bluuebunny/crossref_metadata_2025 huggingface dataset:
IQ Measurement in Children With Skeletal Dysplasia
Authors: Rogers John G. , Perry Mary A. , Rosenberg Leon A.
Published: December 2021

We have reviewed the IQ studies on 68 children with skeletal dysplasia. These data should provide useful information for the counseling of parents with newborn affected children. Previous studies have documented retardation and hydrocephalus in association with achondroplasia. Some parents report that they were given a poor prognosis for their child's mental development early in his or her life. This study shows that the 34 children with achondroplasia and 34 with other skeletal dysplasia performed intellectually in the same range as other children.
The Role of the Pediatrician in the Delivery of Mental Health Services to Children
Authors: Goldberg Irving D. , Regier Darrel A. , Mclnerny Thomas K. , Pless Ivan B. , Roghmann Klaus J.
Published: December 2021

Nine pediatricians reported on all patients seen during a four-week period in January and February 1976 in Monroe County, N.Y., to determine the prevalence and nature of mental health problems seen in their practices, the characteristics of the affected children, and the treatment provided to them. Of the 3,742 patients seen, 187, or 5.0%, were reported to have an emotional, behavioral, or school problem. The prevalence rate ranged from 1.4% to 7.8% by pediatrician, with five reporting rates within ± 1.2% of the mean. High rates were associated with children in the 7 to 14 year age group (9.9%), those on Medicaid (8.6%), those who were not living with a father (10.9%), those whose presenting complaint was a chronic physical condition (11.7%), and children with a disease of the digestive system (16.7%) or with "symptoms, signs and ill-defined conditions" (14.3%). Functional impairment was reported to be moderate or severe in 40% of the 187 children with mental health problems. The most frequently reported problems (primary or otherwise) were adaptation reaction (22.5%), specific learning disorder (19.3%), hyperkinetic disorder (19.3%), psychosomatic disorder (12.8%), and conduct disorder (12.8%). The most frequent form of treatment provided was supportive therapy or counseling (85.6%) and suggestions regarding environmental changes (43.3%). Drugs were prescribed for 16.0% of the affected children, with 6.4% receiving methylphenidate or amphephetamines. Referral for psychological care or consultation was made for 36.9%. The frequency of mental health problems observed by the pediatricians was about five times the annual rate of Monroe County children contacting a psychiatric inpatient or outpatient setting.
The Microbiology of Serous and Mucoid Otitis Media
Authors: Giebink G. Scott , Mills Elaine L. , Huff John S. , Edelman Charlene K. , Weber Marcia L. , Juhn S. K. , Quie Paul G.
Published: December 2021

One hundred forty-four serous and mucoid effusions were cultured for aerobic and anaerobic bacteria, Mycoplasma pneumoniae, and virus. Thirty percent of all effusions yielded an unequivocally positive culture for aerobic bacteria. Although serous effusions were culture positive as often as mucoid effusions, Haemophilus influenzae was isolated predominantly from serous effusions and Staphylococcus epidermidis predominantly from mucoid samples. Only one of 73 effusions yielded a viral isolate (Herpesvirus honiinis). None of 33 effusions yielded M pneumoniae, and only one of 17 effusions yielded an anaerobe (Propionibacterium). These findings suggest that aerobic bacteria may play a role in the pathogensis of serous and mucoid otitis media.
Hazards of Inadvertent Umbilical Venous Catheterization in a Patient With Anomalous Pulmonary Venous Drainage: A Case Report
Authors: Nickerson Bruce G. , Sahn David J. , Goldberg Stanley J. , Allen Hugh D.
Published: December 2021

Obstructed anomalous pulmonary venous return may masquerade clinically as persistent fetal circulation in newborns. Even after cardiac eterization has been performed, a similar conclusion could be reached if pulmonary blood flow is low in volume and pulmonary venous return is significantly delayed. To make the diagnosis by demonstrating the confluence of pulmonary veins by direct catheterization from the venous side may be difficult and can lead potentially to sudden deterioration by increasing the obstruction to venous return. We encountered these pitfalls in making the diagnosis of obstructed pulmonary venous return in a recent patient, which prompted this case report.

CASE REPORT
Hypernatremic Dehydration Resulting From Inadequate Breast-Feeding
Authors: Clarke Thomas A. , Markarian Marguetrite , Griswold William , Mendoza Stanley
Published: December 2021

Scientific evidence accumulated over the years confirms that breast milk has many advantages over formula feeding.1.2 The difficulty of monitoring an infant's intake from breast-feeding may occasionally lead to problems in the rare baby in whom inadequate intake of food and fluids is not apparent. In the present case, a 2-week-old infant developed severe hypernatremic dehydration. Hypernatremia has not been reported previously in a totally breast-fed infant.

