bluuebunny/crossref_metadata_2025 huggingface dataset:
Adult Height in Children With Growth Hormone Deficiency Who Are Treated With Biosynthetic Growth Hormone: The National Cooperative Growth Study Experience
Authors: August Gilbert P. , Julius Joanne R. , Blethen Sandra L.
Published: December 2021

Objective. To determine whether the height gain during puberty in children with growth hormone deficiency (GHD) who are treated with biosynthetic growth hormone (GH) is similar to that in otherwise healthy children with delayed bone ages and whether the height standard deviation score (SDS), which began to increase before puberty, continues to increase during puberty.

Methods. The inclusion criteria included a diagnosis of idiopathic GHD, prepubertal on enrollment in the National Cooperative Growth Study, and spontaneous onset of puberty, as defined by Tanner stage 2 breast development in girls and a testicular volume of at least 3 mL in boys. Near-adult height was judged to have been attained in the subjects who had reached a chronologic age of at least 18 years (females) or 20 years (males) or had reached at least pubertal stage 4 and a chronologic age of at least 14 years (females) or 16 years (males). These subjects constituted group 1. Group 2 was a subgroup of these subjects who met a more stringent criterion for near-adult height; in addition to meeting the above criteria, they had to have attained a bone age of at least 14 years (females) or 16 years (males).

Results. Group 1 consisted of 480 males and 194 females. Group 2 consisted of 153 males and 105 females. In the subjects in group 1, the Tanner pubertal stage 2 was 14.1 ± 1.5 years in males and 12.6 ± 1.6 years in females; the bone age at this stage was 11.9 ± 1.5 years in males and 10.6 ± 1.5 years in females; and the height SDS was −2.1 ± 0.9 in males and −2.4 ± 0.9 in females. The total height gained during puberty was 22.4 ± 7.9 cm in males and 17.4 ± 6.3 cm in females; the percentage of adult height gained during puberty was 13.3% ± 4.6% in males and 11.3% ± 4.0% in females; the near-adult height SDS was −1.3 ± 1.0 in males and −1.6 ± 0.9 in females; and the target adult height SDS was −0.4 ± 0.8 in males and −0.5 ± 0.7 in females. The growth characteristics in the subjects in group 2 were of similar magnitude. In both groups, there was a significant negative correlation between age at the onset of Tanner stage 2 and both the total height gained during puberty and the percentage of adult height gained.

Conclusions. The growth characteristics of these subjects were similar to those reported in normal children and in previous reports of the pubertal growth in smaller populations of children with GHD. The height SDS increased in these subjects during puberty, but the target adult height SDS was not attained. This is a strong argument for early diagnosis and treatment in children with GHD to optimize prepubertal growth.
Early Emotional Care for Mothers and Infants
Authors: Stern Nadia Bruschweiler
Published: December 2021

The experiences of most child health professionals give them only partial insight into the complex emotional and behavioral changes brought on by maternity. This article describes an approach to clinical management and emotional care based on the principles of birth as an opportunity for reorganization and changes; the meeting of the mother's “real” and “imagined” infants; appreciation of the infant's strengths; and development of a therapeutic alliance with the mother. Central to this process is the creation of a safe holding environment for the mother, especially mothers of preterm infants.
International Perspectives in Early Emotional Development
Authors: Haggerty Robert J.
Published: December 2021

This article provides a unique look at development—the lessons highly industrialized nations can learn from the rest of the world. Thailand, for example, created a comprehensive child development program through integration of health, education, economic development, social welfare, and community involvement. The program was proven to improve developmental outcomes that included IQ and nutritional status.
Clerkship Curricular Revision Based on the Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics Guidelines: Does It Make a Difference?
Authors: Kuo Alice A. , Slavin Stuart J.
Published: December 2021

Objective.

To compare general pediatric knowledge acquisition and clinical problem-solving skills by students pre- and postcurricular reform based on the 1994 Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics (APA–COMSEP) curricular guidelines.

Setting.

A large, urban academic medical center.

Subjects.

Third-year medical students on a required clerkship in Pediatrics.

Intervention.

Pre- and postcurricular revision, the students were given both the National Board of Medical Examiners (NBME) Pediatric Subject Examination and an objective examination, which was developed in-house, based on the APA–COMSEP guidelines (Pediatric Clerkship Examination [PCE]). Baseline data before curricular revision were obtained on 52 students from May 1995 to May 1996. After curricular redesign in May 1996, data were obtained on 42 students from May 1996 to May 1997. Curricular revision focused on the following: defining educational principles, selecting teaching strategies, defining learning objectives, implementing the curriculum, and evaluating the students with an examination.

Results.

Before curricular revision, the average NBME score was 521 ± 122. The average PCE score was 53.7% ± 10.1%. After curricular revision, the average NBME score was 520 ± 109, and the average PCE score was 67.7% ± 8.4%. Content areas showing the greatest improvement were fluids and electrolytes, issues pertaining to the newborn, and health supervision.

Conclusions.

