bluuebunny/crossref_metadata_2025 huggingface dataset:
CONGENITAL AND INFANTILE APHASIA
Authors: VAN GELDER D. W. , KENNEDY L. , LAGUAITE J.
Published: December 2021

The clinical features of infantile aphasia include failure or delay in development of speech. When speech develops, it is frequently garbled. Hearing and intelligence may be normal although both are difficult to evaluate. Abnormal behavior may appear in these children simply because they lack normal opportunities to express themselves.

It is pointed out that many of the children of 4 to 5 years of age with delayed speech development may not simply be "deviates from the norm" but may actually suffer from mild degrees of aphasia. Earlier recognition and proper guidance for milder types of aphasia will depend ultimately on better definition of the pattern and rate of normal speech development.

At present, there apparently is little or no agreement either as to frequency or actuality of this syndrome in childhood. Unfortunately, mild cases are apt to be passed over and more severe ones are often tragically mislabeled as mental defectives.
SOME ASPECTS OF THE CHEMICAL COMPOSITION, PHYSIOLOGY AND PATHOLOGY OF INTRACELLULAR FLUID
Authors: WALLACE WILLIAM M.
Published: December 2021

I ACCEPT the Mead Johnson Award for 1951 with gratitude tempered with the sense of the future obligation that your choice imposes. The preparation of a presentation such as this accentuates the realization of how many of one's own thoughts are but those of others phrased in the terms of individual experience. The present award must be considered as given to many. Dr. James L. Gamble has pointed to the problems and, by his presence and work in the laboratory, provided the stimulus and guidance for pursuing the work to be discussed. Dr. Charles A. Janeway has carried the difficult and unseen and, so often, unthanked burden of seeking and providing the means for carrying on the work and, by his wide field of interest and knowledge, suggested many of the ideas pursued. To my contemporaries in the laboratory, Dr. Jack Metcoff, Dr. Leonard Eliel, Dr. Malcolm Holliday, Dr. Robert Schwartz, Dr. Ernest Cotlove, Dr. William Schwartz, Drs. George and Nancy Nichols and Dr. William Bergstrom must go the credit for the great bulk of the work done. Any credit that may accrue must also be shared with those who did so much of the analytic and secretarial work and provided the nursing care in the clinical studies. Work of the type to be discussed requires substantial financial support and appreciation must be expressed to the Mead Johnson Company, the United States Public Health Service and the Grant Foundation for supplementing the liberal opportunities for research at the Children's Medical Center.

It is the purpose of this paper to consider some concepts of the electrolyte composition, physiology and pathology of the intracellular fluid and to inquire into their application to clinical problems.
COAGULATION STUDIES IN THE NEWBORN INFANT
Authors: GROSSMAN BURTON J. , HEYN RUTH M. , ROZENFELD IRVING H.
Published: December 2021

Data on the whole blood clotting time, platelet count, prothrombin concentration, protamine titration and gross observation for clot lysis are presented on 21 normal newborn infants within six hours of birth, and on the third and fifth days of life.

The whole blood clotting time within the first six hours of life ranged from 7 to 38 minutes with an average of 14 minutes. On the third day of life the range was from 10 to 60 minutes with an average of 25 minutes. On the fifth day of life the range was from 6 to 38 minutes with an average of 16 minutes.

Protamine titration was increased as compared to normal adult values in 6 of 26 infants within the first six hours of life. On the third day 7 of 26 showed an increase. All titrations were normal on the fifth day.

The prothrombin concentration showed all variations of patterns, the average pattern being high on the first day, lower on the third day, and high on the fifth day.

Platelet values for the three days studied were all within normal limits, for adults.

Further data on 35 normal newborn infants, studied in groups of five through the first seven days of life using the above technics with the addition of the heparin sensitivity test, are presented.

The significance of the data is discussed.
CHRONIC HEMOLYTIC ANEMIA IN A WHITE CHILD DUE TO THALASSEMIA AND SICKLEMIA
Authors: WASSERMAN CHARLES F. , PHELPS V. RAE , HERTZOG A. J.
Published: December 2021

The authors have described the second case in the United States of chronic hemolytic anemia resulting from the genetic factors for sicklemia and thalassemia minor in combination. A complete hematologic study of 37 relatives of the propositus is presented. The four possible theories, as proposed by earlier investigators, which may explain the severe clinical manifestations, are given.
CHEMICAL COMPARISON OF NORMAL MECONIUM AND MECONIUM FROM A PATIENT WITH MECONIUM ILEUS
Authors: BUCHANAN DOROTHY J. , RAPOPORT S.
Published: December 2021

A series of chemical analyses comparing normal meconium with meconium from a patient with meconium ileus demonstrated the following differences:

a. Normal meconium contained over four times the amount of total reducing sugar found in the meconium from a patient with meconium ileus. About 15% of the reducing sugar of both the normal and the abnormal meconium was dialyzable.

b. Normal meconium contained less total nitrogen than meconium from a patient with meconium ileus. Most of this was found to be nonprotein, while that of the abnormal meconium was mostly protein in nature.

c. The phosphorus and purine contents were minimal in both samples.

The ammonium sulfate fractionation of normal meconium differed from that of meconium from a patient with meconium ileus.

