bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Pure Red Cell Hypoplasia in Identical Twins
Authors: Waterkotte G. W. , McElfresh A. E.
Published: December 2021

Congenital aregenerative anemia is a relatively uncommon disease first described by Blackfan and Diamond in the late 1930s.1 The condition usually begins in early infancy as a normochromic, normocytic anemia with decreased red cell precursors in the bone marrow and normal numbers of thrombocytes and leukocytes. With the exception of a few patients undergoing spontaneous remission, patients required repeated transfusions until steroids became available.

Over the past forty years several hundred cases of this disease have been reported with speculation regarding the etiology. Occasional families have been described with two or three involved members, suggesting genetic transmission. We have recently observed a set of twins with the uncommon disease.
An Alternate Method of Managing the Hyperactive Child
Authors: Crook William C.
Published: December 2021

I'm writing to report an alternate method of managing the hyperactive child which has received scant notice in the medical literature: dietary manipulation with the avoidance of foods which appear to cause adverse reactions in the nervous system.

As long ago as 1923, a Minnesota pediatrician, Shannon,1 told of seven children whose fretfulness, restlessness and irritability dramatically improved when one or more foods were removed from their diets. And when the foods were added back, the symptoms returned.
The Effects of Pressurized Isoproterenol and Salbutamol in Asthmatic Children
Authors: Murray A. B. , Hardwick D. F. , Pirie G. E. , Fraser B. M.
Published: December 2021

The effects of inhaling 250µg of isoproterenol, 200µg of salbutamol, or water mist were studied in 58 asthmatic children. While a highly significant increase in mean FEV1 occurred after both medications, several individual cases failed to respond: a poor response was most often seen in those with a low initial FEV1. After isoproterenol there was a significant correlation between FEV1 and increase in heart rate, and a highly significant correlation between increase in FEV1 and a fall in Po2. No significant change in heart rate or in Po2 occurred after either salbutamol or water. It is concluded, first, that both bronchodilator aerosols in recommended dose are effective in some cases of asthma but not in others, particularly severe ones; secondly, if a patient is able to inhale a full recommended dose of isoproterenol tachycardia is likely to result; and thirdly that a fall in blood oxygen tension may be expected if isoproterenol-induced bronchodilatation occurs.
Statement on Reye's Syndrome
Authors: Katz Samuel L.
Published: December 2021

At its meeting in Washington, D.C., on April 29, 1974, the Committee on Infectious Diseases and representatives of FDA and CDC reviewed this year's (1973-1974) experiences with Reye's syndrome. It is clear that a definite increase in this disease occurred in the United States and that this increase bore a temporal and geographic relation to outbreaks of influenza due to strains of inuenza virus B. Outbreaks of influenza overseas may not have been associated with the syndrome. A small percentage of U.S. cases was associated with other infections, including influenza A and vanicella. Although epidemiologically associated in many instances, a direct cause and effect relationship between influenza B infection and Reye's syndrome has not been established. Pathogenesis of the syndrome remains unclear. Therefore, immunization with influenza B vaccine in an effort to prevent Reye's syndrome is without established basis.

The Center for Disease Control is maintaining continuous epidemiologic surveillance of the syndrome. The Committee on Infectious Diseases urges full cooperation with this effort, as follows: (1) All cases meeting the usual diagnostic criteria (encephalopathy plus liver abnormalities, most often an SGOT twice normal or greater, without other obvious explanation) should be reported to the Viral Diseases Branch, Center for Disease Control, Atlanta, Georgia 30333, either directly or through the state health department. (2) As much pertinent clinical and laboratory data as is consistent with good patient care should be collected and recorded for later transmission to the CDC if requested. Particular attention should be paid to exposure to toxic substances on drugs such as ASA.
Lettrt To The Editor
Authors: Rapkin Richard H.
Published: December 2021

Dr. Vogel has, I believe, missed a major point of my discussion.

The child with a positive blood culture needs to be reassessed for meningitis. The meningitis may be subclinical and may develop after an initial negative lumbar puncture, as is demonstrated in cases 4 and 5.

I believe that when a child has a positive blood culture a lumbar puncture should be done. I believe this is important whether or not the child has had a recent negative lumbar puncture and whether or not he has central nervous system symptoms or signs.
How much reading?
Authors: Snyder Russell D.
Published: December 2021

Many therapies have been recommended for remediation of learning disabilities. Elsewhere in this issue of Pediatrics, Silver1 presents a timely review of current methods of remediation with comments on their effectiveness which provides a valuable reference source for the physician dealing with learning-disabled children. A learning disability is an unexpected school failure in a circumscribed area of performance. The child must have relatively normal intelligence and willingness to learn. A cognitive deficit is presumed. If the child's problem involves reading, a selective reading disability exists. Selective disabilities occur in other areas such as arithmetic, art, and physical education, although these disabilities are seldom brought to clinical attention.
Questions Regarding the Diagnosis of Sarcoidosis
Authors: Pickering Larry K.
Published: December 2021

The article by Kendig1 reviewing 33 patients assumed to illustrate the clinical picture of sarcoidosis deserves comment. Kendig lumps together a group of children under the diagnosis of sarcoidosis made on the basis of conventional, clinical, roentgenographic, and peripheral biopsy data compatable with this diagnosis. Sarcoidosis is difficult to define and protean in its manifestations and simulates many disease entities such as tuberculosis, fungal infection, leprosy, syphilis, berylliosis, silicosis, tumor, and foreign bodies.

