bluuebunny/crossref_metadata_2025 huggingface dataset:
ACETAMINOPHEN POISONING
Authors: Goulding Roy
Published: December 2021

Acetaminophen* is being increasingly used as a mild analgesic/antipyretic both as a replacement for phenacetin and as a substitute for aspirin. In Britain the current consumption of acetaminophen has been estimated to be about 50% of that of aspirin, which in turn has been calculated to be the equivalent of 6,000 million tablets per year.1

The consumption of acetaminophen has risen progressively over the past decade owing to the virtual absence of adverse effects from it when taken in ordinary doses, but this has been matched by a steady increase in the number of deaths per year from acetaminophen overdose during this time. However, the total number of deaths from acetaminophen relative to its usage when compared with aspirin is still very small. In 1971 in England and Wales there were 29 deaths due to overdosage of acetaminophen alone compared with 233 due to aspirin or salicylate alone.2

In Britain, acetaminophen tablets are as freely and widely available as aspirin tablets, and brand names are actively promoted. In view of this widespread usage it is perhaps surprising and gratifying that the number of admissions to hospital in England and Wales for accidental acetaminophen overdosage in children under 5 years of age during 1970 was considerably less than 8003 compared with about 6,000 for aspirin.4 One can speculate on the reasons for this difference and these could include the fact that acetaminophen tablets are usually larger than aspirin tablets and, more especially, there are very few specially flavored pediatric tablets of acetaminophen.
THE LATER GROWTH OF THE BRAIN AND ITS VULNERABILITY
Authors: Dobbing John
Published: December 2021

In recent years there has been an increasing interest in a new kind of vulnerability of the developing brain which is concerned with disturbances and distortion of its later growth program, rather than with gross morphological anomaly, destructive lesions, or metabolic error. Thus there has grown up the concept of heightened sensitivity of the brain to growth retardation during its "growth spurt," a period arbitrarily defined as the time when the brain is passing through its most rapid phase of growth. The following remarks represent a personal view of the present situation and are amplified fled elsewhere.

Almost all the evidence for the special vulnerability of the brain growth spurt comes from experimental animals, usually rats, in whom nutritional growth restriction has been imposed during gestational, suckling and postweaning periods, or selectively in any one or two of these.
NOISE LEVELS IN INFANT INCUBATORS (ADVERSE EFFECTS?)
Authors: Blennow Gösta , Svenningsen Nils W. , Almquist Bengt
Published: December 2021

Certain environmental factors in neonatal intensive care have attracted large interest and have been studied thoroughly. However, less attention has been paid to the noise level inside infant incubators. The present study of four different types of incubators revealed high sound levels of 70 to 80 dB sound pressure level (SPL) at 125 Hz.

Some infants are nursed in incubators for weeks or months and thereby exposed to these noise levels for an undue period of time. It is suggested that the high noise levels in infant incubators should be considered a perinatal risk factor with regard to later hearing impairment. It deserves more attention as hitherto, especially with consideration to the construction of incubators, but also in follow-up studies of long-term sequelae after an abnormal perinatal period.
EARLY TREATMENT OF THE UNIVERSAL OTITIS MEDIA OF INFANTS WITH CLEFT PALATE
Authors: Paradise Jack L. , Bluestone Charles D.
Published: December 2021

In 138 infants with cleft palate, secretory or suppurative otitis media was a universal complication. Middle ear aeration was instituted by means of myringotomy, aspiration of middle ear liquid, and insertion of tympanostomy tubes, and this procedure was repeated whenever recurrence of middle ear effusion followed blockage or extrusion of the tubes. In infants with either complete or incomplete clefts of the palate, satisfactory middle ear status could usually be maintained. Otorrhea through tympanostomy tubes occurred frequently, but usually responded promptly to treatment. Palate repair resulted in sharp improvement in middle ear status.

Early relief of middle ear effusion anti establishment and maintenance of middle ear aeration in infants with cleft palate may help maintain normal hearing acuity throughout infancy, with favorable implications for language and intellectual development, and may reduce the risk of permanent middle ear damage and hearing impairment. Further study is necessary to determine the long-term efficacy of this regimen.
Lead Contamination in Milks Fed to Infants: 1972-1973
Authors: Lamm Steven H. , Rosen John F.
Published: December 2021

Previous studies have shown that lead content in commercial milks fed to infants may be sufficient to exceed the daily permissible intake of lead (300µg) for toddlers. Similar studies undertaken one year later have indicated a marked reduction in lead levels of such milks. Nevertheless, processed milks may still deliver up to 100µg of lead daily, whereas, in comparion, fresh human or homogenized bovine milk contains no detectable lead (<0.5µg/100 ml). The presented data suggest that lead contamination is introduced at any one of several processing steps and that milk containers are not a significant source of lead contamination. We propose that currently applied standards of lead in infant milks (six to ten times above the level of contamination) be reviewed.
Review by the Committee on Nutrition
Authors: Holliday Malcom A. , Anderson Arnold S. , Barness Lewis A. , Forbes Gilbert B. , Goldbloom Richard B. , Haworth James C. , Mauer Alvin M. , Scriver Charles R. , Weil William B. , Winick Myron
Published: December 2021