CASE REPORT

A 3,860-gm white female infant was born to a 28-year-old primigravida mother at 40 weeks' gestation after an uncomplicated prenatal course. The amniotic fluid was meconium stained, and cardiac decelerations were noted during oxytocm induction.
Splenectomy and Sepsis: A Warning
Authors: Dickerman Joseph D.
Published: December 2021

The risk of bacterial sepsis directly related to splenectomy performed at any age and for any reason has been clearly defined in the recent literature, yet some physicians remain either unaware or unconvinced of this fact. Even if the sepsis is diagnosed promptly and is appropriately treated, 50% to 75% of patients who develop this illness die. There are approximately 50,000 people in the United States who are functionally asplenic because they have sickle-cell disease. In addition, according to the 1977 Hospital Discharge Survey of the National Center for Health Statistics (unpublished data), about 35,000 individuals undergo splenectomy each year for a variety of reasons, including splenic trauma, idiopathic thrombocytopenic purpura, hereditary spherocytosis, staging laparotomy, and renal transplantation.
Taking the Task Force to Task
Authors: Harper Rita G.
Published: December 2021

The "Task Force" now considers neonatal intensive care a subspecialty and recommends that the time allotted the house officer in the NICU is not to exceed six months over a three-year period, the rationale being that some institutions require extensive time in intensive care and therefore deprive the house officer of primary care experience. I concur that excess time is undesirable. Nevertheless, limiting the quantity of time in the NICU limits the education of future pediatricians with critical and recovering infants, legally forcing them to admit that others are more educated to care for critically ill infants.
Trauma-Associated Periorbital Cellulitis Due to Haemophilus influenzae
Authors: Hill Jeffrey , Paisley John W.
Published: December 2021

Although the role of H influenzae type b in childhood periorbital cellulitis is well recognized, cases associated with superficial trauma are usually due to Gram-positive cocci.1-3 A recent review suggested that appropriate antibiotic treatment of such cases might be limited to a penicillinase-resistant pencillin.3 The following case emphasizes the potential danger of this therapeutic approach.

A 20-month-old boy was entirely well until 24 hours prior to admission when he fell and sustained a superficial laceration on his right upper eyelid.
Letters to the Editor
Authors: Etkin Thomas , O'Shea John S.
Published: December 2021

Although we are unable to defend the statistical analysis offered in our paper (Pediatrics 62:844, 1978) concerning the incidence of systemic hypertension in the parents and/or siblings of our two groups of patients, we do not share Dr. Tunnessen’s concerns concerning the effects of race and socioeconomic status on pediatric blood pressures.

We have been impressed with the relative lack of influence of race on pediatric blood pressure, especially in children less than age 14, sharing the beliefs of Londe and co-workers (J Pediatr 90:93, 1977) that "impressive racial differences in blood pressure do not appear in children 3 to 14 years of age," although mindful of the findings of Miller and Shekelle (Circulation 54:993, 1976) that 15- and 16-year-old blacks have somewhat higher mean diastolic (but not systolic) pressures than whites.
Nasal Septal Trauma in Children
Authors: Olsen Kerry D. , Carpenter Robert J. , Kern Eugene B.
Published: December 2021

If the septal component of a nasal injury is adequately managed, usually the entire nasal injury will be well managed. Major or minor nasal trauma can cause cartilage fracture, deviation, dislocation, hematoma, or abscess formation, and the various associated sequelae, some of them life-threatening. A negative x-ray report should never be used as a substitute for a complete intranasal examination in any child with nasal trauma. Any nasal abnormality should be referred for immediate evaluation and treatment.
Posterior Fossa Hemorrhage in the Term Newborn: Report of Two Cases
Authors: Ravenel Samuel DuBose
Published: December 2021

Two term newborn infants born by frank breech delivery had posterior fossa hemorrhage diagnosed by CT scan within the first 72 hours of life and underwent successful surgical drainage of hematoma. Previously reported cases with long-term postoperative survival have included 12 term newborns with good out-come in nine. Most remaining reported examples of postenor fossa hemorrhage in newborns have been from autopsy reports on premature infants. It is suggested that operative intervention is often indicated in cases of early neonatal posterior fossa hemorrhage and that additional data on long-term outcome of operative intervention as well as outcome in nonoperated cases are needed. One of the two cases reported here and one previously reported presented with onset of seizures as the initial clinical manifestation.
Group B Streptococcal Colonization in Prepubertal Children
Authors: Maurer Molly , Thirumoorthi M. C. , Dajani Adnan S.
Published: December 2021

Colonization of prepubertal boys and girls with group B streptococci was studied prospectively for one year. Throat, anal canal, and vaginal cultures were obtained from 415 children not receiving antimicrobics. The over-all colonization rate at any site was 11.3% and did not vary with age, sex, or season. Streptococci were recovered most commonly from the anal canal. Throat colonization was comparable in boys and girls. A total of 71 sites were positive for the organism in the 47 colonized children. Serotype Ia was the most common (41% of isolates). Types II and III accounted for 24% and 20%, respectively. Colonization at more than one site occurred in 20 children and in two of these children, different serotypes were recovered from different sites.
Bathtub Drownings: Report of Seven Cases
Authors: Pearn John H. , Brown Joseph , Wong Richard , Bart Robert
Published: December 2021

The domestic bathtub is an important site for infant drownings. A total population study of drowning and near-drowning accidents involving Honolulu infants has enabled the risks to be specified with greater detail. A series of seven consecutive bathtub immersion accidents is presented. The "at risk" profile comprises highly mobile families of bower socioeconomic status; usually younger siblings in larger families are involved and often the father had immediate care of the infant at the time of the accident. Another case of bathtub immersion as a form of nonaccidental injury is described. In five of the other six cases reported, the drowned child was left attended by an older sibling. Preventive strategies are discussed.
Aflatoxin B1: Its Role in the Etiology of Reye's Syndrome
Authors: Ryan Nell J. , Hogan Gwendolyn R. , Hayes A. Wallace , Unger Peter D. , Siraj Mohamed V.
Published: December 2021