Our baseline data indicate that despite spending two thirds of the clerkship in the ambulatory setting, students did not acquire adequate general pediatric knowledge or clinical problem-solving ability. After broad clerkship revision based on the APA–COMSEP Core Curriculum, students' acquisition of general pediatric knowledge and clinical problem-solving improved significantly, as measured by the PCE. The overall NBME Pediatric Subject Examination scores did not reflect this increased acquisition of general pediatric knowledge.
Administrative Data for Quality Improvement
Authors: Schwartz Rachel M. , Gagnon David E. , Muri Janet H. , Zhao Q. Rose , Kellogg Russell
Published: December 2021

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level.

This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred.

As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.
Neonatal Intensive Care: Satisfaction Measured From a Parent's Perspective
Authors: Conner Jeanette M. , Nelson Eugene C.
Published: December 2021

Health care systems today are complex, technically proficient, competitive, and market-driven. One outcome of this environment is the recent phenomenon in the health care field of “consumerism.” Strong emphasis is placed on customer service, with organized efforts to understand, measure, and meet the needs of customers served. The purpose of this article is to describe the current understanding and measurement of parent needs and expectations with neonatal intensive care services from the time the expectant parents enter the health care system for the birth through the discharge process and follow-up care. Through literature review, 11 dimensions of care were identified as important to parents whose infants received neonatal intensive care: assurance, caring, communication, consistent information, education, environment, follow-up care, pain management, participation, proximity, and support. Five parent satisfaction questionnaires—the Parent Feedback Questionnaire, Neonatal Index of Parent Satisfaction, Inpatient Parent Satisfaction–Children's Hospital Minneapolis, Picker Institute-Inpatient Neonatal Intensive Care Unit Survey, and the Neonatal Intensive Care Unit-Parent Satisfaction Form—are critically reviewed for their ability to measure parent satisfaction within the framework of the neonatal care delivery process. An immense gap was found in our understanding about what matters most and when to parents going through the neonatal intensive care experience. Additional research is required to develop comprehensive parent satisfaction surveys that measure parent perceptions of neonatal care within the framework of the care delivery process.
Behavioral and Self-Concept Changes After Six Months of Enuresis Treatment: A Randomized, Controlled Trial
Authors: Longstaffe Sally , Moffatt Michael E. K. , Whalen Jeanne C.
Published: December 2021

Background.

Previous studies have suggested changes in self-concept with successful treatment of primary nocturnal enuresis (PNE), but behavioral changes have not been reported as a consistent associated finding.

Objective.

To determine if self-concept and behavior change after 6 months of treatment of monosymptomatic PNE by conditioning alarm or desmopressin acetate (DDAVP).

Design.

Randomized, controlled trial in an inner-city hospital clinic. Subjects were 182 children referred or recruited through media publicity, randomly assigned both to 1 of 8 pediatricians and 1 of 3 treatment groups (alarm, DDAVP, or placebo). Included were children >7 years old with PNE, no daytime symptoms, bladder capacity >50% expected, and wetting >3 times a week. Excluded were children with central nervous system disorders or developmental delays, and those currently on DDAVP or alarm. Subjects completed thePiers-Harris Children's Self-Concept Scale and Harter's Perceived Competence Scale for Children (PCSC) at initial visit and after 6 months of treatment. Parents completed the Achenbach Child Behavior Checklist (CBCL) at the same times.

Results.

After 6 months of treatment the Piers-Harris total score showed a highly significant treatment by period interaction effect for DDAVP, a significant effect for alarm, and no effect for placebo. For children who achieved 75% dryness the CBCL showed a treatment by improvement interaction effect that was highly significant for DDAVP and placebo with no effect for alarm. For the PCSC there were no treatment or outcome interaction effects.

After 6 months of treatment there were significant changes over time unrelated to outcome or treatment in the Piers-Harris Subscales and in the CBCL Internalizing and Externalizing Scores, and the Social Thought and Attention Problems Subscales. The PCSC was more stable with no changes in total score, and positive changes over time in only 2 Subscales, Scholastic and Social.

Conclusion.

Children's self-concept improved with the type of treatment and amount of success. Parents' perceptions of behavior improve with type of treatment and amount of success. Children rate their self-concept and some physical attributes better after treatment with any of DDAVP, alarm, or placebo regardless of outcome. Frequent follow-up with emotional support and encouragement appear to be important components of an efficacious intervention for children with nocturnal enuresis.
The Associations Among Pediatricians' Knowledge, Attitudes, and Practices Regarding Emergency Contraception
Authors: Sills Marion R. , Chamberlain James M. , Teach Stephen J.
Published: December 2021

Objectives.

To quantify practitioner administration of the emergency contraceptive pill (ECP) among adolescent patients, and to determine if such administration is associated with physician knowledge and attitudes regarding efficacy, side effects, and appropriate use.

Design.

Survey of pediatricians.

Setting.

The survey address list was generated from a database of active Fellows of the American Academy of Pediatrics in the District of Columbia metropolitan area.

Main Outcomes Measures.

Prescription of the ECP in the previous 12 months, or counseling of an adolescent patient about the ECP.

