bluuebunny/crossref_metadata_2025 huggingface dataset:
THE FIRST AMERICAN PLEA FOR A PERMANENT HOSPITAL FOR SICK CHILDREN (1852)
Authors: C. T. E.
Published: December 2021

In 1852, James Stewart (1799-1864), under the pen name "Phiopedos," originated a plan for the establishment of a children's hospital in New York City. When the institution was opened on March 1, 1854, under the name of the New York Nursery and Child's Hospital, it was the only hospital on this continent devoted to children. (There had been a hospital devoted exclusively to sick children in Boston as early as 1846, but financial difficulties forced it to close after a few years.)

"Philopedos" wrote1:

It must be evident to all who will reflect upon the large amount of sickness there is among the children of the poor in our city [New York], that hospital accommodations for them are among its most urgent wants. In the dwellings of the very poor there is almost always .. absence of everything necessary for the ordinary relief of the sick, and especially of the unremitting attention that is needed by them. The necessity of constant occupation to obtain the means of existence, precludes the possibility ...of devoting any time to the requirements of the sick; and it is from this want of attendance, next to want of pure air, that children suffer most. For those who have the necessary comforts for the sick, or who have the time that they may bestow upon their families, when they most require it, dispensary attendance is sufficient for their wants in sickness; but when it is known that many children are absolutely destitute of all these—indespensable as they are—the necessity of proving well-ventilated accomodations is evident; a place where all the wants of the sick [child] may be supplied, and especially when personal care must form an essential pant of the arrangement;—a need only to be supplied by the establishment of a well-organized hospital....
Ectopic Immature Renal Tissue Over the Dorsum of Lumbar and Sacral Area in Two Infants
Authors: Posalaky Zoltan , Drake Robert M. , Mawk John R. , Franciosi Ralph A. , Spencer Bernard H. , Athinarayanan Pakshi R. , Baker Theresa A. , Viring Norman
Published: December 2021

During reparative surgery for meningomyelocele of the lumbar area, a 7-week-old female infant was found to have a small, well-delineated, subcutaneous, renal blastema. A 3-month-old female infant was found to have immature renal tissue, consisting of glomeruli and tubules, in a soft tissue swelling dorsal to the sacrum. Neither of these patients showed neuroloic or renal abnormalities. The second patient has had a disease-free follow-up period of six years. The possible etiology and significance of these benign findings and their relation to the origin of Wilms tumors are discussed.
Neonatal Circulatory Changes Following Elective Cesarean Section: An Echocardiographic Study
Authors: Jacobstein Mark D. , Hirschfeld Stephen S. , Flinn Celia , Riggs Thomas , Fanaroff Avroy
Published: December 2021

Right ventricular systolic time intervals have been used in neonates to demonstrate both normal and abnormal cardiovascular adaptation to extrauterine life.1,2 The ratio of these intervals, which include the right ventricular preejection period (RVPEP) and right ventricular ejection time (RVET), correlates closely with pulmonary vascular resistance (PVR) and pulmonary artery diastolic pressure.3 Previous echocardiographic studies in normal newborns have demonstrated the decline in PVR, but have excluded babies delivered by cesarean section (CS).1

Many respiratory abnormalities are noted following both elective and emergency CS. These are attributed to respiratory distress syndrome, transient tachypnea of the newborn (TTN), aspiration syndromes, and persistent fetal circulation (PFC).4-9
Sucrose or Glucose for Diarrhea
Authors: Hughes-Davies T. H.
Published: December 2021

In the letter "Sucrose or Glucose for Diarrhea" by Hughes-Davies (Pediatrics 68:607, 1981), in the third paragraph the third sentence should read as follows: In the study of Nalin et al3 40% of the babies on sucrose needed more than 24 hours of treatment compared with 15% of those on glucose.
Round Table Discussion
Authors: MILLER JOHN J. , SMITH CHARLES E. , HATFERSLEY PAUL , BRUYN HENRY B. , TURSKY ROSEMARIE J. , LEVY GILBERT J.
Published: December 2021

1. CLINICAL SIGNIFICANCE OF Rh SENSITIZATION

Dr. Paul Hattersley: I shall begin with an obvious oversimplification. I shall speak of the Rh factor. We all are aware that there are many Rh factors. However, it has been established that at least 99% of sensitizations within the Rh group of antigens are by the Rho or D antigen. It is therefore almost entirely among individuals negative for this factor that sensitization occurs. On this basis it is clinically correct to classify individuals as Rh-positive or Rh-negative according to the presence or absence of this one important factor.

The Rh factor is a hereditary characteristic, inherited as a simple Mendelian dominant. Being antigenic, it is capable of stimulating the formation of antibodies upon reaching the body of an Rh-negative individual. There are 2 ways in which Rh-positive cells, containing the Rh antigen, can reach the circulation of an Rh-negative person. The first and most obvious is by intravenous or intramuscular transfusion. The second is by pregnancy. Small amounts of the blood of the fetus cross the placental barrier into the circulation of the mother. If the fetus is Rh-positive, and the mother is Rh-negative, sensitization of the mother to the Rh factor may occur.

