bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Pulmonary Function Tests in Detecting Exercise-Induced Bronchoconstriction
Authors: Buckley Jerome M. , Souhrada Joseph F.
Published: December 2021

In an attempt to compare most of the available pulmonary function tests in detecting airway obstruction after exercise, two studies were conducted. In the first study 24 bronchodilator-dependent asthmatic boys were evaluated before treadmill exercise (baseline) and at 7 and 30 minutes afterwards. The following pulmonary function parameters were measured: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum mid-expiratory flow (MMEF), peak expiratory flow rate, thoracic gas volume, airway resistance, specific airway conductance (SGaw), and closing volume (CV). Results showed that SGaw, MMEF, and CV were the most sensitive parameters reflecting changes in airway caliber. Less significant changes also appeared in FEV1 and in FVC. The significance of these changes and their relationships to other parameters are discussed.

In an attempt to better understand the effects of airway obstruction on the maximum-expiratory flow-volume curve (MEFV curve) after exercise, a second study was conducted. Comparisons were made between "classical" parameters such as MMEF (measured by spirometry), SGaw (measured by body plethysmography), and flowvolume parameters (measured by wedge spirometer). Sixteen asthmatic subjects (9 to 12 years of age) whose airway obstruction was further exacerbated by exercise of a moderate work load on the treadmill (2 w/kg of body weight) were studied. The asthmatic subjects were tested prior to exercise and at 7 and 30 minutes after exercise.

All the measurements mentioned above were done in a randomized manner. When both MMEF and SGaw were decreased in the post-exercise period, significant correlations were obtained between these "classical" parameters and all of the flow-volume parameters. However, when only one of the two was decreased, no correlation could be obtained with any of the flow-volume parameters. It was concluded that under certain conditions flow-volume curves reflect airway obstruction satisfactorily, but under other conditions they appear to be less sensitive than the "classic" parameters. These results are also discussed.
The Athlete and Medication
Authors: Yaffe Sumner J. , Bierman C. Warren , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Soyka Lester F. , Stern Leo , Weiss Charles F. , Chudzik Gregory , Shirkey Harry C. , Ballin John C. , Done Alan K. , Farchione Louis , Scott C. P. , Lockhart Jean D. , Sawchuk Steven , Simopoulos Artemis P.
Published: December 2021

The Committee on Drugs unites with the Joint Committee on Physical Fitness, Recreation, and Sports Medicine in condemning the use of drugs to improve athletic performance, However, the Committee on Drugs would like to clearly distinguish between the promiscuous use of drugs and their pharmacologic use to control a specific disease state enabling the adolescent to participate in sports, for example, the use of insulin for diabetes, anticonvulsants for epilepsy, digitalis for heart disease, or bronchodilators for asthma.

Children and adolescents with handicaps should be given the same advantages as other children, including participation in athletic activities. Athletes with medical conditions controlled by drugs should not be placed in the same category as youths taking drugs for other purposes, and there should be minimal, if any, restrictions imposed on them. One recent example of the type of restrictions which should not be imposed is the athlete with exercise-induced bronchoconstriction who was disqualified in the 1972 Olympics in Munich because he used a bronchodilator prescribed by his physician. Exercise-induced bronchospasm is a common handicap of allergic youth, and may occur in between 60% and 80% of individuals with allergic respiratory distress.1 Such bronchoconstriction can be modified by the administration of theopylline, theophylline epherdrine combinations,3 or cromolyn sodium,4, 5 The Committee on Children with Handicaps also recommends that children with asthma participate in sports and physical education and that every effort be made to minimize restrictions.6

At the annual meeting of the American Academy of Allergy in Washington, D.C., February 14, 1973, the following resolution was approved unanimously: "Participants in competitive athletics with asthma and other allergic conditions should not be disqualified because of the use, with medical supervision, of therapeutic doses of ephednine before and during athletic competition."7
Growth Standards for Infants and Children: A Cross-Sectional Study
Authors: Robson J. R. K. , Larkin F. A. , Bursick J. H. , Perri K. P.
Published: December 2021

Measurements of height and weight were collected on 1,233 Black and white infants and children attending a Child Health Clinic in Washtenaw County, Michigan. Polynomial curves were fitted to each race and sex group and, from these, estimates were made of the 3rd, 50th, and 97th percentiles for height and weight. Blacks tended to be lighter and shorter than whites in early infancy. In the second year of life, Blacks tended to exceed whites in height and weight achievement. For infants and children in the 97th percentile this change in status occurred earlier. The differences in weight and height achievement were statistically significant in the two race groups, but not between sexes.

