bluuebunny/crossref_metadata_2025 huggingface dataset:
Raising a Hyperactive Child, edited by Mark A. Stewart, M.D., and Sally Wendkos Olds (New York, Harper & Row, 1973, 299 pp, $8.95)
Authors: Mowat Alex P.
Published: December 2021

Pediatricians involved in helping parents of hyperactive children can recommend to them this readable, authoritative manual which by its positive, enthusiastic, but realistic tone will help them deal with difficulties presented by such children. They will find detailed advice on practical methods of influencing their children and their behavior to make life less trying for all in the short term and perhaps even in the long term.

The lack of understanding of the basic cause of this abnormality of temperament and the absence of follow-up studies showing that the recommended management has beneficial long-term effects are conceded by the authors as limiting the authority of the text.
Psychosocial Functioning of Mothers of Malnourished Children
Authors: Kerr Mary Ann D. , Bogues Jacqueline Landman , Kerr Douglas S.
Published: December 2021

The relationship between infant malnutrition and maternal psychosocial behavior was explored by comparing mothers of malnourished children with mothers whose children were matched for age and family income but were not malnourished. The mothers were interviewed and asked to describe their relationships with their children, their children's fathers, extended families, friends, and employers. The mothers of malnourished children described more chronically disrupted lives. Their housing conditions and employment records reflected disorganization. They had fewer social contacts except with extended families who supervised excessively. The fathers of their babies were either not present or unsupportive. Relationships were more stereotyped, transient, and focused on material aspects. The mothers' narcissistic concerns took precedence over the needs of their children. Nearly all the mothers, including the controls, had suffered severe deprivation in childhood. Some mothers of malnourished children were apathetic and dependent, whereas others were manipulative and evasive. These findings were consistent with those previously described for mothers of children with "failure-to-thrive" in affluent countries.
SOME OLD DATA TO SUPPORT THE NOTION THAT LEAN CHILDREN HANDLE INFECTIONS BETTER THAN THOSE WHO ARE HEAVIER
Authors: Stickler G. B.
Published: December 2021

In looking at old family papers, I found the report of a study° my father conducted while a resident of Pfaundler in Munich. He reviewed the course of scarlet fever in 200 children and diphtheria in 500 patients. He arranged them according to their weight and found that children with weights greater than the mean weight of the group had more days of fever, had more deaths (five vs. one) than those who were lean. The patients with diphtheria had more days requiring intubation than the children with weights below the mean. The author could then only speculate about the cause for the difference.
Head Trauma for the Pediatrician
Authors: Singer Harvey S. , Freeman John M.
Published: December 2021

A physician's concern about continued or progressive alteration in consciousness or neurologic function will result in the early recognition of head trauma complications that require medical or surgical intervention. The role of the pediatrician following "minor" head trauma is to serve as the overseer, coordinating observations and providing informed decisions on the necessity of additional medical or diagnostic requirements. This article provides an approach to handling the patient with mild head trauma based upon our experiences and interpretations of the literature.

In conclusion, we emphasize the following points: (1) patients with head trauma, especially if associated with loss of consciousness, should be examined and subsequently evaluated by reliable observers; (2) skull x-ray films rarely provide information that affects medical management; (3) deterioration in the patient's clinical condition demands consultation and appropriate neuroradiologic studies; (4) the presence of a seizure or basilar skull fracture does not in itself necessitate therapy; and (5) continued evaluation of head trauma management is required to determine the optimal approach.
Failure of Inflammatory Response to Accidental Intracranial Lipid Infusion
Authors: Black Virginia D. , Little George A. , Marin-Padilla Miguel
Published: December 2021

The introduction of parenteral nutrition during this decade has significantly improved the nutritional status of many infants but not without serious complications. Early users were confronted with deficiency states of trace elements1 and fatty acids.2 Metabolic abnormalities were frequent, and catheter complications resulted in significant morbidity and mortality. Reports of sepsis,3 extravasation into the abdomen or thorax,4 and hydrocephalus5 are not uncommon. Equally serious, but rarer, complications have included obstruction of venous return6 and subacute Candida endocarditis.7 Recent use of peripheral intravenous nutrition has virtually eliminated the well-known catheter complications.8 Infrequent and relatively minor problems have been reported following infiltration.
THE LOW-BIRTH WEIGHT HORSE: A POOR BET
Authors: L. J. F.
Published: December 2021

Thoroughbreds are bred solely with a view to racing, and their performances are well documented. Racehorses are good subjects, therefore, for studying the effects of perinatal disorders on physical development and achievement. Thoroughbreds become fully grown at about 3 years . . . but in flat racing they are raced first at 2 years and the majority have completed their racing careers by the end of their third year, although a few continue after this age. At 2 years some are still not fully developed and their potential ability is often not evident until the third year.