There are 3 variable factors which, in different degree, determine whether an Rh-negative individual will become sensitized to the Rh factor. They are the total dose of Rh antigen received, the duration of time in which this dose is received, and the individual's antibody producing capacity. It is not surprising, therefore, that while the over-all percentage of sensitization by pregnancy alone is around 4%, the incidence of sensitization by transfusion approaches 50%.
NEWS AND ANNOUNCEMENTS
Authors: FANCONI G.
Published: December 2021

The Boston Floating Hospital, the Pediatric Teaching Unit of the New England Medical Center, announces the appointment of Dr. Orvar Swenson as Surgeon in Chief on October 15, 1950. Dr. Swenson has also been appointed Associate Professor of Surgery in the Tufts College Medical School.

The Pediatric Cardiology Department of the Children's Division of the Cook County Hospital is now accepting applications for fellowships for immediate appointment. The department offers large material of both congenital and acquired diseases of the heart.
BRAIN DAMAGE IN A JUVENILE DIABETIC PATIENT ASSOCIATED WITH INSULIN HYPOGLYCEMIA
Authors: GARDNER LYTT I. , REYERSBACH GERTRUD C.
Published: December 2021

Clinical data are presented on a child with diabetes mellitus who developed, in association with repeated episodes of insulin hypoglycemia, progressive mental deterioration and organic brain damage which ultimately led to epileptiform seizures unassociated with hypoglycemia.

The implications of these findings are discussed and similar cases in the literature are reviewed.
THERAPY OF TUBERCULOSIS IN INFANTS AND CHILDREN
Authors: HIGH ROBERT H.
Published: December 2021

Streptomycin, or dihydrostreptomycin, along with other agents, such as promizole® or PAS, is of value in the treatment of serious forms of tuberculosis in infants and children. Progressive pulmonary tuberculosis and miliary tuberculosis seem to respond most satisfactorily. Tuberculous meningitis has a serious prognosis but some patients apparently have this infection arrested.

The use of streptomycin for patients with forms of tuberculosis which have a good prognosis without treatment is not recommended. The potential toxicity of the drug and the possible emergence of streptomycin-resistant tubercle bacilli are the major reasons for this recommendation.
TOTAL BODY WATER IN CHILDREN
Authors: FRIIS-HANSEN BENT J. , HOLIDAY MALCOLM , STAPLETON THOMAS , WALLACE WILLIAM M.
Published: December 2021

Total body water was determined in 24 normal infants and children by deuterium oxide dilution and by the antipyrine method. A micro-modification of the antipyrine method is described. Agreement between the two methods for determining total body water was good.

Total body water was found to be highest in premature and newborn babies, the values ranging from 70 to 83% of body weight. During the first 6 months of life there was a gradual decrease of body water as per cent body weight. From 6 months to 11 years of age, the values varied between 53 and 63% with no correlation to age or sex.
OBSERVATIONS ON 26 INFANTS UNDER ONE YEAR OF AGE OPERATED ON FOR TETRALOGY OF FALLOT OR TRICUSPID ATRESIA
Authors: LEININGER C. R. , GIBSON STANLEY
Published: December 2021

Since September 1946, surgical relief for tetralogy of Fallot or tricuspid atresia has been performed in 234 instances. During this period an anastomosis has been created in 24 infants under 1 year of age. Pulmonary atresia prevented an anastomosis in two additional infants. In those children in whom an anastomosis was possible, the mortality was 33.3% under 1 year of age as compared to an over-all mortality of 9.8%, with a mortality of only 2.9% between the ages of 3 and 16 years.

The reasons for this higher mortality in infants are explained and surgical relief in selected cases is recommended.
SAFETY APPARATUS FOR INTRAVENOUS THERAPY
Authors: FLETCHER JOHN P.
Published: December 2021

THE administration of potent drugs and fluids intravenously often requires much more accurate control than is possible with the usual drip method.

This is particularly applicable in the case of small infants for the following reasons:

1. Due to change in position of the infant or relaxation of spasm in the vein receiving the fluid, there may be large variations in the rate of flow, resulting in under-or over-hydration. In the latter case, excessive administration of water or specific electrolytes may cause death in an acutely ill patient.

2. Rates of flow of 10 to 15 cc. per hour are often desirable. It has been found to be impractical to measure a 15 cc. per hour outflow from a 500 cc. flask. Consequently, the nurses must frequently slow down the rate of flow so that stoppages often occur.

3. Certain intravenous medication—notably sodium sulphadiazine, penicillin and calcium gluconate—when injected into standard intravenous tubing, results in massive intermittent dosage. It is more desirable to give continuous intravenous therapy, maintaining the blood level at a uniform concentration. Crystallization of sodium sulphadiazine in the intravenous tubing has been observed when the drug is injected intermittently. This results in a stoppage of the intravenous and irritation of the vein.

A simple graduated safety cylinder (chart 1) has been designed to overcome these difficulties.
THE PRESIDENT'S PAGE
Authors: BEAVEN PAUL W.
Published: December 2021

ONE of the first acts of this administration was to write a letter to those foundations and commercial firms which had donated so generously to the work of the ICH Committee. In that letter it was pointed out that previously the Survey Committee had been assigned a task and when it was completed the committee was dissolved. They turned their data over to another group for them to discover the significance of the facts that had been gathered. This was the Committee for the Improvement of Child Health. They, in turn, had completed their task and had been dissolved. Their work had been tremendous and their influence great. They had brought the Academy a leadership in the field of child health which it had never before realized.