Alcohol fractionation of normal meconium gave precipitates whose reducing sugar to nitrogen ratios rose from 3.2 to 6.6 with increasing alcohol concentrations. Meconium from a patient with meconium ileus gave precipitates whose reducing sugar to nitrogen ratios rose from 0.47 to 0.86 with increasing alcohol concentrations.

The action of pepsin and trypsin on normal meconium was not significant; on meconium from a patient with meconium ileus trypsin increased the per cent of nonprotein nitrogen twice and pepsin, six-fold.

The reducing sugar to nitrogen ratio of meconium from a premature infant was shown to increase as it proceeded down the intestinal tract.
Round Table Discussion
Authors: BLOOMER HARLAN , STROTHER CHARLES , BREESE BURTIS B. , GLEASON A. L.
Published: December 2021

Chairman Bloomer: In leading this round table I have with me Dr. Charles Strother, Professor of Clinical Psychology in the College of Medicine of the University of Washington at Seattle. I am from the University of Michigan Speech Clinic in Ann Arbor. We are very glad to be with you at this round table because it suggests the close relationship between the fields of speech pathology and pediatrics.

We come to the American Academy of Pediatrics as representatives of the American Speech and Hearing Association which is the national organization for professional people interested in the study of speech disorders, their causes and their methods of treatment. Perhaps you are familiar with the official publication of the Association, the Journal of Speech and Hearing Disorders. We bring you greetings from the Association.

I think you may be interested in a brief outline of our general plan of discussion for the afternoon. The first part of our discussion will review the importance of a knowledge of speech disorders to specialists in pediatrics. Next we shall discuss in some detail the nature of these disorders and the etiologic factors which are frequently encountered, and then we shall suggest methods for handling the speech problems which the individual child may present. We shall be glad to have your participation, your questions, and your comments at any time during our discussion.

We feel that this subject is particularly timely because of the steadily increasing interest of pediatricians in the general aspects of child growth and development rather than in only the medical care of children.
SPECIAL ARTICLE
Authors:   THE EXAMINATIONS COMMITTEE
Published: December 2021

STATISTICAL analysis of the January 1951 written examination of the American Board of Pediatrics has been completed. The following comments are offered for general information.

Like the examination of January 1950 (see Pediatrics 8:598, 1951), this examination also consisted of 200 false and true statements. It was a completely new examination, that is, none of the statements contained in it had appeared in previous examinations. Tabulation of the responses of all the candidates to each of the 200 items disclosed the fact that some of the statements had been poorly phrased, that some of them dealt with details of disease with which the vast majority of candidates were unfamiliar, that some few were answered correctly by 99% of the candidates. Such statements do not contribute to the accuracy of grading. They are, however, unavoidable before new statements have been tested on the candidates. The committee charged with preparing the examination is aware of this weakness and will continue to assemble statistics and comments toward the objective of reducing the number of poor questions to a minimum.

The examination was taken by 366 candidates. The method of grading was the same as has been used in the past, that is, to the number of correctly answered statements is added half the number of unanswered statements and from the total 100 is subtracted; the remainder is the grade. The distribution of these grades is shown graphically in the histogram (see chart 1). Superimposed on the histogram is a normal frequency curve the ordinates of which were computed from the mean and standard deviation of all the grades.[See chart 1 in Source Pdf]
THE PRESIDENT'S PAGE
Authors: QUILLIAN WARREN W.
Published: December 2021

IT IS axiomatic to say that recent achievements in medical science have greatly improved the quality of medical care. One of the fields of study, constituting an important area of activity in which progress can be cited, is the care of the prematurely born infant. Not only has there been general utilization of new drugs and equipment, but a better knowledge and application of methods employed in reduction of the hazards confronted by the infant during this critical age period. Perhaps the most important single factor destined to influence favorably the morbidity and mortality statistics of prematures is the proper training of professional personnel assigned to their care.

During recent years many changes have developed both in the character and the content of medical education. There is little value in planning for more and better health services unless consideration is first given to providing well-trained physicians to render those services. Assumption of responsibility, with the application of fundamental principles to specific cases, is the foundation of good medical judgment. The service rendered in their local communities by practicing physicians can be only so good as the training, skills and abilities of the individuals who give it. An encouraging trend since World War II has been the very widespread effort on the part of pediatricians to avail themselves of additional training in medical centers, to acquire there the skills and modern methods so necessary for utilization in their own practice. There is general recognition of the principle that better preparation for the care of sick children and the health supervision of well children will necessarily be reflected in improved standards of practice—a step along the way toward our Academy goal of better health for more children.
CARBOHYDRATE METABOLISM
Authors: BEST CHARLES H.
Published: December 2021

Total absence of vascular disease occurred infrequently after 20 years of diabetes, but 8% only of the 702 twenty-year survivors died from their vascular lesions. Juvenile diabetic patients survive to more than middle age. Nearly all (oven 90%) after 30 and after 25 years of diabetes were free from blindness, gangrene and cerebrovascular accidents. Two-thirds were free from the potentially incapacitating lesions proliferating retinitis and vascular nephritis. Vascular lesions did not appear to he dependent upon duration of diabetes alone. Poor control of diabetes paralleled both the degree and the frequency of the vascular lesions. Sepsis, too, appeared to be an important inciting factor. Some remedial measures have been attempted with apparent success. Despite the preponderance of vascular lesions after 20 years, they are not disabling in the majority of the cases. It is apparent that, just as lethal coma, lethal sepsis and lethal tuberculosis are no longer inevitable, lethal vascular disease can be averted or, at least, postponed.
Round Table Discussion
Authors: COLLINS-WILLIAMS C. , RATNER BRET , MORRISON HOWARD J. , KEITER W. EUGENE
Published: December 2021

Specific Diagnostic Practice

Chairman Collins-Williams: The specific diagnosis of the child with respiratory allergy comprises the following: (1) general pediatric care; (2) careful allergic history; (3) complete physical examination; (4) indicated laboratory procedures including nasal smears; (5) skin testing.

