bluuebunny/crossref_metadata_2025 huggingface dataset:
RICKETS AND MYOPATHY CURED BY REMOVAL OF A NONOSSIFYING FIBROMA OF BONE
Authors: Pollack James A. , Schiller Alan L. , Crawford John D.
Published: December 2021

A 9-year-old boy presented with progressive muscle weakness, waddling gait, and diminishing growth velocity of 16 months' duration.

Radiographs demonstrated active rickets and a lytic lesion of the distal radius. Normocalcemia (9.6 mg/100 ml), hypophosphatemia (1.7 mg/100 ml), and elevated alkaline phosphatase (31.6 Bodansky units) suggested X-linked resistant rickets but bone structure in films taken prior to age 7 was normal. No other family members had hypophosphatemia. Glomerular function was normal; generalized aminoaciduria and glycosuria were absent, but urinary glycine was elevated. Normal serum parathyroid hormone levels were suppressed by induced hypercalcemia. Chemical improvement and radiological healing were not obtained on vitamin D2 in doses to 200,000 units/day, but occurred promptly, with complete symptomatic relief, when oral phosphate, 1,250 mg daily, was added. The lytic radial lesion, initially not excised because of its benign radiological appearance and proximity to the metaphysis, responded to therapy with increasing sclerosis. Nonetheless, even after three years of medical treatment, chemical rickets exacerbated when vitamin D, but not phosphate, was omitted. When the patient was 12 years old, all therapy was discontinued and the lesion, a benign, nonossifying fibroma of bone, was excised. Within four days all biochemical indices of rickets returned to normal, except for the hyperglycinuria which declined more slowly over three weeks. One year after surgery the patient was without clinical or biochemical evidence of recurrent disease. The data suggest the acquired, hypophosphatemic rickets with myopathy was induced by elaboration in the tumor of a humoral substance, not parathyroid hormone, the nature of which is unknown.
ONCOGENOUS RICKETS: POSSIBLE ELABORATION BY A TUMOR OF A HUMORAL SUBSTANCE INHIBITING TUBULAR REABSORPTION OF PHOSPHATE
Authors: Harrison Harold E.
Published: December 2021

Pollack et al.1 have introduced the intriguing speculation that some rare tumors of mesenchymal origin release a humoral substance which inhibits tubular reabsorption of phosphate and through the resultant profound hypophosphatemia causes vitamin D unresponsive rickets and osteomalacia. There have been sufficient reports of hypophosphatemic vitamin D-resistant rickets and osteomalacia cured by removal of tumors of bone or soft tissue to support the inference that there is a causal relationship between such tumors and the hypophosphatemic rickets. The demonstration of marked reduction of tubular reabsorption of phosphate in such a patient and the dramatic rapid return of tubular reabsorption of phosphate to normal following tumor excision is certainly circumstantial evidence of the secretion by the tumor of an inhibitor of phosphate retrieval by the renal tubule.
Thanatophoric Dwarfism–Maybe Genetic but not Polygenic
Authors: Hall Judith G.
Published: December 2021

I cannot agree with the conclusions reached by Pena and Goodman1 that thanatophoric dwarfism is a polygenic condition. They imply that thanatophoric dwarfism is a homogenous entity. If one reviews the cases cited by them, a wide range of severity of bony involvement and body proportions is seen. Conditions with different etiologies are probably represented in the cases published thus far as thanatophoric dwarfism.

In order to establish the genetic nature and recurrence risk of thanatophoric dwarfism, Pena and Goodman cite reports of two families2,3 in each of which parents were normal and two sibs were affected.
IMMUNIZATION AGAINST HEMOPHILUS INFLUENZAE
Authors: Mortimer Edward A.
Published: December 2021

This issue contains a description of progress toward the development of a vaccine for Hemophilus influenzae, type b.1 The present status of this vaccine and the successive steps that must be taken to determine the safety and efficacy of any such product before it can be recommended for use are outlined, and a description of the antigenic anatomy of H. influenzae is included. Acquaintance with this information should be of value to pediatricians in the not-too-distant future when immunization against this organism may become available.

Why should attempts be made to develop a vaccine against H. influenzae? Review of the literature suggests three reasons: the frequency of meningitis due to this organism, the apparent increase in that frequency, and the severity of the disease in spite of current treatment.
PLASMA CORTICOSTEROIDS IN INFANTS WITH THE RESPIRATORY DISTRESS SYNDROME
Authors: Baden Melvin , Bauer Charles R. , Colle Eleanor , Klein George , Papageorgiou Apostolos , Stern Leo
Published: December 2021

Plasma total corticosteroid concentrations were measured in 44 premature infants with the respiratory distress syndrome (RDS). Further assay of serum concentrations of cortisol, cortisone, corticosterone, corticosterone sulfate, and 11-deoxycorticosterone sufate was carried out in 24 of these infants and in 10 healthy, nonstressed premature controls. Infants with RDS had higher concentrations of cortisol (22.1±4.3µg/100 ml) and corticosterone sulfate (7.7 ± 0.8 µg/100 ml) than control infants (6.6 ± 0.8 µg/100 ml, 1.2 ± 0.3 µg/100 ml, and 4.2 ± 0.4 µg/100 ml, respectively).