It has long been recognized by breeders and trainers that twin foals rarely develop into successful racehorses but there is little information on the outlook for single foals of low birth weight.
Transient Neonatal Hypothyroidism
Authors: Chabrolle J. P. , Rossier A.
Published: December 2021

The article by La Franchi et al. regarding transient neonatal hypothyroidism (Pediatrics 60:538, October 1977) raises an important question concerning the possible role of apparently small doses of iodine in causing this condition. In the case reported, the patient's mother received a daily supplement of 150 µg of iodine, which could be of some importance because it may result in iodine overload in the fetus. The only way to test this hypothesis would be to measure 24-hour urinary iodine excretion.
Varicella Vaccine: The Crossroads Is Where We Are Not!
Authors: Brunell Philip A.
Published: December 2021

The commentary on the Japanese varicella vaccine (Pediatrics 60:930, December 1977) implies that there is some urgency in proceeding with testing at this particular time. I do not feel that we are at the "crossroads" any more than we were three years ago when one of the authors of the commentary wrote eloquently in Lancet expressing concern about the same vaccine. One would hope that we could all adopt an attitude that would permit us to make decisions based on the continuing evaluation of information which addresses the concerns we have all expressed about the vaccine.
Juvenile Laryngeal Papillomas With Cardiomegaly and Polycythemia
Authors: Hawkins Donald B. , Udall John N.
Published: December 2021

Juvenile laryngeal papillomas are one of the most dangerous and treacherous chronic airway problems of childhood. The following case report illustrates several interesting points regarding laryngeal papillomas and the pediatric airway.

CASE REPORT

This 1½-year-old girl was brought by her parents to the Los Angeles County-University of Southern California Medical Center in October 1973 with a history of fever, cough, and wheezing respiration for four days. Intramuscularly administered penicillin and a corticosteroid given by her private physician had not lessened these symptoms. History was significant in that her voice had always been hoarse, progressing to aphonia in recent weeks. During the preceding six months, she had been treated for wheezing and respiratory distress on four occasions.
Annual Summary of Vital Statistics—1977
Authors: Wegman Myron E.
Published: December 2021

In the article " Annual Summary of Vital Statistic—1977" by M.E. Wegman (Pediatrics 62:947-954, December 1978) an incorrect figure was given (p 948, col 1) for the number of babies born to white mothers under 19 years of age. The sentence should read: " White mothers age 19 and under had 398,329 babies; black mothers in the same age group had 160,597."
Supporting Breast-Feeding
Authors: Kemberling Sidney R.
Published: December 2021

For those interested in another approach to breast-feeding, Jelliffe and Jelliffe have recently published an elegant paper titled " Breast Is Best."4

Developing skills that enhance breast-feeding can be learned by reading the books listed at the end of this article. If pediatricians want to be strong advocates of breast-feeding, they must be convinced of the advantages of breast milk. Many physicians say that they support breast-feeding but will, for instance, send formula bottles to the bedside of a breast-feeding mother.

The antagonistic physician or member of the office team may make remarks such as "Are you going to breast-feed until your child goes to school?" " Are you still breast-feeding?" or " The baby needs solid foods for good nutrition." These innuendos can defeat and demoralize the breast-feeding mother. Unless the physician provides strong support against these remarks, the mother will lose her confidence. Many husbands who are advocates of breast-feeding will defend her against these discouraging remarks. Group sessions of lactating mothers also bolster morale. Many mothers find duenna substitutes whom they can communicate with by telephone. (A duenna is an elderly woman who has charge of young unmarried women in a Spanish family.) However, when breast-feeding mothers confront a serious problem for which they have no simple solution, the pediatrician has to provide the ultimate backup support.
X-LINKED LYMPHOPROLIFERATIVE SYNDROME REGISTRY
Authors: L. J. F.
Published: December 2021

The X-Linked Lymphoproliferative Syndrome Registry was recently established and is funded by the National Cancer Institute. We invite referrals of possible cases of the X-linked lymphoproliferative syndrome (XLP) as well as unusual complications associated with infectious mononucleosis. The following criteria may be used to ascertain whether a case is a candidate for the registry:

1. Phenotypes1 of the proliferative types, including fatal infectious mononucleosis (IM), immunoblastic sarcoma of B cells, immunodeficiency with hyper IgM following IM, or American Burkitt lymphoma; or aproliferative phenotypes such as agranulocytosis, aplastic anemia, or acquired hypogammaglobulinemia are present.

2. Phenotypes of XLP are present in two or more maternally related males.

3. In affected males, following infection by Epstein-Barr virus (EBV), infected B cells grow spontaneously, saliva transforms cord lymphocytes, and EBV antibody is usually absent in sera.

By studying affected patients and their families, we seek to increase knowledge on the etiology and pathogenesis of XLP and ultimately to offer a basis for rational therapeutic intervention.

Please address all inquiries to David T. Purtilo, M.D., or Janet Hamilton, M.S., Registrar, Department of Pathology, University of Massachusetts Medical Center, Worcester, MA 01605, or telephone (617) 856-2439
The Antenatal Use of Betamethasone in the Prevention of Respiratory Distress Syndrome: A Controlled Double-Blind Study
Authors: Papageorgiou Apostolos N. , Desgranges Marie F. , Masson Michel , Colle Eleanor , Shatz Richard , Gelfand Morrie M.
Published: December 2021