The letter further stated that the task of the Academy now was to carry on the work of the ICH Committee and to build on the foundation that had been so well laid. It was our purpose to integrate its work among the several committees and, thereby, not only have all the membership share the responsibility, but increase the usefulness of our organization by the participation of more members.

The response to the letter was almost unanimous and showed a deep interest in our work. A number stated that their budgets were allocated for the year, but they would be glad to consider us if we should later send in a specific request. Others sent us money. All were grateful for the information and expressed their belief that the Academy was a power for better child health.
TRICUSPID ATRESIA
Authors: ABRAMS HERBERT L. , ALWAY ROBERT H.
Published: December 2021

The recent literature on congenital tricuspid atresia is reviewed. Three previously unreported cases are described. The generally accepted diagnostic criteria are discussed and elaborated.
ACUTE HEMOLYTIC ANEMIA DUE TO INGESTION OF NAPHTHALENE MOTH BALLS
Authors: MACKELL JAMES V. , RIEDERS FREDRIC , BRIEGER HEINRICH , BAUER EDWARD L.
Published: December 2021

Naphthalene moth balls are potent hemolytic agents, capable of producing an acute, severe and perhaps fatal anemia. Moth ball poisoning should be suspected in children manifesting evidence of sudden hemolytic anemia, and an attempt should be made to demonstrate naphthalene or its derivatives in the urine. Care should be taken to prevent moth balls from being reached by infants and children.

α- and β-naphthol and α- and β-naphthoquinone were found in the urine of a child suffering from severe hemolytic anemia due to ingestion of naphthalene moth balls. The hemolytic properties of naphthalene, of the naphthols and naphthoquinones were examined in vitro and in vivo (rabbits).

Naphthalene itself was found to be nonhemolytic in vitro or in vivo. The hemolytic power of the naphthalene metabolites in vitro decreased in the following order: α-naphthol, β-naphthol, α-naphthoquinone, β-naphthoquinone.

Hemolysis due to α-naphthol was observed in vivo (rabbits). However, its hemolytic action was significantly weaker than in vitro. β-naphthol and the naphthoquinones showed no hemolytic activity in vivo (rabbits).

Plasma, cholesterol and lecithin did not inhibit the hemolytic activity of the naphthalene metabolites in vitro.

Formation of methemoglobin was not observed.
Superficial Lumps in Children: What, When, and Why?
Authors: Knight Philip J. , Reiner Charles B.
Published: December 2021

Deciding whether a visible or palpable lump should be excised is a trivial problem if one believes that every unexplained mass in an infant or a child must be promptly removed. But with the present increased public awareness of cancer, this approach would unnecessarily raise parental anxiety. This review of superficial lumps excised in infants and children shows that approximately 1% are malignant. Although a precise diagnosis on the basis of clinical findings remains imperfect, four fifths of the malignant lesions can be recognized on the basis of five risk factors: onset in the neonatal period, a history of rapid or progressive growth, skin ulceration, fixation to or location deep to the fascia, and a firm mass >3 cm in diameter. In the abscence of any of these risk factors, parents can be reassured with a 99.7% accuracy about the benign nature of their child's lump at the initial consultation. Approximately 6% of these lumps will spontaneously regress and, therefore, do not require excision. However, more than 90% of superficial lumps will persist or slowly enlarge and should be electively excised for cosmetic reasons, to prevent late infection or inflammation, and to diagnose the remaining three malignant lesions per thousand lumps that would not be recognized using the above five risk factors.
Childhood Migraine and Motion Sickness
Authors: Barabas Gabor , Matthews Wendy Schempp , Ferrari Michael
Published: December 2021

The incidence of motion sickness among 222 children in four diagnostic categories—migraine, nonmigraine headaches, seizure disorders, and learning disabilities—was compared. Motion sickness was found to be an associated feature in 45% of the cases of childhood migraine, in contrast to a 5% to 7% incidence in the other groups. Therefore, it is suggested that motion sickness be regarded as an additional reliable minor criterion in the diagnosis of childhood migraine. Hypotheses of common central and peripheral mechanisms underlying both conditions are offered.
GLASS IN THE HAND AND FOOT: WILL AN X-RAY FILM SHOW IT?
Authors: Marcuse Edgar K.
Published: December 2021

Roentgenograms of 66 different kinds of glass fragments embedded in chicken legs were taken to evaluate the roentgenographic detectability of glass in an animal tissue similar in size and structure to the human hand or foot. All 66 specimens were easily seen. The presence of lead or other heavy elements was not required for visualization. Fragments as small as 0.5 mm were easily detected if there was no overlying bone. Standard plain x-ray films of the injured hand or foot are useful in determining whether glass fragments are present in the wound.
Selecting Appropriate Normal Limits for Transcutaneous Screening for Hyperbilirubinemia
Authors: Thornbery James M.
Published: December 2021

