bluuebunny/crossref_metadata_2025 huggingface dataset:
Was This Experiment Necessary?
Authors: Shaw Edward B.
Published: December 2021

The article on pharmacokinetics of acetaminophen in the human neonate Levy et al.1 in the June 1975 issue prompts some questions and a carping comment.

Why would one give acetaminophen to a neonate when significant need for an antipyretic is almost nonexistent at this age, even in the presence of infection?

The infants reported were given a dose of this medication for experimentation only and with no thought of benefit. The dose was small, amounting to 36 mg for an infant weighing 3 kg or more, but neither the therapeutic dose nor the toxic dose is known for this age.
In Reply: Was This Experiment Necessary?
Authors: Levy Gerhard , Khanna Narinder N. , Stern Leo
Published: December 2021

The issue of neonatal research is so charged with emotion that it can apparently cause a reader to pick up his pen to write a letter of criticism without having read carefully the report which he is criticizing.

We are rebuked for subjecting newborn infants to numerous venipunctures though we stated clearly that no venipunctures at all were done for investigational purposes. The single reported serum bilirubin determination per subject was made as part of the routine neonatal care and involved the withdrawal of a very small volume of blood by heel-prick.
Comments on Blood Pressure II
Authors: Repice Joseph P.
Published: December 2021

I would like to comment on the commentary by Mitchell et al.1

While the authors admit that their data in Table I ("Percentile Values for Blood Pressure by Age") are "neither ideal nor perfect" and cite three references from which their data were obtained,2-4 several facts should be known by the reader.

The 50th and 95th percentiles for the systolic and diastolic pressures for the age group 0 to 6 months are apparently from one study3 and are not an average of the three studies as stated, since the studies of Zinner et al.2 and Londe4 were reported for age groups 2 to 14 years and 4 to 15 years, respectively.
THE HANDICAPPED CHILD, ed 3. Edited by Agatha Bowley and Leslie Gardner. London, Churchill Livingstone, $8.25; 216 pp
Authors: Wigglesworth Robert
Published: December 2021

This handy, inexpensive, soft-backed book is written by two senior and exceptionally well-experienced psychologists oh the subject of the handicapped child. It is really about the child with central nervous system handicaps and it is with the neuropsychologically handicapped child that the authors have gained their long, special, and unique experience. Dr. Agatha Bowley is consultant psychologist at the internationally famous Cheyne Centre for Spastic Children in Chelsea, London, England, and also the Surrey (England) Horsham and Crawley Child Guidance Clinics.
Prevention of behavior problems: A clinician's view
Authors: Turtle William J.
Published: December 2021

Over the years in practice, those of us who started in the 30s were happily able to pass on to our patients the tremendous advances in preventive pediatrics continuously being made in the field of immunology and in the management of a wide variety of physica1 disorders. Unhappily, no comparable advances, preventive-wise, were being made in psychosocial pediatrics. When it came to helping parents with behavior problems—which accounted for the bulk of our time—preventively, we had very little to offer. Treatment centers and the numbers of those treating behavior and adolescent problems grew astronomically, but without any perceptible decline in the incidence of those problems.
Epidemiologic Studies of Measles, Measles Vaccine, and Subacute Sclerosing Panencephalitis
Authors: Modlin John F. , Jabbour J. T. , Witte John J. , Halsey Neal A.
Published: December 2021

Histories obtained in 350 of 375 clinically confirmed cases of subacute sclerosing panencephalitis (SSPE) reported to a national registry showed that 292 patients had measles and 58 had no history of measles. Forty of the latter patients received live, attenuated measles virus vaccine. In patients with a history of measles, measles illness occurred before age 2 years in 46%, and a mean of 7.0 years before onset of SSPE. In contrast, there was no relationship of SSPE with age at vaccination in 35 of the 40 patients historically associated with measles vaccine, and SSPE occurred a mean of 3.3 years after vaccination.

Based on estimated national measles morbidity data and national measles vaccine distribution data, the risk of SSPE following measles vaccination (0.5 to 1.1 cases/106) appears to be less than the risk following measles (5.2 to 9.7 cases/106). Because live measles vaccine is highly effective in preventing measles illness and a high proportion of children in the United States have received measles vaccine, these data are consistent with the observed downward trend in SSPE incidence since 1969.
Osteoid Osteoma in Children and Young Adults
Authors: Orlowski James P. , Mercer Robert D.
Published: December 2021

Osteoid osteoma is a relatively common benign tumor of bone which occurs most often in adolescents and young adults. The pattern of the pain with its characteristic response to aspirin and the roentgenographic findings make the clinical diagnosis easy and virtually certain. An example is presented to help the pediatrician become familiar with the tumor and its diagnosis.
Serial Neurologic Examination of Hyperactive Children
Authors: McMahon Shirley A. , Greenberg Laurence M.
Published: December 2021

Forty-four of 102 children undergoing pharmacologic treatment of hyperactivity received serial neurologic examinations on five separate occasions. The responses to three of the "soft" neurologic signs administered were analyzed: heel gait, toe gait, and diadochokinesis. A high degree of variability of response within individuals was documented. There was no evidence of interaction between treatment and the subjects' responses. The degree of variability was such that to have used these data as measures of "improvement" (i.e., drug effect) would have been misleading. The value of these signs for purposes of diagnosis or assessment of therapy is doubtful.
Blood Volume Changes in Patients With Cystic Fibrosis
Authors: Rosenthal Amnon , Button Lawrence N. , Khaw Kon Taik
Published: December 2021