One hundred forty-six pregnant women were enrolled in a prospective double-blind study to assess the effectiveness and side-effects of antenatal administration of betamethasone in the prevention of respiratory distress syndrome (RDS) in potentially premature infants. On admission to the study, the women were given, at random, either 12 mg of betamethasone or placebo. The same dose was repeated 24 hours later and then weekly up to 34 weeks of gestation. Gestational age of the infants ranged from 25 to 34 weeks, and birth weights ranged between 730 and 2,650 gm. Statistically significant differences in favor of the infants in the betamethasone group were found in the incidence of RDS, 20.7 in the betamethasone group compared with 59.5% in the control group (P < .005); in the severity of RDS (P < .05); and in the death rate (P < .05). A higher incidence of hypoglycemia was found among infants in the betamethasone group (P < .05). Prolonged rupture of the membranes played no protective role against RDS, and the incidence of infection was similar in both groups.
Neonatal Diagnosis of Familial Dysautonomia
Authors: Perlman Max , Benady Sam , Saggi Ephraim
Published: December 2021

The serious prognostic implications of familial dysautonomia (FD) for the affected individual and his family make early definitive diagnosis mandatory. Familial dysautonomia has rarely been diagnosed in the neonatal period in hitherto unaffected families. We describe here three such newborn patients to reinforce the limited data available on this subject. In spite of the variability of expression and the incompleteness of the manifestations of FD in the neonatal period, as well as the presence of a number of "dysautonomic" features in normal newborns, we believe that it is possible to establish a diagnosis of FD neonatally. We pay particular note to the altered state of consciousness and behavior in neonatal FD, the unusual posture and limb movements, and the swallowing disorder with tendency to neonatal aspiration. In addition, the incidental finding of bile pigment in the amniotic fluid of an affected fetus without hemolytic disease may hint at a possible approach to fetal diagnosis of this condition.
THE VOICE OF FASHION
Authors: Lorie A.
Published: December 2021

The voice of fashion has not fallen silent; rather it screams in a thousand languages and dialects. . . .

. . . its symbolic language has now become overlaid with printed verbal messages. T-shirts advertise favorite products, cultured tastes (VILLAGE VOICE, JEFFERSON STAR-SHIP), political opinions, membership in real or imaginary organizations (HARVARD UNIVERSITY, OLYMPIC SCREWING TEAM), real or imaginary personality (FOXY LADY, MALE CHAUVINIST PIG), sexual preference (GAY POWER, EAT ME), and current mood (SMILE, BLUE MONDAY). . . .

. . . according to my teenage son, the very brand of blue jeans worn in junior high school is a sign: "Freaks always wear Lees, greasers wear Wranglers, and everyone else wears Levis."
What Every Primary Physician Should Know About the Postoperative Cardiac Patient
Authors: Moss Arthur J.
Published: December 2021

Many patients with the defects discussed here are under continuing postoperative observation by the cardiologist, and that is as it should be. This is particularly likely to be the case with tetralogy of Fallot and transposition of the great arteries. Some patients, however, are returned from distant cardiac centers, and the services of another cardiologist may not be readily available. Even if available, the cardiologist depends on the patient's local physician to detect early signs of trouble. Also, the family generally has a warmer relationship with the primary physician and looks to him for guidance and counsel. This assumes particular importance when one considers the high incidence of psychologic problems that tend to occur in children who have been subjected to cardiac surgery.63 These psychologic disturbances are attributed to such things as inability to compete physically, hospitalizations, family anxiety, and parental protectiveness or pampering.

Most patients who have experienced cardiac surgery should be reevaluated periodically, preferably by an experienced cardiologist. Of all the lesions discussed here, patent ductus arteriosus has the best long-term prognosis. With this lesion, once the electrocardiogram and roentgenogram have returned to normal, it probably is no longer necessary to reevaluate the patient from a cardiac standpoint unless there is a change in the murmur or a new one appears. With all the other lesions, continued cardiac reevaluation is recommended, the exact interval to be determined by the age of the patient, the postoperative course, and the time elapsed from the date of operation. During periods of stress, such as pregnancy and later adult life, closer observation may be necessary.
Regional Newborn Screening for Hypothyroidism
Authors: Levy Harvey L. , Mitchell Marvin L.
Published: December 2021

Newborn screening for phenylketonuria (PKU) is now so firmly established in North America and in many other areas of the world that it is a bit difficult for most pediatricians to recall when PKU was diagnosed on the basis of mental retardation. The key to PKU screening has been the Guthrie test, the genius of which is not the bacterial assay that is employed (though this assay was certainly a momentous development) but the simple filter paper blood specimen. This specimen, easily obtained by blotting a few drops of blood from the heel of a neonate, is even more easily mailed to a central laboratory for testing.
Letter To The Editor
Authors: Forsythe Alan B. , Wolf Sheldon M.
Published: December 2021

In a follow-up article,1 we divided the children into two groups for the purpose of analysis. In the first group were children with a single, brief, generalized initial febrile seizure and no history of prenatal, perinatal, or postnatal abnormalities that might suggest the possibility of brain damage. In the second group were those children with such birth abnormalities, and/or a severe initial febrile convulsion, and/or abnormal results of neurological examination.

In the first group, the 36-month recurrence rates were 5% for those randomly assigned to continuous phenobarbital therapy and 34% for those receiving intermittent or no phenobarbital therapy (P > .001).
ILLITERACY
Authors: Fiske Edward B.
Published: December 2021

A high school graduate on Long Island sues the local school system because he cannot read above the third-grade level. The chief of personnel for the Navy reports $250,000 in damage to a diesel engine because a sailor who worked on it could not read the maintenance manual. The National Assessment of Educational Progress shows a group of 17-year-olds a replica of a traffic ticket, and more than half cannot determine the last day on which the fine can be paid.