Skin testing is necessary in order to help determine the specific etiologic allergens. The allergens tested with should include the common foods and the common inhalants, pollens and molds in the environment.

Eosinophiles and Eosinophilia

Eosinophilia occurs in a great many conditions other than allergy and these must be taken into account in interpreting differential blood counts.

The nasal smear is a useful laboratory test in the diagnosis of nasal allergy. Eosinophiles may temporarily appear in considerable numbers in the nasal smear of the nonallergic child during recovery from a respiratory infection, but otherwise a predominance of eosinophiles in the nasal smear is diagnostic of nasal allergy.

Office Treatment of Respiratory Allergy

The office treatment of a child with respiratory allergy includes the following: (1) general pediatric care; (2) symptomatic relief of allergic symptoms; (3) removal of incriminated foods from the diet; (4) as complete an elimination of environmental allergens as possible; (5) specific desensitization.

Specific Desensitization

Dr. Ratner: The method of specific desensitization which we use in practice is as follows:

The treatment extract consists of a 1:5,000 dilution of each of the inhalants, pollens and molds with which the patient gave a positive reaction. Each week the patient receives one injection from a tuberculin syringe containing 0.15 cc. of this treatment extract, 0.15 cc. of a 1:20 dilution of mixed bacterial vaccine, 0.15 cc. of a 1:20 dilution of pertussis vaccine, and 2 minims of adrenaline.
HEREDITARY SEXUAL PRECOCITY
Authors: JACOBSEN A. WILMOT , MACKLIN MADGE T.
Published: December 2021

A family is reported in which 27 males were affected with precocious somatic and sexual development.

The trait is shown to be dependent upon a sex-limited autosomal gene with a little less than complete penetrance.
Symposium
Authors: JASPER HERBERT H. , MCEACHERN DONALD , RABINOVITCH REUBEN , HAWKE WILLIAM A. , MCRAE DONALD L. , PENFIELD WILDER , JASPER HERBERT H. , ROBB JAMES PRESTON , MCNAUGHTON FRANCIS L.
Published: December 2021

It is indeed with great pleasure that neurologists of Canada have accepted the invitation of the Academy to participate in its meeting in Toronto and we take this occasion to express our sincere welcome to all our colleagues from south of the border.

When Dr. Orr asked me to organize this Symposium, he added that he would like it to be an "all Canadian show." I objected seriously to usurping the program in this manner and not inviting several outstanding speakers from among our colleagues in the United States who would have added greatly to this program. But finally we have yielded to Dr. Orr's persuasiveness in giving you a sample of some of the work being done in this country. We have the good fortune of possessing, in Canada, a Neurological Institute which is rapidly becoming a Canadian National Institute, established in Montreal under the direction of Dr. Wilder Penfield, who is to participate in the Symposium today, speaking on his favourite subject, epilepsy, with particular emphasis on a new conception of focal epilepsy in children. Dr. William Hawke, of the Hospital for Sick Children in Toronto, whom we like to claim as an adopted member of the staff of the Montreal Neurological Institute, will present some of the results of his life long studies of behaviour problems in children. Dr. McEachern, who was unable to attend this meeting because of ill health, has been replaced by Dr. Rabinovitch, who will present a summary of his extensive experience in the study of neuromuscular diseases, a subject which presents puzzling problems to most pediatricians.
Round Table Discussion
Authors: LINCOLN EDITH M. , SCRIVER J. B. , BIGGS A. D.
Published: December 2021

Chairman Lincoln:We will try to stay as close to the subject matter as possible and then if we have time and you want to go off into other subjects connected with tuberculosis, we can. I think there is plenty of material for discussion in early diagnosis and the treatment of the early phases of tuberculosis, that is, primary and postprimary tuberculosis. This will take up our time without going into the discussion of chronic pulmonary tuberculosis, since that is not a form of tuberculosis which is common in children.

Specific therapy has changed the attitude of pediatricians to tuberculosis. Formerly a pediatricians took the attitude that the great majority of children who had primary infection, evidenced by positive tuberculin tests without or with positive x-rays, would get better without ever having any symptoms; that a few of them might develop complications such as tuberculosis of the cervical nodes, or of the bones or joints, which could be turned over to a specialist and not be seen again by the pediatrician. A few cases would develop fatal complications such as meningitis or miliary and promptly die. Therefore, there was little of interest to the clinician in the story of tuberculosis in the child. As recently as 5 years ago, just before chemotherapy, I talked to pediatricians in many teaching centers and I was repeatedly told that the diagnosis and the care of tuberculous children was a minor problem and that tuberculosis was practically never seen in their services.