Simultaneous red blood cell (RBC) and plasma volume determinations were obtained in 16 patients with cystic fibrosis (CF) and moderately severe pulmonary involvement. Hypervolemia with an increase in both RBC and plasma volumes was observed. Changes in blood volume were marked when values were indexed by weight but less significant when indexed by height. Decreasing systemic arterial oxygen saturation was associated with a progressive increase in RBC mass, hematocrit value, and hemoglobin level and a decrease in mean corpuscular hemoglobin concentration. RBC and total blood volumes were highest in patients with cor pulmonale and congestive heart failure. However, the compensatory polycythemic response in patients with CF was inadequate when compared with the response to hypoxemia in patients with cyanotic congenital heart disease. The insufficient oxygen-carrying capacity may compromise tissue oxygen delivery and necessitate treatment.
Prolonged Continuous Monitoring of Intracranial Pressure in Severe Reye's Syndrome
Authors: Shaywitz Bennett A. , Leventhal John M. , Kramer Michael S. , Venes Joan L.
Published: December 2021

Evidence from both clinical and pathological investigations suggests that increased intracranial pressure (ICP) is a significant factor in the mortality of patients with Reye's syndrome. This, coupled with a critical review of our previous 22 patients, which failed to document the efficacy of exchange transfusion, led us to include continuous ventricular pressure monitoring in the supportive care of children with Reye's syndrome. To date, three children, ages 3 to 5 years, have been managed with continuous ICP monitoring. All had stage IV coma by both clinical and electroencephalographic criteria. Peak blood ammonia concentrations were 1,036, 316, and 560µg/100 ml; all had elevations of serum glutamic oxaloacetic transaminase level, prothrombin time, and creatine phosphokinase level as well. Rapid, unpredictable increases in ICP occurred for many days in all children. Therapeutic measures most successful in controlling ICP were the intravenous administration of mannitol and hyperventilation. Elevations in ICP occurred despite serum osmolality as high as 418 mOsm and following oral administration of glycerol. Rapid increases in ICP also resulted from routine manipulation of the patients (e.g., postural drainage). Exchange transfusion, used in two of the three patients, increased ICP in one child and had no effect in the other. All three children have achieved complete recovery and are doing well 6 months after their illness. Our experience with these children suggests that vigorous supportive therapy, including careful monitoring of ICP, should be used as a basis of comparison when evaluating claims of specific treatment in Reye's syndrome.
Is Routine Intravenous Urography Indicated in Patients With Hypospadias?
Authors: Lutzker Letty G. , Kogan Stanley J. , Levitt Selwyn B.
Published: December 2021

Hypospadias is associated with an increased incidence of "significant" urologic anomalies as compared with the general population. Most do not require immediate surgical intervention, but this information may be important in planning the long-term management of the boy, including follow-up and advice given in regard to contact sports. Ultrasonography avoids the possible hazards of intravenous urography and would seem to be the ideal screening test for detecting the urologic anomalies associated with hypospadias. Intravenous urography should be reserved for a selected group of children with hypospadias with abnormal ultrasonograms or urologic symptomatology.
More Comments on the Ampicillin Rash Problem
Authors: Campbell A. Bruce , Soyka Lester F.
Published: December 2021

We agree with Dr. Sokoloff that patients developing a maculopapular (also called morbilliform or exanthematous) rash after initiation of ampicillin therapy need not automatically be labeled "allergic to penicillin" without additional evidence to that effect. However, we do not agree that ampicillin can later be administered with impunity to these individuals. Two "types" of rash commonly occur in response to amplicillin exposure: urticarial and maculopapular, while others such as erythema nodosum, erythema multiforme, purpuric, eczematous, and vesiculobullous are relatively rare.
Scabies: Transcutaneous Poisoning During Treatment
Authors: Lee Beulah , Groth Paul
Published: December 2021

The FDA Drug Bulletin (6:28, 1976) alerted physicians and other health professionals to the possibility of adverse central nervous system (CNS) side effects, particularly in children, that may occur from high doses of the commonly employed scabicides. The American Academy of Pediatrics has requested its members to report adverse reactions from scabicides to the AAP, which, in turn, will keep the FDA informed.

Following the FDA Drug Bulletin alert and the announcement by the AAP, the FDA's Division of Drug Experience received the following clinical reports of suspected CNS toxicity to gamma benzene hexachloride (GBH, Kwell, Gamene, lindane).
DUNCAN'S DISEASES OF METABOLISM: GENETICS AND METABOLISM, ed 7. Edited by Philip K. Bondy and Leon E. Rosenberg. Philadelphia, WB Saunders Co, 1974, $26; 948 pp
Authors: Soyka Lester F.
Published: December 2021