Results.

Of the 236 questionnaires distributed, 143 (61%) were returned and 121 (51%) were usable. Twenty-four pediatricians (20%) reported prescribing the ECP, and 29 (24%) had counseled adolescent patients about the ECP. Of the practice-related variables surveyed, both the number of adolescents seen per week and the practice setting were significantly associated with these outcomes. Of the knowledge-related variables surveyed, knowledge of the timing and the Food and Drug Administration-labeled status of the ECP were significantly associated with outcomes. None of the attitude-related variables surveyed were associated with outcomes.

Conclusions.

This study demonstrates that knowledge deficits, not attitude-related variables, are significantly associated with the low level of ECP administration and counseling among District of Columbia pediatricians. Because knowledge deficits are amenable to educational interventions, our data suggest that informing pediatricians about the ECP may increase its administration among their adolescent patients.emergency contraceptive pill, pediatricians, adolescents.
Evolution of a Children's Health Insurance Program: Lessons From New York State's Child Health Plus
Authors: Trafton Sarah , Shone Laura Pollard , Zwanziger Jack , Mukamel Dana B. , Dick Andrew W. , Holl Jane L. , Rodewald Lance E. , Raubertas Richard F. , Szilagyi Peter G.
Published: December 2021

The State Children's Health Insurance Program (SCHIP) was passed by Congress in 1997. It provides almost $40 billion in federal block grant funding through the year 2007 for states to expand health insurance for children. States have the option of expanding their Medicaid programs, creating separate insurance programs, or developing combination plans using both Medicaid and the private insurance option. New York State's child health insurance plan, known by its marketing name Child Health Plus, was created by the New York Legislature in 1990. New York's program, along with similar ones from several other states, served as models for the federal legislation, especially for state health insurance plans offered through private insurers. New York's program provides useful data for successful implementation of SCHIP.
PRESIDENT'S ADDRESS
Authors: QUILLIAN WARREN W.
Published: December 2021

Economic and social progress in our practice depends upon the sustained interest and the effort of the individual physician. Courage and faith are necessary foundations for action in this critical year of decision, and there is every reason to believe that the new generation of pediatricians has every qualification necessary to continue the quest for better health among children. His adventure in "practical idealism" will not be an easy one. But, fortified by the assurance of his noble heritage of accomplishment and adherence to high standards, he will accept the challenge of the future with a deep sense of responsibility. He will keep faith with those who have gone before, and attempt to retain the confidence and trust of the people as did our fathers, by holding high the banner of service.

The price of success in this undertaking involves a determination to reach our objectives regardless of adverse circumstances, concentration on the immediate problems, and by long range plans for fulfilling our obligations to the children of America. Frustration and differences of opinion are inevitable. Changing conditions require flexibility in our adaptation to existing needs. Let us keep our eyes upon the stars, but our feet upon the ground! Our responsibilities are great. The Dean of the School of Medicine at the University of Wisconsin, Dr. William S. Middleton, recently stated the challenge in these words: "Make no small plans; they have no magic to stir man's soul!"

Medicine progresses, even in a troubled world. Changes in governments, in laws and controls, have not interfered with this progress. Civilizations of the past have been destroyed by the decay and infamy and greed within their own structure. Let us renew our faith in the simple basic principles, which have characterized the growth and development of the Academy for 22 years.
CONGENITAL DISLOCATION OF THE HIP
Authors: PLUMMER GEORGE W.
Published: December 2021

Physical and roentgen examinations were performed on 227 nine month old Japanese infants to discover all cases of congenital dislocation of the hip. Twenty-seven cases were found in which the roentgenograms of the hips were interpreted as abnormal; of these, 15 showed only lack of calcification of the acetabular rim, and the other 12 showed some degree of displacement of the femoral head, in addition to the deficiently calcified acetabulum.

A large percentage of these 27 infants had no physical signs relative to hip deformity.

Repeat examinations at 18 months and 25 months of age demonstrated that all infants with only deficient acetabular calcification and 7 of 12 with some displacement of the femoral head had either healed completely or showed marked improvement without treatment. Five cases had persistent and aggravated dislocation of the hip.

Limitation of abduction of the flexed thighs is the most consistent and valuable sign of congenital dislocation of the hips, and this is in accord with other investigators' conclusions.

It is proposed that inadequate muscular and ligamentous support to the hip joint is the primary physiologic defect in congenital dislocation of the hip. This view is important in that it serves to direct attention to the fact that early support to the hip without immobilization of the infant is the most desirable therapy—from a physiologic standpoint—which will prevent deformity of the bony parts of the joint.
Round Table Discussion
Authors: PERLSTEIN MEYER A. , MCDONALD EUGENE T.
Published: December 2021

Chairman Perlstein: In neuromuscular disabilities there are many problems to consider. However, about half of these comprise that group of diseases we know as cerebral palsy. We will start by orientating ourselves toward cerebral palsy, and in the discussion taking up the question of differential diagnosis and related subjects.