Since chemotherapy there has been a new interest in tuberculosis and I think this is shown partly by this round table discussion.
THE PEDIATRICIAN AND THE PUBLIC
Authors: WISHROPP EDWARD A. , MARTMER EDGAR E.
Published: December 2021

At the annual meeting of the State Chairmen of the American Academy of Pediatrics in 1952, Dr. Edward A. Wishropp made a brief report of the plan for giving comprehensive pediatric care in Windsor, Ontario. This had been studied by the Academy's Committee on Medical Care Plans.

In order that the membership of the Academy might have more information about the work of this important committee, the editor of this column requested Dr. Wishropp and Dr. Edgar E. Martmer to prepare a communication on this subject.

INSURANCE PLAN REPORT

THERE are many programs throughout the United States, Canada and several foreign countries, providing some degree of medical services for infants and children. These range from governmentally financed programs, offering supposedly complete care, to those furnished by individual pediatricians having agreements between the pediatrist and the parents.

Because no comprehensive review of these various plans has been made, the Executive Board of the American Academy of Pediatrics created a committee to study insurance plans and programs.

The president, Dr. Warren Quillian, appointed a Committee on Medical Care Plans as a fact-finding group. Serving with Dr. Edward A. Wishropp, chairman, are:[See Table In Source PDF]

Some basic considerations, presented by Dr. S. J. Axelrod, Assistant Professor of Public Health at the University of Michigan, can be outlined as follows and these must serve as a working nucleus in determining a worth while and workable plan.
Systemic Reaction to Human Growth Hormone Treated With Acute Desensitization
Authors: WALKER SUSANNAH B. , WEISS MICHAEL E. , TATTONI DIANA S.
Published: December 2021

Recombinant DNA technology has led to increased production and widespread use of recombinant growth hormone. Systemic allergic reactions to recombinant growth hormone such as urticaria, angioedema, or anaphylaxis have not been described in the literature. We report a patient who developed generalized urticaria from recombinant human growth hormone (Humatrope, Eli Lilly and Company) in whom we successfully desensitized to growth hormone using a protocol modified from an insulin desensitization schedule.1

CASE REPORT

A 12-year-old girl with hypopituitarism and short stature had been treated with 2 mg to 5 mg of Humatrope (depending on her weight and responsiveness to treatment) intramuscularly 6 days a week for 3 years without any problems.
Causation of Kwashiorkor: Toward a Multifactorial Consensus
Authors: JELLIFFE DERRICK B. , JELLIFFE E. F. PATRICE
Published: December 2021

The pioneer research and writings by Hendrickse on the human health hazards of aflatoxins, including their potential role in the etiology of kwashiorkor, are of great importance.1,2 They draw attention to at least some of the wealth of mycotoxicological information sometimes inadequately recognized by pediatricians and other health professionals. However, while acknowledging the significance of this underemphasized linkage and the need for much further communication between workers in the various highly complex fields involved, a different interpretation of the potential role of aflatoxins in the etiology of kwashiorkor needs consideration, based on present evidence. The converse is also true, as the focus of mycotoxicologists regarding human pathology seems mainly concerned with cancer of the liver.
ECMO and Sepsis
Authors: LEBLANC MICHAEL H.
Published: December 2021

To the Editor.—

The article by Hocker et al, "Extracorporeal Membrane Oxygenation and Early Onset Group B Streptococcal Sepsis,"1 purports to show that extracorporeal membrane oxygenation (ECMO) is effective in Group B Sepsis. The study begins comparing results prior to ECMO therapy with results after ECMO therapy. The incidence of death from Group B Sepsis went from 3 of 28 or 11% prior to the institution of ECMO to 9 of 53 or 17% after the institution of ECMO.
Past, Present, and Future of Measles, Mumps, and Rubella Virus Vaccines
Authors: Hilleman Maurice R.
Published: December 2021

It is a real pleasure for me to speak on this memorable occasion. Dr Saul Krugman is now entering his ninth decade while enjoying the world status of senior statesman! Saul and I have collaborated often during the last three of these decades. In the studies of new vaccines in our laboratories, our first clinical probes were made in cooperative studies with the late Dr Joseph Stokes and his colleagues and successors at the Children's Hospital of Philadelphia. Following such initial phase, Dr Krugman received the vaccines for expanded clinical studies. Hence, he has been an indispensible clinical partner in most of the new viral vaccine developments in our laboratories during the past 30 years. In discussions with Dr Wade Parks, I was advised that I might speak on any subject I choose. I chose to talk about the measles-mumps-rubella vaccine (M-M-R), a topic that has occupied Dr Krugman for nearly three decades and that is receiving renewed attention in the worlds of pediatrics and public health at the present time. This being a festive occasion, I feel I should keep it light. Therefore, I want to emphasize the science, but also to recount some of the less well-known "behind-the-scenes" activities that led to the creation and birth of M-M-R. There were lessons learned that might provide historic insight into problems that can be avoided in the future. MEASLES Measles vaccine began when the late Dr John Enders and Dr Samuel Katz and their coworkers developed and tested their Edmonston strain of attenuated live measles virus.1
The Changing Role and Responsibilities of Chairmen in Clinical Academic Departments: The Transition From Autocracy
Authors: Brent Robert L.
Published: December 2021