The percentile estimates differed significantly from the percentiles of local as well as the "Iowa," "Harvard," and "Tanner" (United Kingdom) standards. Differences in the racial and environmental background of the clinic population and the samples used in the development of the national standards probably accounts for the variations in the percentile estimates. It is concluded that race- and sex-specific standards are required before growth achievements in infants and children can be properly evaluated.
A Comparison of the Physical and Intellectual Development of Black Children With and Without Sickle-Cell ell Trait
Authors: McCormack Michael K. , Scarr-Salapatek Sandra , Polesky Herbert , Thompson William , Katz Solomon H. , Barker William B.
Published: December 2021

Sickle-cell trait, a condition present in 7% to 9% of the United States Black population, is usually considered to be a clinically benign condition. However, there is increasing evidence to indicate the contrary, that is, the clinical pathophysiology is variable, ranging from a benign condition in most cases to a relatively few cases of severe pathological involvement. Physical and intellectual growth measures were taken on 19 children with sickle-cell trait (12 boys and 7 girls) from a large study of Black same-sex twin pairs from Philadelphia, Pennsylvania, and compared to measures taken of a sample of normal Black children from 155 monozygotic and dizygotic same-sex twin pairs. Sickle-cell trait carriers were found to weigh less, have smaller upper arm circumference, lesser skinfold thickness, and showed less mature skeletal age, differing significantly from normal children. Sickle-cell carriers tended to score lower on four of five intellectual measures, scoring one fifth to one third of a standard deviation lower than normal children.
Nasoduodenal Versus Nasogastric Feeding in the Very Low Birthweight Infant
Authors: Van Caillie Micheline , Powell Geraldine K.
Published: December 2021

The practicality, effectiveness, and safety of feeding very low birthweight infants (less than 1,300 gm) by continuous nasoduodenal infusion was assessed by comparison with continuous nasogastric feeding. The nasoduodenal group appeared to have a clear advantage over the nasogastric group for the overall period in terms of caloric intake (131 cal/kg/day vs. 106 cal/kg/day), average weight gain (16 gm/day vs. 10 gm/day), and safety. This advantage was even more striking in the first two weeks of life. A caloric intake of 120 cal/kg/day could be reached within 48 to 72 hours after tube placement in the nasoduodenal group but only after a week in the nasogastric group.

Nasoduodenal feeding resulted in faster weight gain than comparable published data on conventional feeding, peripheral intravenous alimentation, and parenteral alimentation.

There were no cases of aspiration associated with tubes placed in the duodenum whereas two cases of aspiration pneumonia were associated with tubes placed in the stomach. With the tip of the catheter in the duodenum, none of the complications reported with nasojejunal tubes (intussusception, perforation, or necrotizing enterocolitis) were seen, either in the initial pilot study reported here or in 50 additional infants.
Abdominal Pain in Children Caused by Linea Alba Hernias
Authors: Bugenstein Robert H. , Phibbs Clifford M.
Published: December 2021

Children with chronic recurrent abdominal pain present a frequently encountered and often perplexing problem in differential diagnosis. Apley states that the incidence of this condition, based on his investigation of 1,000 unselected schoolchildren, was calculated to be 10.8% of all children; and in a large outpatient clinic, Conway found this condition in an estimated 10% of all pediatric patients. Organic causes of chronic recurrent abdominal pain occur with an estimated frequency varying from 5% to 20% of these afflicted children.