Kent et al.2 reported 27 to 33 patients (82%) with clinical, roentgenographics, and histologic manifestations of sarcoidosis on biopsy of peripheral tissues who were found to be misdiagnosed when studied further.
China—lessons for the United States
Authors: Arena Jay
Published: December 2021

Even a short sojourn in China shows conclusively that China is changing. Yet, in a larger sense, China is also changeless, being too immense, too diverse, too complex, too civilized, too world-weary for any regime to tear up the past by the roots and start all over again. In China, if the peaks of privilege have been laid low, so also the valleys of poverty and disease have been filled.

Very few Chinese regard themselves as poor, although they have little in the way of material goods. The Chinese have a rich cultural life; they are articulate; they use their leisure time profitably; they have a clear understanding of where they want to go—and how they are going to get there.
Answers to Saintly Diseases
Authors: C. T. E.
Published: December 2021

Answers to saintly diseases. Pediatrics, 54:683, 1974. St. Blaize's disease should be spelled Quinsy.
Nocardiosis in Children: Report of Three Cases and Review of the Literature
Authors: Idriss Ziad H. , Cunningham Robert J. , Wilfert Catherine M.
Published: December 2021

The clinical illnesses observed in three adolescents with Nocardia asteroides infection are described. The organism has been classified as a bacterium and placed in the Actinomycetaceae family. Sulfonamides remain the first choice for chemotherapy but alternative drugs are available and may be essential in successful therapy. Nocardial infections in children indicate the need for evaluation for an underlying immunological deficiency. Nocardia species should be considered as possible causative agents in immunocompromised patients with infection.
Fatal Chloroquine Poisoning in a Child: Experience With Peritoneal Dialysis
Authors: McCann William P. , Permisohn Robert , Palmisano P. A.
Published: December 2021

Chloroquine overdose is commonly fatal in children.1 We report here such a case in which peritoneal dialysis was tried. Analyses of tissues, serum, urine, and dialysate for chloroquine confirmed the diagnosis and indicated that little of this drug was removed from the body by dialysis.

CASE REPORT

A healthy 28-month-old black boy weighing 17.17 kg was seen holding two 500-mg chloroquine diphosphate (Aralen) tablets from a relative's purse about 3:30 PM one afternoon. One-half hour later he was found unconscious and was brought to the Children's Hospital, arriving at 5 PM apneic and with fixed, dilated pupils. It was stated that breathing stopped just before arrival.
Child Care in the People's Republic of China: 1973
Authors: Wray Joe D.
Published: December 2021

The enthusiastic accounts of remarkable and widespread improvements in health care in the People's Republic of China (PRC) provided by recent visitors there have been provocative, to say the least. For everyone familiar with, and concerned about, the problems of providing decent health care and adequate nutrition to the millions of preschool children in developing countries throughout the world, the Chinese approach to such problems is of interest. After many years of teaching pediatrics or community pediatrics in developing countries and many opportunities to examine child care problems in other such countries, my own interest was particularly great.

Thus, an invitation to join the American Early Childhood Development Delegation for a threeweek visit to the PRC in late 1973 came as an unexpected and altogether delightful surprise. The Delegation were guests of the government of the PRC from November 15 to December 6, 1973. In response to requests submitted earlier by the Delegation, our hosts provided an extensive itinerary that included a variety of child care facilities but focused on nursery schools and kindergartens. We visited such facilities in and around four cities, Canton, Peking, Sian, and Shanghai-in urban neighborhoods, old and new, in factories, and in rural communes. As the only physician in the Delegation, I was assigned the primary responsibility for observing and investigating the health and nutritional aspects of child care. Our hosts arranged interviews with those responsible for health care in the nurseries and kindergartens visited, where there were often full-time health personnel. In addition, I visited a variety of neighborhood and district health centers and hospitals in urban areas, factories, and communes.
Medication for Hyperkinetic Children
Authors: Kugel Robert B. , Scherz Robert G. , Seidel Henry M. , McMahon Jean L. , Rinker Andrew , Garell Dale C. , Van Gelder David W. , Ellis Effie O. , Knutti Sarah H. , Poncher John R.
Published: December 2021

One must be cognizant of the fact that there is probably more confusion in relation to diagnosis and appropriate criteria for the use of medication for the treatment of hyperkinetic children than there is regarding the choice of medication. Many physicians, as well as the general public, do not truly appreciate the differential diagnosis of the overactive child. The symptoms may be an expression of basic personality, anxiety, subclinical seizure disorders, strictly in the eyes of the beholder, or true hyperkinesis; the latter is the only condition in which stimulants might be expected to be beneficial.