Seven cases of Reye's syndrome in which aflatoxin B1 was isolated from the blood or liver or both are presented. In two cases aflatoxin B1 was found in the blood during the acute phase of the disease; a finding not previously reported. In six cases aflatoxin B1 was recovered from autopsy specimens of liver. A number of case reports linking aflatoxin B1 to Reye's syndrome have appeared in the literature but until now only one case has been reported from the United States. Aflatoxin B1 and its possible role in the etiology of Reye's syndrome is discussed. It is concluded that Reye's syndrome is the result of multiple interrelated factors.
Altered Consciousness as an Early Manifestation of Intussusception
Authors: Singer Jonathan
Published: December 2021

Two children who had neurologic symptoms as prodromal manifestations of intussusception are presented. Previously described alterations in central nervous system functioning with intussusception are reviewed.
Polyneuropathy in Childhood
Authors: Evans Owen B.
Published: December 2021

Polyneuropathy is an uncommon neurologic disorder that occurs in childhood. An evaluation of 61 patients over a period of seven years showed the Guilain-Barré syndrome and degenerative polyneuropathies to be the most common diagnoses. Other etiologies included metabolic, toxic, and neuropathies associated with systemic diseases. A group of idiopathic neuropathies was identified in which an unusual finding was a large sub-group of children with chronic or progressive central nervous system disease.
Risk Factors Associated with Failure to Receive Vaccinations
Authors: Marks James S. , Halpin Thomas J. , Irvin John J. , Johnson Deane A. , Keller John R.
Published: December 2021

A major purpose of a state-wide survey to document the vaccination status of 1,003 2-year-old children was to identify factors associated with failure to receive the recommended vaccinations. With a basic series of immunization defined as three doses of diphtheriatetanus-pertussis (DTP), three oral polio vaccine (OPV), one measles, and one rubella, 72.5% of the children had completed the series. When the completed series was redefined to include a fourth DTP and mumps vaccine the rate of completion dropped to 40.8%. However, 59.1% of the children who had not completed this optimal series could be brought up-to-date with a single visit to their provider of medical care.

Demographic variables independently associated with completion of the basic series were increased paternal education (P < .001), increased maternal education (P < .02), smaller family size (P < .01) and higher socioeconomic status, as determined by census tract or rural town of residence (P < .02). Race was not found to be a factor associated with vaccination rates when socioeconomic status was controlled.

Patients who received their vaccinations from private physicians had a better vaccination rate than those who attended health department clinics. This difference persisted even when socioeconomic status was controlled by residence (P < .02).

The simultaneous comparison of parental education and family size demonstrated that a child having one parent with < 12 years education or having at least three siblings has a fourfold greater risk of failure to complete his immunization than children whose parents are both college graduates. By using paternal and maternal education level and family size as screening variables, children at high risk for failure to complete their immunizations could be identified prospectively and made the target of intervention programs to improve compliance.
Phenol and Neonatal Jaundice
Authors: Doan Helen McK. , Keith Leslie , Shennan Andrew T.
Published: December 2021

A report from the Center for Disease Control1 noted two outbreaks of idiopathic neonatal hyperbilirubinemia associated with the use of a phenolic disinfectant detergent, when used in higher than recommended concentrations. These outbreaks were examined in more detail by Wysowski et a12 at the Atlanta Center for Disease Control, confirming a temporal relationship between the excessive utilization of the phenol and neonatal hyperbilirubinemia. Daum et al,3 on the basis of these reports and their own in vitro experiment, concluded that the results thus far warranted removal of concentrated phenolic detergent solutions from newborn care areas, or the assurance of the proper dilutions. There are as yet, however, no reports examining the effects of this detergent on the neonate when used in recommended concentrations. Since a phenolic disinfectant detergent (Superphen, Rebco Chemicals, Burlington, Ontario) was already in use in all areas where newborns are housed at this hospital (in the manufacturer's recommended dilution of 1¼ oz/gal, applied daily to floors and once a month to walls), a prospective study was designed to compare the incidence of significant physiologic neonatal jaundice when either a phenolic (Superphen) or nonphenolic (Quaternary Ammonium, Quad "detergent sanitizer" formula no. 1492, G. H. Woods Company, Toronto, Ontario) disinfectant detergent was used in the nursery areas.

MATERIAL AND METHODS

Two nurseries in Women's College Hospital (designated nursery I and II) were included in the study. In nursery I, the use of Superphen was continued as usual for the first six months of 1976, and the Quad compound used for the second six months.
Nonimmune Hydrops Fetalis: Report of 22 Cases Including Three Siblings
Authors: Etches P. C. , Lemons James A.
Published: December 2021

Twenty-two cases of nonimmune hydrops fetalis (NIHF) seen over a three-year period are described. Eight cases were associated with major congenital anomalies, seven cases with minor anomalies or other disease entities, and seven idiopathic cases. The overall mortality rate was 50%, greatest in those cases complicated by major anomalies. The clinical problems commonly encountered in management of these patients are reviewed, and include prenatal detection, perinatal asphyxia, disseminated intravascular coagulopathy, fluid and electrolyte imbalance, and respiratory difficulty. A review of the literature for those entities found in association with NIHF is also included. The case studies of three consecutive siblings with NIHF born to the same parents are briefly analyzed.
Biochemical Alterations in Neonatal Hyperbilirubinemia and Bilirubin Encephalopathy: A Review
Authors: Karp Warren B.
Published: December 2021