Since the great majority of children with this complaint seem to demonstrate no primary underlying organic cause, the assumptions can be made that either the examination failed to expose the somatic abnormality responsible for the pain or that these children's symptoms are from what is referred to as "functional," "idiopathic," or "emotional" origins.
Pathogenesis of Reye's Syndrome: A Working Hypothesis
Authors: Thaler M. Michael
Published: December 2021

The brief history of Reye's syndrome has been one of progressive familiarity with a deepening mystery. It is possible that the syndrome reflects a variety of etiologically unrelated conditions with similar clinicopathological manifestations. In this view, subclinical defects in ammonia metabolism may constitute a distinct, identifiable group among disorders responsible for encephalopathy with fatty liver. Awareness of the possible role of mutant urea cycle enzymes and deficient substrates in the pathogenesis of this important illness should stimulate investigations of enzyme kinetics and intracellular transport mechanisms which may reveal a spectrum of abnonmalities in ammonia metabolism-and a specific therapy for each.
Reduced Thrombus Formation With Silicone Elastomere (Silastic) Umbilical Artery Catheters
Authors: Boros Stephen J. , Thompson Theodore R. , Reynolds John W. , Jarvis Charles w. , Williams Hugh J.
Published: December 2021

This report describes clinical experience with a radiopaque silicone elastomere (Silastic) umbilical artery catheter. Twenty infants, ten with polyvinyl chloride (PVC) umbilical artery catheters and ten with Silastic umbilical artery catheters, all positioned at the aortic bifurcation, had aortograms performed at the time of catheter removal. Catheter-associated thrombus formation was observed in nine of the ten infants (90%) with PVC umbilical artery catheters and in one of the ten infants (10%) with Silastic catheters. The incidence of lower extremity vasospasm associated with the two catheters was not significantly different. Aortic pressure tracings recorded through Silastic catheters were accurate, but slightly damped. Autopsies were performed on five additional infants who died with indwelling Silastic umbilical artery catheters. None of the catheters, nor their surrounding tissues, showed evidence of thrombus formation on either gross or microscopic examination. It is our experience that radiopaque silicone elastomere tubing can be used as an umbilical artery catheter and appears to have the advantage of being less thrombogenic than the standard PVC tubing currently in general use.
Is confidentiality in health care records a pediatric concern?
Authors: Hofmann Adele D.
Published: December 2021

Revelations of the existence of vast federal data banks and other Orwellian spectres1 may, at first glance, seem to have little relevance for the day to day practice of pediatrics. But children and adolescents have just as vital an interest in the protection of their privacy as do adults. And, in the matter of confidentiality and the health care record, these issues can be much more complex.2 For here the usual interrelationships between physicians and their patients are expanded to include the parents as well. In addition, more "third parties" are interested in the health of children than for their elders, and more health care resources are often involved.
Respiratory Illness in Preschool Children With Different Forms of Day Care
Authors: Strangert Katherine
Published: December 2021

The incidence of respiratory tract disease was investigated in three groups of Swedish children: those in 14 day-care centers with 18 to 68 children each; those in home care (usually no siblings); and those in family day-care homes (average, four children). In family day-care homes a mother cared for her own and one to four other children during the day. A preliminary nine-month study of 41 preschool children attending a day-care center and 41 comparable children in home care showed that children under 2 years of age in the center had more days with respiratory symptoms and more febrile illnesses (four per child) than those in home care (one per child). In a subsequent eight-month study of children under 2 years of age, children in day-care centers and home care were compared with children in family day-care homes. The 108 children in centers had more febrile illnesses (five per child) than the 57 children in home care (two per child), but the 42 children in family day-care homes had as many illnesses as those in day-care centers. The data suggest that increasing the number of contacts of an infant in day care beyond four to six children does not increase remarkably the incidence of respiratory tract disease.
Carbohydrate Malabsorption in Necrotizing Enterocolitis
Authors: Book Linda Sue , Herbst John J. , Jung August L.
Published: December 2021

A prospective investigation was conducted to determine if infants with necrotizing enterocolitis had evidence of carbohydrate intolerance prior to the onset of clinical symptoms of advanced disease. Stool specimens were examined for fecal reducing substances with Clintest tablets from well, full-term infants and sick premature infants. Only two of 45 (4.4%) formula-fed, full-term infants demonstrated higher than 2 + fecal reducing substances. Ten of 14 (71%) formula-fed premature infants who developed necrotizing enterocolitis had higher than 2 + reducing substances detected in their stools. Daily measurement of fecal reducing substances can be a useful adjunct in the management of sick premature infants.
Neonatal Diagnosis of Familial Type II Hyperlipoproteinemia
Authors: Andersen Gunnar E. , Friis-Hansen Bent
Published: December 2021