A significant correlation was found with the five-minute Apgar score (negative correlation, p = 0.005) and a possible correlation with the A-aDO2 gradient. Among premature infants with RDS, those of 32 weeks' gestation or less had higher concentrations of cortisol (28.3 ± 23.6 µg/100 ml) and corticosterone (3.9 ± 2.7 µg/100 ml) than those of more than 32 weeks (11.5 ± 5.4 µg/100 ml and 1.7 ± 0.7 µg/100 ml, respectively), suggesting either elevated response to stress or a diminished ability to metabolize these compounds.
LEUKEMIA IN TWINS
Authors: Falletta John M. , Starling Kenneth A. , Fernbach Donald J.
Published: December 2021

A disorder for which identical twins are not completely concordant must be caused, at least in part, by environmental factors. Acute childhood leukemia is such a disorder, with concordance ratios as follows: approximately 1:5 for monozygotic twins, approximately 1:80 for dizygotic twins, and more than 1:500 for ordinary siblings.

Of all malignancies, only acute childhood leukemia carries such an extraordinary risk of twin concordance. It is the only childhood malignancy in which a large number of circulating malignant cells are found. In most instances, twins with concordant leukemia have their onset of illness within weeks or months of each other, suggesting a similar inciting event. Since placental cross-circulation is found commonly in monozygotic twins and occasionally in dizygotic twins, cross-infusion of malignant cells has been postulated to account for the high twin concordance ratios. Leukemia in most twins might then represent only one occurrence of leukemia and not two.

This hypothesis, while consistent with most observations, does not explain the pattern of disease in the twins described in this paper. Our proband became ill at nearly 6 years of age, and her twin's illness occurred more than 6 years later. These twins probably remained at risk of concordant disease because of postnatal factors affecting predisposed siblings. Whether the predisposition was due to genetic or to prenatal environmental factors remains unknown.
Umbilical Catheters and Hepatic Abscesses
Authors: Brans Yves W. , Ceballos Ricardo , Cassady George
Published: December 2021

In contrast to interstitial hepatitis which often accompanies septicemia, solitary liver abscesses are rare in newborn infants. Thirteen cases appear in the literature. A single recent report implicates an umbilical venous catheter as the responsible agent. The present observations provide clinical as well as postmortem evidence which again strongly incriminates an umbilical venous catheter.

See figure in PDF file

Case Report

A 2,610-gm male Caucasian infant of a gestational diabetic mother, delivered electively at "term" by cesarian section, developed respiratory distress and was referred to the High Risk Nursery of University Hospital on October 26, 1970, a few hours after birth. No instrumentation was performed before transfer.
Infectious Mononucleosis and Epstein Barr Virus in Childhood
Authors: Tamir Dov , Benderly Abraham , Levy Joseph , Ben-Porath Edna , Vonsover Ami
Published: December 2021

The Epstein-Barr virus (EBV) antibody titer was examined in 22 children whose atypical mononuclear cells appeared in the peripheral blood smear. Paul-Bunnell and mononucleosis tests were negative in all these children, but antibodies to EBV were demonstrated in 21 of them. Only five children in a control group of 27 had antibodies to EBV. We conclude that the presence of EBV antibodies with a rising titer supports a diagnosis of infectious mononucleosis. It is of particular importance in children under 1 year of age in whom the finding of atypical mononuclear cells in the absence of positive Paul-Bunnell and mononucleosis tests shows a strong correlation with EBV antibody titer. This finding frequently occurs in the absence of typical clinical features of infectious mononucleosis.
Whom Do We Reach? A Study of Health Care Utilization
Authors: Leopold Edith A.
Published: December 2021

Two groups of families, all eligible for a neighborhood pediatric program, were compared as to enrollment and utilization. It was hypothesized that, despite popular assumptions of homogeneity, the "urban poor" present a wide range of family characteristics, problems, and resource utilization patterns. Sample selection was based on 391 ranked "family functioning" scores derived from an earlier survey. The two study groups comprised the 27 highest need (HN) and the 27 lowest need (LN) families. Service records indicated that HN families completed fewer medical and dental registrations, basic examinations, appointments, and referrals. Moreover, the HN group featured significantly more fatherless homes, nuclear families, public welfare dependency, non-working mothers, residential mobility, and irregular school status. A matrix of several objective indicators is proposed for differentiating truly "high risk" families from other residents of "disadvantaged" neighborhoods. Recommendations cover special outreach and supportive services to families resembling the HN/low utilization profile.
Effect of a Mailed Appointment Reminder on Appointment Keeping
Authors: Nazarian Lawrence F. , Mechaber Judith , Charney Evan , Coulter Molly P.
Published: December 2021

Poor appointment keeping is a major problem in many health facilities. At The Anthony L. Jordan Health Center, we studied 670 pediatric appointments to see if a postal card reminder mailed one week before the appointment would make a difference in the keep rate (kept plus canceled appointments, divided by kept plus canceled plus broken appointments). The appointments studied were 12 days to eight weeks from the time of scheduling.

In the control group, the keep rate was 48%. Those receiving mailed reminders had a keep rate of 64%, a significant difference (X2 = 16.92; p < 0.001).

The effects on the keep rate of age, interval to appointment, time of day, referral pattern, reason for appointment, and prior keep rate were minor.