The use of drug therapy in the management of the hyperkinetic child does not differ appreciably from drug therapy in other treatable maladies. In both instances prescription drugs should be prescribed only by appropriately licensed physicians. Although the screening of patients may frequently be done by other disciplines, the ultimate selection of patients remains the responsibility of the prescribing physician. Rarely is hyperkinesis an isolated symptom. Hopefully, the selection of the drug to be used is based on such factors as history and physical examinations with appropriate emphases and the weighing of risks (that is, the ramifications of the untreated patient versus side effects and long-term sequelae of medication). A satisfactory means of evaluating the effects of therapy and periodic reevaluations (follow-up) should be included.

Whatever the diagnostic nomenclature, the "indications" depend largely on clinical acumen rather than pathognomonic findings. There is some agreement about the indications for the clinical use of stimulant drugs for hyperkinetic children even though there must be a trial on the medication before its efficacy can be determined for a particular child.
Lettrt To The Editor
Authors: Soule A. Bradley
Published: December 2021

The authors appreciate the points raised by Dr. Manniello. Our findings have indeed corroborated those of other workers who have demonstrated how fluctuations in infant behaviors are sensitive reflections of a vast number of perinatal factors.

While Brazelton's Neonatal Assessment was an early indicator of (impending) withdrawal, we do not feel we were in a position to forecast one week hence with our limited sample.
PUNISHMENT AND REFORMATION
Authors: Shaw G. B.
Published: December 2021

To punish a man you must injure him: to reform a man you must improve him; and men are not improved by injuries.
The Modification of Pediatrician Activity Following the Addition of the Pediatric Nurse Practitioner to the Ambulatory Care Setting: A Time-and-Motion Study
Authors: Kahn Lawrence , Wirth Patricia
Published: December 2021

Time-and-motion studies were performed before and after PNPs began working in the offices of three pediatricians and the emergency room of a municipal general hospital. Pediatricians' activities changed in different ways, but all benefited by the generation of available time. The three pediatricians in office settings gained the equivalents of 21.6%, 21.7%, and 36% of the working day by the addition of the PNP. Physicians working in the emergency room gained 14.7% during that time of day the PNP was present. PNP visits with patients were longer than those of the pediatricians, the average length of time being related directly to that of the associate physician. Patients interviewed perceived no difference in personal characteristics between pediatricians and PNPs in three of the four settings. In the fourth setting, both were at high levels, but the pediatrician ranked higher than the PNP.
The Case of the New Family Physician and the Practicing Pediatrician in Delivery of Health Care for Children in Canada
Authors: McKendry J. B.J.
Published: December 2021

The College of Family Physicians of Canada has evolved a firm philosophy of its new image. The medical school graduate of the future will enter a two-year program partly hospital-based and partly community clinic-or private office-based to develop the adequate skills necessary to render primary care in internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and trauma, with a continual infusion of knowledge related to the psychosocial dynamics of family life. This new physician will require the services of the social worker, the public health nurse, the school nurse, the psychologist, the family counsellor and the psychiatrist.
Assumptions on Battering Questioned
Authors: Stover William H.
Published: December 2021

In their recent review of the battered child syndrome in Pediatrics,1 Lauer et al. conclude that "minority children were less likely to be abused than whites." This statement's validity, however, depends on an unstated, unproved, and unlikely assumption that the rates of hospitalization of whites and nonwhites for all causes but battering are equal. An increased incidence of hospitalization for other illnesses would, in effect, "dilute" the number of battered children, so that battering would in actuality occur in a smaller percentage of admissions, while the incidence among the general minority population could be the same as in white populations, as noted in previous studies.
Encopresis, soiling, constipation: What's to be done?
Authors: Fitzgerald Joseph F.
Published: December 2021

Though a frequent problem with a tremendous negative impact on the family as well as the child, fecal incontinence has received little attention in the pediatric literature. Levine's study of the natural history of children with encopresis in this issue of Pediatrics is, therefore, a welcome contribution. Encopresis is defined as incontinence of feces not due to organic defect or illness. Mercer preferred to define encopresis as the voluntary or involuntary passage of an ordinary bowel movement into the clothing, and soiling as the constant involuntary seepage of feces associated with impaction. He reported that the former was rare in his experience.
Neonatal Intracranial Hemorrhage in Premature Infants
Authors: Deonna Thierry , Payot Maurice , Probst Alphonse , Prod'hom Louis-Samuel
Published: December 2021

Since the advent of modern methods of neonatal care, intracranial hemorrhage in premature infants, which is usually intraventricular, is probably not as uniformly fatal as generally admitted and the survivors are likely to develop post-hemorrhagic hydrocephalus.

This paper is a retrospective study of 11 premature babies born between 1968 and 1972 and diagnosed as haying hydrocephalus secondary to neonatal intracranial hemorrhage. Nine of these are still alive and two have died, one at 3 and one at 17 months of age. Eight underwent permanant surgical drainage of hydrocephalus.

The perinatal history, laboratory data, clinical evolution, and neurological outcome were studied. Two groups of infants were identified: those with signs of acute neurological deterioration in the neonatal period who had the most severe neurological sequellae (in four cases, periventricular lesions in addition to hydrocephalus were seen on the air study and in one case confirmed at autopsy) and those showing no obvious neurological signs in the neonatal period. Of this latter group, two appear to be developing normally. The therapeutic implications of the findings are discussed.
Dr. Gerrard Replies
Authors: Gerrard J. W.
Published: December 2021

I am very grateful to Dr. Call for drawing my attention to the work of Campbell1 and his colleagues, and for emphasizing that it is not enough to pay lip service to breast-feeding, but that action is needed.