Cord serum prebeta-β-lipoprotein concentrations, was measured in a radial immunodiffusion assay in 303 randomly selected, full-term infants whose parental phenotypes were unknown. Six infants had elevated concentrations, that is above a cut-off limit of 197 mg/100 ml (97.5th percentile). Three of these infants suffered from classic type II hyperlipoproteinemia, and this diagnosis was confirmed by family studies at follow-up. The three other infants and their parents were shown to be normolipemic at follow-up. The elevated cord serum prebeta-α-lipoprotein in these three infants could be explained by highly elevated cord serum triglyceride and/or cholesterol.

The 297 infants with normal cord serum prebeta-β-lipoprotein and their parents were all shown to be normolipemic at follow-up

It is concluded that the measurement of prebeta-β-lipoprotein in cord serum allows the identification of children with familial type II hyperlipoproteinemia, if infants with transient neonatal hypertriglyceridemia and hypercholesterolemia are excluded.
Carrier Detection in Classical Hemophilia
Authors: Hathaway Helen S. , Lubs Marie L. , Kimberling William J. , Hathaway William E.
Published: December 2021

Rabbit antibody to purified human factor VIII was prepared and absorbed until it formed only one precipitin line against normal and hemophilic plasmas and no line against severe von Willebrand's disease plasma. The plasma protein which combines with this rabbit antibody to factor VIII is referred to as factor VIII antigen. The ratio of percent factor VIII activity (by coagulation assay) to percent factor VIII antigen was used for carrier detection. Thirty-seven normal women, 33 obligate carriers, 12 probable carriers, and 39 possible carriers, were studied by this technique. Using the ratio of 0.84 as the division between normals and carriers, 31 of the 33 carriers (91%) were classified as carriers. Twenty of the 39 possible carriers were classified as carriers (51%) and ten of the 12 probable carriers were positively identified. The results of discriminate analysis of all three variables (VIII activity, VIII antigen, and the ratio of VIII activity to VIII antigen indicated that the discrimination power of the ratio alone could not be improved by introducing the other variables on this set of data. These findings confirm the usefulness of the VIII activity to VIII antigen ratio in the detection of carriers of classical hemophilia.
Intrauterine Torsion of An Intra-Abdominal Testis
Authors: Campbell John R. , Schneider Charles P.
Published: December 2021

Intra-abdominal torsion of an undescended testis is a rare surgical problem in the neonate. However, one must consider the possibility of intrauterine torsion in a neonate who presents with an undescended testis and an abdominal mass.
Methodology Questioned
Authors: Hook Ernest B.
Published: December 2021

The article by Quinn and Rapoport1 raises a great number of questions about the methodology of the study.

(1) In Table II data on 21 controls are compared with those on 81 in the total sample diagnosed as "hyperactive." But nowhere is there a description of this control group or the way in which they were comparable to the hyperactive group. They could hardly be a "matched" sample since they are only one quarter of the total number of hyperactive children.
The Use of Xanthines in Treating Apnea of Prematurity
Authors: Kuzemko J. A.
Published: December 2021

Your correspondents' comments about aminophylline suppositories1-4 are interesting but largely theoretical since all the evidence quoted was derived from older children. In fact, rectally administered aminophylline is well absorbed in the premature baby.

In a consecutive series of 12 babies (birthweights, 900 to 1,500 gm) given 5-mg aminophylline suppositories, peak levels (mean, 12µg ± 3.2µg of plasma) were obtained at 32 to 36 minutes. No immediate side effects were noted and there were none after 22 months of foolow-up.
Changing of Umbilical Artery Catheters
Authors: Fomufod Antoine K. , Risenberg Herman M. , Nishinda Hiroshi
Published: December 2021

Two recent reports on umbilical artery catheter replacement in Pediatrics1,2 prompt us to record our experience with this procedure.