The use of a mailed reminder can improve appointment keeping and facilitate better care and more efficient scheduling and use of personnel.
Cholesterol at Birth and Age 1: Comparison of Normal and Hypercholesterolemic Neonates
Authors: Tsang Reginald C. , Fallat Ronald W. , Glueck Charles J.
Published: December 2021

Plasma cholesterol was evaluated at birth and at age 1 in 56 infants who had elevated cord blood cholesterol levels, and in 42 infants who had normal cord blood cholesterol levels. Both groups of infants came from a study of 1,800 unselected live births. Familial hypercholesterolemia was documented by three-generation transmission (from grandparent to parent to neonate) or by presence of tendinous xanthomatosis with hyper-beta-lipoproteinemia in eight neonates and kindreds. A minimal estimate of the heterozygote frequency of familial hyperlipidemia in unselected live births was 0.44% (8/1,800). On moderate-high cholesterol intake at age 1, three of four infants with familial hypercholesterolemia maintained distinctive elevations of plasma cholesterol. On low cholesterol diets, the distinction between four infants with familial hypercholesterolemia and normal or other hypercholesterolemic infants was blurred. Responsiveness to low cholesterol diet may hold promise in a long-term approach to normalization of plasma cholesterol in infants with familial hypercholesterolemia.
Characterization of Newborn Fecal Lipid
Authors: Watkins John B. , Bliss C. Michael , Donaldson Robert M. , Lester Roger
Published: December 2021

Fecal lipid excretion was quantitated and analyzed in two groups of normal infants 3 to 11 days and 23 to 72 days of age. Total lipid excretion was similar in both groups averaging 10.8% of dietary intake. Fecal lipid was partitioned into four fractions: neutral lipids, insoluble divalent calcium soaps, ionized fatty acids and bound lipids. The neutral lipid fraction predominated in both groups, equalling 56 ± 5.3% (mean ± S.E.M.) of fecal lipid. It contained significant quantities of glycerides (13.6 ± 6.0% of the total lipid excreted). Calcium soaps comprised the other major fraction (25 ± 5.3%); analysis of this fraction by gas liquid chromatography showed that it contained primarily long-chain saturated fatty acids.

The demonstration of glycerides in fecal lipid establishes that lipolysis is defective in newborn infants. Identification of long-chain saturated fatty acids in the calcium soap fraction documents the association between calcium and saturated fatty acid excretion. The presence of fecal monoglyceride, while conceivably the result of colonic bacterial hydrolysis of triglyceride, raises the possibility that lipid micellization and/or mucosal transport is insufficient for optimal lipid absorption. Thus, the intraluminal phase and possibly the mucosal phase of lipid absorption are not fully developed in the full-term newborn infant.
Nutritional Value of Egg Beaters® Compared With "Farm Fresh Eggs"
Authors: Navidi Meena Kasmaii , Kummerow Fred A.
Published: December 2021

The Council of Foods and Nutrition, in a statement entitled "Diet and Coronary Heart Disease," has recommended that "In ‘risk categories’ it is important to decrease substantially the intake of saturated fat and to lower cholesterol consumption." The food industry has attempted to provide high-quality protein food items and for this purpose a new product, "Egg Beaters," has been introduced as a cholesterol-free egg substitute. It contains according to the label statement on the carton "egg white, corn oil, nonfat dry milk, emulsifiers (vegetable lecithin, mono and diglycerides and propylene glycol monostearate), cellulose and xanthan gums, trisodium and triethyl citrate, artificial flavor, aluminum sulfate, iron phosphate, artificial color, thiamin, riboflavin and vitamin D."
Unusual Occurrence of Neonatal Septicemia Due to Group G Streptococcus
Authors: Baker Carol J.
Published: December 2021

A case of septicemia due to beta-hemolytic streptococcus, Lancefield group G, in a premature newborn is reported. Maternal intrapartum transmission was suggested by isolation of identical organisms from the mother's vagina and the infant's blood, and onset of clinical illness at birth. With the increasing incidence of neonatal infections due to hemolytic streptococci, the importance of accurate identification of precise Lancefield group is emphasized.
A Study of Nutritional Status of Preschool Children in the United States, 1968-1970
Authors: Owen George M. , Kram Kathryn M. , Garry Philip J. , Lowe Jay E. , Lubin A. Harold
Published: December 2021

INTRODUCTION

Evaluation of nutritional status of population groups has been undertaken in many areas of the world during the past 40 years. Attempts have been made to standardize procedures and methodologies in order to allow comparisons of results from different studies.13

During the 1950s and 1960s, under the auspices of the Interdepartmental Committee on Nutrition for National Defense, a number of surveys were undertaken in developing countries of the world where children comprise the majority of the population. The preschool child was particularly vulnerable to malnutrition and mortality rates were quite high, often exceeding 50% in the first five years of life. Most infants in these countries seemed to thrive during the first 6 to 12 months of life, particularly if they were breast-fed. After this period, their diets declined nutritionally, both in quality and in quantity. Combined effects of malnutrition and of infection largely accounted for the high mortality rates in the postweaning age.