Such anecdotes are being heard with increasing frequency these days and point to a conclusion that is becoming painfully obvious to employees, educators, politicians, and the general public alike: the United States has a serious problem of illiteracy.
OCCUPATIONAL DISEASE AMONG OPERATING ROOM PERSONNEL
Authors: H. R. J.
Published: December 2021

United States members of the American Academy of Pediatrics served as one of two control groups in a two-year effort by the American Society of Anesthiologists to investigate the health experience of anesthesia and operating room personnel in the United States. A segment of the American Nurses' Association served as the other control group. The results are of interest not only because of the involvement of pediatricians but because of the findings of adverse effects on pregnancy and the offspring where parents are exposed to anesthetic gases.

The study was conducted by mailing questionnaires to 49,585 exposed operating room personnel in four professional societies and to 23,911 unexposed individuals in two professional societies serving as a comparison group.

For female members of the operating room-exposed group, there was an increased risk of spontaneous abortion and various types of cancer. For both female and male exposed personnel, there was an increased risk of hepatic disease and of congenital malformations in their offspring. No increase in cancer was found in exposed males.

Considerable evidence in animal studies supports the hypothesis of a cause-effect relationship between increase in the rates of these diseases and exposure to waste anesthetic gases. The present study is consonant with such a relationship but does not establish it. The report makes a strong recommendation for venting of waste anesthetic gases wherever used.
Neonatal Traumatic Proximal Femoral Epiphysiolysis
Authors: Towbin Richard , Crawford Alvin H.
Published: December 2021

Traumatic proximal femoral epiphysiolysis is a rare event. Early recognition and management are important to minimize sequelae. Evaluation should include plain roentgenograms and arthrography. Treatment should be conservative with open reduction reserved only for severe cases.
Selective Fibrinolysis for Acute Portal Vein Thrombosis in Infants
Authors: Dotter Charles T.
Published: December 2021

Acute portal vein thrombosis secondary to omphalitis or umbilical vein catheterization usually leads, years later, to death from the hemorrhagic consequences of portal hypertension. While the delayed manifestation, sometimes inaccurately referred to as "cavernous transformation of the portal vein," is therapeutically approached by surgical portosystemic shunting, results are dismal. A feasible, untried, therapeutic attack on the primary problem is now available in selective fibrinolysis of the acute portal vein thrombus. Streptokinase (or urokinase), given by catheter either into the superior mesenteric artery or via transhepatic portal vein catheterization directly into the fresh thrombus, could be expected to result in complete lysis within a matter of hours.
Effect of Aminophylline on Respiratory Center Activity and Metabolic Rate in Premature Infants With Idiopathic Apnea
Authors: Gerhardt Tilo , McCarthy Jeane , Bancalari Eduardo
Published: December 2021

The effects of aminophylline on the respiratory center output were studied in 14 premature infants with idiopathic apnea. The mean birth weight was 1,052 gm, and the mean gestational age was 30.2 weeks. These infants had a normal expired volume per minute (Ve) [291 ml/(min x kg)] and a normal esophageal pressure change per breath (4.5 cm H2O); however, their alveolar ventilation per minute (Va) was decreased [89 ml/(min x kg)], resulting in an elevated end-tidal PCO2 (PAco2) [47.8 mm Hg]. The reasons for the elevated PAco2 were the relatively large anatomical dead spaces (Vd) found in these infants (3.4 ml/kg), and a decreased slope of the CO2 response curve [22.2 ml/ (mm x kg x mm Hg PAco2)], with a shift of the curve to the right. Oxygen consumption was normal [7.0 ml/( min x kg)]. Forty-eight hours after initiating treatment with aminophylline (2 mg/kg of body weight every six hours), the incidence of apneic episodes decreased from 29.7 to 4.4 per 24 hours, Va and PAco2 became normal secondary to a 33% increase in esophageal pressure change per breath, and the position of the CO2 response curve showed a significant shift to the left without change in slope. Oxygen consumption increased 20% from basal value. These findings support the hypothesis that apnea in premature infants is related to an immature respiratory center characterized by a decreased output. Aminophylline probably increases respiratory center output by lowering the threshold of the central chemorecepter to CO2.
Immunofluorescence in Group B Streptococcal Infection and Idiopathic Respiratory Distress Syndrome
Authors: Pinnas Jacob L. , Strunk Robert C. , Fenton Lawrence J.
Published: December 2021

Immunofluorescence was perfornued on lungtissue obtained at necropsy from 18 newborn infants, including five with group B streptococcal (GBS) sepsis, seven with idiopathic respiratory distress syndrolne (IRDS), and six control infants who died from other causes. Deposits of C3, IgG, and fibrin were found within hyaline membranes of infants who died with GBS sepsis or IRDS within 48 hours after birth. In some cases, C4, factor B, and IgM were also observed. In five infants with IRDS who died more than five days after birth, immunofluorescent lung findings were less common and less intense. Hyaline membranes, attributed to mechanical ventilators and oxygen therapy in two infants who did not have GBS infection or IRDS, were negative for complement and immunoglobulimis although fibrin was detected in one specimen. These data suggest that immunologic processes may contribute to the pathogenesis of certain types of acute lung injury, particularly in infants who die from GBS infection or IRDS during the early neonatal period.
Anemia as a Criterion for Evaluation of a Special Supplemental Food Program for Women, Infants, and Children
Authors: Weiler Philip G. , Stalker H. Philip , Jennings Stephen W. , Fister Walter T.
Published: December 2021