Cerebral palsy is not a single disease but a group of conditions which have in common a disorder of the motor system. It can be paralysis, incoordination, tremors or excessive motions, due to involvement of the motor centers of the brain. In other words, palsy and cerebral are defined. The important thing about cerebral is that the motor centers must be involved. If the problem is lack of development because of mental deficiency, you can exclude it. Likewise, spinal palsy, polio, and other causes of motor defects not due to involvement of the motor center are excluded. In schools for children with physical handicaps of all types, about half the children are cerebral palsied. So, from the viewpoint of frequency, cerebral palsy is the most frequent of the disabling conditions.

Much confusion exists in the terminology and classification of cerebral palsy. The term "Little's disease" has often been used as a generic term to cover all forms of cerebral palsy. Actually, Little described only one of the many types. Likewise, the term "spastic" is often used by the doctor and laymen to cover all categories. This tendency is conducive to loose thinking. A logical classification of the types of cerebral palsy would help to clarify this confused subject.
COMPARISON OF THE THERAPEUTIC EFFICACY OF FOUR AGENTS IN PERTUSSIS
Authors: AMES ROSE G. , COHEN SOPHIA M. , FISCHER A. E. , KOHN J. , MCPHERSON A. Z. , MARLOW JEANETTE , RUTZKY J. , ALEXANDER HATTIE E.
Published: December 2021

The results of the study suggest that H. pertussis infection is usually a mild disease in all age groups if there is effective control of most secondary bacterial infections by penicillin. Not one of the four therapeutic agents studied, streptomycin, chloramphenicol, antipertussis rabbit serum and hyperimmune human serum, was shown to bring about prompt elimination of the signs of pertussis. On the basis of duration of the infection in the patients studied, however, only 30% were suitable clinical material for comparing therapeutic agents in pertussis.

The hypothesis is advanced that prompt recovery from pertussis can be anticipated only when effective therapy is instituted early in the course of the disease; the preparoxysmal stage is recommended.

While the data failed to show convincing therapeutic value of any of the four specific agents tested, they suggested some modification by each. A significant difference in degree of influence among the four treatments was not demonstrated. On the basis of toxicity, case of administration and cost, chloramphenicol is for the present the agent of choice.

In a comparison of the capacity of the four treatments to eliminate H. pertussis from the nasopharynx, rabbit antiserum was best and chloramphenicol next.

All four specific therapeutic agents showed some influence on the characteristic response in the white blood cell count.
PERIPHERAL CIRCULATORY RESPONSE TO FEEDING IN THE NEWBORN INFANT
Authors: Yao Alice C. , Wallgren C. Göran , Sinha Sachchida N. , Lind John
Published: December 2021

The peripheral circulatory response to feeding was studied in 39 normal term infants, age ranging from 24 hours to 9 days. Blood flow to calf of left leg was measured by the venous occlusion plethysmographic method before and half hourly after feeding for 3 to 3½ hours. Arterial pressure was monitored in nine infants via an umbilical arterial catheter simultaneously and regional vascular resistance to flow in the leg calculated. Changes in pulse rate, and skin and rectal temperatures were also monitored. A significant drop in the calf perfusion averaging 49% of the control value was observed at the 30 minutes postprandial recording. This was due to an increased regional vascular resistance and blood pressure remained unchanged during the time of study. As a rule, a superseding hyperperfusion of the limb overshooting the control value by 40 to 50% occurred 1½ to 3 hours after feeding. This was comparable to the hyperkinetic phase described in adult man and other species after meals. The early postprandial vasoconstriction in the leg seems unique to the newborn.

It is suggested that having the early circulatory demand provoked by feeding is relatively bigger in the newborn than in the adult and is met partly at the expense of lower limb perfusion.
Selective Hearing Loss: Clues to Early Identification
Authors: Holm Vanja A. , Thompson Gary
Published: December 2021

The child in this report was thought at various times to be mentally retarded, emotionally disturbed, and brain damaged before his selective hearing loss was discovered at age 53¼ years. He had developed puzzling behavior secondary to the confusing verbal messages he received and his unpredictability in turn had had a disturbing effect on his environment. Physicians will assist in the early identification of these children if they:

(1) Recognize conditions in infancy associated with high risk of hearing handicap.

(2) Listen to parents' observations about their child's language development and take their concerns seriously.

(3) Pay attention to language development in the 2-year old; delay can easily be demonstrated on the Denver Developmental Screening Test.

(4) Remember that prolonged jargoning, poor enunciation, and excessive use of gestures are suspicious symptoms of hearing loss.

(5) Are aware of the fact that informal hearing screen may fail to identify partial hearing loss.