The article by Lamm and Rosen raises problems which are discussed by Mitchell and Sarett and which, in the opinion of the Committee on Nutrition, deserve careful attention. Lamm and Rosen imply in subtle fashion that lead in milk has been reduced as the consequence of action resulting from attention given to the problem. This response may indeed have followed action taken by milk companies to protect milk products from lead contamination, but we believe the data of Lamm and Rosen do not prove this point. Unfortunately, two different methods of lead analysis in milk were used in the 1971 (preaction) and 1972-1973 (postaction) studies.
Fever and Petechiae With Adenovirus Type 7 Infection
Authors: Sahler Olle Jane Z. , Wilfert Catherine M.
Published: December 2021

The presumptive diagnosis of meningococcemia was made in a 10-year-old boy with fever and petechiae. Adenovirus type 7 was isolated from a throat and stool swab. An antibody rise from 0 to 1:128 in acute and convalescent sera occurred in temporal relationship to his illness. A microtiter tissue neutralization test is described.
Hypoplastic Pelvis in Association With Multiple Anomalies
Authors: Baden Melvin , Ortiz Amil , Goyette Richert E. , Kirks Donald R.
Published: December 2021

The association of esophageal, anorectal and sacral anomalies with malformations of the urinary tract has been well recognized.

See figure in PDF file

In addition the presence of facial, pulmonary, and musculoskeletal malformation with oligohydramnios and amnion nodosum has been frequently described in what has been termed "Potter's syndrome."

However, the existence of a hypoplastic pelvic outlet with anomalies of the urinary tract has received no mention in the pediatric literature and only two previous reports in the recent radiology literature. In each report two infants presented with multiple anomalies consistent with a diagnosis of Potter's syndrome and the importance of an associated contracted pelvic outlet was discussed.
Vitamin K1 Content of Infant Formula Products
Authors: Schneider Donald L. , Fluckiger Hubert B. , Manes J. Damon
Published: December 2021

Milk-substitute formulas have been implicated in hypoprothrombinemia in infants and the Committee on Nutrition, AAP, has recommended that those low in vitamin K be supplemented with vitamin K1. A recently developed chromatographic procedure was used to survey the amount of vitamin K1 in commercially available infant formula products. Milk-substitute formulas containing soy oil provided appreciable vitamin K, i.e., 79 to 118µg/liter (as fed), even without vitamin K1 added. Formulas to which vitamin K1 have been added contain from 118 to 256µg/liter. Milk-based formulas contain from 19 to 69µg/liter (depending on the type of oil used), but these have not been implicated in hypoprothrombinemia. According to chick bioassay, vitamin K1 added to infant formula products is biologically available.
Letter to the Editor
Authors: Ellis Elliot F. , Taylor John C. , Lefkowitz Martin S.
Published: December 2021

The report of Gardner et al. regarding the use of racemic epinephrine in croup prompts us to comment as follows.

The administration of racemic epinephrine aerosol with a face mask is the therapy presently in vogue in many pediatric centers for treatment of croup. The basis of the use of racemic epinephrine in croup is its topical vasoconstrictive effect when applied to mucous membranes resulting in decreased mucosal edema. Nowhere to be found in any of the six published reports discussing this modality of therapy is a precise definition of the composition of racemic epinephrine.
Letter to the Editor
Authors: Thompson Robert S.
Published: December 2021

I should like to offer the following comments about the recent article by Gardner, and others, on the use of racemic epinephrine in croup.

1. Unfortunately the racemic epinephrine was not delivered by IPPB, using a respirator, as by those who have reported impressive successes, albeit uncontrolled, with that method.

2. Based on their initial positive experience with postanesthetic croup, Jordan et al. took the battle directly to the surgeons and won many surgical converts by initially performing the racemic epinephrine procedure only on patients about to undergo tracheotomy.
The Effects of Hospitalization on Children: Models for their Care, edited by Evelyn K. Oremland, M.S.W., and Jerome D. Oremland, M.D. Springfield, Illinois: Charles C Thomas, Publisher, 1973, 341 pp., $12.75
Authors: Becker R. D.
Published: December 2021

It is clear that breakthroughs in medical intelligence combined with technological advance and refinement in diagnostic medicine and surgical approach now make possible a host of operative procedures which avert death, rehabilitate function, and under some conditions can even generate outright cures. Corrective surgery for complex multiple congenital malformations or systemic anomolies is indeed now commonplace in the first years of life. However, these operative procedures are not without some attendant psychological risk to the future emotional development of the involved child.
Galactokinase Deficiency in Twins: Clinical and Biochemical Studies
Authors: Olambiwonnu N. Olatunji , McVie Robert , Ng Won G. , Frasier S. Douglas , Donnell George N.
Published: December 2021

Identical twin girls with galactokinase deficiency are described. The diagnosis was made at 4 months of age when a random urinalysis in one twin showed a nonglucose reducing substance subsequently identified as galactose. Clinical findings were limited to bilateral perinuclear cataracts in both infants. There was no jaundice or hepatomegaly.

While receiving an evaporated milk formula, the urines contained large amounts of galactose and galactitol. Erythrocyte galactokinase activity was absent in both patients, and 50% of normal activity was found in both parents.