The background and rationale of the Special Supplemental Food Program for Women, Infants, and Children (WIC) are reviewed. Problems concerning the implementation of the program and the need for evaluation are discussed. The authors selected anemia as a WIC program criterion to evaluate the effectiveness of the program. The reasons for this selection are discussed. The study involves the evaluation of 37 of 311 infants who were enrolled in the WIC program of a local health department. Hemoglobin values were observed at certification and recertification and the expected change vs the observed change in hemoglobin during the six-month period was calculated. In addition to observing change in hemoglobin values, a cost analysis was done. Results showed 27 out of 37 infants had a positive increase in hemoglobin levels. Eight of the 37 infants had a negative hemoglobin level, whereas two of the 37 had a zero change. It is concluded that anemia as a criterion for the WIC program is cost effective if certain considerations and modifications in the anemia criteria are made. It is also pointed out that paired hemoglobin determinations at two separate points and time is the best assessment for changes in hemoglobin levels.
THE BIGGER THE SYSTEM, THE NARROWER AND MORE SPECIALIZED THE INTERFACE WITH INDIVIDUALS
Authors: Gall John
Published: December 2021

In very large systems, the relationship is not with the individual at all but with his Social Security number, his driver's license, or some other paper phantom. In systems of medium size, some residual awareness of the individual may still persist. A hopeful indication was recently observed by the author in a medium-sized hospital. Taped to the wall of the nurses' station, just above the Vital Signs Remote Sensing Console, which enables the nurses to record whether the patient is breathing and even to take his pulse without actually going down the hall to see him, was the following hand-lettered reminder: THE CHART IS NOT THE PATIENT.

Unfortunately, this slogan, with its humanistic implications, turned out to be misleading. The nurses were neither attending nor making notations in the charts. They were in the hospital auditorium, taking a course in interdisciplinary function (Interdisciplinary function may be defined as the art of correlating one's own professional activities more and more with those of other professionals while actually doing less and less.)
Infant Strangulation in a Mesh Portable Crib
Authors: Sinal Sara H. , Stanton William A.
Published: December 2021

There has been a recent surge of interest in crib accidents in the pediatric literature.1.2 Safety standards have been established by the US Consumer Product Safety Commission (USCPSC) for the manufacture of all full-size and some portable cribs.3.4 We also have evaluated at our medical center a number of crib-associated accidents. One case of infant strangulation is of particular interest because it occurred with a caretaker in the room, and involved a mesh-type portable crib not covered by current safety standards4 (Consumer Product Safety Commission, personal communication, February 1978).

CASE REPORT

An 11-month-old white female was brought to the North Carolina Baptist Hospital Emergency Room by a rescue squad with the chief complaint of having "choked on a button."
Electrode Belt: A New Method for Long-Term Monitoring
Authors: Kelly Dorothy H. , O'Connell Kathleen , Shannon Daniel C.
Published: December 2021

Infants who have experienced an episode of prolonged sleep apnea associated with cyanosis, pallor, and limpness requiring vigorous stimulation or mouth-to-mouth resuscitation to restore breathing, are at risk of experiencing a recurrence that may result in death1.2. The American Academy of Pediatrics has recommended that such infants be treated by 24-hour surveillance either in the home or in the hospital. Electronic monitoring devices "may be useful adjuncts" to such surveillance.3 Since 1973, we have monitored 270 infants at home with apnea or cardiac monitors. A major problem with monitoring infants at home has been false alarms, such as alarms for apnea when the infant is breathing, on heart rate or apnea alarms due to a loose electrode.
Perioral Dermatitis From a Flavored Lip Balm
Authors: Tunnessen Walter W.
Published: December 2021

Intrigue with scents and odors of cosmetics and other medicaments occasionally has resulted in injury to the user. Frequently, the popularity of these products is enhanced by fadism and eye-catching advertising. One recent fad is Bonne Bell Lip-Smackers, large, attractively packaged, semisolid sticks available in multiple flavors and marketed to protect the lips from sunburn and chapping. The case of an 11-year-old girl with a dermatitis of four months' duration is presented to illustrate the insidious nature of sensitivity to this product.