(6) Refer the child suspected of hearing impairment to the audiologist regardless of the child's age, developmental level, and behavior. The audiologist is the professional best qualifled to determine the degree of testing accuracy that can be obtained.
ANNUAL SUMMARY OF VITAL STATISTICS—1969
Authors: Wegman Myron E.
Published: December 2021

This year's summary of vital statistical data of particular interest to pediatricians is later than usual because the increased complexities of compiling and issuing the data on which the report is based imposed an unexpected delay. As has been noted in previous years,1 the data on which these reports are based are issued by the National Center for Health Statistics and the fundamental material comes from the "Annual Summary for the United States, 1969: Births, Deaths, Marriages and Divorces," published this year October 21, 1970.2 In partial compensation for the delay, more up to date information is possible on the monthly trends during the year 1970 from the report published October 27, 1970.3
Letters to the Editor
Authors: Lourie Reginald S.
Published: December 2021

Dr. Hans Neumann has written a most interesting and valuable article on the chewing habits of West African children.1 However, it is a sufficiently important contribution in its own merit without its being linked to the problem of pica. Dr. Neumann's definition of pica is in contradiction to the commonly accepted understanding of what this term means. He defines pica as "chewing nonedible materials with or without ingestion following." The definition of pica in standard dictionaries and in common usage indicates that this term is reserved for the actual eating of nonedible materials.
Antinauseant Drugs in Treatment of Epidemic or Virus Gastritis? (Continued)
Authors: Casteels-Van Daele Maria
Published: December 2021

I fully agree with Dr. O. W. Anderson, who questions the rationale of a central nervous system drug for a disease of the gastrointestinal tract.1 We came to the same conclusion in our paper entitled "Dystonic Reactions in Children Caused by Metoclopramide."2 Metoclopramide is a new antiemetic drug, derived from chlorbenzamide, having a direct central effect at the level of the "vomiting centre." It causes the same extrapyramidal reactions as those known to occur with phenothiazines, though it is chemically quite different from these substances.
Hodgkin's Disease and Cellular Immune Mechanisms
Authors: Phillips Keith M.
Published: December 2021

Von Bernuth et al. (Pediatrics, 45:792) recently reported a case of Hodgkin's disease in a 5-month-old infant with thymic alymphoplasia. The authors note that this case is of particular interest because of the recognized association of immune deficiency syndromes and lymphoreticular malignancies, and because Hodgkin's disease is "extremely uncommon" in children under the age of 2 years. They cite Pitcock, et al.1 who had questioned the diagnosis in eight children between 2 and 5 months of age reported earlier2 because "most were too poorly documented to allow confirmation."
ENCEPHALOPATHY AND FATTY DEGENERATION OF THE VISCERA IN NORTHEASTERN THAILAND. CLINICAL SYNDROME AND EPIDEMIOLOGY
Authors: Olson Lloyd C. , Bourgeois Curtis H. , Cotton Robert B. , Harikul Supha , Grossman Richard A. , Smith Thomas J.
Published: December 2021

Encephalopathy and fatty degeneration of the viscera (EFDV) is a common cause of death among children in northeastern Thailand. During a clinical and epidemiological study in 1969, 67 cases of EFDV were studied.

Clinical features of this disease and Reye's syndrome were found to be similar. The incidence of the disease increases during the latter part of the rainy season. Almost all cases occur in children from rural areas. In Thailand, there is a geographic and seasonal association between the incidence of EFDV and the distribution of aflatoxin, indicating a possible etiologic relationship.
MANY AMERICAN MOTHERS A CENTURY AGO WERE UNABLE TO BREAST FEED THEIR INFANTS, ACCORDING TO DR. EDWARD H CLARKE OF BOSTON
Authors: C. T. E.
Published: December 2021

One of the accepted beliefs of both contemporary pediatricians and parents is that most mothers a century ago could successfully nurse their infants. That this may be a myth seems evident from the quotation below:

In the normal state, Nature has made ample provision in the structure of the female for nursing her offspring. In order to furnish this nourishment, pure in quality and abundant in quantity, one must possess a good development of the sanguine and lymphatic temperament, together with vigorous and healthy digestive organs. Formerly (prior to 1873) such an organization was very generally possessed by American Women, and they found but little difficulty in nursing their infants. It was only occasionally, in case of some defect in the organization, or where sickness of some kind had overtaken the mother, that it became necessary to resort to the wet-nurse or to feeding by hand. . . . It is a fact, that large numbers of our women (in 1873) are anxious to nurse their offspring and make the attempt: They persevere for a while–then fail. . . . There is still another class that cannot nurse at all, having neither the organs nor nourishment requisite even to make a beginning....1
BETA-GALACTOSIDASE AND BETA-GLUCURONIDASE ACTIVITIES IN INTESTINAL MUCOSA OF INFANTS AND CHILDREN
Authors: Antonowicz Irena , Shwachman Harry , Sotoo Ishida
Published: December 2021