I was aware of Campbell's work, but did not refer to it in my review, believing that some readers might feel that I was overstating the case. In this context it should be added that the breast provides an additional contribution to the immune status of the baby, for colostrum and breast milk contain white cells, mainly mononuclears, numbering from 1,500 to 4,000/cu mm.2
Intravenous Scalp Needle for Use in Premature Infants
Authors: Taeusch H. William , Heafitz Lesley B.
Published: December 2021

The recent commentary by Heird and Driscoll1 points out their difficulty of continuously running peripheral; intravenous infusions (IV) on small premature infants. They indicate that the success achieved by Cashore et al.2 using total, or near total, peripheral intravenous nutrition may not be easily obtained by others less able to maintain peripheral IVs around the clock. No doubt Cashore et al. were able to maintain peripheral IVs better than many because their use of Intralipid eliminates the need for very hyperosmotic infusates of dextrose.
A first priority–Childhood automobile safety
Authors: Reichelderfer Thomas E.
Published: December 2021

Pediatricians are well acquainted with the fact that accidents are the leading cause of death in children after the first year of life, and that the automobile causes more deaths than all other accidental causes combined. During the last 20 years, while the death rates from infectious diseases and other causes have shown a marked decline, death rates from accidents, in children under 4 years of age, have remained unchanged. It is all too apparent that vigorous action among those providing medical care for children must now be directed to the prevention of accidental death and injury, particularly from the automobile.
Learning Disabilities: An Office Approach
Authors: Denhoff Eric
Published: December 2021

The pediatrician has an important contributing role in the problems associated with learning disabilities, but often does not know how to capitalize on his strengths. He knows the child and family intimately, and parents will listen to him for guidance and direction. He can rule out disease and point to areas of inefficient development which contribute to the frustration of both child and teachers. He can provide a comprehensive assessment under his supervision. He can offer specifics in management, and he can be an advocate by offering to provide guidance and direction. With the physician as the advocate, parents will come away with the feeling that someone cares what happens, and that the pediatrician, knowing the local scholastic, political, and legislative situation, can guide them more directly to obtain the proper help for their learning-disabled child.
Temporary Aphasia as a Complication of Mycoplasma Infection
Authors: Guobrandsson Björn
Published: December 2021

In late 1974, there were an increased number of Mycoplasma infections in Iceland. Usually these are mild and go undetected as atypical pneumonias, but occasionally they are severe, with prolonged fever and breathing difficulties, as shown in the following report.

T. M., a 5-year-old boy, was admitted to St. Joseph's Hospital, Reykjavik, Iceland, on November 11, 1974. He had had high fever for two weeks, with pneumonia. In spite of ampicillin therapy, his fever stayed high, and on admission he was quite sick.
Use of Homologous Platelet Survival in the Differential Diagnosis of Chronic Thrombocytopenia in Childhood
Authors: Buchanan George R. , Scher Charles S. , Button Lawrence N. , Nathan David G.
Published: December 2021

Twenty-one children with chronic thrombocytopenia of obscure etiology, 19 of whom had normal numbers of bone marrow megakaryocytes, were evaluated in order to determine if factors extrinsic to the platelets themselves (presumably antibodies) caused the thrombocytopenia. The rapid destruction of platelets by such antibodies has been demonstrated to cause idiopathic thrombocytopenic purpura (ITP). History, physical examination, and routine laboratory studies were unable to provide an exact diagnosis in these patients. Measurement of platelet survival, using sodium chromate Cr 51 labeled homologous platelets obtained from unrelated donors, permitted a clear separation of these children into two groups. One group (11 patients) had a markedly shortened platelet life span, and was considered to have chronic ITP. The other group (10 patients) had a normal or only slightly reduced platelet life span. Thus, the destruction of platelets by extrinsic factors could be ruled out. Since the diagnosis of chronic ITP was excluded, splenectomy could be avoided in these patients since it is rarely useful in children with nonimmune forms of chronic thrombocytopenia. Homologous platelet survival measurement is a useful diagnostic tool in certain children with chronic thrombocytopenia.
The Determination of Aspirin Levels in the Presence of Hyperbilirubinemia
Authors: Fenton Lawrence J. , Beresford Mary E. , Keenan William J.
Published: December 2021

Many major medical centers are presently utilizing a shortened method (Keller) for determining serum aspirin levels which does not remove interfering compounds. This report documents that the presence of even 1 mg of bilirubin/dl of serum is sufficient to cause a falsely high aspirin level. It is suggested that any method for determining serum bilirubin which does not remove interfering substances constitutes a danger to many groups of patients and should be discontinued.
Relation Between Arterial Blood Pressure and Blood Volume and Effect of Infused Albumin in Sick Preterm Infants
Authors: Barr Peter A. , Bailey Penrhyn E. , Sumners James , Cassady George
Published: December 2021

The relation between directly measured arterial blood pressure and blood volume was studied in 61 sick preterm infants. Mean blood volume (derived from plasma volume [T1824 ten-minute albumin space] and hematocrit value) of 26 hypotensive infants (89.1 ± 17.26 ml/kg) was not significantly different from that of 35 normotensive, but otherwise comparable, infants (91.4 ± 14.57 ml/kg). There was no relation between arterial mean blood pressure and blood volume.