A "lactose-free" formula was instituted at 43½ months of age. Growth and development has been normal over 24 months of treatment. The cataracts, however, showed no significant change. Galactose and galactitol excretion was markedly decreased, but not completely eliminated. The turnover of endogenous galactose-containing compounds may be responsible for the residual galactose and galactitol excretion.
Reye's Syndrome: Clinical Diagnosis and Treatment With Peritoneal Dialysis
Authors: Samaha Frederick J. , Blau Edward , Berardinelli John L.
Published: December 2021

Twenty-four cases of Reye's syndrome are studied with regard to the effect of peritoneal dialysis on survival and with regard to the clinical criteria for diagnosis. A good correlation is observed between the typical clinical presentation with abnormal prothrombin time, SGOT, SGPT and blood ammonia levels and the abnormal liver histology described in Reye's syndrome.

Of the 11 patients treated with hepatic coma regimen and peritoneal dialysis, 9 (82%) lived. Two of the 13 patients (15%) treated only with the hepatic coma regimen lived (p < .025). When used before evidence of irreversible brain stem damage, peritoneal dialysis is a mode of therapy which may offer hope in reversing the high mortality of Reye's syndrome.
Sodium Bicarbonate Prophylaxis of Sickle Cell Crisis
Authors: Mann Jillian R. , Stuart John
Published: December 2021

A crossover study of the value of orally administered sodium bicarbonate in the prevention of infarctive crisis has been made in 18 children with sickle cell disease. Bicarbonate was given for 12 months of a two-year study period in a dose adjusted to maintain the urine either neutral or alkaline to litmus. There was no significant reduction in crisis frequency at a bicarbonate dose of 0.1 to 0.4 gm/kg of body weight per day; this contrasts with earlier claims, in uncontrolled studies, of the prophylactic value of oral sodium bicarbonate.
Fetal Complications of Diagnostic Amniocentesis: A Review and Report of a Case With Pneumothorax
Authors: Cook Larry N. , Shott Roger J. , Andrews Billy F.
Published: December 2021

Amniocentesis, introduced 40 years ago, has become a commonly performed obstetric procedure. Its applications, originally related to Rh isoimmunization, have been expanded to include assessment of fetal maturity and prenatal genetics. The maternal complications of this procedure have been stressed for some time, but with increasing frequency fetal complications are being observed. This report reviews the maternal and fetal complications of amniocentesis and illustrates the potential fetal morbidity with a case report of a tension pneumothorax in a neonate resulting from fetal puncture during diagnostic amniocentesis.
Prevention of Diabetic Atherosclerosis
Authors: Feeman William E.
Published: December 2021

Diabetes mellitus is a chronic disease with such chronic sequelae as atherosclerosis. The only hope of preventing them lies in early detection of the diabetes, so that a regimen preventing conversion of elevated blood glucose to sorbitol (with subsequent vascular basement membrane thickening) may be instituted. If this proves possible, the regimen would require early and close attention to diet, with multiple small meals and restriction of simple sugars, saturated fat, and cholesterol. Insulin could be added as needed, screening done for other atherosclerotic risk factors, regular exercise strongly encouraged, and maintenance of lean body weight required.
Letter to the Editor
Authors: Walters Thomas R.
Published: December 2021

This is to express my disappointment in your publication of "Anesthetic Risks in Sickle Cell Trait." Reference words in the abstract such as "sickle cell trait, anesthesia risks, and sudden anesthetic death" expand the implication of the title.

There are several criticisms. Case 2 in the Table identifying the five Negro children with sickle cell trait shows hemoglobin electrophoresis results as S-C. Current terminology in sickle cell disease indicates that this patient has a double-heterozygote state, is not a patient with sickle cell trait and, therefore, cannot be included.
Letter to the Editor
Authors: Cherry James D. , Powell Keith R. , Gardner H. Garry , Roden Vernon J.
Published: December 2021

Thank you for giving us the opportunity to comment on this latest communication about the treatment of croup by Adair and disciples. It would appear that most aspects of their letter which are worthy of a response have already been presented in our two previous letters. We do have the last word however:

Banter and fury have their place And to stir controversy is no disgrace But to take as fact without control One must have faith within his soul.
Vesicoureteral Reflux and Pyelonephritis, by John A. Hutch, M.D. and Arjan D. Amar, M.B., M.S., F.R.C.S.(C), F.A.C.S. New York: Appleton-Century-Crofts, 1972, 236 pp, $12.75
Authors: McCrory Wallace W.
Published: December 2021

This monograph presents the views of two urologists on the mechanisms responsible for vesicoureteral reflux and its relation to pyelonephritis and urinary tract infections. The authors are both experienced pediatric urologists and one of them (J. A. Hutch) is internationally recognized as one of the pioneers in this field in recognition of his major contributions in defining the importance of vesicoureteral reflux in the pathogenesis of pyelonephritis. The combined clinical experience of the authors is both unique and extensive.
Neonatal screening for hyperlipidemia
Authors: Kwiterovigh Peter O.
Published: December 2021

Premature atherosclerosis, and its association with cardiovascular disease, is a major public health problem in this, and other industrialized countries. Considerable deliberation has recently been given to the concepts that atherosclerosis begins in childhood and that preventive efforts should begin early in life. Atherosclerosis as a pediatric problem has been the subject of several previous commentaries and reivews. Among the risk factors implicated in the development of cardiovascular disease, one of the most important is hyperlipidemia, i.e., an increased plasma concentration of either cholesterol or triglycerides or both. The article by Tsang, Fallat and Glueck in this issue of Pediatrics addresses some basic questions concerning the validity of neonatal screening for hyperlipidemia and emphasizes the importance of diet in assessing hyperlipidemia in the first year of life.
The Use of Blood Levels of Antiepileptic Drugs in Clinical Practice
Authors: Kutt Henn
Published: December 2021

Measurement of blood levels of antiepileptic drugs has been carried out for over a decade. In earlier years, mostly spectrophotometric and colonmetric methods were used to determine diphenylhydantoin and phenobarbital concentrations. In more recent years, gas-liquid chromatographic methods have been employed which generally offer greater specificity and allow determination of several drugs simultaneously.