CASE REPORT

An 11-year-old girl with an unremarkable medical history had swelling, erythema, and irritation of the lips in mid-January.
Physical Growth in Phenylketonuria: I. A Retrospective Study
Authors: Holm Vanja A. , Knox W. Eugene
Published: December 2021

A retrospective cross-sectional survey of phenylketonuria (PKU) was conducted in 1967. Questionnaires on 693 patients, clinically thought to have PKU, were reanalyzed to obtain information on growth in height and head circumference in patients with untreated and previously treated PKU. To provide a comparison to the growth findings of the Collaborative PKU Study, a definition of PKU was adopted to correspond to the one used in that study. Stature in 232 outpatients with untreated PKU was normal but, in 31 institutionalized individuals, the mean height was —1.4 standard deviations below the mean of a normal population. Head circumference in patients with untreated PKU was normal at birth, but showed an increasingly negative deviance with age and was —1.4 SD in untreated adults. Height measurements of 135 children with PKU in whom treatment was started before 121 days of age (age chosen to coincide with criteria for the Collaborative Study) had a significant reduction in height growth, —.8 SD. Head circumference measurements of 115 children treated for PKU were —.7 SD of normal. The depression in head circumference was less in treated subjects with PKU than in untreated ones of the same age. These findings are corroborated by a review of the literature, which contains no convincing report of normal growth during treatment of PKU.
LEARNING HOW TO THINK
Authors: Adams V.
Published: December 2021

Once they've learned how expert thinkers think, how do scientists teach what they've learned to novices? Certainly not by lecturing. "During a lecture," said Robert E. Spanks of Washington University in St. Louis, Mo., "the only mind working at reasonable efficiency is that of the lecturer." That is why cognitive scientists require students to take an active part in learning how to think. "The origins of this ‘new’ view are quite old," Dr. Lochhead observed, and he quoted Galileo: "You cannot teach a man anything; you can only help him to find it within himself."
Cloprednol Therapy in Steroid-Dependent Asthma
Authors: Shapiro Gail G. , Tattoni Diana S. , Kelley Vincent C. , Pierson William E. , Dorsett Carol S. , Bierman C. Warren
Published: December 2021

Cloprednol is a new oral corticosteroid with a short half-life that is presently under investigation for use in asthma. Seventeen steroid-dependent children and adolescents were switched from daily treatment with prednisone to cloprednol for a one-year study. Patients showed a statistically cally significant improvement in symptoms while receiving cloprednol therapy. Two patients had extraordinarily good responses. Growth trends, bone age, and chest roentgenograms were not remarkably changed by cloprednol. Pulmonary function was stable. There was a significant improvement in fasting morning cortisol levels and ability to respond to metyrapone and adrenocorticotropic hormone (ACTH) challenge. Cloprednol appears to be a promising drug for steroid-dependent patients who require oral corticosteroid therapy.
Long-Term Use of Propranolol, Ibuprofen, and Spironolactone in the Management of Bartter's Syndrome
Authors: Cunningham Robert J. , Brouhard Ben H. , Berger Michael , Petrusick Tom , Travis Luther B.
Published: December 2021

This report concerns two patients wter'sth Barter's syndrome who were treated with propranolol, spironolactone, and potassium supplements. When ibuprofen was added to this regimen, potassium supplements were no longer required. In both patients, plasma renin activity decreased, plasma volumes increased, and a "catch-up" in linear growth ensued. This report confirms others that indicate prostaglandin synthetase inhibitors are a useful adjunct in the therapy of Bartter's syndrome.
Left Atrial Myxoma: Association With Acute Coronary Embolization in an 11-Year-Old Boy
Authors: Tanabe Junichi , Williams Robert L. , Diethrich Edward B.
Published: December 2021

An 11-year-old boy had clinical signs of an acute inferior wall myocardial infarction. On echocardiography, a left atrial myzoma was demonstrated. Coronary artery embolization from myzoma was confirmed by selective coronary arteriography. The tumor was removed 12 days after acute coronary embolization. The clinical value of echocardiography is demonstrated in this report of a successful surgical excision of left atrial myzoma in a child with a niyocardial infarction due to tumor embolization.
The Mechanism of Pulsus Paradoxus
Authors: Morin David P.
Published: December 2021

In their excellent study correlating the severity of asthmatic symptoms and degree of pulsus paradoxus (Pediatrics 61:46, January 1978), Dr. Galant and his colleagues state that pulsus paradoxus "is thought to be caused by hyperinflation of the lung with mediastinal stretching which produces an increased intrapulmonary pressure. This impedes venous return to the heart as well as leading to cardiac compression, consequently decreasing cardiac output." There is much experimental and clinical evidence favoring an alternative explanation.
Liver Replacement for Pediatric Patients
Authors: Starzl Thomas E. , Koep Lawrence J. , Schröter Gerhard P.J. , Halgrimson Charles G. , Porter Kendrick A. , Weil Richard
Published: December 2021

Between March 1963 and January 1978, 74 patients 18 years of age or younger have had liver replacements at the University of Colorado Medical Center, Denver. The most common cause of native liver failure was biliary atresia (48/74, 65%); the second most common cause was chronic aggressive hepatitis (12/74, 16%). Twenty-nine patients (39%) lived for at least one year, and 16 are still alive one to nine years after transplantation. Technical surgical problems, rejection, and infection were the main causes of death. Improved immunosuppression is needed; nevertheless, the quality of life in the long-term survivors has encouraged continuation of this difficult work.
Renal Anomalies in Fetal Alcohol Syndrome
Authors: Qazi Qutub , Masakawa Akiko , Milman Doris , McGann Barbara , Chua Albina , Haller Jack
Published: December 2021

Six patients with fetal alcohol syndrome were found to have developmental abnormalities of the kidney. In only one patient was investigation for renal pathology made in the absence of clinical indication. Two had palpable masses in the left upper quadrant, one had pyelonephritis, one had painless hematuria, and the fifth patient had symptomatology suggestive of renal failure. Although the renal pathology was not of the same type in all cases, it is of interest that four patients had either unilateral or bilateral renal hypoplasia.
Conotruncal Malformation Complex: Examples of Possible Monogenic Inheritance
Authors: Miller Marvin E. , Smith David W.
Published: December 2021