Twenty-one infants with arterial mean blood pressure less than 30 mm Hg were given 1.0 g/kg of 10% salt-poor albumin. Significant increases in blood pressure occurred but were small in magnitude; more than one half of infants had arterial mean blood pressures persistently less than 30 mm Hg. Arterial/alveolar Po2 ratio decreased significantly with albumin infusion in six infants with hyaline membrane disease not receiving continuous distending-airway pressure, suggesting an association between infused albumin and impaired oxygen exchange.
Enuresis: Focus on a challenging problem in primary care
Authors: Starfield Barbara
Published: December 2021

Enuresis is the most common chronic condition seen in general pediatric practice. Current medical literature contains more articles about entiresis than about infantile diarrhea or child abuse, and approximately the same number as are written about childhood malnutrition or infant nutrition. Enuresis is encountered in all societies. When I visited the Peoples' Republic of China, I encountered in every outpatient clinic at least one child, supine and sporting an acupuncture needle 7.6 cm(3 in) below the umbilicus. Physicians with whom I spoke said the rate of cure was "about 40% with most others improved," which is similar to the cure rate in the United States.
Estrogen Treatment of Teenage Girls in the United States: Description of the Treated Population
Authors: Rooks Judith Bourne
Published: December 2021

It is estimated that each year approximately 20% of all 15- to 19-year-old American girls receive estrogens in the form of a pharmaceutical agent. The proportion of blacks in this age group who receive some form of estrogen therapy is estimated at 36%. The great majority of estrogen use is for the purposes of contraception and, to a lesser extent, suppression of lactation following childbirth. Less than 1% of the girls in this age group receive estrogen for treatment of medical conditions.
Neurologic Sequelae after Childhood Near-Drowning: A Total Population Study from Hawaii
Authors: Pearn John H. , Bart Robert D. , Yamaoka Ronald
Published: December 2021

Whether or not a resuscitated child will suffer brain damage is crucial to the management of drowning and near-drowning victims. The length of time one persists with attempted resuscitation, the intensity of supportive therapy, and the prognosis one can give to parents in the hours or days after rescue, all depend on this point. With the proliferation of childhood drowning accidents1 it is essential that the natural history of hypoxic brain damage after near-drowning be accurately documented.

Two recent large studies2,3 have attempted to shed light on this subject, but have given diametrically opposed results. One such report, a total population study from Queensland, Australia,1,4 has shown that the incidence of neurologic deficit after loss of consciousness in fresh water was only 5%,2 although 30% of such childhood cases had an abnormal subscale scatter in formal IQ assessments. It was concluded that from the neurologic point of view, "the prognosis of near-drowning in childhood is excellent."

By contrast, a large study from California3 (published almost simultaneously with the study from Australia) found that 21% of children (72 cases) who were admitted after near-drowning were severely brain damaged. So worrying were these figures that it was concluded that before intensive hospital-based life support was commenced, consideration should be given to the significant possibility that a permanently brain-damaged child would result. It was concluded that "it is a misconception that irreversible brain damage is an uncommon complication in near drowning."

It is unlikely that water temperature differences between these two centers would explain this diversity (ranges of water temperatures were not given in either report).
Patterns of Skin Injury in Nonaccidental and Accidental Injury
Authors: Pascoe John M. , Hildebrandt H. M. , Tarrier Ann , Murphy Miriam
Published: December 2021

The patterns of soft tissue injuries in a group of 154 children reported to protective services for child abuse or neglect were compared with patterns of soft tissue injury found in a group of 91 emergency room patients who sustained an accidental injury and 105 children seen in a pediatric ambulatory clinic. All children in the three groups were 1 to 12 years old. Children in the suspected child abuse and neglect group had significantly more (P < .01) soft tissue injuries over the cheeks, trunk, genitals, and upper legs. Lacerations were significantly more common (P < .001) in the emergency room group.
Infectious Mononucleosis and Encephalitis: Recovery of EB Virus from Spinal Fluid
Authors: Halsted Crystie C. , Chang R. Shihman
Published: December 2021

Epstein-Barr virus (EBV), the accepted cause of infectious mononucleosis (IM), has been associated with a variety of neurologic disorders including encephalitis, aseptic meningitis, transverse myelitis, Guillain-Barré syndrome, and Bell's Palsy.1,2 These neurologic syndromes may occur as the sole manifestation of EBV infection or together with the more typical clinical features of IM. It is unclear whether the central nervous manifestations of EBV result from direct invasion of the central nervous system by EBV or from a more indirect mechanism. This report describes the recovery of EBV from the spinal fluid of an 11-year-old boy with IM and encephalitis.