Ceneral experience from the determination of antiepileptic drug blood levels indicates that there is some correlation between (1) the drug dose and blood level, (2) blood level and therapeutic effects, and (3) blood level and some toxic effects. The relationships are evident and usually reproducible in any individual patient. However, there are marked variations in these relationships among different patients due to variations in their individual-specific pharmacokinetic characteristics and/or external factors. Thus a wide range of blood levels may be seen in patients receiving the same dose and a wide range of clinical effects may be seen in patients having the same blood level. Nevertheless, an expected range of blood levels from a given dose can be defined, as well as an expected range of blood levels in which toxic or therapeutic effects are usually seen in the majority of patients. These expected values are clinically useful in that they caution the physician to look for specific causes in those patients whose blood levels fall far above or below the expected range.

WHAT DOSAGE REGIMEN TO USE

The majority of antiepileptic drugs are eliminated slowly and cause relatively stable blood levels to be maintained as long as the drug intake is constant.
Letter to the Editor
Authors: McIntosh Sue , Aspnes Gregg T.
Published: December 2021

The studies of Bleyer and co-workers indicate an association between high cerebrospinal fluid antifolate levels and subsequent neurological damage following intrathecal methotrexate administration. Clinically, neurotoxicity has been ascribed to intrathecal methotrexate or its preservatives in several series. Symptoms and signs occur within hours to a few days after intrathecal administration. Since the CSF half-life of methotrexate is three to six days, encephalopathy appearing more than two weeks from the time of intrathecal therapy is unlikely to be due to direct toxic effects.
Certification for the Pediatric Nurse Associate
Authors: Hochheiser Louis I.
Published: December 2021

The recent letter to Pediatric Nurse Associates and members of the American Academy of Pediatrics reporting the division between the AAP and American Nurses Association on certification, is an unfortunate and deplorable happening. Since the onset of the first Pediatric Nurse Practitioner Program in 1965, more than 1,000 nurses have graduated from over 45 programs adding a new dimension to care for children. Although touted by many as the answer to manpower problems for child health care, evidence over the past five years indicates that a new dimension has been added to pediatric care.
Who Should Have Children: An Environmental and Genetic Approach, by Dwight J. Ingle. Indianapolis/New York: The Bobbs-Merril Company, Inc., 1973, 141 pp., $1.95
Authors: Baumiller Robert C.
Published: December 2021

Population is a problem. The handicapped, the retarded, the dull, the culturally deprived, and the criminal are all problems. Scientifically, all these problems can be attacked and with sufficient funding, propaganda, and legislation, these problems can be reduced, if not eliminated. To have this capability and not actualize it is frustrating for the scientist.

Dr. Ingle very honestly qualifies the title of this book with "an environmental and genetic approach." And so it is. The limitations on the data presented, which is not the main theme of the book, are well understood by the author.
On the Use of Nasal Continuous Positive Airway Pressure
Authors: Harris Thomas R. , Stevens Richard C. , Nugent Michael
Published: December 2021

Although the application of continuous positive airway pressure (CPAP) by endotracheal tube, head chamber and face mask is quite straightforward, its successful application by nasal cannula or prongs as recently described by Novogroder et al. and Kattwinkel et al. presupposes an understanding of certain crucial points not emphasized in these original articles.

The new factor that comes into play when applying CPAP by nasal route is the variable leak at the mouth. When a large mouth leak is present in a delivery system that also has an appreciable flow resistance at the site of the nasal prongs or beyond in the nasal passages, a significant pressure drop may occur across these points.
Monitoring for Human Mutagenesis
Authors: Sutton H. Eldon
Published: December 2021

Mutation is an intrinsic property of genes and has provided the variability that we value as a characteristic of human populations as well as the variability that was necessary for evolution to occur. Nevertheless, an increase in mutation rate is almost universally regarded as undesirable. The likelihood that a random change in a gene will be beneficial to the host is small. The likelihood that it will be detrimental is much larger. There is much argument as to the proportion of genes that truly are neutral, but these are of no special concern to the present discussion.

When a detrimental mutation occurs, it is expressed ultimately as failure of a zygote to develop, as abortion, as overt disease, or as reduced fertility. The expression may be immediate or delayed, depending on the degree of dominance of the mutalion. The social consequences of these different outcomes are different, much more so than the genetic consequences. A genetic death is failure to survive and reproduce, whether that failure be due to early death (as in Tay-Sachs disease) or to reduced fertility in an otherwise healthy person.

