bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacterial Endocarditis Caused by Vitamin B6-Dependent Viridans Group Streptococcus
Authors: Feder Henry M. , Olsen Neil , Mclaughlin James C. , Bartlett Raymond C. , Chameides Leon
Published: December 2021

Two cases of bacterial endocarditis in children, caused by viridans group Streptococcus which requires vitamin B6 or thiol compounds for growth are reported. It is important to recognize these organisms as a possible cause of endocarditis because supplemented media are needed for their isolation and sensitivity testing. These organisms may be penicillin-sensitive, -resistant, or -tolerant. An organism is considered tolerant to an antibiotic when the minimum bactericidal concentration of that antibiotic is ≥32 times the minimum inhibitory concentration. One of our patients relapsed when treated with a single antibiotic to which the B6-dependent viridans group Streptococcus was tolerant. If a B6-dependent viridans group Streptococcus is isolated from a patient with endocarditis, therapy should be initiated with penicillin and an aminoglycoside until sensitivities are available. Sensitity testing should include both the MIC and MBC and adequate therapy can be confirmed by determining the serum bactericidal activity.
Continuous Monitoring of Arterial Oxygen Tension in Infants: Four Years of Experience with an Intravascular Oxygen Electrode
Authors: Pollitzer Melanie J. , Soutter Linda P. , Reynolds E. Osmund R.
Published: December 2021

In the article "Continuous Monitoring of Arterial Oxygen Tension in Infants: Four Years of Experience with an Intravascular Oxygen Electrode" by Pollitzer et al (Pediatrics 66:31, 1980) the name of one of the authors, Michelle D. Whitehead, BSc, was inadvertently omitted.
Tuberculosis Control
Authors: Farer Laurence S.
Published: December 2021

Two actions of the Public Health Service have been cited by Dr Kendig1 as serving "to minimize the seriousness" of the tuberculosis problem in American children. These are the discouragement of routine tuberculin testing in this country and the change in counting tuberculosis cases which was instituted in 1975.

In correspondence which I have had with Dr Kendig, we have agreed on our mutual commitment to eradication of tuberculosis in children. I do not think he intended to suggest that the Public Health Service is not concerned about tuberculosis in children.
Ectopia Cordis and Chromosome Errors
Authors: King Charles R.
Published: December 2021

Recently, Garson and associates1 suggested that ectopia cordis may be the result of chromosome errors. They reported a mosaic 45,X/46,XX female with ectopia cordis. The following case report supports the contention that chromosome errors may be important in the etiology of this lesion. However, since several of the reported patients have attained childhood and do not exhibit either multiple anomalies or mental retardation, all cases of ectopia cordis are probably not secondary to chromosome errors.
Some Children Have Occasional Obstacles to Learning (SCHOOL)
Authors: Ushkow Martin
Published: December 2021

Parcel et al in their article "A Comparison of Absentee Rates of Elementary Schoolchildren with Asthma and Nonasthmatic Schoolmates" (Pediatrics 64:878, 1979) report that schoolchildren with chronic disease will be absent more than their healthy peers.

School districts provide homebound instruction for students who because of permanent severe defects are unable to attend school and others who are temporarily incapacitated. Since the cost is borne by the district, a waiting period is required to control the number of students receiving homebound instruction.
Letters to the Editor
Authors: Kendig Edwin L
Published: December 2021

I have read Dr Lindenbaum's letter in regard to the article and commentary on tuberculin testing (Kraut JR, Christoffel KK, Berkelhamer JE, et al: Assessment of tuberculin screening in an urban practice. Pediatrics 64:856, 1979; Kendig EL Jr: Tuberculin testing in the pediatric office and clinic. Pediatrics 64:965, 1979).

At a recent press conference, the Center for Disease Control reported that, with the exception of pneumonia, more deaths in the United States result from tuberculosis than any other reportable disease.
Vidarabine Therapy of Neonatal Herpes Simplex Virus Infection
Authors: Whitley Richard J. , Nahmias André J. , Soong Seng-Jaw , Galasso George G. , Fleming Charles L. , Alford Charles A. , Connor James , Bryson Yvonne , Linnemann Calvin
Published: December 2021

Vidarabine (adenine arabinoside) was evaluated for treatment of neonatal herpes simplex virus infection in a randomized controlled study. Of 56 infected newborns, 13 had infection of skin, eye, or mouth only, 16 had localized brain disease (CNS), and 27 had disseminated disease. Both treatment and placebo groups were comparable by disease distribution and for major population characteristics. Because of the severity of CNS and disseminated disease, these groups were combined for mortality assessment. Mortality was significantly reduced in babies with CNS and disseminated disease from 74% to 38% with drug therapy, P = .014. Outcome in babies with disseminated disease alone, although improved, was poor. Death rate was reduced from 85% to 57% with therapy. Only 14% of drug and 8% of placebo recipients were assessed as normal at 1 year of age. Outcome was better with localized CNS disease; mortality was reduced from 50% to 10%. With treatment, 50% of infected newborns were normal and without only 17%. With skin, eye, or mouth infection death did not occur; however, severe sequelae occurred in 38% of placebo and minor sequelae in 25% of drug recipients. No evidence of acute toxicity was identified in this study. Thus, a beneficial effect of vidarabine therapy on neonatal herpes simplex infection is similar to that evident with therapy of herpes simplex encephalitis occurring in older individuals. Nevertheless, improvement in the mode of therapy or the development of more potent antiviral drugs is essential.
Child Abuse Presenting as Chylothorax
Authors: Green Hubert Gordon
Published: December 2021

Child abuse may be seen with a broad array of signs and symptoms.1,2 Some cases are easily recognized, with one or more of the now classic historical and physical features of this condition. Others come to attention only after more subtle findings lead to consideration of the diagnosis. Some cases, unfortunately, escape recognition and are not identified as instances of child abuse, leading to incomplete diagnosis and possibly inappropriate treatment and follow-up.