This review article discusses some current questions concerning the measurement of bilirubin in the blood of newborn infants and the relationship of these blood parameters to the biochemical defects responsible for bilirubin encephalopathy. A discussion of numerous theories, which have been put forth to explain the specific biochemical mechanism by which bilirubin acts on brain metabolism, demonstrates that presently there is no un- equivocal explanation for the molecular events leading to bilirubin encephalopathy.
Kawasaki Disease Continues to Increase in Japan
Authors: Shigematsu I. , Shibata S. , Tamashiro H. , Kawasaki T. , Kusakawa S.
Published: December 2021

Mucocutaneous lymphnode syndrome (MCLS) or Kawasaki disease was reported first by Kawasaki in Japan in 1967.1 Cases of MCLS have been reported in many countries, since it was reported in Pediatrics in 1974.2

By the end of 1976, about 12,000 cases were collected and registered throughout Japan by the MCLS Research Committee which was organized in 1970. The Committee is now conducting the fifth nationwide survey of all pediatric departments of hospitals with more than 100 beds (1,688 hospitals) in order to register cases of MCLS newly diagnosed during 1977-1978.
Introduction of Beikost
Authors: Rivara Frederick P.
Published: December 2021

I found the recent article, "Recommendations for feeding normal infants" by Fomon et al (Pediatrics 63:52, 1979) helpful and informative. However, I disagree with their conclusion that early feeding of beikost to help infants sleep through the night is undesirable.

With more than 30% of mothers with children under the age of 3 working outside the home, and with the ever increasing number of single parent families, factors that enable a parent to cope with raising a child under these circumstances must be advanced.
A Depression Rating Scale for Children
Authors: Poznanski Elva O. , Cook Stephen C. , Carroll Bernard J.
Published: December 2021

A rating scale is needed for clinical and research studies of depression in childhood. A Children's Depression Rating Scale (CDRS) was devised and tested on 30 inpatient children in a medical hospital. A high correlation was found between the global ratings by two psychiatrists of the severity of depression and the scores on the CDRS. The items on the CDRS which had the highest correlation with a global rating of depression were social withdrawal, capacity for fun, irritability, schoolwork, expressive communication, general somatic features, hypoactivity, and depressed mood. The syndrome of depression in childhood can be characterized and rated primarily by observed behaviors.
The Diagnosis of Insulinoma in a Child in the Absence of Fasting Hyperinsulinemia
Authors: Wolfsdorf Joseph I. , Senior Boris
Published: December 2021

This report concerns an 8-year-old girl with fasting hypoglycemia caused by a functional islet cell adenoma. During two separate fasting studies the blood glucose concentrations decreased to abnormally low levels yet the serum concentrations of insulin were consistently within the accepted range of normal. This report illustrates the diagnostic value of three simple functional tests—the inhibitory effect of insulin on ketogenesis and on glycogenolysis and the stimulatory effect of leucine on insulin secretion.
Primary Care Approaches to Developmental Disabilities
Authors: Shonkoff Jack P. , Dworkin Paul H. , Leviton Alan , Levine Melvin D.
Published: December 2021

Ninety-seven board certified pediatricians who spend at least 75% of their professional working hours involved in the delivery of primary care in New England were interviewed to explore their attitudes and current clinical approaches to developmental disabilities.

The majority of the pediatricians relied exclusively on clinical judgment and general observations for assessing developmental problems in their offices. Responsibility for preschool screening for potential learning problems and the assessment of school failure were considered appropriate pediatric concerns. Reported customary approaches to a variety of developmental problems were not affected by the size of the practice nor by the socioeconomic status of the patient population. Patterns of referral for consultation appeared to be more dependent on the nature of the suspected disorder than on the characteristics of the physicians or their practices.

The need for more rigorous training in the developmental aspects of child health has been emphasized. In order to meet this challenge, more precise techniques for pediatric developmental assessment and more conclusive evalutions of specific interventions will have to be produced.
ADVERSE MEDICAL CONSEQUENCES OF ROLLER SKATING FOR AMERICAN GIRLS, AS VIEWED IN 1885
Authors: C. T. E.
Published: December 2021

During the 1880s roller skating became enormously popular among American children. But this physical activity was considered detrimental to the health of young girls as is evident in this letter published in 1885.1

Sir: I am very much interested in this subject of "roller-skating" for girls; especially so because I have from thirty to forty girls under my care for physical training and treatment. Theoretically, I believe it was going to be a good thing, but my experience is forcing me to the conclusion that no good, moral, mental, or physical, comes from this source. With the utmost care as to time and amount, I find it unsatisfactory. It seems to bring out any latent predisposition to disease. I have been compelled to forbid those who had the slightest tendency to kidney or heart trouble, in fact, any organic trouble, indulging in the sport. In one case only, of enlarged liver, subject to acute attacks of congestion, etc., I have seen no bad effect. A case of anaemia, the most intractable one I ever had to deal with, I am sure was caused by skating excessively. The disease had so far yielded that I, in an unguarded moment, said "Yes" to a plaintive "Just one hour, please?" and the result was severe vomiting of the next meal. She had been able to take no food without great uneasiness since, and I see I'll have much of the old ground to go over. Those who have skated very much . . . have leucorrhoea, and confess it is aggravated by the limited amount of exercise I have allowed.
The Effects of Observed Sudden Infant Death Syndrome (SIDS) on Hospital Staff
Authors: Friedman Gertrude R. , Franciosi Ralph A. , Drake Robert M.
Published: December 2021

We have described an observed case of SIDS in a hospital setting. The victim was "well baby" hospitalized for psychosocial reasons. Death occurred on the fifth hospital day, during sleep and two hours after feeding. The death was silent and was preceded by cyanosis and respiratory arrest.