Such detrimental genes are removed eventually from the population through natural selection—rapidly if the mutant allele is expressed in the heterozygote, much more slowly if the allele is completely recessive. Eventually an equilibrium is reached, with the number of mutant alleles eliminated by selection equal to the number produced by mutation. In the case of recessive alleles, many generations are required to establish a new equilibrium.
C-Peptide Immunoreactivity (CPR): A New Method for Studying Infants of Insulin-Treated Diabetic Mothers
Authors: Block Marshall B. , Pildes Rosita S. , Mossabhoy Nafessa A. , Steiner Donald F. , Rubenstein Arthur H.
Published: December 2021

Proinsulin is converted to insulin and C-peptide in the pancreatic islet cells; the latter two polypeptides are then secreted in equimolar concentration. Thus, measurement of C-peptide may provide an alternative means of studying B-cell function in pregnant, insulin-treated, diabetic patients and in their newborn infants (IDM). Using this approach, B-cell function was studied in eight normal, ten juvenile onset and five gestational diabetic patients at the time of delivery. Normal maternal and cord CPR (C-peptide immunoreactivity levels, mean ± SEM, were 1.5 ± 0.3 and 0.9 ± 0.1 ng/ml, respectively. In six of ten juvenile onset diabetics, CPR levels were undetectable, while in four CPR was elevated. Five gestational diabetic women had elevated CPR levels. Cord CPR levels were significantly higher in all IDM than in the normal controls. A prompt rise in CPR was seen following intravenous glucose load in four IDM. Gel filtration of selected sera demonstrated both C-peptide and proinsulin, the latter protein being bound to circulating insulin antibodies which have crossed the placenta. Thus, active B-cell secretion composed of proinsulin, C-peptide and presumably insulin is present during insulin therapy in gestational, in some juvenile-onset-diabetic, pregnant women and in their offspring.
Letter to the Editor
Authors: Menkes John H.
Published: December 2021

Let me write in support of the letter of Livingston et al. in the November issue of Pediatrics. The use of amphetamines or other analeptics in the treatment of nocturnal seizures is a time-honored one, dating back to at least the early part of the 19th century. As is often the case with traditional forms of therapy, well-controlled studies on children are not available. However, we too have followed several children who have experienced generalized tonic-clonic seizures (grand mal) during their sleep.
IS CAT LEUKEMIA TRANSMISSIBLE TO MAN?
Authors: Miller Robert W.
Published: December 2021

A recent editorial in the New England Journal of Medicine cited eight characteristics of cat leukemia viruses which suggest that they may be leukemogenic in man (Levy, S. B., New Eng. J. Med., 290:513, 1974). Cat leukemia is a misnomer, since about 90% of cases so classified are actually lymphoma. Thus, it is human lymphoma more than leukemia that should be examined for a relationship to feline exposure not only during intrauterine life or infancy, as suggested by Dr. Levy, but also among older persons with immune suppression, either inborn or acquired, who are known to be at increased risk of lymphoreticular neoplasia. When these tumors are found in immunodeficient persons, the physician should inquire about exposure to cats, and when found, should seek appropriate virologic studies of both the patient and pet.
Australia Antigen and Neonatal Hepatitis Syndrome
Authors: Kattamis Christos A. , Demetrios Demetrios , Matsaniotis Nicholas S.
Published: December 2021

The status of Australia antigen (Au-Ag) and Australia antigen antibody (Au-Ab) was investigated in 27 infants less than 4 months of age with direct reacting hyperbilirubinemia, and in their parents. A diagnosis of viral hepatitis could be excluded in eight infants; of the remaining 19, ten were positive for Au-Ag and another three had suggestive evidence of hepatitis virus B (HBV) infection.

The high proportion of infants with neonatal hepatitis associated with Au-Ag in this series is attributed to the high prevalence of Au-Ag carriers in Greece as well as to the high frequency of exchange transfusions in newborn infants.

The other 14 cases of direct-reacting hyperbilirubinemia, none of which showed Au-Ag or evidence of HBV, were due to congenital malformation of the biliary tract (four cases), septicemia (three cases), cytomegalovirus (CMV) infection (one case), and fructosemia (one case). The remaining five patients, all of whom recovered, are believed to have hepatitis virus A infection.

The detection of Au-Ag in prolonged neonatal jaundice with direct bilirubinemia favors a diagnosis of hepatitis type B, which in our experience carries a graver prognosis reflected in deaths and cirrhosis when compared to neonatal hepatitis not associated with Au-Ag.

In our patients, it is inferred that transmission of Au-Ag to the infants occurred at or after birth, rather than during intrauterine life.
The Use of 5-HTP in the Treatment of Down's Syndrome
Authors: Weise Phillip , Koch Richard , Shaw Kenneth N.F. , Rosenfeld Martin J.
Published: December 2021

The clinical use of 5-HTP in the treatment of patients with Down's syndrome was reported by Bazelon and her colleagues in 1967. This approach appeared to offer the hope of improving subnormal development of children with this chromosomal defect. The rationale for the use of 5-HTP is related to its role as the natural biochemical precursor for serotonin (5-hydroxytryptamine). The blood level of this hormone is said to be decreased in Down's syndrome.