Noninvasive screening for neonatal hyperbilirubinemia could limit the need for blood drawing and its associated risk of CNS damage to only those infants with possible true serum hyperbilirubinemia. Any study evaluating a test, such as transcutaneous bilirubin estimation, runs the risk of setting normal limits that "overfit" the study's data, particularly when the actual number of diseased patients is low. Calculations of the test's sensitivity, specificity, and predictive values become unrealistic and will not be achieved subsequently.
Nurse Practitioners and the Intensive Care Unit
Authors: Robertson W. J.
Published: December 2021

It is common knowledge that Level III neonatal intensive care units are almost always short staffed so far as trained neonatologists are concerned and that the Level II centers, especially if they are in geographically remote locations, often do not have a fully trained neonatologist on staff.1,2

Although the training in neonatology of the newly graduated pediatricians is gradually improving, it is probably fair to say that the delivery of modern, high-quality neonatal intensive care is beyond the capability of the average pediatrician graduated prior to 1970 and certainly if graduated prior to 1960.
Letter to the Editor
Authors: Kahn A.
Published: December 2021

Southall makes certain criticisms of our suggestion that the changes in transcutaneous PO2 observed during obstructive sleep apnea in infants could partly be related to changes in blood flow and decrease in cardiac output.

The changes in cardiac output during apnea are not well known. In a study of eight severely ill premature newborns (average gestational age of 30 weeks) under oxygen and bicarbonate therapy, Girling1 reports on the heart rate and pulse pressure changes observed during prolonged apnea.
Ictophobia
Authors: LEWAK NORMAN , ABBOTT MYLES
Published: December 2021

To the Editor.—

Thanks to Drs Watchko and Oski for the commentary on the phobia noted in physicians when the bilirubin level in healthy, nonhemolytic newborns approaches 20 mg/dL.1 They focused on the questionable use of exchange transfusions, but only alluded to the greater problem: phototherapy. Worse than either phototherapy or exchange transfusions, however, is the potential for each of these treatments to create a third problem, that of telling families they have a child who needs treatment to prevent brain damage, which in turn may lead to the vulnerable child syndrome.2
A New Syndrome in Cats
Authors: ROCHLITZ I.
Published: December 2021

To the Editor.—

I read with interest the article on acquired postganglionic cholinergic dysautonomia.1 It bears a striking similarity to a syndrome recently recognized in cats in the United Kingdom; the syndrome is known as the Key-Gaskell syndrome, feline autonomic polyganglionopathy or dilated pupil syndrome.

The first clinical cases were reported in February 1982. Since then more than 35 cats with this condition have been treated at the University of Bristol. I have reports of more than 200 cases from veterinary surgeons in practice throughout the United Kingdom.
Treasures in the Groves of Academe
Authors: GEME JOSEPH W. ST
Published: December 2021

Pediatric chairmen have a privilege, certainly a unique and vitally important opportunity, to produce a new burst of energy within our discipline. Chairmen must possess an excitement about a wide range of issues, an enveloping perspective, and enthusiasm for administrative creativity that will produce an academic renaissance in American pediatrics. The reins of leadership can be grasped comfortably and flexibly, taking the job seriously but with a sense of cheer. We must take pride and share a belief in our discipline, position ourselves as striking examples for our students, and attract the very best of those students to pediatrics. Our mission must be underscored with a determination to educate superior students as superb pediatric clinicians or scientists or both.
Complications of Therapy in Hemophilia
Authors: HILGARTNER MARGARET W.
Published: December 2021

Achievement of hemostasis in patients with hemophilia who develop an inhibitor is known to be much more difficult than in the patient without an inhibitor although the frequency of bleeding is usually not increased. The introduction of prothrombin complex concentrates (PCC) and the activated prothrombin complex concentrates (APCC) containing an inhibitor bypassing activity afford a treatment modality that has been useful in some patients.1,2 However, clinical experience has shown that these concentrates are not as effective in patients with inhibitors as factor VIII concentrates are in patients without inhibitors. The lack of efficacy has resulted in escalation of dose and frequency of administration by physicians, particularly when using the currently available PCC.
Pertussis Vaccine
Authors:   Committee on Infectious Diseases
Published: December 2021

The "Red Book," as the Report of the Committee on Infectious Diseases has come to be known, is not a static document, but is subject to frequent revision. Not only does each edition contain new information available to the Committee, but between editions the Committee communicates further changes to the medical profession via Pediatrics. These communications constitute "Updates" to the Red Book. As everyone knows, scientific information proliferates exponentially, and so the Updates have appeared more frequently in recent years.

The Update that follows concerns pertussis vaccine, and therefore, it supplements information in the 1982 edition of the Red Book. To place it in context, the entire Red Book section on Pertussis (pp 198 to 202) should be reviewed, as well as the general sections on immunization, particularly the section on Informed Consent (p 4) and the section on Vaccine Dose (p 10).

Like many preventable childhood diseases, pertussis is now infrequently reported in this country. Although more than 200,000 cases were reported annually in the 1930s before pertussis vaccine was introduced, only about 2,000 cases are now recognized each year. The success of the vaccine has resulted in the remarkable decline of a formerly feared illness. As the incidence of the disease has declined, adverse reactions attributed to pertussis vaccine have received greater attention and prominence.