In view of such high mortality rates, it was obvious that a substantial proportion of youngsters who did not die almost surely experienced overt malnutrition or some degree of nutritional deprivation during critical periods in development. Increasing attention has been given to study of these "survivors" from the standpoint of physical and intellectual development and behavioral characteristics.4-9

It was apparent in the mid 1960s that we knew little about the nutritional status of young children in the United States. Studies had been undertaken on various segments of the U.S. population,10 but were often limited in scope (only dietary surveys or anthropometric determinations) and in sample size (adolescents or adults in selected areas or occupations).
Fetal Undergrowth: Relation of Head Growth to Later Intellectual Performance
Authors: Babson S. Gorham , Henderson Norman B.
Published: December 2021

Ten girls, mature at birth, who suffered severe fetal growth retardation (< third percentile), but were without evidence of congenital disease, have been followed serially in growth and development for at least seven years. The five infants whose head circumferences at 1 year of age were found to be at or below the tenth percentile had, on the average, an IQ of ten points below the five whose head growth had reached the 25th percentile or better. No neurologic handicaps or significant school deficits were encountered in either group. The mean IQ of 103 for the whole group in this small sample indicated that severe undergrowth in single-born infants, uncomplicated by acute asphyxia or congenital disease, may not prejudice later mental development.
Neutrophil and Band Counts in the Diagnosis of Neonatal Infections
Authors: Akenzua Gregory I. , Hui Yin T. , Milner Ruth , Zipursky Alvin
Published: December 2021

A system has been developed for the evaluation of hematological data in the newborn. Normal values were established for segmented (neutrophil) and nonsegmented (band) polymorphonuclear leukocytes in the peripheral blood of 169 healthy full-term infants during the first five days of life. This normal data is displayed graphically and the values for infants under study are compared directly.

Newborn infants with proven bacterial infections had normal neutrophil counts; however, the band counts increased significantly beyond the normal range. Therefore, the simple laboratory procedure for ennumerating band neutrophils with comparison of absolute values and changes to a normal range represents a hematologic technique of major importance in the diagnosis of sepsis of the newborn infant.
The Role of the Pediatrician in Dental Caries Detection and Prevention
Authors: Ripa Louis W.
Published: December 2021

Dental caries is a disease that usually begins very early in life and from which few people remain unaffected. However, because caries is associated with local etiologic vectors, it can be controlled. Altering the diet to render it less cariogenic and making tooth surfaces more resistant to acid attack through the use of fluoride are two potent mechanisms of prevention.

Pediatricians are in a unique position to contribute to the dental health of their young patients because of the early age at which children are brought to their offices and because mothers are accustomed to accept their recommendations.

The pediatrician's role in caries control includes diagnosis, referral, and preventive therapy. Early referral of children who appear dentally healthy as well as those in which there are obvious cavities in the teeth has been stressed. As part of a caries preventive program, a system of systemic fluoride supplementation has been outlined for those children who are not drinking optimally fluoridated water. In addition, food-caries relationships have been discussed and practical suggestions for reducing the cariogenicity of a child's diet have been made.

Although toothbrushing is considered a traditional method of caries prevention, it has not been discussed in this article for two reasons. First, published evidence does not conclusively support the premise that toothbrushing per se significantly reduces dental caries. Second, the results of the general efforts of the dental profession to motivate patients to adopt either meticulous or frequent brushing habits have been poor. It would be unrealistic to expect the medical profession to initiate procedures that would significantly alter the behavior of their patients' toothbrushing habits. Toothbrushing in the young child, especially the preschooler, should be regarded as another method for providing topical fluoride to the teeth. Parents should be encouraged to brush their young children's teeth as soon as they erupt. A soft, child-size toothbrush should be employed with a scrubbing motion. An anticariogenic toothpaste§ that has proven effective in controlled clinical trials should be recommended by the pediatrician or his nurse.

It is hoped that the mechanisms for influencing children's dental health that were discussed in this article can be incorporated with minimum effort into the normal routine of pediatricians' practices.
Narcotic Poisoning of Children (1) Through Accidental Ingestion of Methadone and (2) in utero
Authors: Blatman Saul
Published: December 2021

Narcotics have been known to man since prehistoric times, and they continue to be among the most used analgesics in the practice of medicine. They comprise a group of drugs whose analgesic effect is coupled with euphoria and somnolence. In addition, their spasmogenic effect on smooth muscle has made them useful agents in the alleviation of certain gastrointestinal tract symptoms. For most narcotics, therapeutic dosage does not produce serious untoward effects. Unfortunately, they have a depressant effect on respiration by directly influencing the respiratory center of the brain. This may be life threatening when recommended dosages are exceeded.

Narcotics have been abused since the recognition that they can induce euphoria and a feeling of well being. Tolerance and physical and psychological dependence result from their repeated use. The occurrence of withdrawal symptomatology in humans using these drugs repeatedly helps to produce a pattern of drug dependence; an individual has but to repeat a dose of drug in order to prevent withdrawal symptoms. Abuse liability is thus great.