The present study concerns 26 children with Down's syndrome who were treated with 5-HTP from early infancy until 3 to 4 years of age: 19 completed the course of treatment. DL-5-HTP was given orally with an initial dosage of 0.5 to 1.5 mg/kg/day. The dose was increased stepwise in 1 mg/kg/day increments to a maximum of 5 mg/kg/day. Children were seen by a clinic physician every 1 to 4 months and were assessed by a clinic psychologist every six months. The Gesell Test of Developmental Abilities was used to assess each child's level of development in terms of a total Developmental Quotient (DQ). The psychological findings were analyzed by applying a t test of the difference between independent mean DQs obtained for each age category. The results of this study indicate that long-term systematic use of 5-HTP is not effective in increasing the rate of development of Down's syndrome children.
Early Development of Children With Abnormalities of the Sex Chromosomes: A Prospective Study
Authors: Leonard Martha F. , Landy Gail , Ruddle Frank H. , Lubs Herbert A.
Published: December 2021

Out of cytogenetic studies of 4,400 consecutive newborn infants, 11 were found to have abnormalities of the sex chromosomes. None had distinguishing clinical abnormalities. These children, with ten normal controls, were evaluated at 1 and at 2½ years by child development specialists who were not informed as to which children had abnormal karyotypes. None of the children was mentally defective, but the control children showed a trend toward slightly higher developmental quotients than the study children. Of all sectors of development, language was the most affected, with language skills considerably delayed in the study children compared with the controls by the age of 2½. Further studies on these children are planned.

Up to the age of at least 2½ years, abnormality of sex chromosomes was not found to cause mental retardation or specific personality deviations. It may be associated with increased vulnerability, with its greatest impact on the development of language. However, a range of developmental levels and personality has been demonstrated in these eleven children, and one cannot predict developmental potential from a knowledge of the genetic constitution.
LEUKEMIA CLUSTER IN IRELAND
Authors: Miller Robert W.
Published: December 2021

In an Irish village of 415 persons, five unrelated people developed acute lymphatic leukemia and one developed lymphosarcoma in a 40-month interval. Their ages were 4, 4.5, 15, 18, 19 and 58 years. The three teenagers were close friends, and two of them worked in the same shop with the 58-year-old patient with lymphosarcoma (Kemmoona, I., Lancet 1:994, 1974). No specific cause fell under suspicion. No mention was made of special laboratory studies to probe the etiology (e.g., cytogenetics, immunology, and study of tumor- or viral-associated markers). (When cancer clusters are noted, sera should be obtained serially on survivors and frozen for later study when new tests are developed.)
Viral Antibody Titers to Rubella and Rubeola in Juvenile Rheumatoid Arthritis
Authors: Cassidy James T. , Shillis Joan L. , Brandon Frank B. , Sullivan Donita B. , Brackett Robert G.
Published: December 2021

Viral antibody titers to rubella and rubeola were examined in 192 patients with juvenile rheumatoid arthritis (JRA) and compared to data from children with other connective tissue diseases, hospitalized children with non-connective tissue diseases, and normal children. Analysis of positive sera indicated that children with JRA had geometric mean titers for rubella that were similar to those observed in normal children and in children with other connective tissue diseases. Their titers for rubeola were lower than those in normal children. Viral antibody titers were correlated in patients with JRA to certain serum immunoglobulin concentrations. Rubella titers were associated with type of onset of arthritis. It is concluded that these data do not support a direct relationship between infection with either of these myxoviruses and development of JRA.
Are the Academicians to Blame?
Authors: Posner Michael K.
Published: December 2021

Although I should hate to sound cynical or even "anti-intellectual," Dr. David G. Nathan's solutions to the primary medical care problem seem to carry a hidden agenda.1 Is the problem an absence of available persons to deal with primary care or a crowd of weary old bones obstructing his view of the bench? In no other area of investigation would a researcher suggest that a particularly vexing problem be tackled by those no longer productive in the areas of their choice.
Therapeutic delirium in Reye's syndrome
Authors: Nadler Henry
Published: December 2021

During the past decade, Reye's syndrome has become a widely recognized clinical and pathologic entity. The clinical manifestations are remarkably uniform. The patient, most frequently between 4 and 15 years of age, develops persistent vomiting within a week usually following a rather mild upper respiratory tract illness, with or without fever. The patient may develop signs of acute encephalopathy including aggressive combative behavior, hallucinations, decreasing responsiveness to external stimuli, loss of deep tendon reflexes, decorticate or decerebrate posturing, and finally loss of brain-stem function and death. Other clinical findings frequently observed include hyperventilation, widely dilated pupils which respond only to strong light, and mild hepatomegaly.
Nephrogenic Diabetes Insipidus With Fluorosis
Authors: Greenberg Larrie W. , Nelsen Carl E. , Kramer Ned
Published: December 2021

The efficacy of fluoride in the community drinking water for the prevention of dental caries has been well established. The average daily intake of fluids in normal children varies with age, sex, temperature and season. Children with polydipsia as in nephrogenic diabetes insipidus consume excessive quantities of water. We are reporting two children with nephrogenic diabetes insipidus and fluorosis, and suggest looking for evidence of fluoride toxicity in individuals with polydipsia. Substituting nonfluoridated water as part of the fluid intake is recommended.
Paronychia Caused by HB-1 Organisms
Authors: Barton Leslie L. , Anderson Lynn E.
Published: December 2021

Paronychia, common infections of the nail fold, are usually attributed to Staphylococcus aureus or group A beta-hemolytic streptococci, although a number of other bacteria, viruses, and fungi have occasionally been isolated from these lesions.