The major indications for changing the umbilical artery catheter in our nursery over the past several years have been failure to withdraw blood, usually for blood gas determination, and radiological demonstration of catheter tip at a point just below the diaphragm. Recently, we adopted a position at or just above the aortic bifurcation (L4-L5), thus eliminating the latter indication.
Punishment Legalized: Protest Against Corporal Punishment in Schools
Authors: Ris Hania W.
Published: December 2021

An unexpected and repressive decision affecting school-children was reached in October 1975 by the United States Supreme Court. It allows the states, if they so choose, to permit teachers to spank students as long as due process is maintained. This implies that other means for control of misbehavior have to be used first, that the student must be informed in advance about the nature of misbehavior which warrants spanking, and that another school official must be present at the time of spanking.
Hospital Maternal Care Is Disruptive
Authors: Call Justin D.
Published: December 2021

"Breast-Feeding: Second Thoughts" by Gerrard,1 sets forth epidemiologic and immunological data on human and other mammalian species showing that colostrum and breast milk actively protect the infant from enterocolitis and respiratory infections when breast-feeding is begun immediately after birth and continued through at least most of the first year of life. Gerrard hypothesizes that breast-feeding provides a smooth transition for the baby from being entirely dependent on the mother for nutritional and immunological requirements to being completely independent from her.
Departments of Pediatrics
Authors: Haggerty Robert J.
Published: December 2021

Petersdorf has recently described "Departments of Medicine 1973."1 What are the similarities and differences in Pediatrics? More important, which facets should we be trying to change? It seems useful to make a personal assessment looking back over ten years as a Pediatric Department chairman. The view is therefore very myopic. My hope is to stimulate debate and change where appropriate.

In Medicine Petersdorf's opinion is that teaching "load" is heavy. The senior faculty are away or in the laboratory, electives are of poor quality, and the scattering of students to many sites makes more structure necessary. In Pediatrics these points are also generally true but not to the same degree.
Books for Children About Death
Authors: Aradine Carolyn R.
Published: December 2021

Books about death for preschool and schoolaged children are reviewed in terms of child development, children's understanding of death, and literary quality. The article is written to help pediatricians and nurses become aware of this literature and to aid them in selectively advising concerned parents about its constructive use to help children understand death. Preventive mental health is the focus rather than use with fatally ill children.
Dermoid Cysts in Children
Authors: Pollard Zane F. , Harley Robison D. , Calhoun Joe
Published: December 2021

A retrospective study of dermoid cysts in children over the past 13 years at St. Christopher's Children's Hospital of Philadelphia, showed that 37% of the dermoids in the body occurred in the orbital and pen-orbital areas. An unusually high percentage of these occurred in the left eyebrow which appears to be the most frequent location for dermoid cysts in children. Dermoid cysts are a very common lesion encountered by ophthalmologists inasmuch as 3.3% of all ophthalmic surgical procedures in children were performed for dermoids. All 231 cases in this series were benign. The manner and time of presentation of these lesions are discussed as well as the treatment.
Relapse of Hemophilus influenzae Type b Meningitis After Combined Antibiotic Therapy: Report of a Case
Authors: Feldman William E. , Laupus William E. , Ledaal Pal
Published: December 2021

Antibiotic therapy of bacterial meningitis is being reevaluated due to reports of ampicillin-resistant strains of Hemophilus influenzae type b. The infant reported had a relapse of H. influenzae type b meningitis after an excellent clinical and bacteriologic response to an initial course of combined antibiotic therapy including chloramphenicol. This relapse is postulated to be due to localized cerebral vasculitis which was not treated for a sufficient period of time during the initial course of therapy. The patient responded well to a second course of penicillin and chloramphenicol. Since the use of penicillin and chloramphenicol will be increasing, the clinician should be aware that bacteriologic relapse of H. influenzae type b meningitis may occur with chloramphenicol therapy.
A Systematic Review of the Literature on Evaluative Studies of Tonsillectomy and Adenoidectomy
Authors: Shaikh W. , Vayda E. , Feldman W.
Published: December 2021

Although tonsillectomy and adenoidectomy (T and A) is frequently performed (indeed, it is the commonest surgical procedure done in North America1,2) considerable controversy persists regarding its effectiveness.

In 1971, 161,301 T and A's were performed in Canada at an estimated cost of close to 25.6 million dollars.3 In the United States in 1968 more than 1 million T and A's were performed.4 Assuming the cost per T and A to be similar to the costs in Canada, around $150 million were spent on this procedure in the United States in that year.