Hospital staff who attended the baby during his admission experienced the same traumatic reactions as families of SIDS victims, ie, shock, disbelief, anger, guilt, fear, blaming, sadness, and behavioral manifestations. Information on SIDS, communication about feelings and continued group support were of utmost importance in helping the staff to deal with the crisis. Although they had experienced death and serious illness on the ward and continued to be faced with grave situations, the unique aspects of SIDS, namely lack of etiology and its sudden and unexpected onset, brought forth personal feelings of vulnerability and called for extra coping devices. Our experience illustrates the need of an in-hospital support system to assess needs, coordinate efforts, and offer timely intervention after the death of an infant or child.
Paying Attention to Attention Deficit Disorder
Authors: Schowalter John E.
Published: December 2021

There is more research activity in and writing about hyperactivity than any other behavioral problem of childhood. Because "hyperactive" and "hyperkinetic" were used as descriptive words before they became a diagnosis, there is still understandable confusion on the part of many as to what the syndrome is and what to do about it. Perhaps the diagnostic label of "attention deficit disorder with hyperactivity," which is part of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIII),1 will prove helpful. This term gives credit to the fact that poor attention and impulsivity are usually more of a problem to teachers and parents than is the hyperactivity.
Assessment of Tuberculin Screening in an Urban Pediatric Clinic
Authors: Kraut J. R. , Christoffel K. K. , Berkelhamer J. E. , Boddie-Willis C.
Published: December 2021

The American Lung Association (ALA) and Center for Disease Control (CDC) have stated that routine screening of children is an inefficient and ineffective method for detection of tuberculosis in the United States. This is at variance with prior recommendations. Our objective, therefore, was to assess prospectively tuberculin screening for our urban, primarily low socioeconomic, clinic population. A prior chart review revealed that only 36% of tuberculin tests had written documentation of results. The following improvements were made: (1) One trained technician administered all tests and recorded data. (2) One hospital mail box was used for receiving tuberculin test postcard results. (3) Telephone follow-up was begun. This resulted in an increase of results documented to 84% (P .001). After these improvements, we prospectively studied the next 1,233 routine screening tests over a period of eight months. The written documentation rate during the study was 90%. Thirteen positive tuberculin tests were found. Three patients had subsequent negative tuberculin tests. One patient received Calmette-Guérin bacillus (BCG) as an infant and had multiple positive tuberculin tests in the past. One patient was lost to follow-up. Eight positive patients were confirmed as new converters. Of these eight patients, six had histories of prior positive tuberculin tests, recent TB exposure, foreign travel, or symptoms.

We conclude that: (1) Prior to the study, recording of tuberculin tests was severely deficient. (2) Reorganization significantly increased the documentation rate. (3) Of 1,233 consecutive tests, eight unsuspected cases were found. This is below the 1% conversion rate recommended by the CDC for routine TB screening in children. (4) The data support the ALA-CDC statement regarding the low yield of routine tuberculin testing of healthy children. (5) However, abandoning tuberculin screening of healthy children would leave undetected a few children with unsuspected tuberculosis infection, who would then be in danger of developing serious illness.
An Outbreak of Vitamin D Deficiency Rickets in a Susceptible Population
Authors: Bachrach Steven , Fisher Julian , Parks John S.
Published: December 2021

Nutritional, racial, cultural, and environmental factors have combined to produce a resurgence of vitamin D deficiency rickets in urban Philadelphia. Between January 1974 and June 1978, 24 cases were diagnosed at the Children's Hospital of Philadelphia. Patients' ages ranged from 4 to 58 months. Presenting complaints included seizures, swollen wrists, pathologic fractures, and developmental regression. Sixteen patients were below the third percentile for length and weight. Laboratory results indicated vitamin D deficiency in nursing mothers as well as in infants. All infants had been breast-fed and all were black. Ingestion of vitamin D was limited by exclusion of meat and/or dairy products in 21, and no infants had consistently taken supplemental vitamins. Nineteen were members of Muslim or Seventh Day Adventist faiths. Endogenous synthesis of vitamin D was limited by dark skin, by dressing in long garments with hoods and veils, and by air pollution in a densely populated northern city. The return to a more "natural" diet, free of food additives, has been accompanied by the return of a classic disease of industrial society. Effective management required patience and respect for religious convictions. With treatment, there was correction of chemical and skeletal abnormalities, but few patients showed catch-up growth.
Amebic Liver Abscess in Children: Clinical and Epidemiologic Features
Authors: Harrison H. Robert , Crowe C. Peter , Fulginiti Vincent A.
Published: December 2021