HB-1 organisms, gram-negative, non-sporeforming rods with distinctive colonial morphology and growth requirements, only rarely infect normal infants and children.1 The association of these bacteria with superficial rather than deep infections is an even rarer occurrence.1 We would like to describe an otherwise normal child who developed a paronychia due to HB-1 bacteria, an association which, to our knowledge, has not been previously reported.

CASE REPORT

D.F., a 7-year-old boy, presented to St. Louis County Hospital with tenderness and swelling around his left fifth fingernail of two days' duration.
Letter to the Editor
Authors: Steinmetz Nicholas
Published: December 2021

Although in accord with Dr. Wineberg's letter (Pediatrics, 52:888, 1973) regarding the interleaving of advertising in Pediatrics, I think the practice of pharmaceutical advertising in a professional journal must be challenged once again. Dr. Frazier's comment in regard to this is weak (Pediatrics, 52:767, 1973).

Physicians should receive information about new and tested treatments or drugs from reputable and unbiased sources. Their use should not be promoted using sophisticated advertising techniques by parties whose primary interest is in selling their particular product.
Treatment of Tricyclic Antidepressant Overdosage Arrhythmias
Authors: Brown T. C. K.
Published: December 2021

The comments on treatment of tricyclic antidepressant intoxications in your May 1973 issue were interesting, but I feel prompted to stress the importance of sodium bicarbonate or alkalinization in the management of these arrhythmias. We have treated over 150 children with tricyclic antidepressant overdosage in our intensive care unit, and of these 50 have had serious manifestations of overdosage—arrhythmias, convulsions, unconsciousness or a combination of these. Initially we experienced the frustration of being unable to control the arrhythmias satisfactorily, but since the value of sodium bicarbonate (given as a bolus of 1-3 mEq/kg intravenously) has been recognized, we have only had one out of 20 patients who did not revert rapidly to sinus rhythm with sodium bicarbonate and even that patient reverted half an hour after diphenylhydantoin and sodium bicarbonate had been given.
Child abuse and neglect: The role of the pediatrician and the Academy
Authors: Mindlin Rowland L.
Published: December 2021

"Child abuse in America is at the point of public outrage at the visible and dramatic end of the spectrum—the beatings, burnings and drownings. A punitive approach is the general rule, and the abusing, yet often loving, parents are fearful and secretive. This pair of attitudes compounds the problems in diagnosis and treatment at both ends of the spectrum. For every severe, recognized case, there are many less severe which pass through treatment agencies unrecognized, and others not even brought to treatment. Yet, where compassionate treatment programs are known in the community, abusing parents are even presenting themselves for help, and finding that an accepting, therapeutic, nonpunitive approach awaits them."
HOW AMERICAN INDIAN MOTHERS CARED FOR THEIR CHILDREN IN THE EARLY 1800'S
Authors: C. T. E.
Published: December 2021

John D. Hunter as an infant of two or three years was kidnapped about 1797 by Indians and then lived for most of his childhood and young manhood with the Kansas and Osage tribes, West of the Mississippi. He returned to white society in 1816 when he was 19 years old. Seven years later, after he had learned to read and write, his Memoirs of a Captivity among the Indians of North America was published in Philadelphia (1823). This narrative contains detailed, first-hand descriptions of many aspects of Indian life in the Midwest during the early part of the nineteenth century.

He described the infant and child rearing practices of Indian mothers as follows:

Their infants, wrapped in skins, are secured with belts to a small thin piece of board placed along the back. As they grow older, should the weather be mild, the skins are removed altogether, and no other dresses are substituted for them, except in very cold weather, till near the period of puberty.

When traveling, the mother places the board to which the infant is secured on her back, and supports it in this manner for the whole distance of the journey. While resting, or at work, she suspends it perpendicularly from the side of her lodge, the arm of a tree, or a post she has erected for the purpose. She administers food to it when she thinks it is hungry, disregards its crying, and seldom unbinds and soothes it to rest, except when she herself retires for sleep.
CLUSTERING OF HODGKIN'S DISEASE IN SCHOOLS
Authors: Miller Robert W.
Published: December 2021

In high schools of Long Island, New York, it has been found that Hodgkin's disease clustered in the same schools during the first half of a ten-year interval as in the second half, a circumstance unlikely to be due to chance (Vianna, N.J., and Polan, A.K., New Eng. J. Med., 289:499, 1973). In an accompanying editorial, MacMahon urged that confirmation be sought of this observation by other investigators.

In a speech at a National Conference on Virology and Immunology in Human Cancer held in New York on November 29, 1973, Pike reported that in Oxford, England, he was unable to confirm the earlier findings of Vianna et al. (Ann. Intern. Med., 77:169, 1973) that Hodgkin's disease under 40 years of age was transmitted through an unaffected person. The proceedings of the symposium will be published in Cancer.
Serum LH and FSH Responses to Synthetic LH-RH in Normal Infants, Children and Patients With Turner's Syndrome
Authors: Suwa Selzo , Maesaka Hatae , Matsui Ichiro
Published: December 2021

Effects of LH-RH on LH and FSH release were studied in 26 normal children and six patients with Turner's syndrome (two of them showed 45 x karyotype and the others were mosaics). Synthetic LH-RH (2µg/kg of body weight) was given intramuscularly after an overnight fast.