The purpose of this study is to review the English language literature pertaining to evaluation of T and A with particular emphasis on an assessment of the scientific merit of studies which have attempted to determine the efficacy of this procedure.

See Table in the PDF File

METHOD

Studies evaluating the results of T and A in the English language literature for the past 50 years5-33 were evaluated according to the following parameters: study design, sampling, completeness of description of illness and therapy, and precision of follow-up. Those studies which were most objective were awarded the highest points in each parameter. Conversely, studies which were purely descriptive or poorly documented received the fewest points.

The maximum number of points which a randomized, prospective, well-documented study could obtain was 34 points.

Table I shows the distribution of maximum scores in the various categories.

For the parameter of study design, points were awarded as shown in Table II. The highest score was given to a randomized study and the lowest to a descriptive one.
Consent
Authors: Brown Rowine H. , Hodes Horace L. , Vaughan Victor C. , Alford Charles A. , Brown Rowine Hayes , Holliday Malcolm A. , Katcher Avrum L. , Sia Calvin C. J. , Sparling David , Barness Lewis A. , James L. Stanley , Katz Samuel L. , Yaffe Sumner J. , Kretchmer Norman
Published: December 2021

Consent must be obtained prior to the institution of medical or surgical treatment. Pediatricians should keep informed concerning court decisions and statutes relative to consent and minors.
"Walk-in" bacteremia
Authors: Quie Paul G.
Published: December 2021

Obtaining blood for culture is an essential part of the diagnostic evaluation of any febrile patient. This is necessary for determining etiology when an infection focus is present and is especially important when the cause of elevated temperature is not obvious. This has been an accepted truism for evaluation of hospitalized patients for a long time, but recently several reports of children with bacteremia well enough to be evaluated in "walk-in" clinics suggest that blood cultures may also be a necessary procedure for febrile patients who are not hospitalized.1-4 In this issue of Pediatrics, McCarthy and co-workers4 report that 117 (6.5%) of 1,783 children who had blood cultures taken in a pediatric outpatient clinic were positive for bacteria.
Detection of Urinary Tract Infections in 3- to 5-Year-Old Girls by Mothers Using a Nitrite Indicator Strip
Authors: Kunin Calvin M. , DeGroot Jane E. , Uehling David , Ramgopal Vadakepat
Published: December 2021

A program to detect urinary tract infections among 3- to 5-year-old girls was conducted in Madison-Dane County, Wisconsin using local pharmacies as the distribution site for test kits. Screening was conducted at home by mothers with a nitrite dip-strip on three consecutive first morning specimens. Twenty-one percent of the target population participated during a one-month study period. Eighteen cases were found among 1,573 participants (1.1%). In addition, 243 girls other than those in the target area or age group participated and yielded eight additional cases, for a total of 26 cases among 1,816 total participants. The rate of false-positive nitrite tests was 0.3%. Newspapers were the most effective means of alerting the public to the program. The only factors which were associated with less awareness or participation were low socioeconomic and rural residence. Past history of infection, minor urinary symptoms, and pyuria were common among the bacteriuric girls. Immunoglobulin-coated bacteria suggestive of tissue invasion were present in one third of the cases. Vesico-ureteral reflux was present in five and caliectasis in two of 23 girls studied. Despite the likelihood that some bacteriuric girls, particularly those infected with gram-positive organisms were not detected, screening at home appears to be a highly efficient method of detecting urinary tract infections in large populations of preschool children.
The Ventilatory Response to Carbon Dioxide in Asthmatic Children, Measured by the Mouth-Occlusion Method (PM100)
Authors: Cosgrove John F. , Neuburger Naftoli , Levison Henry
Published: December 2021

Ventilatory responses to carbon dioxide vary widely in patients with bronchial asthma; some have a high response despite increased airway resistance. This paradoxical response was studied in 31 asthmatic children and 22 age-matched healthy children. Measurement of the ventilatory response to carbon dioxide with a conventional rebreathing method showed wide variation in the patients, paralleling the degree of their airway obstruction as measured by the one-second forced expiratory volume and maximal midexpiratory flow rate, but their mean response was similar to that in the control subjects. The ventilatory response was then determined with a new index (PM100), which rises linearly with increasing carbon dioxide concentration. Despite wide variation in the slope of PM100 in the patients, their mean response significantly exceeded normal, confirming that the neurochemical drive is increased in bronchial asthma.
Transplacental Melanoma–One-Year Survival
Authors: Cavell Bertil
Published: December 2021

