kg/day. These dietary manipulations caused a decrease in the plasma and urine concentrations of L-glutaric acid and β-hydroxyglutaric acid. However, no effect on the clinical manifestations of the disease was noted.