The activity of two galactosidases (lactase and hetero-β-galactosidase) and β-glucuronidase were studied in per oral duodenal biopsies in 50 infants and children. Ten patients served as controls and 40 had nutritional disorders including celiac disease (acute, and in remission), cystic fibrosis (CF), protein losing enteropathy, and some miscellaneous conditions. The values for the 10 control patients expressed in units/gm protein/minute ± S.D. follows: lactase 38.0 ± 13.4, H-β-gal-ase 1.42 ± 0.35., and β-glucuronidase 1.90 ± 0.45. In the acute stage of celiac disease the lactase values were markedly reduced, the H-β-gal-ase normal or slightly reduced, with normal activity for β-glucuronidase. In clinical remission and while still on a gluten-free diet the activity of lactase remained significantly reduced in seven of nine patients even after 2 to 10 years. The lysosomal enzymes H-β-gal-ase and β-glucuronidase were not strikingly affected in patients with CF although four of six patients showed low values for H-β-galactosidase. β-glucuronidase was not affected in a variety of intestinal disorders including those that severely affect the integrity of the intestinal mucosa. In the conditions studied there was no correlation between the activity of the two galactosidases, nor between the two lysosomal enzymes.
MEDICAL STUDENTS AND PEDIATRICS IN THE COMMUNITY
Authors: Shrand Hyman
Published: December 2021

The Home Medical Service students learn diagnostic and therapeutic potential of home visits. Assuming responsibility for patient care, students develop a clinical approach, become critical of their treatment and prescriptions, and see benefits of home care. Students see common disorders early and learn to prevent complications which may need admission to hospital. Students actually get into the community and see for themselves the problems of living in the inner city. These medical students provide a good service and could make a valuable contribution to the health needs of these children.
Recurrent Virus Meningitis
Authors: Nakao Tooru , Miura Ryoichi
Published: December 2021

Seventy-one patients with two or three attacks of aseptic meningitis were seen during the 16-year period, 1953-1968, when a total of 1,956 patients with that disease were observed. All were under 15 years of age. The interval between attacks ranged from a month to 4 years. Clinical and laboratory findings of sequential attacks did not differ. Virological data were available from both of two attacks in 11 patients. These data indicate that a person may be attacked with aseptic meningitis more than once; usually the causative virus is different in subsequent attacks.
Pica? or Dental Hygiene
Authors: Nkrumah F. K.
Published: December 2021

I read with interest the article by H. H. Neumann which appeared in the September 1970 issue of Pediatrics (46:441). I wish, however, to correct what I think is a gross cultural misinterpretation. I cannot subscribe to his view that the use of "kweapea" (chewing stick) or for that matter "sawee" (chewing sponge) in West Africa has anything to do with pica or is an expression of an instinctual need for something to chew on.
Unilateral Abduction of the Infant's Foot: Relation to Carrying Position
Authors: Gorlick Gary M.
Published: December 2021

In well-baby care one not infrequently sees infants, usually 2 to 6 months of age, who have unilateral abduction of a foot. I would like to submit for your consideration and reader response one very simple yet often overlooked cause for this condition.

On close questioning of the mothers involved, I have found that they will hold their infant regularly to one side ("on my right hip" or "on my left hip") and consequently put pressure on one of the baby's lower extremities in such a way that abduction of that foot occurs.
Illegitimacy: Changing Services for Changing Times. New York: National Council on Illegitimacy (44 East 23rd Street), 1970, 98 pp., $3.25
Authors: Sittler Ruth
Published: December 2021

"Illegitimacy: Changing Services for Changing Times" is a collection of seven probing papers presented at the 1969 National Conference of Social Welfare. The foreword by Rose Mary Hill, Vice Chairman of the National Council, is an excellent review of "certain common threads that run through them, different though the papers may be in subject, content, and emphasis. Most striking perhaps is the willingness, indeed the determination on the part of a number of the authors, to examine and demolish some of the stereotypes that too long have dominated popular and even on occasion, professional attitudes toward illegitimacy."
METACHROMASIA AND ASSAY FOR LYSOSOMAL ENZYMES IN SKIN FIBROBLASTS CULTURED FROM PATIENTS WITH CYSTIC FIBROSIS AND CONTROLS
Authors: Kraus Ilana , Antonowicz Irena , Shah Harnish , Lazarus Herbert , Shwachman Harry
Published: December 2021

The ability of Toluidine blue 0 to stain certain cytoplasmic elements metachromatically in cultured skin fibroblasts derived from patients with cystic fibrosis (CF) has been investigated. Fifteen of 18 (83.3%) cell strains from patients with cystic fibrosis were positive, two (11.1%) borderline, and one negative (5.5%). In a control group, 8 of 18 (44.4%) were positive, three borderline (16.6%), and seven negative (38.8%). In addition to the lack of an absolute correlation between metachromasia and CF, inconsistencies in staining reaction were continually noted. Several parameters which account for these variations have been examined.

Since metachromatic granules are felt to represent lysosomal structures, a study of four lysosomal enzymes in the skin cultured fibroblasts was carried out in material from 10 patients with CF and 11 controls. No differences were noted in the activity of β-galactosidase, β-glucuronidase, aryl sulfatase, and acid phosphatase. While these studies do not support the possibility that CF is due to a lysosomal hydrolase deficiency in the metabolism of mucopolysaccharides, they do not exclude it either.
PARENTAL DRUG USAGE: EFFECT UPON CHROMOSOMES OF PROGENY
Authors: Dumars Kenneth W.
Published: December 2021

Illicit drug usage is a serious medical problem. Parental use of LSD and the effect upon the unborn infant is in question. However, parental use of LSD has often prevented acceptance of those children subsequently relinquished for adoption.