Two families are described in which there is possible monogenic inheritance of congenital cardiac defects within the spectrum of faulty conotruncal septation (CTS). Evidence for a genetic control of conotruncal septation arises from genetic and embryologic studies of similar defects in the Keeshond dog model, the excess of sibship pairs with conotruncal septation defects in sibship pairs with congenital heart disease, and previously reported pedigrees of families with multiple affected individuals with conotruncal septation defects. It is suggested that in the small number of cases of congenital cardiac defects in which there is a strong family history for CTS defects, a higher recurrence risk should be considered rather than the usual polygenic recurrence risk of 3% that is usually given in such situations.
The Influence of Funding on the Future of Pediatric Nurse Practitioner Programs
Authors: Kahn Lawrence
Published: December 2021

Current funding sources threaten the future position of PNPs as providers of primary care. Most nurse practitioner programs of all disciplines including pediatrics rely for funds on the Division of Nursing, Bureau of Health Manpower, Department of Health, Education and Welfare. These funds are sufficient only for about half of currently operational programs and other sources of financing are not adequate to support the remainder. Another factor affecting the future of such programs is the trend to modify the preparation of the nurse practitioner from the clinically centered continuing education format to that based in schools of nursing and directed toward the MS degree. This is against the fundamental philosophy of the training of the PNP and will lead to diminishing participation of pediatricians in training programs.

Unless there is evidence to show that the shift to graduate type education is fundamental to the competence of the nurse practitioner, the enthusiastic nurse who chooses to extend her professional skills should be allowed to do so without limiting this activity only to those who seek advanced academic degrees.
The Future of Pediatric Nurse Practitioners
Authors: Ford Loretta C.
Published: December 2021

Kahn's article, "The Influence of Funding on the Future of Nurse Practitioner Programs" (p 106) presents the thesis that despite the effectiveness of and the need for nurse prcb actitioners, future programs are in jeopardy because funding sources are inadequate and, further, that the trend to prepare nurse practitioners at the master's level will discourage physician participation to the detriment of the program. I share some of Kahn's concerns on the former issue and challenge him on the latter. My response to Kahn's work, focusing first on the latter issue, offers information and opinion on historic, academic, and professional dimensions of the discussion; clarifies some misconceptions of the nurse practitioner movement and nursing education; and raises questions about the future.
Chlamydial Pneumonia of Infancy vs Wilson-Mikity Syndrome
Authors: Oetgen William J.
Published: December 2021

Tipple et al clearly delinate the clinical features and treatment of chlamydial pneumonia of infancy in Pediatrics, February 1979.1,2 They also point out the similarity between this disease and an entity called pertussoid eosinophilic pneumonia first described in 19413 and more recently in 1977.4

It is further worth noting that the clinical features of chlamydial pneumonia of infancy (ie, gradual onset of cough, tachypnea, and rales in a 1-to 3-month-old infant who is afebrile and whose chest x-ray shows interstitial infiltrates and hyperexpansion) are virtually identical with the findings on five infants described by Wilson and Mikity in 1965.5
Are Follow-up X-rays Necessary
Authors: Smith Wilbur L.
Published: December 2021

Grossman, Wald, Nair, and Papiez have reported an interesting study on roentgenographic follow-up of acute pneumonia (Pediatrics 63:30, 1979). Their data suggest that routine follow-up radiographs are not reliably normal until six weeks to three months after initial diagnosis despite the patient's clinical improvement. Their emphasis on not radiographing a clinically well pediatric patient until a significant time interval after onset of disease is certainly reasonable.

From this data base they go on, however, to recommend that routine follow-up radiographs in pneumonia patients are only needed if clinical symptoms persist.
Recurrent Abdominal Pain in Children: Lactose and Sucrose Intolerance, A Prospective Study
Authors: Liebman William M.
Published: December 2021

Thirty-eight consecutive children with recurrent abdominal pain underwent lactose tolerance tests; 28 of these were also given sucrose tolerance tests. Abdominal pain and abnormal lactose tolerance tests were noted in 11 of 38, while none of the 28 had an abnormal sucrose tolerance test; however, 1 had abdominal pain. Elimination diet for 4 weeks produced significant or total pain relief in 10 of 11 (lactose free) and 0 of 1 children (sucrose free). Lactose intolerance seems to play a contributory role in recurrent abdominal pain in children, while sucrose intolerance does not.
Evidence for Hypertyraminemia in Reye's Syndrome
Authors: Faraj Bahjat A. , Newman Stephen L. , Caplan Daniel B. , Ali Farouk M. , Camp Vernon M. , Ahmann Peter A.
Published: December 2021