I would like to add another case of transplacental metastatic malignant melanoma to those reported in the article by Dr. Trozak et al.1

The details of the case were reported in 1963.2 The patient, who was born six weeks before term after an uneventful pregnancy, is now 14 years old. Her mother died of widespread malignant melanoma four days after delivery of the girl who seemed well during the neonatal period. At 2 months of age, however, the baby displayed soft tissue tumors in her legs and pulmonary metastatic lesions.
Dr. Crosley Replies
Authors: Crosley Carl J.
Published: December 2021

Drs. Livingston and Pauli have again raised questions about the now frequently reported relationship between anticonvulsant therapy and rickets. Our study demonstrates that the biochemical abnormalities associated with rickets occur frequently in patients on anticonvulsant medications for more than three months. Hahn and co-workers1,2 have shown that the alkaline phosphatase elevations found in children and adults on anticonvulsants are of hepatic origin. While there are few instances of hypocalcemia in our study population, the children on chronic anticonvulsants did have a relative hypocalcemia (treated 9.49 mg/100 ml vs. control 9.76 mg/100 ml; P < .001).
Wiatrowski and Spencer Reply
Authors: Wiatrowski Emilie , Spencer Herta
Published: December 2021

Dr. Rinsler referred to the letter from Dr. Holliday regarding fluoride supplementation.1 In the same issue, our paper2 described the analyzed dietary fluoride intake for infants from birth to 6 months of age. Our studies have shown that the diet of infants aged 6 to 8 weeks already contained 0.57 mg of fluoride per day, and that the diet of infants aged 4 to 6 months contained 1.23 mg of fluoride pen day. Dr. Holliday suggests that the fluoride intake should be 0.5 mg/day, given either as a supplement in areas where the drinking water contains less that 1 mg of fluoride per liter or given as food containing this amount of fluoride.
The practical significance of birthmarks
Authors: Holmes Lewis B.
Published: December 2021

Most, if not all, mothers carefully examine their newborn infants as soon after birth as they have an opportunity. In addition to counting the number of fingers and toes, they look for birthmarks and blemishes of any kind. When the pediatrician talks to the mother after examing the infant, she or he must decide whether to report on every birthmark or to wait for the mother to ask "what is that mark on her...?" Jacobs and Walton have provided some valuable new information that will be useful in answering these questions.1 They confirm what mothers and pediatricians already know: birthmarks are common.
Pneumothorax in the Respiratory Distress Syndrome: Incidence and Effect on Vital Signs, Blood Gases, and pH
Authors: Ogata Edward S. , Gregory George A. , Kitterman Joseph A. , Phibbs Roderic H. , Tooley William H.
Published: December 2021

We determined the incidence of pneumothorax in 295 infants (mean birthweight, 1,917 gm) with the respiratory distress syndrome (RDS) treated according to the same protocol. Fifty-five infants (mean birthweight, 1,594 gm) developed pneumothorax (incidence, 19%); incidence varied with severity of RDS and intensity of respiratory assistance. Pneumothorax occurred in 3.5% (2 of 58) of infants who received no assisted ventilation and in 11% (14 of 124) of infants who received continuous positive airway pressure (CPAP) as the only form of assisted ventilation; the difference between these two groups is not significant. Forty-nine infants initially treated with CPAP later required mechanical ventilation with positive end-expiratory pressure (PEEP). Pneumothorax occurred in 12 of the 49 (24%) and in 21 of 64 (33%) of those infants initially treated with PEEP; the incidence of pneumothorax for both these groups was significantly higher than for those treated with no assisted ventilation or CPAP only.