In the United Kingdom, following Professor G. T. Stewart's alarming reports of brain damage due to pertussis vaccine, immunization rates fell profoundly, and as a result widespread outbreaks of pertussis began to occur.
Total Calcium and Q-oTc Determinations Are Not Useful in the Intensive Care Unit
Authors: MOYA FERNANDO , REKEDAL KIRBY , GETTNER PATRICIA , CHAMBERLIN MILDRED , GERTNER JOSEPH , EHRENKRANZ RICHARD
Published: December 2021

To the Editor.—

Neonatal hypocalcemia (total calcium <7 mg/dL or ionized calcium <3.0 to 3.5 mg/dL) has been reported to be present during the first week after birth in approximately one third of premature infants, asphyxiated newborns, and infants of diabetic mothers.1 Colletti et al2 suggested that the Q-oTc interval of the ECG is a reliable screening test for hypocalcemia in these infants. Several hormonal and metabolic disturbances have been proposed to explain the occurrence of neonatal hypocalcemia.3
A Double-Blind Study Comparing the Effectiveness of Cromolyn Sodium and Sustained-Release Theophylline in Childhood Asthma
Authors: Furukawa Clifton T. , Shapiro Gail G. , Bierman C. Warren , Kraemer Michael J. , Ward Daniel J. , Pierson William E.
Published: December 2021

The effectiveness of cromolyn sodium and theophylline on asthma in children was compared during a 3-month trial. Forty-six children (aged 5 to 15 years) with asthma were assigned at random to cromolyn or theophylline (Theo-Dur) treatment groups. Each subject received theophylline placebo or cromolyn placebo in addition to the active drugs. A methacholine challenge test was done at the start of the study to document asthma and was repeated during the third month. The theophylline dosage was regulated to obtain serum levels of 10 to 15 µg/mL by a physician not involved directly with patient care. Forty patients completed the study. Both theophylline and cromolyn treatment groups showed improvement from base-line status in terms of symptom scores, pulmonary function, and decreased use of inhaled albuterol. Patients treated with theophylline had more side effects and required more frequent office visits than those treated with cromolyn. Both groups had decreased sensitivity to methacholine, and for one statistical test patients treated with cromolyn improved significantly. These results indicate that cromolyn is as effective as theophylline in treating mild to moderate asthma in children; additional benefits were fewer side effects and a possible decrease in bronchial hyperactivity.
Who Should Provide Primary Health Care to Children: Pediatricians or Family Medicine Physicians?
Authors: Hoekelman Robert A. , Klein Michael , Strain James E.
Published: December 2021

INTRODUCTION

—Robert A. Hoekelman, MD

This debate is one of a series entitled "Controversies in Child Health and Pediatric Practice." In 1978 and 1979, the Department of Pediatrics at the University of Rochester conducted 12 such debates, which were published in book form in 1981.1 It is interesting that of these 12 controversies, not one has been resolved. That may prove to be the case for the controversy presented in this debate, "Who should provide primary health care to children: pediatricians or family medicine physicians?"

Our guest speakers are Dr Michael Klein and Dr James E. Strain. Dr Klein is Professor of Family Medicine and Assistant Professor of Pediatrics at McGill University School of Medicine. He is also Director of the Department of Family Medicine and of the Herzl Family Practice Center at the Sir Mortimer B. Davis Jewish General Hospital in Montreal. Dr Klein received his medical degree at Stanford University in 1966, and he was his class's recipient of the pediatric Harold K. Kaiser Award. Dr Klein served his internship at Bronx Municipal Hospital Center at Albert Einstein University and his pediatric residency at Montreal Children's Hospital. During his last year, he served as Senior Resident in Neonatology under Robert Usher at the Royal Victoria Hospital. He then became a fellow in biochemical genetics under Charles Scriver and the Chief Medical Resident at Montreal Children's Hospital under Mary Ellen Avery. In 1970, he came to Rochester as a Fellow in Ambulatory Pediatrics.

Dr Klein's practice experience is extensive. He was the pediatric coordinator of the St Jacques Clinic in Montreal during the late 1960s and the medical director of the Westside Health Services in Rochester from 1971 to 1975, after which he assumed his current position.
Massachusetts Metabolic Disorders Screening Program: III. Sarcosinemia
Authors: Levy Harvey L. , Coulombe J. Thomas , Benjamin Rachel
Published: December 2021

Sarcosinemia has been detected by routine screening of urine for metabolic and transport disorders in Massachusetts. Three infants who had sarcosinemia were detected through the neonatal urine specimen, an observed incidence of 1:350,000. A fourth child had sarcosinemia detected through family screening after his brother was found to have Hartnup disease by neonatal urine screening. These four children with sarcosinemia have plasma sarcosine concentrations ranging from 80 to 603 µmol/L and urine sarcosine from 2.1 to 9.4 µmol/mg of creatinine, findings similar to those reported for persons with sarcosinemia. No treatment has been given. At 3.8 to 15 years of age, the children had normal findings on physical examination and had no specific illnesses. Their full-scale IQ scores ranged from 89 to 111. The oldest child had a learning and emotional disorder, and one other child was emotionally unstable. It was concluded that sarcosinemia as a specific disorder is probably benign and that the mental retardation and dysmorphic features described in some affected persons are likely coincidental with the biochemical defect. The emotional disturbances that were encountered in two children are also probably coincidental but need further attention in this disorder.
Munchausen by Proxy or Polle Syndrome: Which Term Is Correct?
Authors: Meadow Roy , Lennert Thomas
Published: December 2021