All narcotics share this addiction potential. Those most frequently prescribed in clinical medicine are morphine, trieperidine, codeine and methadone. Heroin (diacetylmorphine), the most commonly abused narcotic, available only illicitly, is not prescribed in clinical practice. After injection, it is hydrolyzed to morphine which produces its pharmacological action. While morphine and heroin are absorbed only following parenteral administration, some narcotics are absorbed readily from the gastrointestinal tract as well as after injection (methadone, codeine, meperidine). Regardless of the mode of administration, narcotics taken by a pregnant addict readily pass the placental barrier and are capable of producing effects on the infant in utero and after birth.
Child Abuse: A Five-Year Follow-up of Early Case Finding in the Emergency Department
Authors: Friedman Stanford B. , Morse Carol W.
Published: December 2021

One hundred and fifty-six children under 6 years of age seen for injuries in an emergency department had been previously studied and their injuries were judged by the investigators to represent unreported "suspected abuse," "gross neglect," or an "accident." Five years later, all cases of "suspected abuse" and "neglect," and a random sample of "accidents," were included in a study involving interview of parents and a survey of medical facilities for subsequent contact with these children. Seventy-five percent (41 of 54) of this sample were located and available for study. At the time of follow-up, it was found that children judged to have experienced "accidents" had a lower incidence of subsequent injuries, their siblings had fewer injuries, their relationship to their mother was judged to be better, and there were fewer emotional and social problems in their families. These differences did not reach statistical significance except in a single instance, though by all of these measurements the children from the "suspected abuse" and "gross neglect" groups did not do as well as the children judged to have experienced "accidents." In addition, the two children identified as having experienced abuse during the follow-up period were both initially in the "suspected abuse" category; each of these children also had a sibling involved in abuse during this same period.
The Effect of Phototherapy on the Hyperbilirubinemia of Rhesus Incompatibility
Authors: Shennan Andrew T.
Published: December 2021

A retrospective analysis was made of the case records of 141 infants with jaundice due to rhesus incompatibility born in one unit over a six-year period during which phototherapy was introduced, in order to ascertain the effect of this form of treatment on the serum indirect bilirubin concentration. The infants were allocated to four groups of severity based on cord blood findings and the curve of bilirubin concentration drawn over the first 48 hours of life. Infants born before the advent of phototherapy acted as controls for those treated. There was a highly significant reduction in the level of indirect bilirubin reached in the mildest group not requiring exchange transfusion at birth, the mean bilirubin at 48 hours being lowered by 3.5 mg/100 ml in the treated group. Phototherapy exerted a lesser effect on the jaundice of more severely affected groups but still significantly reduced the rate of rise and the number of second and subsequent exchange transfusions.

It is concluded that phototherapy is a valuable addition to the current methods of treatment of hemolytic disease due to rhesus incompatibility.
Twenty-two Years' Experience in the Medical Management of Juvenile Thyrotoxicosis
Authors: Vaidya Vanitha A. , Bongiovanni Alfred M. , Parks John S. , Tenore Alfred , Kirkland Rebecca T.
Published: December 2021

Ninety-five patients with juvenile thyrotoxicosis have been studied over the period 1952-1974. Medical treatment with propylthiouracil has been the treatment of choice. Of 75 who have been adequately followed, 40% have achieved remission with medical treatment alone. The average duration of medical treatment was 3.2 years. Toxic reactions have been few and mild. Thirty-two cases were treated surgically, 13 because of noncompliance with drug treatment and 13 because of recurrence following discontinuation of the drug. Medical treatment has been eminently satisfactory in this clinic. In the absence of exceptionally skilled surgical services drug treatment is to be preferred and may be continued virtually indefinitely in the absence of drug reaction.
The Sudden Infant Death Syndrome in Hospitalized Babies
Authors: Peterson Donald R. , Beckwith J. Bruce , Benson E. A.
Published: December 2021

"If infants die because, while passing through a period of increased physiological vulnerability, some critical combination of intrinsic and extrinsic factors proves lethal, then it would be strange if death occurs only in the course of minor and not major illnesses. Is it possible that sudden unexplained death does happen in hospital, but is not recognized as such because the major diagnosis is judged to be the cause of death, or do the resuscitative measures which are readily available prevent it?"

This provocative question, posed in an editorial in late 1971,1 drew a response from Raphael, who submitted rather convincing evidence of an instance of sudden unexplained infant death in a Canadian hospital.2
Prolonged Fever in Children: Review of 100 Cases
Authors: Pizzo Philip A. , Lovejoy Frederick H. , Smith David H.
Published: December 2021

One hundred children admitted to a hospital over a six-year period with temperatures over 38.5 C for longer than two weeks and of undetermined etiology are reviewed. Fifty-two were infectious (21 presumed viral), 20 collagen-inflammatory, 6 malignancy, 10 miscellaneous, and 12 discharged undiagnosed. Children less than 6 years were more likely to have an infectious etiology while 80% of collagen-inflammatory disease occurred in the group older than 6. The overall mortality (9%) was not age-related. Careful history and physical examinations were helpful but the usual laboratory data (CBC, urinalysis, X-ray) were notably disappointing; however, sedimentation rates and serum protein electrophoresis were often reliable screening tests. Biopsy and laparotomy were less frequently done but when performed yielded productive information. Unusual presentations of common diseases comprised the majority of childhood fevers.
Pneumothorax and Pneumomediastinum in Infants With ldiopathic Respiratory Distress Syndrome Receiving Continuous Positive Airway Pressure
Authors: Hall Robert T. , Rhodes Philip G.
Published: December 2021

A review of infants with idiopathic respiratory distress syndrome developing pneumomediastinum and pneumothorax reveals (1) an incidence of 20% in patients receiving CPAP with an 11% incidence in comparable infants not receiving this mode of therapy; (2) in the CAPA-treated group the occurrence was at a stage in the illness when the inspired oxygen concentration was being lowered and when ventilation was stable; (3) the inspired oxygen concentration in the CPAP group at the time of the PM and/or PT was 52% (± S.D. 15%) at a mean age of 33 hours (± S.D. 23 hr).