Our purpose in reporting this case is to alert health professionals to an unusual manifestation of child abuse.

CASE REPORT

The patient, A.R., was an 8-month old girl who had, according to her parents, manifested symptoms of an upper respiratory infection for a week prior to her admission to hospital.
Increased Intracranial Pressure Following Treatment of Cystic Fibrosis
Authors: Roach Ewell Steve , Sinal Sara Hendricks
Published: December 2021

Elevated intracranial pressure in children with cystic fibrosis has been previously attributed to vitamin A deficiency,1,2 which is a well recognized cause of increased intracranial pressure.3 Although there are several reports of suture diastasis after improvement of poor nutritional status,4-6 only one similar patient with a bulging fontanel following treatment of cystic fibrosis could be found in the literature.7

We have recently encountered two patients who developed bulging anterior fontanels soon after beginning treatment for cystic fibrosis. Both patients remained asymptomatic. A lumbar puncture demonstrated elevated intracranial pressure in one patient.

CASE REPORTS

Case 1

A 4½-month-old white male infant was admitted for evaluation of poor weight gain, vomiting, and intermittent diarrhea.
The Pediatrician and Parental Discipline
Authors: Christophersen Edward R.
Published: December 2021

"The Pediatrician and Corporal Punishment"1 makes several points that are both timely and well supported by the literature in psychology and child development. Corporal punishment, at least in the forms available to parents, only temporarily alters behavior. When punishment is repeatedly administered, the effects are minimized or negated. This can lead to a snowball effect where the parent, having found mild spankings to be ineffective, increases the intensity of these spankings by employing such instruments as hair brushes, ping pong paddles, or belts. Frequently, the end result of this accelerating process is total frustration for parents since their attempts at behavior management have failed.
Letters to Editor
Authors: Greydanus Donald B. , McAnarney Elizabeth R.
Published: December 2021

We thank Dr Realini for her interest in our article. We have no argument with her comments. Indeed, the specific or overlapping effects of the estrogens or progestins found in combined birth control pills are controversial. This is especially true for adolescents, since there are no studies investigating these effects in this age group. Many clinicians, however, continue trying to relieve certain symptoms by changing the birth control pill brand, based on the "classic" concepts, as outlined in Table 2 of our article(Pediatrics 65:1, 1980).
Combined Pressure-Radionuclide Evaluation of Suspected Cerebrospinal Fluid Shunt Malfunction: A Seven-Year Clinical Experience
Authors: Hayden Patricia W. , Rudd Thomas G. , Shurtleff David B.
Published: December 2021

A simple, safe radionuclide technique for evaluating the functional status of a cerebrospinal fluid shunt has been used in the clinical management of hydrocephalus in 306 patients over a seven-year period. Results of 526 studies showed greater than 99% sensitivity and accuracy in diagnosing distal shunt obstruction and 96% correct correlation with clinical outcome overall. Intrareservoir pressure measurements are especially valuable to diagnose proximal catheter shunt malfunction and to assess shunt dependency.
Effects of 2% Carbon Dioxide, 0.5% Carbon Dioxide, and 100% Oxygen on Cranial Blood Flow of the Human Neonate
Authors: Rahilly P. M.
Published: December 2021

The effects of breathing 100% O2, 2% CO2, and 0.5% CO2 on the cranial blood flow of the normal human baby were investigated. A mercury in Silastic strain gauge was placed around the occipital head circumference (OFC) of a sleeping infant, and jugular flow was measured using venous occlusion plethysmography. Cranial flow was calculated using formulas derived from an electrical model. In matched sleep states cranial blood flow fell with 100% O2 (mean from eight babies = 32.8%), and rose with 2% CO2 (mean from seven babies = 40.6%). With 0.5% CO2 the flow rose in three babies and did not change in another four. These results indicate the extreme sensitivity of cerebral vasculature to the nature of the ambient gas.
Circulating Prostaglandin E2 Concentrations and Incidence of Patent Ductus Arteriosus in Preterm Infants with Respiratory Distress Syndrome
Authors: Clyman Ronald I. , Brett Claire , Mauray Françoise
Published: December 2021

In several species prostaglandin E2 (PGE2) appears to be the most important prostanoid to regulate patency of the ductus arteriosus. We measured the arterial plasma concentration of PGE2 in 29 premature infants (17 with respiratory distress syndrome alone and 12 with respiratory distress syndrome and patent ductus arteriosus) to determine if there was an association between circulating PGE2 and patent ductus arteriosus. The PGE2 concentrations during the first two days after birth were higher than PGE2 concentrations after the third postnatal day (17.1 ± 3.1 pg/ml, mean ± SEM, n = 23, vs 6.12 ± 0.63 pg/ml, n = 19, P < .005). By the third postnatal day, arterial concentrations were similar to adult venous values. There was no significant difference between the plasma PGE2 concentrations in the 12 infants with patent ductus arteriosus and the concentrations in the 17 infants who had no signs of patent ductus arteriosus. These findings do not support the hypothesis that an increased concentration of circulating PGE2 is the primary cause for the persistent patency of the ductus arteriosus in preterm infants with respiratory distress syndrome.
Arterial Oxygen Desaturation during Sleep in Children with Asthma and Its Relation to Airway Obstruction and Ventilatory Drive
Authors: Smith Thomas F. , Hudgel David W.
Published: December 2021