This volume is approximately the first half of a two-volume standard text, and is noteworthy because it follows the sixth edition by only four years. This fact reflects the rapid progress made in the fields of genetics, metabolism, and endocrinology during this period. It is of some interest that sections on nutrition, other than a rather brief discussion of obesity, have been eliminated from a text devoted to diseases of metabolism. Unfortunately, nutrition also has been virtually eliminated from medical curricula, and this important group of diseases is a prominent defect in the education of most physicians.
Determination of Bile Acid Concentration in Human Amniotic Fluid for Prenatal Diagnosis of Intestinal Obstruction
Authors: Délèze Guy , Sidiropoulos Dimitri , Paumgartner Gustav
Published: December 2021

Bile acid concentration was measured in amniotic fluid obtained for standard indications from 11 healthy pregnant women without polyhydramnios (28 to 42 weeks of gestation) and from 9 patients with polyhydramnios (28 to 38 weeks of gestation). Two of the latter women delivered infants with intestinal obstruction distal to the papilla of Vater, a condition that causes regurgitation of bile into the amniotic fluid. In the women without polyhydramnios, the total bile acid concentration ranged from 1.4 to 2.4 µmol/liter. In the seven patients with polyhydramnios not associated with fetal intestinal obstruction, the bile acid concentration in amniotic fluid was not significantly different (0.9 to 1.9 µmol/liter). By contrast, the bile acid concentration in amniotic fluid specimens from the two patients with polyhydramnios who gave birth to children with intestinal obstruction was considerably elevated (30.3 and 83.1 µmol/liter). These findings suggest that determination of bile acid concentration in amniotic fluid permits prenatal diagnosis of intestinal obstruction distal to the papilla of Vater.
Temperature Greater Than or Equal to 40 C in Children Less Than 24 Months of Age: A Prospective Study
Authors: McCarthy Paul L. , Jekel James F. , Dolan Thomas F.
Published: December 2021

In a prospective study, 330 consecutive children less than 24 months old coming to the emergency room of Yale-New Haven Hospital with a temperature ≥ 40 C were evaluated. Nearly all patients had a white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) (Wintrobe), blood culture, and chest roentgenogram. Eighty-eight percent were evaluated 24 to 48 hours later. The mean WBC count and ESR were significantly elevated in children with positive blood cultures or pneumonia. The risk of bacteremia was increased threefold and the risk of pneumonia was increased twofold in children with a WBC count ≥ 15,000/ cu mm or an ESR ≥ 30 mm/hr compared to children without leukocytosis or elevated ESR. Sixty-one percent of children with bacteremia or pneumonia, 63% of children in whom these diagnoses were not apparent on physical examination, and 86% of children with otitis media complicated by pneumonia or bacteremia had either a WBC count ≥ 15,000/cu mm or an ESR ≥ 30 mm/hr. A WBC count ≥ 15,000/cu mm and an ESR ≥ 30 mm/hr were more effective than a polymorphonuclear leukocyte count ≥ 10,000/cu mm and/or a band count ≥ 500/cu mm in screening young children with high fever for bacteremia, pneunlonia, or complicated otitis media.
Auditory and Visual Defects Resulting from Symptomatic and Subclinical Congenital Cytomegaloviral and Toxoplasma Infections
Authors: Stagno Sergio , Reynolds David W. , Amos Catherine S. , Dahle Arthur J. , McCollister Faye P. , Mohindra Indra , Ermocilla Rufino , Alford Charles A.
Published: December 2021

Sensorineural hearing loss was present in ten of 59 (17%) patients with congenital cytomegalovirus (CMV) infection (three of eight born with symptomatic and seven of 51 born with subclinical infection). The defect was bilateral in eight, moderate to profound in eight, and of progressive nature in two. Hearing loss did not occur in 21 patients with natal CMV infection nor in seven of 12 patients with congenital toxoplasmosis. Histopathologic and immunofluorescent studies of the inner ear in two of three neonates who died with severe infection revealed that viral antigens were widely distributed in cochlear structures.

Eye pathology was associated only with congenital Toxoplasma (nine of 12) and CMV (seven of 43) infections. Visual impairments were more prominent and severe in those born with symptomatic infections, exclusively so with CMV. However, ocular defects, in particular chorioretinitis, developed after birth in five of eight patients born with asymptomatic congenital toxoplasmosis.

These data firmly establish clinically inapparent congenital CMV infection as a major public health problem and confirm the fact that congenital toxoplasmosis may be associated with late-appearing, debilitating chorioretinitis.
Nosocomial Transmission of Group B Streptococci in a Newborn Nursery
Authors: Paredes Abel , Wong Peter , Mason Edward O. , Taber Larry H. , Barrett Fred F.
Published: December 2021

Group B streptococcal colonization of normal newborn infants increased from 22.5% within 20 hours of birth to 65.4% at the time of hospital discharge (P < .001). In contrast, colonization in mothers did not change significantly between the time of admission to labor and delivery (27.7%) and the time of discharge (31.1%). Epidemiologic data suggested but did not prove that the mode of nosocomial transmission of group B streptococci among infants was cross colonization via personnel contact.
Pulmonary Edema Associated With Croup and Epiglottitis
Authors: Travis Kenneth W. , Todres I. David , Shannon Daniel C.
Published: December 2021

Two children, ages 9 and 2½ years, with clinical diagnoses of laryngotracheitis (croup) and epiglottitis, respectively, developed florid pulmonary edema without evidence of cardiac enlargement. Both children responded to vigorouS therapy, which included endotracheal intubation, mechanical ventilation with high oxygen concentrations and positive end expiratory pressure, diuretics, and support of the intravascular volume with colloid infusions.