The terms Munchausen syndrome by proxy and Polle syndrome have both been used to describe the situation in which one person persistently fabricates illness on behalf of another (usually a mother on behalf of her child). However, investigation of the family records of the real life Baron von Munchausen in Germany reveal that Polle syndrome is an inappropriate title originally derived from incorrect information.
Coronavirus?
Authors: ROUSSET SOLANGE , CHANY CHARLES , LEBON PIERRE , MOSCOVICI OTTO
Published: December 2021

In Reply.—

In both of our papers,1,2 we referred to coronavirus-associated disease and termed the particles "coronavirus-like." In order to make our position even less equivocal, we stated in our first paper (pages 213-214)1: "At present, because of the lack of viral propagation in tissue culture, the virions found in the stools are only identified on the basis of their morphologic appearance (see Figure). These differences could either represent various aspects of one virus, or different viruses presently classified as coronaviruses.
A Believer in Phototherapy
Authors: ROSENBAUM RICHARD J.
Published: December 2021

To the Editor.—

The impassioned plea by Hein1 to stamp out the use of phototherapy in healthy, term infants with bilirubin levels less than 20 to 25 mg/dL is premature to say the least. To then remark that malpractice fears per se is the main reason physicians treat jaundice of the newborn is incorrect. The main reason that 5+% of all healthy term infants receive phototherapy is that there is reasonable evidence to indicate that (1) bilirubin levels >20 mg/dL in full-term infants may be associated with kernicterus in a percentage of cases;
Treatment of Disabled Infants
Authors: WEHRLE PAUL F.
Published: December 2021

In Reply.—

I am concerned that the Academy's position on treatment decisions regarding seriously ill newborns may have been construed to be one in alliance with the government's hard-line stand on interventionism and insistence upon treatment. It has always been our position that neither the government nor the courts should interfere in decisions best made by parents in consultation with medical professionals. The Academy is as committed to this concept today as it was when it first challenged the Department of Health and Human Services (DHHS) and successfully struck down the first "Baby Doe" rule which ignored the role of parents in this critical decision-making arena.
Serum Antibodies After Vaccination with Haemophilus influenzae Type b Capsular Polysaccharide and Responses to Reimmunization: No Evidence of Immunologic Tolerance or Memory
Authors: Käyhty Helena , Karanko Viena , Peltola Heikki , Mäkelä P. Helena
Published: December 2021

Haemophilus influenzae type b capsular polysaccharide vaccine was given in Finland in 1974 to approximately 50,000 infants and children, whose serum anti-H influenzae type b capsular polysaccharide levels have been followed for 3½ years. The serum antibodies induced by the vaccination proved short-lived (less than 6 months) in the infants younger than 18 months. Elevated serum antibody levels were detectable for 1½ years but less than 3½ years in the children who were vaccinated when 18 to 35 months old. In the children who were 3 to 5 years old when vaccinated, the elevated anti-H influenzae type b capsular polysaccharide levels persisted for at least 3½ years. Therefore, children vaccinated at the age of 18 months may need a new dose of vaccine 1 to 1½ years after the first dose in order to be protected for the period of high susceptibility, until the age of approximately 7 years. Some of the vaccinated children were reimmunized 3½ years after the first dose, and the anti-H influenzae type b capsular polysaccharide levels in their sera were studied in a similar manner. At no time did the anti-H influenzae type b capsular polysaccharide levels after the reimmunization differ from the anti-H influenzae type b capsular polysaccharide levels seen after the first vaccination in children of the same age. In addition, the children who had received their first dose of vaccine when younger than 18 months and therefore were not responding, responded now. Thus, there was no evidence of immunologic tolerance.
Annual Meeting of the Section on Pediatric Urology
Authors: Gonzales Edmond T.
Published: December 2021

Summary of the Meeting, Oct 22-27, 1983 Received for publication Feb 27, 1984; accepted March 8, 1984. This summary of our proceedings is prepared for the practicing pediatrician, who often finds it impossible to attend all the sessions going on simultaneously at the annual meeting. The Section on Urology of the American Academy of Pediatrics met for three days in conjunction with the 52nd annual meeting of the Academy in San Francisco, and many topics of interest to both pediatricians and urologists were discussed. This summary will only include those papers. Papers dealing with particular surgical techniques will not be included, except when they have bearing on the ultimate management of particular problems that may be of interest to the practicing pediatrician.

As has been customary in the past, the section meeting was topic oriented; this year stressed current research interests in pediatric urology. These topics included vesicoureteral reflux, prenatal ultrasound and renal dysplasia, urinary diversion, disorders of the testis, adjunctive diagnostic techniques in the evaluation of ureteral obstruction, and current status of management of posterior urethral valves.