The possibility that arterial oxygen saturation (Sao2) decreases during sleep in children with chronic bronchial asthma was investigated. The relationship between decreases in sleep Sao2 and airflow obstruction and ventilatory drives, as characterized by ventilatory and inspiratory muscle activity responses to hypoxia and hypercapnia was also examined. Sixteen asthmatics on suboptimal bronchodilator therapy and ten healthy children were studied. Both maximum decrease in Sao2 and number of desaturations (decrease in Sao2 ≥4%) per hour during sleep were greater in the asthmatics than in the control subjects. Both maximum decrease in Sao2 and number of desaturations per hour asleep were correlated with change in FEV1 and FEF25%-75% over the sleep period. Changes in Sao2 were not related to awake measurements of ventilatory drive. Eight of the asthmatics also were studied when on a more optimal medication regimen. On this program they had less airflow obstruction before and after sleep, and the number and extent of decreases in Sao2 were not different from those of the control subjects. We conclude: (1) decreases in Sao2 occurred during sleep in suboptimally treated asthmatic children; (2) Sao2 changes during sleep were related to the amount of airflow obstruction that developed during sleep; (3) Sao2 changes during sleep were not related to ventilatory drive measured during wakefulness; and (4) a good therapeutic regimen eliminated abnormal amounts of sleep hypoxemia by inproving airflow limitation. However, as the results of this study indicate, when their pulmonary status is unstable, asthmatic children may develop clinically significant hypoxemia during sleep.
Fatal Echovirus 11 Disease in Premature Neonates
Authors: Modlin John F.
Published: December 2021

Four cases of fatal echovirus 11 disease occurred in premature infants during a community outbreak of enteroviral disease in Massachusetts in 1979. Each infant developed nonspecific symptoms and jaundice at 4 to 6 days of age, and subsequent progressive hepatic failure and generalized bleeding. Only one infant survived longer than six days. Virus was recovered from multiple sites premortem, and from virtually all tissue cultured at autopsy. Myocarditis was not present clinically or pathologically. Clinical and laboratory evidence implicated perinatal transmission of virus from mother to infant. Three mothers experienced a febrile illness with abdominal pain within the last five days of pregnancy. In two, the illness led to a false diagnosis of abruptio placenta and interruption of pregnancy by cesarian section. Review of case reports of this syndrome caused by other echovirus serotypes revealed that many had similar perinatal events. Each mother ultimately developed neutralizing antibody to echovirus 11. However, all four infants were born without passively acquired antibody, probably because they were delivered prior to the appearance of specific maternal IgG. Although laboratory studies by others have shown other factors may be responsible for the ability of enterovirus to cause overwhelming disease in neonates, uncontrolled data from these four infants and their mothers suggest that timing of maternal illness in relation to delivery of the infant may also be important.
Preventing Mental Retardation Associated with Gross Obesity in the Prader-Willi Syndrome
Authors: Crnic Keith A. , Sulzbacher Stephen , Snow Jeff , Holm Vanja A.
Published: December 2021

Twenty-seven patients with Prader-Willi syndrome have been described, ten of whom did not receive comprehensive management, nine who were diagnosed and treated after becoming obese, and eight who were diagnosed in infancy and responded to early preventative treatment. Intelligence scores declined in the first two groups, but the group receiving early treatment maintained a mean IQ score 20 points higher than the other two. Even though the underlying mechanism of this disorder remains undefined, a comprehensive early intervention program appears to improve prognosis.
Mucocutaneous Lymph Node Syndrome and Hydropic Gallbladders
Authors: Krensky Alan M.
Published: December 2021

The article by Slovis et al (Pediatrics 65:789, 1980) reports four patients with hydrops of the gallbladder and mucocutaneous lymph node syndrome (MCLNS). Two of the patients, however, have evidence of coincident streptococcal infection, and hence, do not fulfill the criteria for MCLNS. Patients 1 and 4 both have elevated antistreptolysin O and patient 1 has supportive elevation of anti-DNAase B. Since MCLNS is a diagnosis of exclusion and the most important etiology easily excluded is streptococcal disease, the inclusion of these two cases in a review of MCLNS is an oversight.
Chronic Bronchitis in Childhood: What Is It?
Authors: Taussig Lynn M. , Smith Sandra M. , Blumenfeld Ronald
Published: December 2021