The increase of serum FSH level was significantly greater in normal female infants than male infants. A similar tendency was observed in normal female children aged 2 to 9 years. No sex difference was observed in the LH response to LH-RH in all the normal subjects Studied. The response of FSH release to LH-RH was significantly greater than that of LH in female infants and young female children. The responsiveness of LH to LH-RH gradually increased with advancing age.

Basal serum levels of FSH rather than LH were high in the patients with Turner's syndrome. Again a much greater increase of serum FSH than of LH was noted after the administration of LH-RH to patients with Turner's syndrome.
Hemophilus Influenzae b Meningitis in Identical Twins of a Triplet Sibship
Authors: Coulter David , Whisnant John K. , Marks Melvin I.
Published: December 2021

Hemophilus influenzae type b systemic infection occurring in siblings or close family members has been reported infrequendy.1-4 Recent evidence suggests that genetically controlled host characteristics may determine risk for infection and perhaps type of disease due to H. influenzae type b.2,5 We have had the opportunity to study some of these factors in two cases of meningitis. This report describes H. influenzae type b meningitis in two identical members of a triplet sibship and discusses the implications of these cases in terms of host defense.

CASE REPORT

Case II-1

M.G., an 11-month-old male infant, was the second born of triplets and had been well except for two episodes of otitis media after 7 months of age.
Letter to the Editor
Authors: Sahler Olle Jane Z. , Wilfert Catherine M.
Published: December 2021

Dr. Wald has correctly pointed out that petechiae have been ascribed to mechanical causes such as vomiting or coughing. Patients with such symptoms are usually observed during the course of an illness, often infectious in origin. Petechiae are then attributed to trauma if they are distributed over the head and upper thorax and if evidence for bacterial sepsis is absent. We wonder if viral infections, many of which involve endothelial-lining cells of small vessels, may decrease their stability and predispose to the development of petechiae with mechanical stress.
White, Unused Paper (WUP) in Pediatrics
Authors: Hecht Frederick
Published: December 2021

Idle curiosity and a ruler were used to identify the amount of white, unused paper (WUP) in the March 1974 issue of Pediatrics. WUP was approximately 91 inches. This is equivalent to 9.6 wasted pages or 7.1% of the total page content in this issue. Over a one-year period this will amount to about 115 pages of WUP or roughly an entire issue of Pediatrics. One possible solution to the WUP problem—the recruitment and insertion of good brief papers—is suggested.
Cholestyramine Therapy for Intractable Diarrhea
Authors: Dehghanian Javad
Published: December 2021

I read the article by Tamer et al. in the February issue of Pediatrics (53:217, 1974). It seems that the term "intractable diarrhea" is not appropriate for the cases in the study, because I am not aware of calling 10 or 15 or even 20 days of diarrhea as intractable, especially if there is some clue to the etiology of the diarrhea.

Case I probably explains a case of viral gastroenteritis in a newborn infant, which apparently has been improved on a two-day course of cholestyramine therapy.
Copper Requirements and Actual Recommendations per 100 Kilocalories of Infant Formula
Authors: Cordano Angel
Published: December 2021

The U.S. FDA regulations of December 1971 as well as the Committee on Nutrition of the American Academy of Pediatrics1 call for a minimum level of 60 µg of copper per 100 kcal of infant formula.

This minimum level seems appropriate for a normal-term baby, but may be inadequate for prematures.

Personal concern for a higher need for copper by prematures was expressed in an interview printed in JAMA in 1968:2 "Prematures or low birth weight babies requiring an exclusive milk diet for more than four months may also become copper deficient.
A new regional center for child care
Authors: Wood Richard D.
Published: December 2021

The new Children's Hospital of Philadelphia, in conjunction with affiliated Philadelphia Child Guidance Clinic, opened in June of this year, after 15 years in planning and construction. Ground-breaking took place in September 1968, construction began February 1969, and the physical relocation began June 1974.

The new children's medical center merits attention as a major example of a new tertiary care facility, serving a tristate region and a university complex, while also rendering primary care through expanded ambulatory and emergency facilities, new transient one-day surgical service, and growing affiliations with health maintenance organizations in the general neighborhood. Regionally, the Hospital serves as a major consultative resource and pediatric referral center for hundreds of Delaware Valley hospitals and physicians.
A 16-Year Follow-up Study of 163 Children with Nephrotic Syndrome
Authors: Schwartz M. William , Schwartz George J. , Cornfeld David
Published: December 2021

One hundred and sixty-three children with onset of nephrotic syndrome prior to 1959 are the subjects of this study. The average duration of follow-up was 16.5 years with 79% (129) being followed 15 years. The Life Table survival rate was 77% at 15 years. There were no correlations between the survival rate and the age of onset or sex of the patient. Hypertension in combination with azotemia, and/or hematuria was associated with a poorer prognosis. Twenty percent of the children showed a nonrelapsing course after the first year, whereas 45% experienced several relapses before achieving apparent cure. Ten percent had continued activity. Seventy-nine percent of the patients who were initially resistant to steroid therapy were dead at the 15-year follow-up.