VESICOURETAL REFLUX

Vesicoureteral reflux, despite its prevalence and voluminous literature, continues at times to present a management dilemma. One of the continuing problems facing the clinician is the observation that many children are seen for evaluation with about as much parenchymal atrophy as they seem likely to get. Studies by Ransley1 and Hodson et al2 have proposed that certain areas of the kidney are more vulnerable to parenchymal atrophy because of the presence of intrarenal reflux and that in the presence of infection and vesicoureteral reflux, these particular areas scar quickly and severely.
Administration of Thyroxine to Very Low-Birth-Weight, Premature Infants
Authors: SCHWARTZ ROBERT P. , HICKEY DOCIA E. , RATHBUN MARY ANNE
Published: December 2021

To the Editor.—

We question the advisability of administering thyroxine to premature infants with low thyroxine (T4) levels as reported by Chowdhry et al.1 The low T4 levels noted in this report would be expected in infants of 26 to 28 weeks of gestation. The serum thyrotropin (TSH) values were normal as was the response to thyrotropin-releasing hormone. Hadeed et al2 noted a prevalence of T4 levels less than 6.5 µg/dL in 52% of infants of 28 to 30 weeks of gestational age, 33% of infants of 31 to 33 weeks of gestational age, and 11% of infants of 34 to 36 weeks of gestational age.2
Thyroid Hormone Poisoning: Therapy Questioned
Authors: KIRKLAND REBECCA T. , KIRKLAND JOHN L. , GREGER NANCY G. , EBERLE ANDREA , MARSHALL ROBERT
Published: December 2021

To the Editor.—

We are concerned about the implications of the report of aggressive management of a child with acute ingestion of thyroid hormone. The vigorous treatment of one of two children reported to have ingested large amounts of levothyroxine prompted us to make a telephone call to the Poison Control Center in Houston regarding overdosage with thyroid hormones. The recommendations of the Harris County Poison Control Center with acute thyroid hormone ingestion includes ipecac ifthe ingestion is early and oral charcoal.
A Call for Clinical Prudence in Use of DTP and Other Vaccines
Authors: GERAGHTY KEVIN C.
Published: December 2021

To the Editor.—

I read with great interest the recent editorial by the new chairman of the "Red Book" Committee, Dr Brunell,1 commenting on the impact of litigation on manufacturers and physicians. Brunell quite correctly points out that litigation directed against manufacturers may serve to have an adverse effect on the availability of vaccines. Physicians faced with increasing reports of litigation against colleagues can, as Brunell points out, be expected to demonstrate reluctance in their use of certain vaccines.
Cutis Laxa, Ligamentous Laxity, and Delayed Development
Authors: KARRAR Z. A.
Published: December 2021

To the Editor.—

Sakati and colleagues, at the end of their article state that "All of these observations raise the possibility that the disorder is determined by a gene on the X chromosome which is expressed as an X-linked lethal gene in the hemizygous male and as this syndrome in the heterozygous female."

Our experience following up eight children in five Saudi families from the same area in Central Saudia Arabia compels us to disagree with that speculation.
Personal Experience
Authors: SCHWARTZ RICHARD H.
Published: December 2021

I am pleased that Milman and Bennett continue to research and publicize the problems that frequent marijuana use by young people can cause. I am grateful to Dr Milman for her ceaseless efforts to educate the medical community about the many dangers to humans of all ages of smoking marijuana. As one who suffered greatly as a result of believing widely publicized but poorly documented information regarding the innocence of using cannabis, I hope that others will also be enlightened by Milman's findings, and by my own, showing the dangers of drug use by adolescents and the pain that such use can cause.
Effective Approaches to Patient Education for the Busy Pediatrician
Authors: Bartlett Edward E.
Published: December 2021

Pediatricians spend 35% to 41% of their direct patient care time on patient education and counselling. However, studies indicate that teaching alone generally is ineffective. It is logical that the patient or parent must have an understanding of the basics of the regimen in order to follow the pediatrician's advice. However, teaching, even when supplemented by pamphlets or audiovisual programs, generally is not sufficient to bring about behavior change. A "stepped approac" to patient education is recommended. This approach consists of three steps: (1) using interpersonal skills to establish rapport and provide reassurance; (2) teaching about the illness, regimen, and other health matters; and (3) identifying and overcoming obstacles to behavior change. Step 3 is not necessary if steps l and 2 have been successful in achieving patient adherence to physician recommendations. By questioning the patient or parent at the follow-up visit, the pediatrician can identify the obstacles that are interfering with acceptance of his or her advice—this process is the "behavioral diagnosis." Once the cause of the problem has been determined, selection of the appropriate solution is usually straight-forward. This three-step approach to patient education can be more effective and less time-consuming than traditional approaches.
Introduction to Common Pediatric Complaints
Authors: Lucey Jerold F.
Published: December 2021

Those who have tried to organize a different kind of conference know how difficult that can be. Many presenters can be programmed congenital lecturers. Once on a platform, they dim the lights, flash the first slide, and deliver a 40-minute lecture.

That's not what we wanted in this conference. The goal was to teach pediatricians how to teach. Although this is something most practitioners have been doing, it is unlikely that they ever took courses in how to educate patients. That's a very important part of a practice.