In this study we reviewed the records and clinical state of over 1,000 consecutive infants who were relinquished for adoption. Clinical and developmental examination was conducted upon 47 and chromosomal karyotyping upon 41/47 infants whose parents were illicit drug users. In comparison with comparable controls we found no statistically significant difference in the incidence of chromosomal breakage or rearrangement.

Parental use of illicit drugs does not in itself constitute a valid reason for the refusal to accept or place an infant relinquished for adoption.
BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

Children still tumble down stairs just as did the little girl of 1830 in the illustration below.1 But have contemporary children learned the lesson contained in the last line of this illustration?

In 1830 parents taught their children that God demanded of them absolute obedience to parental commands. This was a period of no "ifs" or "buts."2
REPORT OF THE A.A.P.-A.N.A. CONFERENCE ON UTILIZATION OF ALLIED HEALTH WORKERS IN MEETING THE MANPOWER CRISIS
Authors: Bergman Abraham B. , Fakkema La Verne , Connelly John P.
Published: December 2021

On October 22, 1970 a portion of the annual meeting of the American Academy of Pediatrics in San Francisco was devoted to a conference on the utilization of allied health workers in meeting the manpower crisis. It was jointly sponsored by the American Academy of Pediatrics and the American Nurses' Association and was the third and most successful of similar meetings. The first one, held at the Academy's Chicago meeting in October, 1969, provided an introduction to the concept of pediatric nurse practitioners. The second, held at the Washington meeting of the Academy in April, 1970, resulted in a frank exchange of views of the official nursing organizations and academy representatives and pointed to the need for open discussion and collaboration on the subject.

The San Francisco meeting got down to the business of a more objective analysis of issues, and though there was much heated discussion most of it was constructive. An attempt was made by the planning committee to include on the program different models of allied health workers in pediatrics. The program highlighted discussion about discharged medical corpsmen, laboratory technologists, pediatric assistants, as well as the more familiar pediatric nurse practitioner.

Of the 418 persons in attendance, 294 were nurses, 43 physicians, and 81 were other interested persons. When one of the nurses criticized the fact that there were so few physicians in attendance, Donald Frank of Cincinnati, a member of the Academy's Manpower Committee, pointed out that there was a fivefold improvement in physician attendance since the first conference.

The opening keynote address was given by Philip R. Lee, M.D., former HEW official, now Chancellor of the University of California at San Francisco, who refreshingly offered no simple solutions.
JOINT STATEMENT ON NEONATAL SCREENING FOR HEARING IMPAIRMENT
Authors:   Committee on Fetus and Newborn
Published: December 2021

The following joint statement has been approved by the Committee on Fetus and Newborn and the Executive Board of the Academy:

A common concern with the current status of screening procedures for hearing impairment among newborn infants has led to the formation of a joint committee comprising representatives of the American Academy of Ophthalmology and Otolaryngology, the American Academy of Pediatrics, and the American Speech and Hearing Association. After due consideration of infant hearing screening, this joint committee developed the following statement, which has been endorsed by all three societies represented on the Committee.

In recognition of the need to identify hearing impairment as early in life as possible, auditory screening programs have been implemented in newborn nurseries throughout the country. Review of data from the limited number of controlled studies which have been reported to date has convinced us that results of mass screening programs are inconsistent and misleading.

To determine whether mass screening programs for newborn infants should indeed be instituted, intensive study of a number of variables is essential. These should include stimuli, response patterns, environmental factors, status at the time of testing, and behavior of observers. Furthermore, confirmation of results obtained in the nursery must await data derived from extended follow-up studies which involve quantitative assessment of hearing status.

In view of the above considerations and despite our recognition of the urgent need for early detection of hearing impairment, we urge increased research efforts, but cannot recommend routine screening of newborn infants for hearing impairment.
Testing Need for Eructation (Correction)
Authors: Penchina Claude M. , Penchina Meira Szwarc
Published: December 2021

In our letter in the February issue,1 Figure 2 has been printed upside down so that (contrary to the caption) the time axis increases to the left as the figure was printed instead of the right as originally intended and stated in the caption.
Treatment in Phenylketonuria: Statistical Questions
Authors: Ford Robin C. , Sollee Natalie D. , Kang Ellen S.
Published: December 2021

The recent article by Dr. Kang and her associates1 reviewed their treatment of 82 classical and atypical phenylketonuric children. They arrive at the conclusion that late-treated classical PKU patients function at a significantly lower intellectual level than their non-PKU siblings, while early-treated PKU patients are not different from their own sibling controls. Interestingly, no significant difference was found between the IQ scores of early-treated and late-treated PKU children in their sample. This inconsistency (A > B, B = C, A = C) may have arisen from either, or both, of two reasons.
The Cornelia de Lange Syndrome (Continued)
Authors: Hall Bryan D. , Smith David W. , Fraser F. C. , Pashayan H. , Levy E. P.
Published: December 2021