Swan-Ganz catheterization was performed in the child with epiglottitis to elucidate any hemodynamic malfunction. Pulmonary artery occluded pressure was found to be normal.

We postulate that pulmonary edema may be the result of any of three major physiologic alterations: alveolar hypoxia, increased alveolar-capillary transmural pressure gradient, and a catechol-mediated shift of blood volume from the systemic to the pulmonary circulation. These alterations acting in concert would increase the volume of blood presented to the pulmonary capillaries, the pore size in those capillaries, and the hydrostatic pressure gradient promoting transudation. Failure of pulmonary lymphatics to effectively clear this fluid would result in pulmonary edema.

Although pulmonary edema associated with acute upper airway obstruction is unusual, physicians should be alerted to its possible appearance and the need for early and vigorous therapeutic measures.
The Use of a Crystalline Amino Acid Mixture for Parenteral Nutrition in Low-Birth-Weight Infants
Authors: Meng H. C. , Stahiman M. T. , Otten A. , Dolanski E. A. , Caldwell M. D. , O'Neill J. A.
Published: December 2021

Thirty-six preterm, sick, low-birth-weight neonates were given either total or partial parenteral nutrition. The patients were divided into three groups according to their birth weights: group A—less than 1,00 gm, 12 patients: group B—between 1,000 and 1,500 gm, 15 patients: group C—more than 1,500 gm, 9 patients. The solution for total parenteral nutrition contained 20% glucose and 2.6% crystalline amino acids plus appropriate amounts of vitamins and minerals. The volume of infusate given was usually 125 ml/kg/day, but varied depending on the clinical condition of the patient; occasionally it was as high as 150 to 175 ml/kg/day. Infusate of one-half strength was administered initially; its concentrations of glucose and amino acids were increased to three quarters and full strength gradually, if tolerated. The solution for total parenteral nutrition was infused into the superior vena cava via a central venous catheter; that for partial parenteral nutrition was given into a peripheral vein to supplement inadequate oral feedings. The period of parenteral nutrition lasted froni 5 to 49 days, with an average of 13.2 days. The intake of 500 mg of nitrogen as crystalline amino acids and 100 kcal as glucose was capable of achieving body weight gain. Positive nitrogen balance of various degrees was also observed. Hyperglycemia of a slight to moderate degree was observed in nine patients; only three required insulin therapy. Two patients had thrombotic occlusion of the central venous catheter. The conclusion was reached that total parenteral nutrition or partial parenteral nutrition, when properly managed, is a safe procedure in small, premature infants. The amino acid solution given as a nitrogen source along with adequate calories was effective in promoting weight gain and nitrogen balance; it was apparently well tolerated by low-birth-weight neonates.
Intractable Diarrhea in a Boy With Vasoactive Intestinal Peptide-Producing Ganglioneuroblastoma
Authors: Jansen-Goemans Annelice , Engelhardt J.
Published: December 2021

A 1-year-old boy had intractable diarrhea and symptoms of the watery-diarrhea-hypokalemia-achlorhydria (WDHA) syndrome, a well-known entity in adults. Resection of a ganglioneuroblastoma situated in the neck caused prompt relief of symptoms.

The ganglioneuroblastoma in this instance contained the enterohormone vasoactive intestinal peptide (VIP); blood levels of this peptide were elevated preoperatively. After tumor resection, the VIP level returned to normal, and the diarrhea ceased OIl the day of the operation. The genesis of the diarrhea in relation to the production of polypeptides from neuroendocrine origin is discussed (APUD-cell concept).

VIP may be the mediator in the WDHA syndrome in ganglioneuroblastoma.
FACTORS IN THE DECLINE IN INFANT MORTALITY
Authors: Pakter J. , Nelson F. , H. R. J.
Published: December 2021

Data from New York City show a striking decline (26.4% over 10 years) in infant mortality starting in 1965 with the advent of family planning services and improved medical care for mother and infant. This downward trend in infant mortality has been accelerated since the implementation of liberalized abortion in 1970. Other findings include a marked reduction in fertility, especially among the very young and older women, reduction in low birth weight births, out-of-wedlock births, and births to women of low socioeconomic class, all high risk situations. At a time when it is fashionable to say that we are making no progress in the quality of life, there are some things that are getting better. Whether these decreases in infant mortality are entirely due to medical care is not so clear, but at least the combination of maternity care, family planning, and abortion has been associated with an improvement of major degree.
Trimethoprim-Sulfamethoxazole Compared to Ampicillin in the Treatment of Shigellosis
Authors: Chang Margan J. , Dunkle Lisa M. , Van Reken David , Anderson Donald , Wong Michael L. , Feigin Ralph D.
Published: December 2021