There is considerable literature dealing with the responsibilities of clinical department chairmen, which primarily emphasizes the importance of developing a sound and facilitating administration. This is dependent on the hiring of appropriate support personnel, developing a representative committee structure, being available to the faculty for their needs, and establishing departmental guidelines, procedures, and policies that apply equally to everyone. Nascent chairmen have an extensive literature available to them concerning academic administration, but a chairman's success is primarily dependent on the possession or development of certain interpersonal skills. Developing a concern and interest in the faculty and staff will come naturally to some and may have to be learned by others. A chairman can attempt to create an excellent esprit de corps by introducing a departmental philosophy that is perceived by the faculty to be supportive. Qualities of the chairman that convey this philosophy are fairness, integrity, compassion, confidentiality, effectiveness, judiciousness, and the willingness to exert considerable effort and time in obtaining recognition and rewards for the faculty. Some of the most difficult tasks for a chairman are (1) the prioritization of his or her responsibilities and activities, (2) representing both the university and the department when their goals appear to conflict, (3) recognizing that an autocratic chairman may administer the department with less difficulty and even appear to have more respect than a democratic chairman, (4) learning to expect less accolades and appreciation from faculty than the clinical chairmen of yesteryear, and (5) resisting the commitment of valuable time to negotiations or battles that cannot be won or to activities that do not benefit the department or the university. There are more than 25 areas of responsibility that are mentioned in this paper. Only a few of them are discussed in any detail. There are many positive aspects of the role of chairmanship. As the years go by, the position becomes easier and more enjoyable and represents the most rewarding and fulfilling position in the medical administration hierarchy. It offers the individual an unusual degree of independence and autonomy not available in any of the other administrative positions in medicine, while still permitting involvement in the scholarly and clinical pursuits of academic medicine and the development of future clinicians and academicians.
Capillary Recruitment for Preservation of Cerebral Glucose Influx in Hypoglycemic, Preterm Newborns: Evidence for a Glucose Sensor?
Authors: Skov L. , Pryds O.
Published: December 2021

Changes in cerebral blood volume (CBV) were investigated by means of near-infrared spectroscopy in 18 preterm newborns during treatment with intravenous bolus glucose. All newborns were breathing spontaneously, and their postnatal age was 2 hours. Blood glucose concentration ranged between 0.3 and 2.2 mmol/L. Cerebral blood volume began to decrease shortly after the glucose infusion was terminated, and steady state was obtained after approximately 3 minutes. The decrease in CBV averaged 0.15 mL/100 g (range 0.02 to 0.40 mL/100 g). Thereafter, CBV remained constant. Individual reductions in CBV were inversely related to the pretreatment concentration of glucose, whereas there was no relation between changes in CBV and alterations in blood gas values or in mean arterial blood pressure. It is suggested that previously unperfused capillaries are recruited to maintain the glucose transport into neurons of hypoglycemic, preterm newborns. The rapidity whereby vessels adjust to alterations in glucose levels indicates the existence of a cerebral glucose sensor.
Is There Compensated Hypothyroidism in Infancy?
Authors: Alemzadeh Ramin , Friedman Silvia , Fort Pavel , Recker Bridget , Lifshitz Fima
Published: December 2021

The state-mandated newborn thyroid screening program may uncover infants who exhibit normal thyoxine (T4) levels with various degrees of hyperthyrotropinemia. To elucidate further the thyroid status, the basal metabolic rate (BMR) of 10 infants (7 boys, 3 girls; aged 9 to 63 days) was studied by indirect calorimetry. They were clinically euthyroid and healthy with no evidence of overt biochemical hypothyroidism (low T4, high thyroid-stimulating hormone [TSH]). Confirmatory testing indicated that all infants had normal serum T4 levels for age (mean ± SD: 10.3 ± 3.2 µg/dL). However, serum TSH levels varied from 2.3 to 99.2 µU/mL In 4 infants (2 boys, 2 girls) the BMR was low (38.1 ± 4.1 kcal/kg per day), while the other 6 patients (5 boys, 1 girl) demonstrated BMRs within the normal range (49.6 ± 1.9 kcal/kg per day, P < .001). The serum TSH levels were above 7.0 µU/mL among those infants with a low BMR, whereas the serum TSH levels were always below 6.0 µU/mL among the normometabolic infants. All infants who had a low BMR received thyroid therapy and promptly became normometabolic (BMR: 48.7 ± 1.0 kcal/kg per day) with suppression of TSH levels (3.2 ± 1.3 µU/mL) within 3 weeks of therapy, while their serum T4 levels remained within the normal range. The observed normalization of BMR In parallel to reduction of TSH levels following thyroid replacement therapy strongly suggests that these patients demonstrated a hypometabolic state, despite normal serum T4 levels. Therefore, the assessment of BMR may help define subclinical hypothyroidism in infancy in conjunction with a close monitoring of TSH concentration.
Serum Enzyme Monitoring in Asthma Patients
Authors: CHOI YOUNG S.
Published: December 2021

To the Editor.—

Maguire et al1 have recommended serial monitoring of serum creatine phosphokinase isoenzyme (CPK-MB) levels and electrocardiograms (ECG) for all children requiring admission to an intensive care unit for treatment of severe asthma. I wish to point out what I believe are inaccurate observations and invalid conclusions.