Amebiasis, that is, infection with Entameba histolytica, continues to be endemic in the United States, with liver abscess occurring as an infrequent but constant complication. Seven cases are reported, with epidemiologic investigation of two. Reliable findings in hepatic abscess include fever, abdominal pain, respiratory distress, tender abdomen, and large, tender liver. Anemia, elevated white count with left shift, and the radiographic findings of an elevated right hemidiaphragm are constant. Epidemiologically, amebiasis occurs in clusters in the United States with person-to-person transmission pre-dominant in spread. Infection is associated with poor sanitation and crowding. Investigation of the families of two patients documented 9/21 carriers and an additional 3/21 who were seropositive, as well as crowding and poor sanitation. In this country, treatment of a patient with amebic disease should include investigation of his home and family.
The Cockayne Syndrome: An Evaluation of Hypertension and Studies of Renal Pathology
Authors: Higginbottom Marilyn C. , Griswold William R. , Jones Kenneth Lyons , Vasquez Martha D. , Mendoza Stanley A. , Wilson Curtis B.
Published: December 2021

Three children with renal disease, hypertension, and the Cockayne syndrome were evaluated. All patients had sevpertension; peripheral vein renin was elevated in two patients. Renal biopsy specimens from two patients were studied by light microscopy, electron microscopy, and immunofluoresence. Immunohistologic studies demonstrated deposits of immunoglobulin and complement in the vessels and glomeruli of the first patient; deposits of immunoglobulin and complement were seen in the glomeruli of the third patient. Also electron-dense deposits were seen in the glomerular basement membrane of the third patient. Circulating immune complexes were detected by the Raji cell and Clq binding techniques in this child as well. Both hypertension and renal disease are frequent complications of the Cockayne syndrome.
Complete Biliary Obstruction Due to Erythromycin Estolate Administration in an Infant
Authors: Krowchuk Daniel , Seashore John H.
Published: December 2021

Cholestatic jaundice occurring as the result of treatment with erythrornycin estolate is a well known entity in adults, but less than 2% of all reported cases occur in children under 12 years of age.1 Rarely has this adverse reaction been noted in infants less than 1 year of age.2 We present the case of a young infant who manifested clinical findings suggestive of biliary atresia following a course of treatment with erythromycin estolate.

CASE REPORT

A previously healthy 6-week-old infant was evaluated by his private physician for an acute illness characterized by fever (100.5 C) and irritability. There was no jaundice noted at this time, and other family members were well.
Love, Logic, and Other Approaches to Prevention
Authors: Starfield Barbara
Published: December 2021

Baker's1 on accidents to passengers in motor vehicles inform us that infants, particularly young infants, are at greatest risk of death. Most pediatricians would have guessed otherwise, knowing that toddlers' newly acquired locomotion skills, independence, and inquisitiveness generally make them the most vulnerable target. Why, in this case, is the youngest most likely to suffer?

It is possible that young infants are at greatest risk because they are passengers in cars more often than older children, but Baker1 cites evidence that they are actually less likely to travel in cars than older children. This means that the youngest, exposure for exposure, are even more at risk, probably because they are more vulnerable anatomically and because they are held in arms rather than in proper infant carriers.
Catecholamine Metabolites in Congenital Sensory Neuropathy with Anhydrosis
Authors: Shekim Walid O. , Daniel Anasseril E. , Koresko Richard L. , Dekirmenjian Harutoune
Published: December 2021

Congenital sensory neuropathy with anhydrosis is a rare syndrome in childhood, characterized by disturbed thermoregulation and by absence of pain and sweating.1,2 The etiology is unknown, but researchers postulate the presence of a disorder in the function of the autonomic sympathetic nervous system.3 From among the numberous etiologies considered to play a role in the pathophysiology of the syndrome, we list a few that are relevant to this report: (1) disturbance of catecholamine metabolism,3 (2) an inborn error of metabolism involving a minor pathway of tyrosine metabolism,4 and (3) low biological activity of nerve growth factor (NGF).5

Clinicians have used urinary catecholamine metabolites in the diagnosis of the syndrome.3
Abetalipoproteinemia Presenting as Severe Vitamin K Deficiency
Authors: Caballero Fernan M. , Buchanan George R.
Published: December 2021

Vitamin K deficiency has occasionally been observed in infants after the immediate neonatal period when one or more of the following features is present: diet consisting entirely of breast milk, failure to receive prophylactic vitamin K shortly after birth, therapy with broad-spectrum antibiotics, or chronic diarrhea accompanying malabsorption due to cystic fibrosis or to various acquired causes.1-7 In this report we describe for the first time an infant with the uncommon autosomal recessive disorder abetalipoproteinemia whose major presenting manifestation in early infancy was hemorrhage due to vitamin K deficiency.