Twenty hospitalized children between 1 and 11 years of age were enrolled in a comparative randomized evaluation of trimethoprim-sulfamethoxazole (TM-SM) and ampicillin for the treatment of shigellosis. Each drug was provided for five days. The group treated with ampicillin had significantly more stools per day (mean 21.25) compared to the TM-SM group (8.64). Treatment with TM-SM appeared to be associated with a more rapid reversion of stool cultures to normal, but these differences compared to ampicillin were not statistically significant. Review of all isolates of Shigella from our hospital revealed a marked decrease in sensitivity to ampicillin over the last six years. This pattern has been observed in other centers. TM-SM may be the best dnlg for the treatment of shigellosis in areas where multiple antibiotic-resistant organisms are common.
Low-Dose Intravenous Insulin Infusion Versus Subcutaneous Insulin Injection: A Controlled Comparative Study of Diabetic Ketoacidosis
Authors: Drop Stenvert L. S. , Duval-Arnould Bertrand J. M. , Gober Alan E. , Hersh Joseph H. , McEnery Paul T. , Knowles Harvey C.
Published: December 2021

Fourteen patients, 5 to 17 years old, with 18 episodes of uncomplicated diabetic ketoacidosis were randomly allocated and studied prospectively. The study group received 0.1 units of insulin per kilogram of body weight per hour as a continuous intravenous infusion: the control group received insulin subcutaneously. In both groups, a gradual fall in serum glucose and ketone levels was achieved. Serum ketones persisted longer in the intravenous group. No complications were encountered. The study suggests that both regimens of insulin administration are equally effective, but a low-dose constant infusion may provide more simplified and controlled management than the standard subcutaneous regimen.
Atypical Phenylketonuria With Normal Phenylalanine Hydroxylase and Dihydropteridine Reductase Activity in Vitro
Authors: Bartholomé Klaus , Byrd Dennis J. , Kaufman Seymour , Milstien Sheldon
Published: December 2021

A child with phenylketonuria had normal phenylalanine hydroxylase activity in vitro. In addition, all known components of the phenylalanine hydroxylating system were within the normal range. Despite early treatment with a phenylalanine-restricted diet, the patient developed severe neurological symptoms. Although the primary molecular defect in this child is not known, there are indications that the defect lead to disturbances in phenylalanine metabolism and in the biosynthesis of L-dopa and L-5-hydroxytryptophan. The administration of these two precursors of neurotransmitters brought about a notable improvement in the patient's neurological symptoms.
Concentration of Parenteral Glucose Solution
Authors: Cowett Richard M. , Susa John B. , Schwartz Robert , Oh William
Published: December 2021

It has recently come to our attention that many clinicians may not be familiar with the chemical composition of the dextrose utilized by the pharmaceutical companies in intravenous solutions. While most understand that the solutions are formulated by weight (thus 10% dextrose should equal 100 mg of dextrose per milliliter), many fail to realize that the dextrose is hydrous rather than anhydrous. The chemical composition is C6H12O6·H2O and the molecular weight is 198 rather than 180, with 9% of the dextrose being water by weight, and contains 340 kcal/liter.
Smoking and SIDS
Authors: Rhead William J.
Published: December 2021

We noted with pleasure that an article by Bergman and Wiesner in the November 1976 issue of Pediatrics (p. 665) confirmed both our own earlier data1 and that of Steele and Langworth2 demonstrating an increased incidence of maternal cigarette smoking in sudden infant death syndrome (SIDS). While these three studies are retrospective, it is of further interest that a recent prospective study3 also confirms this relationship. It is now abundantly clear that maternal cigarette smoking contributes to an infant's risk of dying from SIDS.
FEELING PAIN
Authors: Kozol Jonathan
Published: December 2021

Physical pain for most young people in the U.S. is not easy to "believe," for the excellent reason that it is no longer present in their lives. Technological anaesthesia fends off almost all explicit physical ordeal. Ether balms a visit to the surgeon's office. Music and carpets quiet and absorb the panic of the pediatric office. The built-in auto air-conditioner refrigerates our minds and cools our bodies as we speed across the desert of New Mexico at sixty-five polite degrees. Terror and longing, in the aftermath of devastation at the loss of someone that we love, are calmed and quieted by a ten-grain capsule (Librium): half-black, half-green. The sharpest pain that many millions of young people in this nation ever undergo is the brief incision of the Novocain needle that arrests all further pain. It is an ideal metaphor.

No one wishes to see children placed within a field of needless pain: manufactured sickness, fever, panic, devastation. Yet it is true that lifelong technological insulation-unbroken barriers of self-protection from the taste of terror-do benumb our power to fathom, and our capability to feel. The man or woman who never has known pain is oftentimes incapable of pity. This is the case. above all, when there is an excellent reason to be grateful for the barrier of self-protection. "If I feel nothing," Robert Lifton has observed, "then death is not taking place. . . . If I feel nothing, I cannot be threatened by the death all around me. . . . If I feel nothing, then I am not responsible for you or for your death."
Infant Strangulation
Authors: Bergeson Paul S. , Hernried Lucy S. , Sonntag Paul L.
Published: December 2021

All the tragedies described in this paper were avoidable and all involved healthy children. The ages ranged from 17 days to 2 years, but the majority were 2 to 9 months. In this age range children become increasingly agile but may lack the ability to extricate themselves from potentially dangerous situations. The head is large, relative to the body, and may become entrapped if a child's body slides through an opening. Cribs and high chairs should be constructed with this concept in mind. There should be no existing or potential space large enough for the baby's body to slide through. No screws or nails should protrude on which a baby could become suspended. Repairs may be dangerous and must be done carefully; however, cribs and high chairs must be kept in good condition, especially in regard to loose parts. Homemade items may be dangerous. Restraining devices have been responsible for many fatalities as described and should generally be avoided. Ribbons and strings used to hang a pacifier around a child's neck should be strictly avoided as should strings and cords attached to playthings in the crib.