CASE REPORT
Monocyte Subsets in Neonates and Children
Authors: Arenson Edward B. , Epstein Martin B. , Seeger Robert C.
Published: December 2021

Volumetrically distinct subpopulations of peripheral blood monocytes, termed M1, M2, and M3, were identified in healthy normal adults and children. Because normal neonates have abnormal monocyte chemotaxis, it was determined whether monocyte subpopulations have different chemotactic capabilities and, if so, whether chemotactically active subpopulations were quantitatively deficient in neonates. Chemotaxis tests with zymosan-activated normal human serum as the chemoattractant and purified monocyte subpopulations revealed that large M3 monocytes were capable of significantly more directed migration than were small M1 and M2 monocytes. Volumetric analysis of monocytes from normal newborns rather than demonstrating an absence of M3 cells revealed that these cells were the predominant monocyte subpopulation. Therefore, we conclude that the impaired chemotactic ability of newborn monocytes is due to a functional rather than quantitative deficiency of M3 cells.
The Milk Mononuclear Phagocyte
Authors: Pitt Jane
Published: December 2021

A large number of mononuclear phagocytes are present in human colostrum and milk and are transferred from mother to baby. Although one can only speculate on their role in vivo, there is a modest amount of information about their characteristics in vitro which will be reviewed in this paper.

About 80% of the one to two million leukocytes in colostrum and early human milk are mononuclear phagocytes1,2 as determined by esterase staining,3 latex ingestion, and glass adherence. While

See Table in the PDF Document

their concentration diminishes with longer lactation, the number of macrophages secreted daily is large (Table 1).

The milk mononuclear phagocyte spreads avidly onto glass surfaces extending long filamentous processes into the environment (Fig 1). Trypan blue is rapidly taken up into the lysozomes of living cells (Fig 2) as is acridine orange. These cells are lipid laden (Fig 3) and on ultrastructural analysis one sees that the lipid inclusions are not always membrane bound (Fig 4). Mitochondria, an indication of oxidative metabolism, and rough and smooth endoplasmic reticulum, suggesting active protein synthesis, are plentiful. Comparisons between milk and blood mononuclear phagocytes are listed in Table 2.

Lysozyme is one of the proteins synthesized and secreted by the milk mononuclear phagocyte. By competitive binding, radioimmunoassay milk macrophages can be shown to release 100 ± 8 ng lysozyme/ 5 x 105 cells into the supernatant; the level is reduced to 20 ± 4 ng when these cells are cultured in the presence of 10 µg/ml of cyclohexamide, an inhibitor of protein synthesis.

Moreover, it appears that these cells make C3 and C4.
The Mononuclear Phagocyte System: Role in Expression of Immunocompetence in Neonatal and Adult Life
Authors: Blaese R. Michael , Poplack David G. , Muchmore Andrew V.
Published: December 2021

The cells of the mononuclear phagocyte system are critical elements in host defense. They are essential to many specific immune processes in addition to their well-recognized role in nonspecific resistance. In this report we describe studies of the influence of the maturation of this system of cells on the capacity of the neonatal rat to generate specific immune responses. In addition, studies of human cord blood monocyte function are presented along with data demonstrating a previously unrecognized synergistic action between monocytes and a heat labile, nonantibody, serum factor which may play an important role in host defense. Finally, data are presented demonstrating that one of the recognition processes used by monocytes for cellular interaction is dependent upon a system of natural lectin-like receptors on the monocyte cell surface which recognize membrane-bound oligosaccharides on other cells.
Anticipatory Guidance in Pediatric Practice
Authors: Reisinger Keith S. , Bires Jill A.
Published: December 2021

Physicians, by their collective position in society and their individual interaction with patients, can be facilitators in helping families adopt more healthful ways of living. This study addresses the issue of the amount of time pediatricians in private practice spend with patients during well-child visits and the proportion of that time they devote to discussing potential health problems. The study population consisted of a random sample of pediatricians in the metropolitan Pittsburgh area. Observation of physician-patient interactions were made during one day in each of 23 pediatricians's offices. During the days of observation there were 305 well-child visits. The time spent with each patient averaged 10.3 minutes. Anticipatory guidance constituted 8.4% of total visit time. Pediatricians in group practice or partnerships and those recently trained spent more time with patients and a greater part of their time in anticipatory guidance. The amount of time during the well-child visit spent in anticipatory guidance varied with the age of the patient. The most time discussing potential future problems was spent with parents of infants less than 5 months of age (1 minute 37 seconds), with only an average of seven seconds being spent with adolescents. Of particular note was the lack of time spent discussing issues of safety, sex, behavior and growth. Because pediatricians spend more than 60% of their in-office time seeing patients for well-child care, they have an excellent opportunity to motivate parents and patients to change to more healthful ways of living. This opportunity will be lost however unless pediatricians reorient their priorities by addressing currently unmet health problems.
Prolonged Bleeding Time in Children and Young Adults with Hemophilia
Authors: Buchanan George R. , Holtkamp Christine A.
Published: December 2021

Of 49 patients with hemophilia A or B, who had not received replacement transfusions for at least 72 hours, ten were demonstrated to have a prolonged value for the bleeding time. None had evidence of von Willebrand's disease or prior aspirin ingestion, and only one was found to have an associated intrinsic platelet defect. It appears that the bleeding time, generally thought to be a measurement of platelet-subendothelium interaction, may also sometimes be prolonged in congenital coagulation disorders in which platelet function is normal.
Subclinical Levels of Lead and Developmental Deficit—A Multivariate Follow-up Reassessment
Authors: Ernhart Claire B. , Landa Beth , Schell Norman B.
Published: December 2021