CASE REPORT

A 6-week-old baby was brought in for evaluation because of a two- to three-week history of easy bruising.
Variable Susceptibility to Retrolental Fibroplasia: Effect on Case-Control Comparison of Pao2 Exposure
Authors: Sinclair John C. , Anderson Gary D.
Published: December 2021

The cooperative study "Pao2 Levels and Retrolental Fibroplasia" by V. E. Kinsey et al (Pediatrics 60: 655, 1977) seeks an association between occurrence of retrolental fibroplasia (RLF) and extent of prior exposure to oxygen as measured by arterial Po2 (Pao2). The approach used is a case-control analysis in which infants are grouped by outcome (RLF or no RLF) and compared with respect to prior Pao2 history. The authors hypothesized that infants with RLF (cases) would have had higher Pao2 values than infants without RLF (controls).
Clinical Predictability of Intraventricular Hemorrhage in Preterm Infants
Authors: Lazzara Anthony , Ahmann Peter , Dykes Francine , Brann Alfred W. , Schwartz James
Published: December 2021

Ninety-eight infants of less than 35 weeks' gestation, consecutively admitted to a regional neonatal intensive care unit, were followed prior to computerized tomography (CT) scan for clinical signs of subependymal and/or intraventricular hemorrhage. The presence or absence of intracerebral hemorrhage was confirmed by CT scan in all patients, and the severity of hemorrhage was quantitated as mild, moderate, or marked. Thirty-seven out of 98 infants (38%) demonstrated intracerebral hemorrhage on CT scan; 20 of 37 (54%) were predicted clinically. Clinical predictability was related to severity of hemorrhage as quantitated by CT scan. Clinical signs that were found helpful in predicting subependymal and/ or intraventricular hemorrhage were fall in hematocrit, failure of rise in hematocrit with transfusion of packed red blood cells, tight fontanel, decrease in spontaneous activity, decreased tone, abnormal eye signs, and seizures.
Cerebral Intraventricular Hemorrhages in Infants: A Widening Age Spectrum
Authors: Mitchell Wendy , O'Tuama Lorcan
Published: December 2021

Cerebral intraventricular hemorrhage (IVH), a problem widely recognized in premature infants, was found in six older infants, ages 2 weeks to 3 months. IVH was often initially misdiagnosed as subarachnoid hemorrhage or meningitis with a traumatic lumbar tap. IVH occurred primarily in infants with hypoxemia, acidosis, ischemia, and/or hypernatremia, conditions found in association with IVH in premature infants, but also occurred spontaneously. Computerized tomography scans were the most valuable diagnostic procedure for detection of IVH.
Posterior Fossa Subdural Hemorrhage in the Newborn
Authors: Serfontein C. L. , Rom S. , Stein S.
Published: December 2021

Posterior fossa subdural hematoma formation in the newborn is an infrequently reported event. It is characterized by a complicated delivery, usually at term, followed by developing lethargy and irritability within the first few days of life. Respiratory irregularities, tense anterior fontanelle, and increasing head circumference ensue, accompanied by a falling hemoglobin and blood-stained cerebrospinal fluid. Various cranial nerves may also be involved. Previously reported cases have been marked by diagnostic delays that affected the subsequent outcome of some of the patients. Computed tomography (CT) allows for earlier confirmation of the diagnosis, especially where coronal views are employed. Three cases are reported here to illustrate the above features.
Acquired Pulmonary Artery Aneurysm in an Infant
Authors: Viart p. , Cattelain C. , Gallez A.
Published: December 2021

An aneurysm of the left pulmonary artery developed in an infant during a staphylococcal generalized infection. The successful surgical treatment required a left pneumonectomy. In this report the causes of that rare lesion and the prognosis of pneumonectomy in infancy are reviewed.
The Conscience of Pediatricians in Sweden and the United States
Authors: Observer Perplexed
Published: December 2021

The relationship between pediatricians and the infantfood/pharmaceutical industry in Sweden seems to be different than it is in the United States. The contrast is highlighted by two sets of observations:

1. The Swedish Paediatric Association has criticized the role of the infant-food industry in poor countries and it has published a code of ethics for marketing infant foods.1 On May 18, 1979, the Association issued a statement2 indicating that it intends to monitor the activities of the Swedish companies in Turkey.
Early Diagnosis and Management of Cerebritis in a Child
Authors: Liston Thomas E. , Tomasovic Jerry J. , Stevens Edwin A.
Published: December 2021

A 3½-year-old boy with primary staphylococcal septicemia presented with elevated cerebrospinal fluid protein and pleocytosis. Serial computerized tomography examinations revealed the development of an intracranial lesion suggestive of an early infectious process. All cultures of cerebrospinal fluid taken before and after antibiotic treatment revealed no growth. Although no focal neurological findings evolved, both clinical and radiologic abnormalities resolved with antibiotic therapy. Computerized tomography can provide a means to diagnose cerebritis and to evaluate therapeutic response.
Delayed in Vitro Immunoglobulin Production by Cord Lymphocytes
Authors: Miyagawa Yukiaki , Sugita Kenichi , Komiyama Atsushi , Akabane Taro
Published: December 2021

Pokeweed mitogen-induced immunoglobulin (Ig) production by cord lymphocytes was studied in vitro by Ig-secreting plaque-forming cell (Ig-PFC) assay. Although adult mononuclear cells generated all of IgM-, IgG-, and IgA-PFC, cord mononuclear cells generated only IgM-PFC when cultured for seven days. The number of cord IgM-PFC was 102 ± 26/104 mononuclear cells, being about one fourth of that of adult IgM-PFC. When cultured for 14 days, cord mononuclear cells formed increased numbers of IgM-PFC in contrast to adult cells, and yielded IgG-PFC as well, indicating delayed Ig production. Cord T cells were much less effective at helping adult B cells to differentiate into Ig-PFC as compared with adult T cells. Substitution of adult T cells for cord T cell markedly improved the response of cord B cells. The present study demonstrates Ig secretion by cord lymphocytes in response to pokeweed mitogen stimulation. The results further indicate that the delayed Ig production by cord lymphocytes is largely due to functional immaturity of the T cells.
Familial Lymphoid Interstitial Pneumonia: A Long-Term Follow-up
Authors: O'Brodovich Hugh M. , Moser Mark M. , Lu Lawrence
Published: December 2021