These observations suggest that distending airway pressure creates excessive alveolar distention as an underlying mechanism of the air leak. It is recommended that distending airway pressure be lowered prior to achieving an inspired oxygen concentration of 60%. A controlled study is in progress to delineate the optimum distending airway pressures at specific inspired oxygen concentrations in order to reduce the incidence of alveolar rupture to a minimum.
Prevention of Apnea and Bradycardia in Low-Birthweight Infants
Authors: Shannon Daniel C. , Gotay Felicita , Stein Israel M. , Rogers Mark C. , Todres I. David , Moylan Fergus M.B.
Published: December 2021

The efficacy of theophylline in preventing severe apnea was evaluated in 17 low-birthweight infants (mean weight, 1,400 gm). Apnea was detected and accurately quantified by 13-hour pneumogram recordings and correlated with serum theophylline levels. Nursing observations coupled with on-line alarm systems detected only 39% of severe apneic episodes as compared to the pneumogram recording technique.

Theophylline in six hourly oral doses (1.5 to 4.0 mg/kg) yielded two-hour serum concentrations of 6.6 to 11.Oµg/ml which completely controlled apneic spells exceeding 20 seconds in duration and markedly reduced 10- 19-second apneic episodes and any resultant bradycardia. At these serum levels, toxicity was not observed.

Therapy with theophylline should be instituted at a dose of 2 to 3 mg/kg every six hours and the optimum therapeutic dose should be individualized as determined by objective quantitation of apnea and serum theophylline concentration.
Sudden Infant Death Syndrome: Hypothesis of Causation
Authors: Tonkin Shirley
Published: December 2021

The airway of the young infant is anatomically vulnerable at the oropharyngeal level between the soft palate and the base of the skull. Airway occlusion at this level might occur during the muscle relaxation which occurs during REM sleep, facilitated by a hypermobile mandible, by the hypotonia of infection, perhaps by an enlarged tongue with a strong backwards sucking action which might be the result of the artificial feeding of the infant.

It is possible that "cot deaths" (SIDS) may be precipitated by such oropharyngeal airway occlusion, cardiac arrest following variable periods of partial or complete oxygen deprivation.
Typhoid Fever in Children
Authors: Colon A. R. , Gross D. R. , Tamer M. A.
Published: December 2021

An epidemic of typhoid fever occurred in a migrant labor camp some 15 miles south of Miami, Florida in February 1973. It was the largest reported outbreak of typhoid fever in the United States in the last 30 years. Epidemiological data revealed that an 11-year-old retarded girl was the index case, and that her disease was contracted from a carrier living next door. Spread occurred via a faulty well, chlorinator, and sewerage system in the camp. During a period of approximately three weeks, over 300 patients were hospitalized with suspected typhoid. Of this number, 147 were children under 13 years of age.
Management of Tracheobronchial Foreign Bodies in Children: A Reevaluation of Postural Drainage and Bronchoscopy
Authors: Law Dennis , Kosloske Ann M.
Published: December 2021

The efficacy of the inhalation-postural drainage technique for removal of aspirated foreign bodies was compared with that of bronchoscopy in 76 children. Twelve of 49 children on postural drainage coughed out the foreign body (25%); the other 37 required bronchoscopy. The foreign body was successfully removed in 56 of 63 children who were bronchoscoped (89%). Our experience suggests that a trial of inhalation-postural drainage, administered in a hospital, may be valuable in the initial management of aspirated foreign bodies. If unsuccessful after several treatments, however, the technique should be abandoned, and bronchoscopy performed. Delay of foreign body removal beyond 24 hours may be associated with increased morbidity and prolonged hospital stay. With recent improvements in pediatric endoscopic instruments, the efficacy of bronchoscopy exceeds 90%.
Evaluation of a Rapid β-Lactamase Test for Detecting Ampicillin-Resistant Strains of Hemophilus influenzae Type b
Authors: Scheifele David W. , Syriopoulou Vassiliki P. , Harding A. Lynn , Emerson Barbara B. , Smith Arnold L.
Published: December 2021

Chloramphenicol is presently the drug of choice in the initial treatment of serious infections due to Hemophilus influenzae type b. Rapid detection of ampicillin resistance in clinical isolates would facilitate early discontinuation of chloramphenicol therapy in patients infected with ampicillin-sensitive bacteria. A total of 160 strains of H. influenzae type b were tested with a one-hour acidimetric microassay for β-lactamase activity. All ampicillin-resistant strains rapidly hydrolysed the β-lactam ring of penicillin. When isolates were encoded and tested without knowledge of their MICs, the 40 ampicillin-resistant strains (MIC ≥ 2µg/ml) were readily distinguished from 120 sensitive strains. Rapid β-lactamase assay is therefore a reliable detector of ampicillin resistance in H. influenzae type b.
Vitamin A Delivery in Total Parenteral Nutrition Solution
Authors: Hartline John V. , Zachman Richard D.
Published: December 2021