Scores on the McCarthy Scales of Children's Abilities, school reading tests, teacher ratings, and several exploratory measures were obtained for urban black school-aged children, first studied five years previously. These were related, for 63 children, to preschool blood lead, school-age blood lead, and free erythrocyte protoporphyrin levels, and, for 34 children, to dentine lead. Most outcome variables were not significantly related to the lead variables. Preliminary analyses indicated that results of several of the McCarthy Scales, including the critical General Cognitive Index and Verbal Scales, and the reading test were significantly impaired in higher lead level groupings. However, incorporating a brief measure of parent IQ into the analyses decreased variance associated with lead and led to a strong suspicion of the remaining significant results. Few investigators reporting positive effects have considered parent intelligence, which is known to be a major determinant of developmental status. For this and other admittedly difficult methodologic reasons, conclusions from prior studies are questioned.
Is Kernicterus Always the Definitive Evidence of Bilirubin Toxicity?
Authors: Valaes Timos , Gellis Sydney S.
Published: December 2021

Concluding an extensive clinical and pathologic study of 126 cases of kernicterus, Gerrard wrote in 1952: "The pigmentation of the brain is secondary to the nerve cells being first damaged by a factor or factors unknown."1 This opinion was shared by most of the experts of this period. Systematic measurements of bilirubin levels in jaundiced newborns were not part of their management. In the absence of such measurements the jaundiced babies with kernicterus did not appear to be different from the larger number of jaundiced newborns without kernicterus.
New Syndrome in Three Affected Siblings
Authors: Crane James P. , Heise Robin L.
Published: December 2021

A previously undescribed syndrome is reported. Major features include: (1) poorly mineralized calvarium, (2) dysmorphic facies (cleft lip and palate, micrognathia, upturned nares, apparent ocular hypertelorism), and (3) extracranial musculoskeletal anomalies (absence of cervical vertebrae and clavicles, talipes equinovarus, and soft tissue syndactyly). Autosomal recessive inheritance is the most likely mode of transmission. Prenatal diagnosis via ultrasonography was successful in two fetuses at risk.
Mechanism of Development of Bronze Baby Syndrome in Neonates Treated with Phototherapy
Authors: Onishi Shoju , Itoh Susumu , Isobe Kenichi , Togari Hajime , Kitoh Hideyuki , Nishimura Yutaka
Published: December 2021

Comparisons of serum concentrations of unknown pigment and photobiirubin IXα, the two main bilirubin photoproducts, were made during phototherapy in infants with and without bronze baby syndrome who were treated similarly. The serum concentrations of unknown pigment estimated by high-pressure liquid chromatography in infants with the bronze baby syndrome were significantly increased in comparison with those in the control hyperbilirubinemic neonates during phototherapy. However, there was no difference in the serum concentrations of photobilirubin IXα between infants with bronze baby syndrome and the control groups. The unknown pigment separated from bilirubin photoproducts obtained from experiments in vitro by high-pressure liquid chromatography was gradually decomposed into brown products that showed the absorption spectrum similar to that of the serum of infants with bronze baby syndrome. This fact is probably due to reduction in hepatic excretory function of bilirubin photoproducts, especially unknown pigment, because its main excretory pathway is the biliary route. The pigment accumulated in the body may be polymerized and forms bilifuscin-like substances following a free radical reaction. It is concluded that the brown pigment is formed via unknown pigment.
Severe Hypertension, Hyperkalemia, and Renal Tubular Acidosis Responding to Dietary Sodium Restriction
Authors: Sanjad Sami A. , Mansour Fayzeh M. , Hernandez Rudolfo H. , Hill L. Leighton
Published: December 2021

A 13-year-old girl with severe hypertension (240/140 mm Hg), short stature, marked hyperkalemia (8.6 mEq/liter), and renal tubular acidosis was studied. Renal parenchymal and renovascular diseases as well as endocrinologic causes of hypertension were ruled out by appropriate studies. The hypertension was associated with sodium retention, increased plasma volume, suppressed plasma renin activity, and decreased urinary excretion of aldosterone. Impaired renal excretion of potassium was demonstrated by sodium sulfate infusion when the patient was fed a high-sodium diet but a significant kaliuresis occurred when the test was performed on a low-sodium diet suggesting that renal sodium retention may play a role in the defect in potassium excretion. The renal tubular acidosis was associated with normal distal acidification but a low bicarbonate threshold (19 mmoles/liter) and marked suppression of urinary ammonium excretion. The hypertension, hyporeninemia, and hypoaldosteronism as well as the hyperkalemia and acid-base abnormalities were completely reversed by dietary sodium restriction or the administration of thiazides or furosemide. It is concluded that an unusual avidity for sodium chloride reabsorption by the renal tubules leading to extracellular volume expansion and renin-aldosterone suppression plays a significant pathogenic role in this syndrome and may explain the hypertension and biochemical abnormalities discussed.
Adaptations of the Denver Developmental Screening Test: A Study of Preschool Screening
Authors: Sturner Raymond A. , Horton Mark , Funk Sandra C. , Barton Joanne , Frothingham Thomas E. , Cress Joseph N.
Published: December 2021