According to national statistics, over 2.5 million children have chronic bronchitis (CB). The characteristics of childhood CB and the similarities to the adult form are unknown. To determine the conditions under which childhood CB is diagnosed and to evaluate how it is treated, questionnaires were sent to 103 pediatricians and family physicians in Tucson. Forty-five percent responded. A chronic productive cough lasting at least three months a year was important for the diagnosis of CB for only 55% of pediatricians and 74% of family physicians. Recurrent episodes of cough lasting more than two weeks were important for the diagnosis of CB for 86% pediatricians. Sputum production was important for the diagnosis for about 50% of physicians, whereas wheezing was considered an important diagnostic criterion for nearly 60% of physicians. Most physicians felt that allergies were a common cause of childhood CB and bronchodilators were commonly used to treat CB. The results of this survey suggest that: (1) the diagnosis of CB in childhood is not often based on the usual epidemiologic criteria used for diagnosing CB in adults; and (2) CB in childhood may have considerable overlap with asthma with respect to etiology, pathophysiology, and treatment. In fact, for many children, there appear to be few ways to distinguish asthma from CB.
Faith, Doubt, and Statistics
Authors: Day Richard L.
Published: December 2021

Dr Grover Powers's reputation as a clinician, teacher, and sympathetic doctor is worldwide. I do not need to waste words in telling you how appreciative I am of the honor of being invited to stand here.

A more accurate title for this talk might have been simply "Statistics," but that would have led members of any potential audience to find more urgent duties elsewhere, especially those who, like me, know that I am not a statistician. I do, however, respect both faith and doubt, the latter sometimes being elevated to hypothesis, and concerning which we can gather evidence and which our statistician friends can quantify, if we abide by certain ground rules in the accumulation of information. Uncertainty can be quantified but never eliminated. It can be given a comforting value, such as P < .01. My talk is intended to show how necessary it is for us to give the statistician data of high quality, and why we often fail to do so.

The ancient method of making progress has been by observing events and comparing the results with previous experience–in medicine, with "my clinical experience." In Latin, the technique is described by the phrase "post hoc, ergo propter hoc." In the stone age, it led to the pressure flaking of razor-sharp knives from flint and obsidian. Later, our ancestors discovered agriculture, cheese-making, brewing, and the fermenting of grapes; the smelting of tin, copper, bronze, and iron; carbon steel; the recognition of all poisonous plants and animals; and tea, coffee, tobacco, hashish, opium, cocaine, quinine, oil of wintergreen, digitalis, mercury, cascara, curare, castor oil, and the Model T Ford.
Metabolic Abnormalities in the Idiopathic Fanconi Syndrome: Studies of Carbohydrate Metabolism in Two Patients
Authors: Chesney Russell W. , Kaplan Bernard S. , Teitel David , Colle Eleanor , McInnes Roderick R. , Goldman Hy , Scriver Charles R.
Published: December 2021

Two patients with idiopathic Fanconi syndrome and glucose intolerance were studied from a metabolic perspective. They had fasting hyperglycemia, massive glucosuria, insulinopenia, ketosis, and elevated serum free fatty acids. There was a markedly blunted insulin secretory response to glucagon, tolbutamide, glucose, and arginine. One patient had the findings of diabetic retinopathy and a sensory neuropathy. Neither patient could convert galactose to glucose, but they did not have galactosemia. As a result of these studies, and previous reports in which similar changes were noted, we conclude that diabetes mellitus may occur in patients who have had idiopathic Fanconi syndrome for many years.
Prenatal and Postnatal Diagnosis and Carrier Detection of Fanconi Anemia by a Cytogenetic Method
Authors: Auerbach Arleen D. , Adler Barbara , Chaganti R.S.K.
Published: December 2021

Fanconi anemia (FA) is characterized by pancytopenia, spontaneous chromosome instability, and a variety of congenital anomalies. Variable phenotype and age of onset of anemia make accurate diagnosis difficult in some patients. We report a cytogenetic method for rapid diagnosis of FA homozygous blood lymphocytes and amniotic fluid cells, and FA heterozygous blood lymphocytes. When treated with 0.1 µg/ml of diepoxybutane, affected lymphocytes responded with approximately a 175-fold increase in chromosome breakage compared with that exhibited by similarly treated lymphocytes from normal individuals or patients who manifest some clinical features of FA. The breakage in affected lymphocytes was characterized by multiple complex chromatid exchanges. Amniotic fluid cells from four fetuses at risk for FA were studied. Three of these were diagnosed as affected and the fourth as normal on the basis of spontaneous and diepoxybutane-induced chromosome breakage. Lymphocytes from FA heterozygotes showed a fourfold increase in chromosome breakage characterized by chromatid exchange when compared with control lymphocytes. Prenatal and postnatal diagnosis of FA and detection of carriers can therefore be performed with ease by making use of the method described here.
Letters to the Editor
Authors: Clarke Thomas A. , Merritt T. Allen
Published: December 2021

As Dr Sweet states "knowledge of the etiology and pathogenesis of retrolental fibroplasia (RLF) is far from complete." While recent studies have shown that prolonged oxygen therapy with the associated difficulties in monitoring Pao2 may be more important than short-term hyperoxia in placing an infant at risk of developing RLF, the conclusion of authors of the cooperative study1 quoted by Dr Sweet was that the occurrence of RLF was unrelated to Pao2, "as determined by the limited information available from intermittent sampling" and that conservative administration of oxygen may have been responsible for failure to demonstrate quantitative association between Pao2 levels and disease.
Developmental Output Failure: A Study of Low Productivity in School-Aged Children
Authors: Levine Melvin D. , Oberklaid Frank , Meltzer Lynn
Published: December 2021