Vitamin A delivery was studied in total parenteral nutrition as used for neonates. Although the data show that the patient receives more vitamin A than dictated by known needs or advised intakes, delivery to the patient is roughly one third of that which would be predicted from the initial intravenous solution composition. Adsorption of the vitamin to the chamber and tubing is the major factor in decreasing vitamin A administration to the patient. When evaluating nutrition techniques, documentation of nutrient delivery to the patient is essential.
DOWNWARD SPIRAL
Authors: Mahler H. ,   Student
Published: December 2021

Malnutrition is both one of the consequences of social injustice and one of the factors contributing to its maintenance. It bears hardest on small children, contributing to the massive death toll among the young, and together with other adverse environmental factors it interferes with the adequate growth and development of the survivors. It reduces their capacity to learn during childhood and to earn during adulthood. The inevitable result is a downward spiral in which poor malnourished parents produce malnourished children who in turn will become poor and malnourished parents.
Reassessment of the Microcytic Anemia of Lead Poisoning
Authors: Cohen Alan R. , Trotzky Margret S. , Pincus Diane
Published: December 2021

Hematologic abnormalities in childhood lead poisoning may be due, in part, to the presence of other disorders, such as iron deficiency or thalassemia minor. In order to reassess increased lead burden as a cause of microcytic anemia, we studied 58 children with class III or IV lead poisoning, normal iron stores, and no inherited hemoglobinopathy. Anemia occurred in 12% and microcytosis in 21% of these children. The combination of anemia and microcytosis was found in only one of 58 patients (2%). When only children with class IV lead poisoning were studied, the occurrence of microcytosis increased to 46%. However, the combination of microcytosis and anemia was found in only one of these 13 more severely affected patients. Microcytic anemia was similarly uncommon in children with either blood lead concentration ≥ 50 µg/100 ml or erythrocyte protoporphyrin concentration ≥ 110 µg/100 ml. These data indicate that microcytosis and anemia occur much less commonly than previously reported in childhood lead poisoning uncomplicated by other hematologic disorders.
Baby Powder—A Hazard!
Authors: Mofenson Howard C. , Greensher Joseph , DiTomasso Anthony , Okun Sharon
Published: December 2021

Baby powder is widely used in the home for the routine care of infants' skin. The object of this report is to point out the frequency of baby powder aspiration and the potential hazard of careless use. A recent report reviewed more than 25 cases of talcum powder aspiration with a mortality of 20%.1 These cases represent only the most severe episodes. The true incidence of baby powder inhalation is grossly underestimated. Moss2 states that approximately 50 cases a year are reported to the New York City Poison Control Center alone.2 Dusting powders used in the past were predominantly composed of zinc stearate, a talc substitute.
A Clinical Pathologic Reappraisal of Kernicterus
Authors: Turkel Susan Beckwitt , Miller Carol A. , Guttenberg Marta E. , Moynes Diane Radovich , Hodgman Joan E.
Published: December 2021

Kernicterus at autopsy, traditionally associated with hyperbilirubinemia, is now often observed in the absence of markedly elevated levels of serum bilirubin. Attempts to document clinically predictive risk factors for kernicterus have been largely unsuccessful in the current population of sick neonates. In a study of 32 pairs of newborns with and without kernicterus at autopsy and matched for gestational age, weight, length of survival, and year of birth, no differences were found when multiple clinical factors thought to potentiate risk for kernicterus were compared. Microscopic sections of brains from these same matched pairs were then evaluated without knowledge of the clinical or gross findings according to prearranged criteria. Statistical analysis of the microscopic findings was done, comparing each observed change in each anatomic site, all changes in each site, and each change in all sites. Although the gross pattern of staining followed that of classic kernicterus, the expected, specific histologic changes characteristic of kernicterus were found in only three patients. Spongy change, or edema, was significantly more common in the grossly stained brains (P <.0005), but other findings were similar in both groups. Gross bilirubin staining of the neonatal brain with neither hyperbilirubinemia nor specific microscopic changes is probably not the same clinicopathologic entity as classic kernicterus.
Sudden Infant Death Syndrome in Infants With Bronchopulmonary Dysplasia
Authors: Werthammer Joseph , Brown Elizabeth R. , Neff Raymond K. , Taeusch H. William
Published: December 2021

The association between bronchopulmonary dysplasia and sudden infant death syndrome was studied retrospectively in low-birth-weight infants discharged from the neonatal program at Harvard Medical School. The incidence of sudden infant death syndrome was seven times greater in infants with bronchopulmonary dysplasia when compared with a group of control infants without bronchopulrnonary dysplasia. Confounding factors, including birth weight, sex, multiple birth, socioeconomic status, and apnea were evaluated. The results indicate that there is an association between bronchopulmonary dysplasia and sudden infant death syndrome.
Pediatric Victims of Unexplained Stroke and Their Families: Familial Lipid and Lipoprotein Abnormalities
Authors: Glueck Charles J. , Daniels Stephen R. , Bates Stephen , Benton Corning , Tracy Trent , Third Jane L.H.C.
Published: December 2021