Legislation has been passed which addresses itself to the problems of distance between crib slats and space between the mattress and side rails.22-24 We commend the work but point out that cribs manufactured before the present law became active will be in use for many years. A crib safety education campaign has been launched that provides excellent advice on purchasing new cribs and reconditioning old ones.25 We only regret that the information has not been further disseminated. Infant strangulation is a poorly publicized problem that warrants attention of physicians, parents, and manufacturers to help avoid further needless tragedies.
Group B β-Hemolytic Streptococcal Osteomyelitis in a Neonate
Authors: Henderson Kenneth C. , Roberts Reuben S. , Dorsey Susan B.
Published: December 2021

Group B β-hemolytic streptococci have gained much attention in recent years as a cause of serious infection in the newborn. Two clinical syndromes have been defined as "early onset" fulminant septicemia and a "late onset" meningitis.1,2 Howard and McCracken,3 more recently, have documented some previously unrecognized clinical presentations of group B streptococcal disease. These include asymptomatic bacteremia, septic arthritis, osteomyelitis, ethmoiditis with orbital cellulitis, pneumonia with empyema, facial cellulitis, and conjunctivitis. The literature to date reports five instances of osteomyelitis due to group B streptococci as reported in four articles.3-6 This case report of group B streptococcal osteomyelitis is presented to emphasize the insidious nature of this infection in a neonate and the lack of systemic toxicity with which it occurs.
Neonatal Respiratory Distress From Hemothorax
Authors: Mazzi Eduardo , White John J. , Nishida Hiroshi , Risemberg Herman M.
Published: December 2021

Hemothorax that produces acute respiratory distress in a newborn occurs rarely; only ten cases have been reported.1-9 We report another case (associated with hypoprothrombinemia and anemia) in a full-term infant. Thoracentesis successfully relieved the respiratory distress, and transfusion and parenteral vitamin K therapy reversed the bleeding diathesis.

CASE REPORT

A girl, weighing 3,070 gm, was born to a 30-year-old woman, after spontaneous labor and uncomplicated delivery. The Apgar score was 7 at one and five minutes. The infant was brought to the nursery at 10 minutes of age, where she was found to be a cyanotic black girl with grunting respirations and intercostal retractions.
Is intensive care becoming too intensive?
Authors: L. J. F.
Published: December 2021

Each month some new iatrogenic complication of intensive care is reported.1,2 One begins to wonder if our care may not be getting too intensive, to the point that we are paying no attention to the possible therapeutic value of rest and sleep.

The sleeping, quiescent fetus develops in an intrauterine environment of low, but relatively stable, oxygen tension. The sick, prematurely born infant enters an environment vastly different from that to which he/she is accustomed.

Picture yourself in a brightly lit room, nude, defenseless, and your eyes hurting from silver nitrate. You are blindfolded, chilly, and surrounded by a tepid fog.
Fibromuscular Dysplasia as a Cause of Stroke in Infancy and Childhood
Authors: Shields W. Donald , Ziter Fred A. , Osborn Anne G. , Allen John
Published: December 2021

Two children had abrupt onset of hemiplegia due to childhood fibromuscular dysplasia (FMD). Although FMD is a recognized cause of strokes in adults, the disorder has not, to our knowledge, been reported previously in children. Our report reviews the pathology and diagnosis of FMD and discusses the complexities of its treatment.
Child Automobile Restraints: Evaluation of Health Education
Authors: Miller Jean R. , Pless I. Barry
Published: December 2021

An experimental design was used to test the effectiveness of three modalities of instruction in pediatricians' offices. Parents in the experimental and control groups were asked if their children wore a car seat restraint on the way to the office. The parents in the experimental group were encouraged to have their children use restraints via one of the following methods: a pamphlet alone; a pamphlet and verbal instruction by the pediatrician; or a pamphlet, verbal instruction, and a brief slide-tape show. The parents were contacted by telephone, mail, or in person two weeks later and asked if their child used a restraint on their last car trip. There were no statistically significant changes in behavior in any of the groups. Although the group that received all forms of instruction had the highest mean score, the greatest increase occurred with the control group.
The Lacrimo-Auriculo-Dento-Digital Syndrome
Authors: Shiang Elaine Li , Holmes Lewis B.
Published: December 2021

A mother and son had an autosomal-dominant malformation syndrome that included absence of the lacrimal puncta, obstruction of the nasolacrimal ducts, hearing loss, poor dentition, and abnormal thumbs. The son also had severe hypertension with renal anomalies and absence of several salivary glands. Affected members of the only other reported family also had cup-shaped ears and synostosis of the radius and ulna. Early recognition of this disorder is important because of the possibility that the affected infant may have hearing loss and kidney malformations.
Renal Failure During the First Year of Life
Authors: Reimold Ekkehard W. , Don Tran Dinh , Worthen Howard G.
Published: December 2021

All cases of persistent renal failure in infants less than 1 year of age were reviewed to determine whether the prognosis has improved equally for infants as for adults. During a ten-year period, 52 infants were treated by applying uniform therapy; 28, more than half, were less than 4 weeks old. All cases were separated into two groups: 19 infants without and 33 infants with congenital renal or urinary tract anomalies. In 20 patients of the latter group, additional serious anomalies of other organs were present. The age distribution was strikingly different: in 18 of 21 infants, renal anomalies were present, as diagnosed on the first day of life. In contrast, only 3 of 11 infants, 4 to 12 months old, had urinary tract anomalies.