Utilizing a specific and sensitive radioimmunoassay, plasma and urine tyramine were measured in 14 consecutive patients with liver biopsy-proven Reye's syndrome. Plasma tyrosine was measured in 11 of these patients. The results revealed significant (P < .003) elevation in plasma (3.4 ± .52 ng/ml) (mean ± SEM) and urine (1.00 ± .26 mg/24 hr) tyramine as well as plasma tyrosine (204 ± 52.5 µmole/liter) at the onset of the disease when compared to the levels of tyramine and tyrosine in a group of hospitalized patients without hepatic disorders. Furthermore, there was a positive correlation between plasma tyramine and days in coma (r = .86; P < .001), and between plasma tyramine and tyrosine (r = 0.80; P < .001). These data suggest that there is a substantial disturbance of tyrosine metabolism in Reye's syndrome and that the accumulation of this amino acid and its metabolite, tyramine, may contribute to the encephalopathy of this disease.
Pneumococcal Bacteremia in Infants and Children: A Ten-Year Experience at the Cook County Hospital with Special Reference to the Pneumococcal Serotypes Isolated
Authors: Jacobs Norman M. , Lerdkachornsuk Somchitt , Metzger William I.
Published: December 2021

In a ten-year period we identified 305 hospitalized children with a pneumococcal bacteremia. From these children 293 pneumococcal isolates were serotyped, and 90% belonged to a group of 11 "prevalent serotypes." These 11 serotypes were the prevalent serotypes isolated from children in all disease categories, as well as from children with sickle-cell disease. No more than 1% of the isolates belonged to any one of the other serotypes. A pneumococcal vaccine effective against these 11 prevalent serotypes should be optimal for use in children. Our highest case fatality rates were noted in children with meningitis (13%) and children with sickle-cell disease (20%). A polysaccharide pneumococcal vaccine might not have prevented most of our pneumococcal meningitis, as 80% of these children were less than 1 year old, an age when polysaccharide vaccines are poor antigens. On the other hand, many of our children with sickle-cell disease acquired their pneumococcal bacteremia at an older age and should have benefitted from such a vaccine.
Overwhelming Infection with Group B β-Hemolytic Streptococcus Associated with Circumcision
Authors: Cleary Thomas G. , Kohl Steve
Published: December 2021

The lack of valid medical indications has caused routine neonatal circumcision to fall into disrepute in recent years.1-3 However, despite the substantial arguments against continuation of this therapy, it still ranks as one of the most common surgical procedures.3,4

Significant infection is rarely solely attributed to circumcision because a clear-cut cause and effect relationship is difficult to establish. There have been reports5-7 of newborns who have been circumcised and then developed life-threatening infection within several days of this procedure. However, the fact that in these infants infection has occurred at an age when the incidence of infection is high due to other factors complicates interpretation of these reports.
WHAT TO EAT
Authors: Barness L.
Published: December 2021

Given the Babel of information and misinformation, the question emerges: Is there a rational method to decide what to eat? To seek an answer, we must go back to a two-hundred-year-old idea that is usually referred to as "La Place's Principle of Insufficient Reason" and states that events are to be assigned equal probabilities if there is no reason to think otherwise. E. T. Jaynes has recently extended the principle to state use that "in making inferences on the basis of partial information, we must use that probability distribution that has the maximum (informational) entropy . . . maximally noncommital with regard to missing information subject to what is known." Without going into a detailed computer program, we can infer that the most rational aliment will be obtained by fulfilling known nutrient requirements, minimizing intake of proven toxic substances, and randomizing everything else. In other words, the most variable diet that fulfills known constraints is the diet of choice. The clue is variation: use different foods, change brands frequently, and never use the same recipe twice. Bring on the escargot, candied grasshoppers, roast guinea pig, alfalfa sprouts, macadamia nuts, falafel, turnip greens, squid, mare's milk, and seaweed salad. Minimize the intake of packaged foods, since they contain additives of unknown toxicity, and where they are unavoidable, keep varying the suppliers according to additives.
TEENAGE PREGNANCY: WHY THE EPIDEMIC?
Authors: Scharf Kathleen Rudd
Published: December 2021

It is the age of the Pill, yet over a million American teenagers will get pregnant this year. About 600,000 of these young women will give birth . . . . In the 1950s, of course, contraception was illegal in many states even for married adults . . . . By the mid-1960s, contraceptive services were available to some resourceful adolescents, and residents of a few states could obtain reasonably inexpensive legal abortions—though the popular press still shied away from passing along information about either one. Court decisions in the 1970s have made contraception and abortion even more widely available. Now, about 400,000 teenage girls have abortions each year. But of the 600,000 teenagers who give birth, a staggering 94% keep their children. More than a third of these young mothers do not marry. Many are struggling with medical, social, and economic problems. The teenage pregnancy epidemic of the 1970s turns out to be more of a teenage baby-keeping epidemic.
Bilirubin Binding Tests: Living Up to Expectations?
Authors: Gitzelmann-Cumarasamy Nilou , Kuenzle Clive C.
Published: December 2021

In the management of jaundiced infants, the pediatrician is often confronted with the dilemma of whether or not to perform an exchange transfusion. Following the report,1 in 1952, that in infants with erythroblastosis fetalis kernicterus was frequent when total serum bilirubin concentrations exceeded 30 mg/dl but rare when less than 20 mg/dl, it became standard practice to perform an exchange transfusion upon elevation of serum bilirubin concentrations above 20 mg/dl. However, bilirubin encephalopathy has since been observed at serum bilirubin concentrations well below this critical level, ranging down to 9.4 to 14.0 mg/dl in sick, low birth weight premature infants.2-6