A recent communication by Pashayan, Levy, and Fraser1 stressed a valid point that some features of the Cornelia de Lange syndrome may not be as obviously unusual in early infancy as later; in some cases the infant with this disorder may occasionally go undiagnosed until the features are prominent enough to suggest a secure diagnosis. For example, sequential pictures of cases reported by Opitz, et al. (Patient S. St.)2 and Beer, et al. (Case I)3 demonstrate the worsening of the facial characteristics over varying periods of observation.
National Health and Infant Mortality, USA
Authors: Falkner Frank , Wegman Myron E.
Published: December 2021

Many of us look forward to Dr. M. E. Wegman's (Pediatrics, 47:461, 1971) regular section, an "Annual Summary of Vital Statistics" –in this case for 1969. His summary presentations and comments are most helpful. In only one aspect does he continue to grate. He writes (again): "It is again highly gratifying to report a decline in infant mortality. . . ." There is nothing highly gratifying about our infant mortality rate, even if it has declined a tad and reached the all-time U.S.A. low.
Palpation of the Kidneys in the Newborn
Authors: Mims LeRoy C. , Museles M.
Published: December 2021

The article "Renal Anomalies in the Newborn Found by Deep Palpation"1 depicts the usual manner to palpate newborn kidneys. It is difficult to obtain relaxation of the abdomen in the newborn, particularly if the infant is crying and the cold examining hand has stimulated contraction of abdominal muscles. To overcome this problem I suggest supporting the infant in a 45° upright position by placing one hand in the occipital and neck region. Then, while palpating the abdomen with the free hand, firmly flex the head with the other.
Congenital and Pediatric Glaucomas, by Robert N. Shaffer, M.D., F.A.C.S. and Daniel I. Weiss, M.D. St. Louis: C. V. Mosby Company, 1970, 221 pp., $20.50
Authors: Walton David S.
Published: December 2021

The authors begin their presentation–in this, the first textbook I know of devoted entirely to pediatric glaucomas–with a detailed classification of glaucomas in childhood. This is followed by a discussion of diagnostic techniques and the important clinical signs encountered in the pediatric glaucomas. A description of the conditions assoiated with childhood glaucomas follows, including a concise review of their distinguishing ocular features, with additional comments on treatment. The final section deals with methods of treatment; appropriate emphasis is given to the operative techniques used in performing a goniotomy.
GROWTH HORMONE IN NEWBORN INFANTS DURING SLEEP-WAKE PERIODS
Authors: Shaywitz Bennett A. , Finkelstein Jordon , Hellman Leon , Weitzman Elliot D.
Published: December 2021

Normal full-term newborn infants have been studied during a 3-hour period in which EEG, EMG, EKG and eye movements were recorded. Plasma HGH samples were obtained every 20 to 30 minutes in some infants by indwelling venous catheter, but in most by heel stick. Five infants of 2 days of age and eight infants between 4 and 8 days of age were studied.

In the 2-day-old group studied findings for the average plasma HCH in mµg/ml (mean ± S.E.) following at least 5 minutes of sleep (active and quiet) were 33.4 ± 7, 52.8 ± 11, and 43.5 ± 36 following 5 minutes of waking. Comparable values for the 4-to 8-day-old group were 9.1 ± 1.1, 9.5 ± 1.3, and 8.3 ± 1.2. Wide variation in individual samples was found for the 2-day-old's (3 to 150 µg/ml) while this was less so for the older groups (0 to 20.2 mµg/ml). However, only three samples out of a total of 95 had values less than 1 mµg/ml. It thus appears that no clear correlation between plasma HGH levels and sleep-wake cycles was evident in these infants. It is likely that as with other biologic rhythms, HGH rhythmicity develops at a later stage of cerebral maturation.
JONATHAN SWIFT IN 1729 MENTIONS THE WEIGHT OF AN INFANT AT BIRTH AND AT A YEAR OF AGE
Authors: C. T. E.
Published: December 2021

I believe the first mention in English of the weight of an infant at birth and at a year of age is found in Jonathan Swift's (1667-1745) biting satire A Modest Proposal for Preventing the Children of Poor People from being a Burden to their Parents or the Country (1729).

Swift wrote:

I have reckoned upon a medium that a child just born will weigh 12 pounds, and in a solar year, if tolerably nursed, will increase to 28 pounds.1

How did Swift arrive at such an erroneously high figure for the birth weight of the new-born infant? A natural assumption might be that he made it up by pairing Hibernian hyperbole with literary license. But I am convinced this is not so because in Marsh's Library, attached to St. Patrick's Cathedral in Dublin, where Swift actually wrote many of his satires, including his Modest Proposal, he had access to and read carefully the fourth edition (1694) of Mauriceau's (1637-1709) Traité des Maladies des Femmes Grosses. Swift's penned marginalia in Mauriceau's text convince me that this book was the source of the erroneous birthweight mentioned in the above quotation. Mauriceau claimed that an infant weighed about 12 pounds at birth.2 Swift had every reason to accept this statistic because it came from a text written by the foremost obstetrician of the time.