In infants without renal anomalies, renal failure was caused by hypotension or shock in 10 of 19 cases, by pyelonephritis or sepsis in 6 of 19. Of this group, eight infants (42%) recovered completely, nine (47%) died. Death occurred within one to two days of hospitalization in all but three cases, caused by shock or sepsis. In this group medical problems that are amenable to therapy have caused either renal failure or contributed to the infant's death.

In infants with renal or urinary tract anomalies, renal failure was caused by renal dysplasia or agenesis in 16 of 33 infants, by urinary tract obstruction in 12 of 33. Only three patients (9%) recovered, all older than 4 months, 20 (61%) died, and 10 are living with signs of chronic renal failure. Death usually occurred within one week of hospitalization and, in 16 of 20, it was caused by renal failure and multiple additional anomalies. The multiplicity and complexity of the congenital anomalies in most instances precluded effective, lifesaving therapy.

Renal failure in infants is still a serious disease accompanied by a high mortality rate in which therapeutic possibilities are limited. No improvement in prognosis can be expected in the near future.
PaO2 Levels and Retrolental Fibroplasia: A Report of the Cooperative Study
Authors: Kinsey V. Everett , Arnold Harvey J. , Kalina Robert E. , Stern Leo , Stahlman Mildred , Odell Gerard , Driscoll John M. , Elliott James H. , Payne John , Patz Arnall
Published: December 2021

The relation between PaO2 and retrolental fibroplasia (RLF) was studied prospectively in 719 premature infants born in or treated in the intensive care units of a group of university hospitals. Blood gas studies were performed on 589 of these infants, 66 of whom had a diagnosis of RLF; in 27 of these 66, some grade of mostly nonblinding cicatricial disease developed. The frequency of RLF was highest among infants of lowest birth weight. A multivariate statistical method was used to analyze simultaneously the effect of possible etiologic factors associated with RLF.

The occurrence of RLF was found to be unrelated to PaO2, as determined by the limited information available from intermittent sampling. RLF is associated with concentration of oxygen administered in the lightest birth weight group, but the strongest association, aside from birth weight, was with time in oxygen. None of the other variables involving blood chemical values appeared to be associated with RLF. The severity of cicatricial RLF is clearly greater in infants weighing less than 1,200 g at birth.

Conservative administration of oxygen may have been responsible for failure to demonstrate quantitative association between Pao2 levels and disease. Agreement between the observed and predicted numbers of infants with RLF demonstrates the strength of the multivariate technique employed in making the statistical analyses.
Value of Preoperative Chest X-ray Examinations in Children
Authors: Sane Shashikant M. , Worsing Robert A. , Wiens Cornelius W. , Sharma Rajiv K.
Published: December 2021

To assess the value of routine preoperative chest x-ray films in pediatric patients, a prospective study of 1,500 patients, ages newborn to 19 years, was undertaken. Of all the patients, 7.5% demonstrated at least one roentgenographic abnormality, with 4.7% of the patients demonstrating a totally unsuspected significant roentgenographic anomaly. In 3.8% of the patients, surgery was either postponed or cancelled or the anesthetic technique was altered as a result of the roentgenographic finding. It is believed that the routine preoperative chest film is justified if the film is evaluated before surgery and the results clinically followed up.
Persistent Pulmonary Hypertension in a Newborn With Congenital Diaphragmatic Hernia: Successful Management With Tolazoline
Authors: Levy Robert J. , Rosenthal Amnon , Freed Michael D. , Smith Charles D. , Eraklis Angelo , Nadas Alexander S.
Published: December 2021

Persistent elevation of pulmonary vascular resistance represents a major cause of death in infants with congenital diaphragmatic hernia.1 The present report describes an infant with diaphragmatic hernia in whom persistent pulmonary hypertension associated with severe hypoxemia was successfully treated with tolazoline hydrochloride.

CASE REPORT

A 3,250-g term boy was born at Boston Hospital for Women to a 31-year-old, gravida 2, para 1 woman. Pregnancy was unremarkable and labor lasted 12 hours. At delivery, Apgar scores were 5 at one minute and 7 at three minutes. There was extreme respiratory distress and hypoxemia. Intubation and a subsequent chest x-ray film led to the diagnosis of a diaphragmatic hernia.
Caution on Aerosol Use
Authors: Bergner Arthur , Bergner Renée K.
Published: December 2021

Drs. Wittig and Leifer comment in their letter on the insignificance of the Pao2 drop after use of adrenergic aerosols (Pediatrics 57:579, April 1976). They state "... that properly administered, these agents are a great aid to many asthmatics and should not be denied to them."