In this study 20 admissions to intensive care units occurred for "severe bronchial obstruction despite standard initial therapy." Six necessitated use of intravenous isoproterenol for Pco2, values of 50 mm Hg or higher.
Baby's First Spring Water
Authors: GOLDSMITH RICHARD
Published: December 2021

To the Editor.—

I wish to bring to the attention of the readers of Pediatrics, who are not already aware of it, the latest in a long list of absurdities. The Beech-Nut Company has now stooped to marketing a product called "Baby's First Spring Water." This product is simply water of presumed and unquestioned purity and subsequently sterilized and to which has been added 1 ppm of fluoride. Surrounding the Beech-Nut Baby Logo on the label is a blue band in which is written "fluoridated."
Physicians' Interactions with Pharmaceutical Companies
Authors: KOHRMAN ARTHUR F.
Published: December 2021

Comment.—

Dr Procopio's letter raises and outlines the complexity of making ethical decisions in a market-driven economy; free samples are often the only source of medication for patients with limited incomes. In addition, they may offer opportunity for the physician to initiate therapy more rapidly in areas where access to pharmacies is limited. Dr Procopio's letter also raises some of the bigger issues which this debate should move to, and suggests that, if we are going to continue with a competitive market economy for pharmaceutical distribution, we may have to resort to either voluntary or mandatory constraints.
Cigarette, Alcohol, and Other Drug Use by School-Age Pregnant Adolescents: Prevalence, Detection, and Associated Risk Factors
Authors: Kokotailo Patricia K. , Adger Hoover , Duggan Anne K. , Joffe Alain , Repke John
Published: December 2021

Use of cigarettes, alcohol, and other drugs among pregnant adolescents is just beginning to be documented. This study sought to determine the prevalence and associated risk factors of cigarette, alcohol, and other drug use among school-age adolescents attending a comprehensive teenage pregnancy program. All enrollees completed a self-administered questionnaire and provided a breath sample for carbon monoxide analysis. Urine was obtained for quantitative determination of drug metabolites at the initial and one third-trimester visit. A chart review determined medical provider recognition of cigarette, alcohol, and other drug use. Results were analyzed for 93% of 229 eligible patients. Seventeen percent were positive for alcohol or other drug use by questionnaire self-report, provider report, or initial urine screen. Eleven percent were positive by urine screen alone at either the initial or third-trimester visit. Medical providers were successful in identifying nearly all of the cigarette smokers, but fewer than half of the alcohol drinkers and few of the other drug users. Forward stepwise multiple regression determined the most efficient model for predicting alcohol and other drug use. A report of having been high at school and personal or friends' use of cigarettes were the most significant risk factors. Results indicate a high prevalence of alcohol and other drug use and suggest a need for changes in current practice related to the detection and management of such drug use in pregnant adolescents.
Maternal Smoking and Behavior Problems of Children
Authors: Weitzman Michael , Gortmaker Steven , Sobol Arthur
Published: December 2021

Numerous health consequences of children's exposure to maternal smoking have been demonstrated, including increased rates of low birth weight, infant mortality, respiratory infections, asthma, and modest impairments of cognitive development. There is little evidence, however, linking maternal smoking and increased rates of children's behavior problems. Data from the population-based National Longitudinal Survey of Youth were used to investigate the possible association of maternal smoking and behavior problems among 2256 children aged 4 through 11 years. In multiple regression analyses the authors controlled for child's race, age, sex, birth weight, and chronic asthma; family structure, income, and divorce or separation in the prior 2 years; mother's education, intelligence, self-esteem, employment status, chronic disabling health conditions, and use of alcohol during pregnancy; and the quality of the home environment as assessed by the Home Observation for Measurement of the Environment-Short Form to investigate the relationship between maternal smoking and children's behavior problems. The measure of maternal smoking status reflected two levels of smoking intensity (less than a pack per day and a pack or more per day) for each of three different categories of children's exposure: prenatal only (mother smoked only during pregnancy), passive only (mother smoked only after pregnancy), and prenatal plus passive exposure (mother smoked both during and after pregnancy). Measures of children's behavior problems included the overall score on a 32-item parent-reported child Behavior Problem Index (BPI), scores on the BPI's six subscales, and rates of extreme scores on the BPI. Increased rates of children's behavior problems were found to be independently associated with all three categories of exposure to maternal cigarette smoke, with evidence suggesting a dose-response relationship. For example, among children whose mothers smoked both during and after pregnancy, there were 1.17 additional problems independently associated with smoking less than a pack per day (P = .0007) and 2.04 additional problems associated with smoking a pack or more per day (P = .0001). The odds ratio for extreme behavior problem scores for this category of exposure was 1.41 if the mother smoked less than a pack per day (P = .01) and 1.54 if she smoked a pack or more per day (P = .02). These data provide evidence suggesting that increased behavior problems of children should be added to the growing list of adverse child health conditions associated with children's prenatal and passive exposure to maternal smoking.
Correlates of Children's Bicycle Helmet Use and Short-term Failure of School-level Interventions
Authors: Pendergrast Robert A. , Ashworth Carolyn Seymore , DuRant Robert H. , Litaker Mark
Published: December 2021