Children with low academic productivity in late elementary and junior high school present a vexing problem to parents and schools. A subgroup of these youngsters may have underlying subtle handicaps that result in reduced productivity and chronic underachievement. Such children may be clinically characterized as exhibiting "developmental output failure." Using parent and teacher questionnaires, educational achievement tests, and pediatric neurodevelopmental assessments, a group of 26 children was selected according to predetermined criteria from among the clinic population seen in The School Function Program at The Children's Hospital Medical Center. Common findings among the group included problems with expressive language, fine motor tasks, finger agnosia, attention, and retrieval memory. It is suggested that clinicians be aware of the possibility that a child in this age group with low academic work output may have underlying developmental dysfunctions, whose manifestations may not have been evident earlier in life.
Depressed T Cells Following Neonatal Steroid Treatment
Authors: Gunn Tania , Reece Elena R. , Metrakos Katherine , Colle Eleanor
Published: December 2021

Forty-four patients received two doses of 12.5 mg/kg of hydrocortisone or placebo on the first day of life in attempted therapy for respiratory distress syndrome. Follow-up studies were performed on survivors at 5 years of age in ten steroid-treated and seven placebo-treated respiratory distress syndrome subjects. There were no significant differences in growth, intelligence tests, or neurologic examinations in the patients assessed. Abnormal EEGs are present in both groups. Immunologic tests showed no differences in lymphocyte counts, immunoglobulin levels, diphtheria and tetanus antibody titers, or complement components. Diminished percentages of T lymphocytes were found in steroid patients (53%) compared to control subjects (69%). There were also increased percentages of lymphocytes with C3 receptors in steroid patients (20.1%) compared to control patients (13.8%). Episodes of otitis and/or pneumonia were documented in eight of 11 steroid-treated patients between the ages of 1 and 5 years, compared to two of seven patients in the placebo group in the same time period. It is concluded that large doses of steroids on the first day of life may induce lasting immunologic abnormalities and may predispose to an increased incidence of infections.
Essential Fatty Acid Status in Premature Newborns Fed by Nasoduodenal Technique
Authors: Minoli Iolanda , Coppalini Bernardo , Galli Claudio , Moro Guido
Published: December 2021

The fatty acid composition of plasma phospholipids and the triene (20:3, n=9) to tetraene (20:4, n=6) ratio in the same lipid fraction have been determined, as indices of the essential fatty acid status, in a group of 22 healthy premature newborns fed by the nasoduodenal technique. Determinations have been carried out on the first and fifth day of life for all 22 newborns, and also on the tenth and 30th day of life for 12 of them. The normal plasma levels of essential fatty acids obtained indicate a satisfactory utilization of dietary essential fatty acids under these unusual nutritional conditions.
Glucose vs Sucrose in Oral Rehydration Solutions for Infants and Young Children with Rotavirus-Associated Diarrhea
Authors: Black Robert E. , Merson Michael H. , Taylor Philip R. , Yolken Robert H. , Yunus Md. , Alim A.R.M.A , Sack David A.
Published: December 2021

The use of oral rehydration solutions containing essential electrolytes and either glucose or sucrose of equal osmolality was compared in a double-blind sequential trial of 784 children with rotavirus-associated diarrhea treated at a center in rural Bangladesh. The oral fluid failure rate was 11.5% for the sucrose-containing solution group and 7.3% for the glucose-containing group (P = NS). Vomiting was a significantly more common cause of failure for the group treated with sucrose-containing oral rehydration solution and was associated with an increased rate of intake of the sweeter sucrose-containing solution. The purging rate was not different for the two groups. The oral fluid failure rates for children in the most underweight category (<60% of expected weight for age) were not different from those for other groups, although, as assessed by purging rate and initial dehydration, the stool losses of members of this group constituted a greater proportion of their body weight. Glucose is the preferred carbohydrate for oral electrolyte solutions, although sucrose can be substituted with only minimum loss of efficacy.
Immunity to Diphtheria, Pertussis, Tetanus, and Poliomyelitis in Children with Acute Lymphocytic Leukemia After Cessation of Chemotherapy
Authors: van der Does-van den Berg A. , Hermans J. , Nagel J. , van Steenis G.
Published: December 2021

Antibody titers to diphtheria, pertussis, tetanus, and poliomyelitis (types I to III) were measured in previously vaccinated children with acute lymphocytic leukemia in remission after cessation of therapy. The response to revaccination one year after therapy was stopped was also studied. The patients' antibody titers were compared with those of healthy children, matched for age and sex. Two groups of patients were studied: one group (group A, N = 30) was given two drugs (6-mercaptopurine, methotrexate); the other group (group B, N= 19) was given three drugs (6-mercaptopurine, methotrexate, and cyclophosphamide) for maintenance treatment. In general, the patients' antibody titers were lower than those of healthy children, but in most patients they were still at levels considered to be protective. No significant differences in antibody levels between the two patient groups were found. A spontaneous rise in antibody titers in the first year after termination of therapy was not observed. After revaccination the rise in antibody titers was correlated with preexisting antibody titers in the same way in patients as in healthy children, and the antibody titers in patients and in healthy control subjects were on roughly the same level.
Effect of Prior Antibiotics on the Susceptibility of Haemophilus influenzae Type b to Ampicillin
Authors: Kaplan Sheldon L. , Mason Edward O. , Kvernland Sally J.
Published: December 2021