Since patients do not usually consider or fear sprays as medicine and frequently exceed recommended doses in spite of physicians' and package warnings, the studies and statements claiming "safety" when "properly administered in recommended doses" are too often meaningless in clinical reality.
Dr. Huessy Replies
Authors: Huessy Hans R.
Published: December 2021

I appreciate the opportunity to answer the letter of Drs. Axelrod and Haller. The questionnaire used did in fact segregate children at high risk from children at low risk. It has learning as well as behavioral items within it, making it broader than the Conners questionnaire. It contains an item about fidgety behavior. Only one of the 21 items deals with aggressive behavior. Until this summer (1976) we had no resources for detailed data analysis.
Comment on Silver Nitrate Prophylaxis
Authors: Shaw Edward B.
Published: December 2021

The interesting article by Armstrong et al. (Pediatrics 57:884, June 1976) presents a little known aspect of ophthalmia neonatorum. They report that, during a six-year period, twice as many newborn eye infections were of chlamydial rather than gonococcal etiology (86 compared to 43). This provides support to those who long ago objected to silver nitrate as a routine prophylactic. Crede (1881) reduced his incidence from 13% to zero by using 2% silver nitrate, so he must have dealt only with gonococcal infection (Chlamydia are not affected by silver nitrate prophylaxis).
Improving Access to Health Care
Authors: Wheatley George M.
Published: December 2021

Dr. Haggerty's commentary "Who Will Monitor Access?" (Pediatrics 57:169, February 1976) raises a question which the Medicaid program in New York State is making a valiant effort to answer through CHAP. CHAP stands for Child Health Assurance Program and is the State Department of Social Services' implementation of EPSDT. The Social Services District of each of the 56 counties in the state must, as part of CHAP, have provision not only to interview the parent of each eligible child at least every six months to offer and arrange for initial and periodic health supervision, but also to followup those who are found to need further diagnosis and treatment.
Letter to the Editor
Authors: Kafka H. L.
Published: December 2021

There is no need for highly qualified, highly paid personnel like public health nurses and health assistants to monitor access to care and to encourage the use of the services. Lesser trained, but well known persons in the community, such as a community health worker, would be better received by the community and, therefore, would do a better job. It may be possible in some areas to use volunteers.

A study using such a group of people in a well-defined area would certainly help to establish this kind of health worker as a permanent institution in the public health services.
Questions About PDQ
Authors: Perrin James M.
Published: December 2021

The Prescreening Developmental Questionnaire (PDQ) (Pediatrics 57:744, May 1976) may be a useful device to diminish some of the demands of developmental screening among preschool children. There has been some reluctance to recommend routine developmental screening of all children,1 and the PDQ, by diminishing the number of false positives in low-prevalence populations, may make such screening more appropriate for these populations.

There are some apparent inaccuracies in the presentation of the predictive value of a positive screen2 throughout the article.
Drs. McCarthy and Dolan Reply
Authors: McCarthy Paul L. , Dolan Thomas F.
Published: December 2021

It is true that the occurrence rate of bacteremia in healthy afebrile children is not known. However, our data suggest that there is a direct correlation between height of fever and bacteremia.

We have recently completed a prospective study of children less than 2 years of age with a temperature of greater than or equal to 40 C (104 F).1 We asked the resident physicians to predict the presence of bacteremia from clinical evaluation and prior to knowledge of complete blood cell count and ESR.
Diagnosis of CNS Involvement Questioned
Authors: Walker Stuart H.
Published: December 2021

The report of Dr. Klimek et al. (Pediatrics 58:133, July 1976) concerning the relationship between infection with Mycoplasma pneumoniae and CNS disease recalls persisting difficulties in establishing the relationship between viral infection and CNS disease. Infection with a viral agent such as the varicella (VZ) virus may be associated with the detectable presence of the virus within the CNS (encephalitis, aseptic meningitis, etc.) or by inflammatory CNS disease in the absence of detectable evidence of the virus (parainfectious demyelinating disease or Reye's syndrome).1
Dr. Bergman Replies
Authors: Bergman Abraham B.
Published: December 2021

Dr. Dershewitz is a few jumps ahead of us. We consider our study to be in the realm of basic accident research, i.e., searching for etiologic factors. He's into practical application. That's okay! Jenner came up with a means to prevent smallpox long before the virus was identified.

The existence of accident-prone children is widely assumed with little solid supporting data. There is even less information available on effective methods of altering behavior that leads to accidents.
Questions That GPs Are Deficient in Knowledge
Authors: Merenstein Joel H.
Published: December 2021

As a family practitioner with a particular interest in streptococcal pharyngitis,1 I was surprised and annoyed by the report "Treatment of Acute Sore Throats: A Comparison of Pediatricians and General Practitioners" (Pediatrics 57:422, March 1976). In their article, Gordis et al. conclude that general practitioners are deficient in knowledge and practice concerning management of sore throat. The limited validity of questionnaire answers is well known, and response rates of 36% do not warrant any generalizations.
Drs. Henrichs and Teller Reply
Authors: Henrichs I. , Teller W. M.
Published: December 2021

We were interested in the response of Drs. Euler and Ament to our article. We are especially appreciative of the reference to their publication,1 which we did not know of at the time of submission of our paper. Dr. Euler and colleagues confirm our results of elevated postpartum gastrin concentrations in the neonate, as have Niessen et al.2 In their second communication Dr. Euler et al. have also proved our findings in mothers and their offspring.3