The finding of low levels of high-density lipoprotein cholesterol (C-HDL) and/or high levels of triglyceride in several children with "unexplained" ischemic cerebrovascular accidents led to a systematic review of lipids and lipoproteins in 11 pediatric victims of unexplained stroke and their families. Each of the children, 1 to 17 years of age, had an acute, nonhemorrhagic cerebrovascular accident documented by symptoms, signs, history, physical examination, and laboratory radiographic studies; no known causes or strong preclisposing factors were elicited. Of the 11 pediatric stroke probands, only one had normal lipid and lipoprotein levels; five had low C-HDL levels alone, two had elevated levels of plasma triglycerides with low C-HDL levels, two had high levels of triglycerides with normal C-HDL levels, and one had high levels of low-density lipoprotein cholesterol (C-LDL) alone. A consistent trend toward familial clustering of low C-HDL, elevated triglyceride, and/or C-LDL levels was observed. Nine of the 11 kindreds had two generation parent:child stroke proband, or parent:child clustering of elevated triglyceride and/or depressed C-HDL levels, whereas one parent:child stroke proband pair had elevated levels of C-LDL. In five of nine kindreds for whom siblings of the pediatric stroke probands were available for testing, there were low C-HDL and/or high triglyceride levels in otherwise healthy and entirely asymptomatic siblings. In nine of the 11 kindreds premature coronary heart disease and/or ischemic cerebrovascular disease was observed in the probands' adult relatives. We speculate that familial lipoprotein abnormalities, particularly those involving low levels of C-HDL and/or high levels of triglycerides, may mediate occlusive cerebrovascular arteriosclerosis, and thus may predispose children to ischemic cerebrovascular strokes. The apparent association of lipoproteins and ischemic strokes in children and their families merits further exploration with a particular focus on familial aggregation of low C-HDL levels, already known to be a significant risk factor for ischemic cerebrovascular and cardiovascular disease in adults.
Autosomal Recessive Type of Whistling Face Syndrome in Twins
Authors: Kousseff Boris C. , McConnachie Peter , Hadro Teresa A.
Published: December 2021

A report of concordant monochorionic, diamnionic like-sex twins with whistling face syndrome is presented. The diagnosis was based on the characteristic facies with prominent supraorbital ridge, sunken eyes, telecanthus, short nose and colobomata of the nostrils, long philtrum, high narrow palate, and marked microstomia with puckered lips and an "H"-shaped cutaneous dimpling on the chin. The hands showed symmetrically clenched fmgers with camptodactyly and ulnar deviation. The feet demonstrated mild bilateral talipes equinovarus. HLA studies to determine the zygosity of the twins showed discordance in HLA haplotypes, which indicated dizygosity. The pedigree analysis showed normal nonconsanguineous parents, and no other family members had the syndrome. The findings support the existence of an autosomal recessive type of whistling face syndrome.
SUBDURAL EFFUSIONS COMPLICATING BACTERIAL MENINGITIS
Authors: SMITH MARGARET H. D. , DORMONT RICHARD E. , PRATHER GEORGE W.
Published: December 2021

Twenty cases of subdural effusion are presented occurring in infants under the age of 14 months during their convalescence from acute bacterial meningitis due to H. influenzae type b, D. pneumoniae, paracolon bacillus and Ps. aeruginosa.

The incidence of these effusions must be quite high, since at least 20 out of 43 cases of meningitis under the age of 2 years had fluid in the subdural space at some time during their hospital stay.

The authors believe that subdural taps should be performed on admission for diagnostic purposes whenever the patient has been treated with antibiotics before coming to the hospital, and has no organisms in the spinal fluid at the time he is first seen, as well as in all patients who give evidence of prolonged fever, focal neurologic signs, convulsions, etc., following meningitis.

The trauma incident to subdural taps is probably not itself responsible for causing subdural effusions, since in most cases fluid was present at the first tap.

The matter of age incidence needs investigation. There is no reason to believe that such effusions are limited to infants. The possible presence of a subdural effusion should be considered in an older patient whose convalescence from meningitis is slow, accompanied by prolonged fever, headaches and any suggestive focal neurologic signs.

The authors' experience, as well as a review of the older literature, indicates that from the confusing clinical entities known as subdural hygroma, pachymeningitis hemorrhagica interna, etc., one group can be singled out as occurring on the basis of an underlying infection. Its frequent occurrence in recent years is owing to the high survival rate in bacterial meningitis.

The actual pathogenesis of this lesion; the incidence of loculated fluid; the incidence of "membranes"; the possible influence of different treatment regimens on the occurrence of this syndrome; the possibility suggested by analogy with "pleuropneumonia" that subdural effusions, when infected, may serve as foci for later recurrences of meningitis; the possible influence of early recognition and treatment of subdural effusions on the ultimate prognosis in meningitis are matters for the future to determine.
MEAT IN THE DIET OF PREMATURE INFANTS
Authors: SISSON THOMAS R. C. , EMMEL ANNE F. , FILER LLOYD J.
Published: December 2021

Meat protein is as well retained and utilized as milk protein by the premature infant and is therefore as safe and efficient a source of protein as milk. The fat absorption of the premature infant is not significantly altered when the milk fat in the diet is partly or wholly replaced by meat fat or meat fat and olive oil.

Strained meats do not contain a sufficient quantity of Ca and P to maintain an adequate intake of these minerals for the premature infant without further supplementation from other sources such as milk or pure mineral supplements.

Strained meats are an excellent and readily available source of Fe for premature infants. The Fe of meat is absorbed by them, but how well it is stored and utilized by them requires further investigation.