Ampicillin-resistant strains of Haemophilus influenzae type b are responsible for a substantial number of cases of invasive disease caused by this organism in infants and children.1 Syriopoulou et al2 have observed that ampicillin-resistant isolates of H influenzae (type b or non-b) occur more frequently in ill children who have received prior β- lactam antibiotics. However, Lerman et al3 found that recent antibiotic therapy did not influence the susceptibility to ampicillin of H influenzae (type b or non-b) recovered from the nasopharynx of healthy children. Inasmuch as the prevalence of ampicillin-resistant H influenzae type has been increasing steadily at Texas Children's Hospital since 1974, we initiated a prospective study of the influence of prior antibiotics on ampicillin susceptibility of H influenzae type b from children with invasive disease.
Retrolental Fibroplasia: A Modern Parable by William A. Silverman
Authors: L. J. F.
Published: December 2021

This 585-gm book had a gestational period of 30 years. It has been worth the wait. It is a remarkable book. It's clearly written, exciting, informative, and fascinating. It's also provocative and scary.

Retrolental fibroplasia has been the subject of hundreds of scientific articles over the past 35 years, but the full story of that awful iatrogenic epidemic has never been told. This is it. Silverman is a master storyteller. He was a researcher and practitioner in the midst of the epidemic and involved in the events and decisions.
Advances in the Diagnosis and Treatment of Stinging Insect Allergy
Authors: Yunginger John W.
Published: December 2021

Allergic reactions to insect stings occur in approximately 0.4% of the general population.1,2 Severe anaphylactic reactions may occur in sensitive patients, and estimates suggest that 40 persons die during such reactions each year in the United States.3 From the standpoint of allergy the Hymenoptera order of insects is the most important; this order includes the bees (honeybees and bumblebees), vespids (wasps, yellow jackets, and hornets), and fire ants.

CLASSIFICATION OF STING REACTIONS

Insect sting reactions may be grouped into immediate (within two hours) or delayed (more than two hours) categories. Immediate reactions can be subdivided into local, large local, or systemic reactions, depending on the severity and extent of the reaction. Local reactions are normal reactions—a sting will cause transient pain, redness, and swelling at the sting site. In large local reactions the reaction is much more extensive, although all signs and/or symptoms produced are contiguous with the sting site. For example, a sting on the finger may produce swelling of the entire forearm or extremity. In a systemic reaction signs and/or symptoms occur at sites remote from the sting site. For example, a sting on the finger may produce angioedema of the eyelids or generalized urticaria. Toxic reactions are nonimmunologic reactions produced when an individual is stung by multiple insects within a short period of time; signs and symptoms are those of a systemic allergic reaction, but are due to the physiologic effects of vasoactive materials in the venom. Systemic allergic reactions are immunologic reactions produced by vasoactive materials released from the blood basophils or tissue mast cells as a result of interaction between venom components and specific IgE antibodies fixed to the basophils or mast cells.
Streptococcal Submandibular Cellulitis in Young Infants
Authors: Patamasucon Pisespong , Siegel Jane D. , McCracken George H.
Published: December 2021

Six infants with streptococcal submandibular cellulitis and bacteremia were managed in our institution during a seven-month period. Five uncomplicated cases were caused by group B β-hemolytic Streptococcus, and one rapidly progressive case of Ludwig's angina was caused by group A Streptococcus. Recognition of this characteristic clinical presentation of group B streptococcal infection may be beneficial in the management of such patients.
Persistent Pharyngeal Colonization with Haemophilus influenzae Type b After Intravenous Chloramphenicol Therapy
Authors: Shapiro Eugene D.
Published: December 2021

A recent prospective study has demonstrated that age-susceptible household contacts of children with Haemophilus influenzae type b (HIB) meningitis are at significantly increased risk of developing systemic HIB disease.1 Studies of meningococcal disease have suggested that chemoprophylaxis of close contacts of the index case may decrease this risk by reducing transmission from carriers to noncarriers.2 Chemoprophylaxis of household and day care contacts of children with HIB meningitis has been recommended.3 Three children treated with intravenous chloramphenicol for ampicillin-resistant HIB meningitis were found to harbor HIB in the pharynx prior to hospital discharge. These patients represent a potential source for the reintroduction of HIB into the household.
Letters to the Editor
Authors: Schulman Joseph
Published: December 2021

Salt depletion was considered in the infants that were presented and was part of the basis for performing a sweat test on patient 2 when his electrolytes had normalized. Both of the infants were cared for during the month of February in upstate New York. Our evaluation of the home environments did not raise suspicions of the possibility of excessive sweating.

Dr Silber emphasizes an interesting consideration in the differential diagnosis of water intoxication. I appreciate his effort to broaden the message of my original communication.
Kilopascals
Authors: Viles Peter H.
Published: December 2021

I share Dr VanGelder's concern about the abandonment of the millimeter of mercury (Pediatrics 66:325, 1980).