Developmental screening tests are only rarely used in pediatric practice, reportedly because of lack of available time. This study evaluated a shortened form of the Denver Developmental Screening Test (DDST-S) consisting of only those items immediately to the left of the child's individual age line, three in each sector or a total of 12. This DDST-S was administered to four cohorts of preschool children (aged 52 to 64 months), 1,819 children in all. Subsamples of these children returned within three months for one of several developmental (criterion) tests (McCarthy Scales of Children's Abilities, the complete DDST, or the Stanford-Binet). The DDST-S was scored by selecting the profile of passes and failures most predictive of McCarthy test results, using indices of copositivity, conegativity, underreferral, and overreferral as the basis for the decision. Utilizing this scoring system, use of the DDST-S was able to identify low scorers (those scoring less than 70) on the Stanford-Binet (sensitivity = .67, specificity = .95, predictive value = .54, underreferral = 2.5%, overreferral = 4%) as well as the complete DDST. Low scoring children could thus be identified in less than half the time required by the complete DDST. A two-stage DDST-S and DDST procedure was found to have even greater predictive value (76%; 100% if borderline cases [score of 70 to 80] are considered positive) than either form alone.
Modified Schema for Classifying Positive-Pressure Tympanograms
Authors: Smith Clyde G. , Paradise Jack L. , Young Tina I.
Published: December 2021

Tympanograms with peaks located in the high-positive air pressure range (≥ 50 mm H2O) are infrequently recorded in clinical practice and have been little discussed in the literature. Such tympanograms accounted for 1.2% of a series of 8,011 tympanograms recorded at various times from 1,556 subjects ranging in age from 7 months through 12 years. Correlations between otoscopic diagnoses and tympanometric findings in the case of 65 of the high-positive air pressure tympanograms form the basis of the present report. Of the 65 high-positive air pressure tympanograms, 51 showed relatively high compliance (≤5.5 Madsen units), and of these 46 (90%) were associated with ears considered normal otoscopically. Fourteen of the high-positive air pressure tympanograms showed low compliance (>5.5 Madsen units), and of these, six (43%) were associated with ears considered normal, six (43%) with ears showing signs of acute infection, and two (14%) with ears in which the presence of effusion seemed probable. A previously presented zonal schema for classifying tympanograms has been modified on the basis of these findings.
Carboxyhemoglobin Concentration in Fetal Cord Blood and in Blood of Mothers Who Smoked During Labor
Authors: Bureau M. A. , Monette J. , Shapcott D. , Paré C. , Mathieu J. -L. , Lippé J. , Blovin D. , Berthiaume Y. , Bégin R.
Published: December 2021

It has been established beyond doubt that maternal cigarette smoking is associated with increased perinatal morbidity (prematurity, failure to grow, vaginal bleeding of pregnancy) and perinatal mortality (abortion and fetal or neonatal death).1,2 Various mechanisms have been implicated to explain these adverse effects of maternal smoking on the fetal outcome and among these, chronic carbon monoxide intoxication of the fetus induced by maternal smoking is identified as a major cause of the fetal toxicity of smoking.3,4 In animal studies, chronic exposure to a low level of carbon monoxide produced perinatal complications similar to those reported in pregnant smokers,1,3,4 In humans, accidental carbon monoxide poisoning from sources other than smoking caused fetal death or fetal brain damage.5
Bilirubin and Brain Damage— A Real Mess
Authors: Lucey Jerold F.
Published: December 2021

What to do for the low-birth-weight jaundiced neonate has been a subject of debate for 30 years.

It is generally agreed that the "20 mg/100 ml level" for an exchange transfusion in a full-term infant with hemolytic disease, has been effective in avoiding deaths due to kernicterus and brain damage due to bilirubin neurotoxicity. It's not perfect, but it has been effective. This is amazing because the original studies, judged by modern standards, would not be acceptable today.1

Trouble first began when this concept was extended to jaundiced low-birth-weight infants. It was assumed that "the level" should be lower in smaller infants.
Letters to the Editor
Authors: David Ronald , Ellis Demetrius
Published: December 2021

We believe the evidence presented by Weir is insufficient to reject the hypothesis that the infants described in our report had inappropriate secretion of antidiuretic hormone (SIADH).

First, we reported the fluid intake for each of the patients in our series and noted that the volume ingested did not exceed the limits of renal excretory function. The maximum tolerable water intake is estimated to be 750 See Table in the PDF File ml/kg/day at 2 weeks of age and declines to 550 ml/kg/ day at 1 year of age.1
Bronchopulmonary Dysplasia
Authors: Tarnow-Mordi William
Published: December 2021

In their detailed study of the long-term survivors of bronchopulmonary dysplasia (BPD) Smyth and colleagues1 contrast their findings of a high incidence of abnormal pulmonary function in early childhood with the commonly held view that pulmonary function becomes normal in most children surviving BPD.2 However, they do not give us detailed parameters of the mode of intermittent positive pressure ventilation (IPPV) used on their patients, in particular maximum peak pressures, inspiratory: expiratory ratios and rates, or type of pressure wave curves generated by the ventilators used.