To test the utility of school-level interventions for child bicycle safety and to identify social and behavioral factors associated with children's bicycle helmet use, a two-level intervention was conducted in two suburban elementary schools. Children (N = 209) and parents (N = 125) in school 1 and in school 2 (children, N = 470; parents, N = 364) were surveyed regarding bicycle injuries and helmet use. Children and parents in schools 1 and 2 received literature about bicycle safety and discount coupons for helmet purchase. School 1 was then the target of an intensive safety campaign, including meetings with the school safety committee and the PTA and a classroom presentation to children emphasizing helmet use. Ten months later the same survey was again administered. Children in school 1 were more likely at posttest to believe that helmets were protective (P = .003) but did not differ on other variables. Logistic regression showed that sibling helmet ownership, parental helmet use, and lower parental perceived social barriers to helmet use were independently associated with children's reported helmet use and with parental intent for the child to use a helmet at posttest.
Meconium Aspiration Pneumonitis and/or Persistent Fetal Circulation
Authors: REYNOLDS DAVID W.
Published: December 2021

To the Editor.—

While reviewing the literature on neonatal illness associated with meconium-stained amniotic fluid (MSAF), it became clear to me that a change in nomenclature would be helpful. The term, meconium aspiration syndrome, appears to encompass the entire spectrum of cardiopulmonary disease occurring with MSAF. The presumption then is that persistent fetal circulation which develops in a neonate with MSAF is caused by the aspiration of meconium into the lungs. There is substantial evidence that speaks against a major role for meconium in the genesis of pulmonary hyperreactivity in this condition and very little to support a causal effect.1
Caveats on Abdominal Central Venous Pressure Measurement
Authors: LLOYD THOMAS R. , DONNERSTEIN RICHARD L. , BERG ROBERT A.
Published: December 2021

In Reply.—

We appreciate Dr Tong's kind comments on our study. As we stated, "Abdominal vena cava pressure may be significantly higher than right atrial pressure...(in) patients with extrinsic compression of the inferior vena cava," and this may well occur in patients with severely elevated intraperitoneal pressure due to the presence of fluid or air. It is worth pointing out that the same caveat applies to intrathoracic venous pressure measurement in the presence of extrinsic compression of the superior vena cava or right atrium (eg, by pneumomediastinum).
Estimated Number of AIDS Orphans in the United States
Authors: CALDWELL M. BLAKE , FLEMING PATRICIA L. , OXTOBY MARGARET J.
Published: December 2021

To the Editor.—

The human immunodeficiency virus (HIV) epidemic in child-bearing women impacts our society in a number of ways. One of these is the legacy of uninfected children left without their mothers when these women succumb to acquired immunodeficiency syndrome (AIDS). We have calculated a crude estimate of the current and future number of these AIDS orphans.

As of December 31, 1991, 21 225 women (≥13 years of age) with AIDS were reported to the Centers for Disease Control from the United States, Puerto Rico, and the Trusts and Territories; 17 910 (84%) were of reproductive age (15 to 44 years) at the time they were diagnosed with AIDS.
Lyme Arthritis as the Incorrect Diagnosis in Pediatric and Adolescent Fibromyalgia
Authors: Sigal Leonard H. , Patella Sondra J.
Published: December 2021

In areas endemic for Lyme disease there is increasing concern and anxiety about possible chronic and untreatable manifestations of the disease. The authors have diagnosed fibromyalgia in many patients with chronic musculoskeletal complaints in whom chronic Lyme arthritis had previously been diagnosed as the cause of their joint pains. Fibromyalgia is a common disorder, causing arthralgia (not true arthritis), fatigue, and debility. The repeated and/or long-term antibiotic therapy prescribed for "chronic Lyme disease" is not successful in curing the symptoms of fibromyalgia. Especially in areas where anxiety about Lyme disease is great, it is important to be careful in diagnosing chronic Lyme disease. Fibromyalgia is a potentially treatable and curable cause of chronic complaints and should be considered in the differential diagnosis of "refractory Lyme arthritis."
Prolonged Dexamethasone Therapy Reduces the Incidence of Cryotherapy for Retinopathy of Prematurity in Infants of Less Than 1 Kilogram Birth Weight With Bronchopulmonary Dysplasia
Authors: Sobel Daniel B. , Philip Alistair G.S.
Published: December 2021