I believe the definition of 1 torr is the pressure exerted by 1 mm Hg under the influence of the earth's gravity. Therefore, my blood pressure of 120/70 mm Hg in my office is also 120/70 torr. In the unlikely event that I should be doing a consultation on the surface of the moon (one fifth the earth's gravity) my blood pressure would remain 120/70 torr but would be 600/350 mm Hg.
Letters to the Editor
Authors: Shaywitz Bennett A.
Published: December 2021

Drs Porayko and Baptist are quite correct in indicating that the dose of mannitol should be in grams rather than in milligrams. My apologies for this oversight in proofreading the manuscript.
Thrombogenicity of Tips of Umbilical Catheters
Authors: Hecker John F.
Published: December 2021

In an experiment in which several types of umbilical artery catheters were inserted into the aortas of newborn lambs, several catheters had discrete thrombi located at the tip. There appeared to be a difference between types of catheters in the proportion with thrombi at the tip. Scanning electron micrographs of catheter tips showed that several types had rough tips. It is suggested that a rough tip would promote the formation of thrombus at a location where it could be dislodged by flushing of the catheter. The problems that have been reported with umbilical artery catheters may have been caused by thrombus at the tip rather than on the shaft of these catheters.
Effects of Alterations of Inspiratory and Expiratory Pressures and lnspiratory/Expiratory Ratios on Mean Airway Pressure, Blood Gases, and Intracranial Pressure
Authors: Stewart A. R. , Finer N. N. , Peters K. L.
Published: December 2021

Twenty neonates requiring mechanical ventilation for respiratory failure, including 13 with hyaline membrane disease, were studied to assess the effects of alterations in ventilator settings on mean airway pressure (MAP), blood gases, and intracranial pressure (ICP). The study involved random alterations in peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and inspiratory/expiratory ratio while MAP, Pao2, ICP, and end-tidal Pco2 were continuously monitored. The results showed a significant relationship between MAP and Pao2 that was expressed as the change in Pao2 per millimeter of mercury change in MAP (ΔPa02/ΔMAP) with a mean ΔPao2/ΔMAP of 4.92. The ΔPao2/ΔMAP was highest for changes in PEEP (6.08), followed by PIP (5.07), and inspiratory/expiratory ratio (1.9). There was a significant relationship between alterations in PEEP and PIP vs Paco2 and pH. Increases in PEEP and decreases in PIP resulted in an elevated Paco2 and a lowered pH, and decreases in PEEP and increases in PIP resulted in a decreased Paco2 and an elevated pH. There was no significant relationship between MAP and ICP, but there was a significant association between ΔICP and ΔPaco2 during alterations in PIP (r = .64, P <.001). Increases in PEEP will lead to the greatest increase in Pao2 per change in MAP, followed by increases in PIP and inspiratory /expiratory ratio using a pressure-limited ventilator.
Acquired Eventration of the Diaphragm: A Complication of Chest Tube Placement in Neonatal Pneumothorax
Authors: Marinelli Philip V. , Ortiz Amil , Alden Errol R.
Published: December 2021

Air leaks are frequently encountered in newborns with respiratory distress syndrome who require assisted ventilation.1 Tension pneumothorax is a lifethreatening emergency that requires prompt drainage of the pleural space with a chest tube. Hemorrhage,2 lung perforation, 34 and infarction,5 are reported complications of closed tube thoracostomy. Recently, Ayalon et al6 have reported an unusual complication: phrenic nerve injury with diaphragmatic eventration. This communication also describes an infant with acquired eventration of the diaphragm following chest tube insertion.

CASE REPORT

D. L., a 1,480-gm male infant of a 30-week gestational pregnancy developed respiratory distress that required 40% oxygen. Chest radiographs revealed diffuse bilateral reticulogranular pattern and air bronchograms.
Relactation by Mothers of Sick and Premature Infants
Authors: Bose Carl L. , D'Ercole A. Joseph , Lester Agnes G. , Hunter Rosemary S. , Barrett Janet R.
Published: December 2021

Relactation, the induction of lactation at any time beyond the immediate postpartum period, has received minimal scientific investigation. In this study, one adoptive mother and six mothers ten to 150 days postpartum, who for a variety of reasons did not initiate or maintain lactation after delivery, attempted relactation. Each suckled her infant at regular feeding intervals. Prior to milk production, formula was provided during suckling through an artificial device. Serum prolactin responses to thyrotropin-releasing hormone infusion and to suckling were measured at the start of the study and to suckling at approximately weekly intervals thereafter. All mothers produced milk; three completely nourished their infants and two others provided at least half of their infants' nutritional needs. The adoptive mother and one other failed to provide significant quantities of milk. Mothers reached their maximum potential for milk production in varying periods of time (eight to 58 days). Shorter postpartum interval and less postpartum breast involution correlated with the likelihood of successful relactation and the rapidity of the onset of lactation. Basal prolactin levels and stimulation tests were of no additional predictive value. Each mother, regardless of milk production, expressed positive feelings about nurturing her infant in this manner. We conclude that relactation frequently is possible and may offer the mother of a sick or premature infant who desires to breast-feed an alternative if she does not maintain lactation in the immediate postpartum period.
Idiopathic Thrombocytopenic Purpura and Intracranial Hemorrhage
Authors: Krivit William , Tate Douglas , White James G. , Robison Leslie L.
Published: December 2021

In this issue of Pediatrics (p 453) Drs Woerner, Abildgaard, and French present three new cases of intracranial hemorrhage in children with idiopathic thrombocytopenic purpura (ITP) and review the data of 15 previously reported cases. The authors discuss the care and management of this most severe complication of an otherwise mainly benign disorder and emphasize that, although it occurs most commonly in the early days after diagnosis, intracranial hemorrhage can occur in patients with ITP at nearly any time after onset. Their review and personal experience indicate that, even if CNS symptoms are already present, the alert physician with the present armamentarium of computed tomography (CT) scan, platelet transfusion, and splenectomy should be able to prevent permanent Sequelae in the majority of patients treated in an effective manner.
Letters to the Editor
Authors: Paradise Jack L.
Published: December 2021

As my review article stated, reported studies supporting the efficacy of antimicrobial prophylaxis for otitis media have involved only sulfonamides or ampicillin. As stated further, all those studies were restricted in scope and left important questions unanswered.