If this effort is successful, the reader will learn some of the tricks of the trade from the masters. Our presenters were selected not just because they are experts on their respective subjects, but also because they are effective teachers. In the following six papers, they teach us how to provide effective education for patients with common pediatric complaints.
Otitis Media
Authors: Ginsburg Charles M.
Published: December 2021

Earache, a common symptom in children, causes many parents to seek medical attention. Aside from trauma and the discomfort that often accompanies viral infections of the upper respiratory tract, acute otitis media with effusion is the commonest cause of otalgia in infants and children. Proper management requires a team effort between the physician and the child's parents or caretaker. The physician must transmit to the parents a concise but thorough overview of the problem and a plan for management. This should include information on the pathophysiology of ear disease, its incidence, therapy and the potential adverse effects, and any measures that the parents may take to prevent recurrence. The primary responsibility for transmittal of this information lies with the physician. Ancillary medical personnel and communication aids (videotapes, computers, printed materials) should be utilized, if available, to reinforce the physician's "message.'
Weaning Time
Authors: LAWS HARRY F.
Published: December 2021

To the Editor.—

There seems to be a great deal of argument as to when a child should be switched from breast/formula to cow's milk. Supportive data are difficult to come by for an exact age, although recommendations abound. The consensus appears to favor the concept that excess cow's milk can lead to problems, especially if started at a very early age.

Here is a method that I have been using in my practice for the last few years: Observing that weaning from the breast/bottle to a cup results in decreased milk consumption and overall caloric intake becomes supplemented with solid foods, this weaning time becomes a logical time to suggest starting cow's milk (as a decreased intake, decreases the "risks" associated with cow's milk intake).
Treatment of Occult Bacteremia
Authors: CARROLL WILLIAM L.
Published: December 2021

In Reply.—

I appreciate Feldman's comments about our study. Although physicians' assessment has proved useful in predicting which children have serious bacterial infections such as meningitis, this appears not to be applicable to children with occult bacteremia. In most of the studies cited by Feldman, the number of children with bacteremia was too small to determine the physicians' ability to predict which children were bacteremic.1 In the study by Waskerwitz and Berkelhamer,2 physicians were able to predict bacteremia in only eight of 17 cases, and five of these eight patients had meningitis.
Intellectual Functioning and Ectodermal Dysplasia
Authors: TANNER BARRY A.
Published: December 2021

To the Editor.—

The considerable but scattered literature on the ectodermal dysplasias contains little information on the intellectual aspects of that family of disorders. With two exceptions dealing with youngsters suffering from especially rare, mixed forms of dysplasias,1,2 what information exists tends to occur in passing references, eg, a sentence on a child's school performance or a physician's impression of intellectual functioning.3-5

My experience is that parents are hungry for information about all aspects of their child's disorders, and that they are likely to turn to their pediatrician for such information, including likely intellectual development.
Intellectual Functioning and Ectodermal Dysplasia
Authors: HOYME H. EUGENE
Published: December 2021

In Reply.—

Tanner raises some interesting points with respect to the ectodermal dysplasias which deserve further comment: "Ectodermal dysplasia" is not a specific diagnosis. Malformations of ectoderm are frequent manifestations of a host of multiple malformation syndromes. An accurate, specific overall diagnosis is essential for the dysmorphologist or pediatrician to discuss prognosis and recurrence risks with parents in a knowledgeable fashion. Therefore, of paramount importance is the assignment of an accurate diagnosis in a child with an ectodermal dysplasia.
Levothyroxine Poisoning
Authors: LEHRNER LAWRENCE M. , WEIR MICHAEL R.
Published: December 2021

In Reply.—

The letter by White and Litovitz raises the important issue of the reliability of basing medical decisions on case reports. When our patients were examined, we found nine case reports in the literature describing the toxicity of acute thyroid hormone ingestions. The message of the majority of the case reports is that thyroid hormones are toxic and that therapy is indicated. White and Litovitz cite two additional reports (one is an abstract) which predate our article.
Phenobarbital and Intraventricular Hemorrhage
Authors: BEDARD MARY P. , POLAND RONALD L.
Published: December 2021

In Reply.—

We thank Boynton and Merritt for pointing out the error in the figure in our paper.1 The abscissa should be labeled "Total number of united pairs" as they have indicated. When using sequential analysis, a plan is constructed that takes into account the probability of erroneously rejecting the null hypothesis ( ), the probability of erroneously accepting the null hypothesis (β), and the degree of change sought (0).2 Only pairs in which the outcomes are different ("untied pairs") are plotted on the sequential plan.
Nutritional Proteins in Milk and the Protein Requirement of Normal Infants
Authors: Räihä Niels C.R.
Published: December 2021

All whey proteins in human milk are not absorbed and thus not nutritionally available. There is evidence that secretory immunoglobulin A (SIgA), lactoferrin, and lysozyme are resistant to proteolytic action, and the major part of these protective proteins is excreted in the infant's stool. An exclusively breast-fed infant would thus have a mean intake of 1.3 g of protein per kilogram of body weight per day during the first month and about 0.9 g/kg/d during the third month. Term infants fed with formulas containing 1.5 g of protein per deciliter show metabolic changes that indicate that the infants receive more protein than they require for growth; these changes are not seen in breast-fed infants or in infants receiving a whey-predominant formula containing only 1.1 g/dL of protein. A reevaluation of protein requirement and intake during infancy is suggested.