To determine whether prolonged dexamethasone therapy, used in the treatment of bronchopulmonary dysplasia (BPD), affects the incidence of cryotheraphy for retinopathy of prematurity, the authors conducted a retrospective review of all infants admitted to a neonatal intensive care unit between October 1988 and October 1990 (n = 957) whose birth weights were less than 1 kg (n = 90). All admissions were reviewed to determine birth weight, gestational age, survival, incidence of BPD and cryotherapy, use and duration of dexamethasone therapy, length of mechanical ventilation, continuous positive airway pressure, and additional supplemental oxygen. Of all neonatal intensive care unit admissions, 9.4% weighed less than 1 kg, and 64% survived for greater than 28 days (n = 58). Of the survivors, 82% had BPD. Cryotherapy for retinopathy of prematurity was used only in those with birth weights of less than 1 kg and with BPD. All those treated with dexamethasone (n = 23) had BPD and significantly lower gestational ages (25.6 vs 26.4 weeks) (P= .05) and birth weights (759 vs 824 g) (P < .05) than those not treated (n = 25). Dexamethasone was used in 23 of 48 infants (9 for ≤24 days, 14 for >24 days). Eleven required cryotherapy: 5 of 25 with no dexamethasone, 5 of 9 treated for 24 days or less, and 1 of 14 treated for longer than 24 days (P < .04). In those treated with prolonged (>24 days) dexamethasone, cryotherapy was significantly reduced compared with those treated for shorter periods. Although the probability was significant, the 95% confidence intervals were wide. Controlled prospective trials are needed to determine optimal usage and side effects of dexamethasone in premature infants.
Day Care Center Attendance and Diarrheal Morbidity in Colombia
Authors: Hillis Susan D. , Miranda Clarybel M. , McCann Margaret , Bender Deborah , Weigle Kristen
Published: December 2021

This study was designed to determine whether day care center attendance was associated with increased risk of diarrheal disease among poor children in an urban, developing country setting. From July 17 to December 18, 1988, mothers of 493 Colombian children less than 5 years old (241 attendees and 252 nonattendees) were interviewed weekly about diarrheal events during the previous week.

The incidence of diarrhea was greater for day care center attendees than for nonattendees (3.2 vs 2.0 episodes per child-year, P < .0005). For children less than 2 years of age, attendees experienced 7.2 episodes/child-year vs 3.5 episodes per child-year for nonattendees (P < .0005). Analyses controlling for water source and availability, excreta disposal, socioeconomic status, and duration of follow-up showed that the increased diarrheal risk was limited to children younger than 3 years of age spending more than 30 hours per week in the centers. In addition, although the risk among attendees of suffering diarrheal episodes of longer duration was fairly constant across levels of socioeconomic status, this risk was inversely proportional to socioeconomic status for nonattendees. In summary, the increase in risk of diarrhea among young, full-time day care attendees was modest, yet important, because diarrhea continues to be a major cause of morbidity and mortality in Colombian children.
Health Insurance Coverage of Adolescents: A Current Profile and Assessment of Trends
Authors: Newacheck Paul W. , McManus Margaret A. , Gephart Joann
Published: December 2021

Data from the National Health Interview Survey reveal that 4.7 million or 15% of US adolescents aged 10 through 18 were uninsured in 1989. Among adolescents, 73% were privately insured, 10% were publicly insured, and 2% were both privately and publicly insured. Poor, near-poor, and minority adolescents were at the greatest risk for lack of health insurance coverage. Among adolescents without insurance, cost continued to be cited as the leading barrier to obtaining coverage. A comparison of 1989 National Health Interview Survey data with a previous analysis, in which 1984 data were used, revealed a 10% increase in the proportion of adolescents without insurance coverage. The increase in the proportion of uninsured adolescents was entirely attributable to an erosion of private health insurance coverage. No significant change occurred in the proportion of adolescents with coverage under public programs. Planned expansions of the federally and state-financed Medicaid programs will help to stem further increases in the size of the uninsured adolescent population. However, unless marked improvements occur in the private health insurance sector, progress will be limited.
The Cost of Assistive Devices for Children with Mobility Limitation
Authors: Korpela Raija Anneli , Siirtola Taisto Olavi , Koivikko Matti Juhani
Published: December 2021

This study evaluated the costs of assistive devices for children with motor limitations at home, in day care, and in school, and the effect of diagnosis and severity of disabilities on costs. 201 children (mean age 7.4 years) who used 1274 various assistive devices (85.7% at home, 6.1% in day care, and 8.2% in school) were studied. The cost per device varied from $8.14 to $8138 with an average value of $539 per device. The distribution of costs per capita was unequal: 52.2% of children used 15.6% of total costs and 4.5% of children used 20.8% of total costs. The severity of motor impairment and the age of the child were the most important indicators associated with the need and cost of assistive devices. Assistive devices for basic needs, such as sitting, mobility, and personal hygiene, had a relatively low effect on costs in comparison with the high-technology devices, like powered wheelchairs and computers. Better cooperation with day care and school professionals, better assessment of needs, follow-up, and recirculation of assistive devices are ways to promote rehabilitation services and partly solve the discrepancies between the costs of available technology and the resources to pay for it.
Primary Human Herpesvirus-6 Infection (Exanthem Subitum) in the Newborn
Authors: KAWAGUCHI SHINJI , SUGA SADAO , KOZAWA TORU , NAKASHIMA TOSHIHIKO , YOSHIKAWA TETSUSHI , ASANO YOSHIZO
Published: December 2021

Human herpesvirus-6 (HHV-6) is a newly identified herpesvirus and a causative agent of exanthem subitum (roseola infantum).1 Serologic studies have shown that a substantial proportion of adults are positive for the antibody to HHV-6 and that infection with the virus occurs during the first year of life.2 The virus persists throughout adult life and frequently is shed in the saliva. 3,4 However, the disease does not usually develop during the first months of life. It is probable that maternally acquired antibody to HHV-6 protects infants from the disease.2 In this paper we discuss a 21-day-old boy with exanthem subitum, who had HHV-6 viremia in the febrile stage of his illness and had a seroconversion to the virus.