My review suggested that, pending the outcome of further studies, penicillin G might constitute a preferable alternative to either sulfonamides or ampicillin on grounds of (1) safety and (2) efficacy against most strains of Haemophilus influenzae. Other grounds not stated were (3) the very low cost of penicillin G and (4) concern about using a broad-spectrum antibiotic such as ampicillin for long-term prophylaxis.
Transcutaneous Measurement of Carbon Dioxide Tension: Effect of Sleep State in Term Infants
Authors: Martin Richard J. , Herrell Nancy , Pultusker Mark
Published: December 2021

Transcutaneous measurement of carbon dioxide tension (tcPco2) was used to assess the effect of sleep state on arterial carbon dioxide tension (Paco2) in infants. Initially, tcPco2, was correlated with Paco2 in 50 sick preterm and term neonates with indwelling arterial lines. At a skin electrode temperature of 42 C, the correlation coefficient between tcPco2 and Paco2 was .95. In eight healthy term infants there was a small but significant decrease in tcPco2, of 2 ± 1 mm Hg (P < .001) during active as compared to quiet sleep. This decrease in tcPco2 was accompanied by a significant decrease in transcutaneous oxygen tension (tcPo2) of 5 ± 4 mm Hg (P < .02) as has been previously described. The simultaneous decrease of both tcPco2 and tcPo2 appears to indicate ventilation/perfusion inequalities in these infants during active sleep. These findings illustrate that tcPco2 can accurately predict Paco2 in infants and that this is a useful technique for studying neonatal respiratory control during various stages of sleep.
L'HÔPITAL DES ENFANTS-MALADES, THE WORLD'S FIRST CHILDREN'S HOSPITAL, FOUNDED IN PARIS IN 1802
Authors: C. T. E.
Published: December 2021

The Hôpital des Enfants-Malades founded in 1802 on the Rue de Sévres in Paris was the first hospital especially established for the treatment of sick children.

The building that was to become the first children's hospital was not a new one. It was originally known as the Maison Royale de l'Enfant-Jésus founded in 1722 by Abbé Languet de Gregy as a work shelter for 100 poor Parisian women. These women were employed in the spinning of flax and cotton, an effort that soon became a financially profitable venture.

During the French Revolution the Maison Royale de l'Enfant-Jésus was taken over by the civil authorities to be used for the storage of coal and as a garage for carriages. Soon afterward, in July 1795, the building was refurbished by a decree of the Revolutionary Public Health Commission to serve as a central orphan asylum (Maison Nationale des Orphelins) for 436 children and was so used until April 29, 1802. On that date, by a decree of the Conseil Général des Hôpitaux, the orphans were to be moved to another institution in Paris and the building was then to become the Hôpital des Enfants-Malades to be used exclusively for the care of sick children of both sexes under 15 years of age. The number of beds was fixed at 300; there were 59 staff members including two clinicians and one surgeon.1

Over the years since 1802 many new buildings have been added but part of the original building remains today.

Many famous French physicians have worked at the Hôpital des Enfants-Malades including Armand Trousseau, Henri Roget, Anatole Chauffard, Bernard Marfan, and Paul Broca.2
Esophageal Muscular Ring and the VACTERL Association: A Case Report
Authors: Heyman Melvin B. , Berquist William E. , Fonkalsrud Eric W. , Lewin Klaus J. , Ament Marvin E.
Published: December 2021

A 2-year-old girl with persistent vomiting of solid foods was evaluated; the diagnosis was esophageal muscular ring. This rare congenital anomaly and its diferentiation from esophageal stricture are discussed. This case represents a variation of the esophageal malformation associated with the VACTERL association.
Patterns of Illness in the Highly Febrile Young Child: Epidemiologic, Clinical, and Laboratory Correlates
Authors: Wright Peter F. , Thompson Juliette , Mckee Kelly T. , Vaughn William K. , Sell Sarah H. W. , Karzon David T.
Published: December 2021

Three hundred one episodes of fever ≥103 F were documented in 375 infants and young children observed in a comprehensive care clinic during the period October 1974 to October 1978. Of such highly febrile illnesses 79% were accompanied by respiratory tract signs or symptoms, 7% by disease at a site other than the respiratory tract, and 22% of illnesses had no localizing signs or symptoms. Viral cultures were obtained from the respiratory tract in 178 cases and were positive in 68:57/ 134 from respiratory illness; 2/4 from illness at sites other than the respiratory tract; and 9/40 in children without localizing disease. Bacterial cultures of the upper respiratory tract were obtained in 191 illnesses, but the overall rate of isolation of Haemophilus influenzae, Streptococcus pneumoniae and group A streptococci (46%) did not differ from that in a group of well children (39%). Bacterial cultures of the blood were obtained in 89 patients with fever ≥103 F and in an additional 41 children with lower temperatures. Nine children had documented systemic bacterial disease (eight positive blood cultures and one positive CSF). The rate of clinically apparent systemic bacterial disease in these otherwise normal infants was one bacteremic episode per 94 years of child care.