We describe two brothers who developed chronic pulmonary disease in early childhood. Lung biopsies were diagnostic of lymphoid interstitial pneumonia (LIP). Familial LIP has not been previously reported, and the natural history is unknown. The elder brother experienced progressive respiratory disability and died 10 years after the onset of symptoms. The younger brother, age 13, has been observed for 11 years and, despite progression of pathological changes revealed in his second lung biopsy, he has had few symptoms and leads an active life. Current pulmonary function tests reveal decreased lung volumes, increased maximal expiratory flow rates, and decreased lung compliance. Arterial Po2 is 75 mm Hg at rest and falls to 56 mm Hg with exercise. These findings, consistent with restrictive lung disease, contrast with the obstructive ventilatory pattern seen in some adult patients.
Zinc Deficiency, Acrodermatitis Enteropathica, Optic Atrophy, Subacute Myelo-optic Neuropathy, and 5,7-Dihalo-8-quinolinols
Authors: Sturtevant Frank M.
Published: December 2021

Acrodermatitis enteropathica, a heritable disease of zinc deficiency, was formerly amenable to treatment only with dihaloquinolinol drugs. A few cases of optic atrophy were reported in surviving patients and were proposed as examples of ocular drug toxicity, principally because of the association between iodochlorhy-droxyquin and subacute myelo-optic neuropathy (SMON) in Japan. An alternate hypothesis is now offered: that the optic atrophy was secondary to the zinc deficiency, which is consistent with diverse evidence cited from the literature. Therefore, it would seem worthwhile to investigate zinc in cases of disk pallor described as idiopathic or drug associated, and to investigate visual function in cases of severe malnourishment.
Criteria for Early Infant Discharge and Followup Evaluation
Authors: Brann Alfred W. , Hall Robert T. , Harper Rita G. , Little George A. , Maisels M. Jeffrey , McCracken George H. , Poland Ronald L. , Sunshine Philip , Whittinghill John A.
Published: December 2021

INTRODUCTION

It is cautioned that there is an element of risk in early discharge insofar as medical supervision during the infant's transitional period must, of necessity, be intermittent rather than continuous. With this in mind, the following guidelines are suggested.

CRITERIA FOR EARLY INFANT DISCHARGE

1. Attendance at prenatal childbirth education and infant care classes where problems of the first three to five days of life are included.

2. Identification of a supporting person to assist with care at home in the neonatal period.

3. Identification of physician-directed source of continuous medical care following hospital discharge. This should include an appointment at 2 to 3 days of age.

4. Uncomplicated antepatum, intrapartum, and postpartum course of both mother and infant.

5. Term infant (38 to 41 completed weeks) who is normally growrn (2,500 to 4,500 gm) and who is examined by a physician prior to discharge and found normal.

6. A minimum of six hours of hospitalization during which time the infant has achieved thermal homeostasis and fed successfully (demonstrated a normal suck and swallowing mechanism).

7. Laboratory data: (a) maternal or cord blood serologic test for syphilis; (b) cord blood (or infant blood) type and Coombs if mother Rh negative or type O. A Coombs test should be performed on all infants if a screening test for irregular antibodies was not performed during pregnancy; and (c) hemoglobin and blood sugar determinations as clinically indicated.

8. Maternal skill and demonstrated ability with: (a) feeding technique; (b) skin care, including cord care; (c) temperature assessment and measurement with thermometer and (d) assessment of infant well being and recognition of illness.
Metrication and SI Units
Authors: Hohn Arno R. , Amler Alfred B. , Bergeson Paul S. , Gold Harvey R. , Griggs Stewart L. , Shattuck Gerald B. , Singer Stanford A. , Smith Edwin Ide , Wingert Willis A.
Published: December 2021

Because of the increasing international use of the SI system (International System of Units) in medicine, the Committee on Hospital Care has written this statement to familiarize pediatricians with this concept. The current state of the system, its derivation, purported advantages, and controversial aspects are described; and the Committee has made specific recommendations for consideration regarding its future use and development.

BACKGROUND

The British Imperial System of Weights used in the United States today derives from a variety of ancient cultures. A Roman contribution is the use of the awkward number 12 as a base. Royal decree established the yard as the distance from the tip of the nose to the end of the thumb of King Henry I. The inch was based on the size of three grains of barley "dry and round." Equally illogically derived units evolved to eventually form the irrational English "system."1

The metric system with its "base-10" or "decimal" system derived its units of mass and volume from its units of length, thus correlating its basic units to each other. The need for further refinement of metrics and a single worldwide and interdisciplinary system of measurements led to the development of the International System of Units (le Systeme International d'Unités) with the international abbreviation "SI." This is sometimes referred to as "the modern metric system" and is said to complete the process of metrication.2

Seventeen countries, including the United States, signed the Metre Convention in 1870. This led to the establishment of the International Bureau of Weights and Measures at Sèvres, France, which acts as an international standards reference laboratory and as the permanent secretariat for the Metre Convention.