To assess the value of frequent measurement of vital signs, blood gas tensions, and pH in the recognition of pneumothorax, we analyzed these variables by the cumulative sum statistical technique. We noted the following significant changes associated with pneumothorax: arterial blood pressure, heart rate, and respiratory rate decreased in 77% of cases; pulse pressure narrowed in 51% of cases; Po2 decreased in 17 of 20 cases in which ventilatory settings were constant for at least three hours prior to pneumothorax. However, pH and PCO2 showed no consistent changes. Frequent measurements of vital signs and Po2 aid in the early diagnosis of pneumothorax.
The Role of Acidosis at Birth in the Development of Hyaline Membrane Disease
Authors: Kenny John D. , Adams James M. , Corbet Anthony J. S. , Rudolph Arnold J.
Published: December 2021

To test the hypothesis that intrapartum acidosis has a role in the etiology of hyaline membrane disease (HMD), blood was collected from the umbilical artery (UA) at birth from 110 premature infants and analyzed for hydrogen ion concentration ([H·]), Pco2, standard bicarbonate, and lactic acid. The infants were followed until a definite diagnosis was made of HMD (33 infants), type II respiratory distress syndrome (16 infants) or the absence of respiratory distress (61 infants). In general, infants with HMD were more premature and had lower Apgar scores than nondistressed infants; however, there were no significant differences between the two groups in any acid-base measurement. Only in those patients of 32 to 37 weeks' gestational age was it possible to detect a significant increase in UA [H·] in infants with HMD compared to those without respiratory distress. There was evidence that the reduced Apgar score of infants with HMD may be due to immaturity and abnormal pulmonary function secondary to lung disease. It is concluded that acidosis at birth is not a factor in the development of HMD except possibly in more mature infants.
Predicting Accident Frequency in Children
Authors: Padilla Eligio R. , Rohsenow Damaris J. , Bergman Abraham B.
Published: December 2021

The concept of "accident proneness" is frequently discussed and rarely documented. We predicted that children who take more risks as judged by their behavior in gym class, or who have more stressful life changes as determined by their score on a Social Readjustment Rating Questionnaire (SRRQ), would be more likely to injure themselves. 103 junior high school boys were rated for these factors, and then followed for injuries by weekly telephone calls for five months. Boys having high SRRQ scores had significantly more accidents than those with low scores; risk-taking levels were not predictive. In this study, children undergoing stressful changes in their lives were more susceptible to accidents.
A Simple Estimate of Glomerular Filtration Rate in Children Derived From Body Length and Plasma Creatinine
Authors: Schwartz G. J. , Haycock G. B. , Edelmann C. M. , Spitzer Adrian
Published: December 2021

Based on statistical analysis of data in 186 children, a formula was derived which allows accurate estimation of glomerular filtration rate (GFR) from plasma creatinine and body length (GFR (ml/min/1.73 sq m) = 0.55 length (cm)/Pcr (mg/dl). Its application to clearance data in a separate group of 223 children reveals excellent agreement with GFR estimated by the Ccr (r = .935) or Cin (r = .905). This formula should be useful for adjusting dosages of drugs excreted by the kidney and detecting significant changes in renal function.
Gastrin Concentration in Plasma of the Neonate at Birth and After the First Feeding
Authors: von Berger Ludwig , Henrichs Ivo , Raptis Sotirios , Heinze Eberhard , Jonatha Wolfdieter , Teller Walter M. , Pfeiffer Ernst F.
Published: December 2021

Plasma gastrin was determined simultaneously in 19 newborn infants and their respective mothers shortly after birth and in ten neonates before and after the first feeding.

The gastrin concentrations in the umbilical vein plasma of the newborn infants were significantly higher than in the peripheral vein plasma of their mothers. The values were statistically not different from those obtained in the neonates before the first feeding. There was an increase in gastrin concentrations after the first feeding. From these results it is suggested that gastrin is produced in the neonate independently from the mother. It is already secreted after the first feeding. Experiments in rats showed that 125I-gastrin is not transported through the placenta. From these findings we assume that most likely the gastrin measured in plasma of newborn infants is of neonatal origin.
Isoniazid Hepatotoxicity in Childhood
Authors: Brasfield Dana M. , Goodloe Travis B. , Tiller Ralph E.
Published: December 2021

A case of isoniazid-associated hepatitis has been encountered in a pediatric patient. Only two previous such patients have been reported in the pediatric literature.1,2 Both of those children had more cutaneous manifestations than liver involvement. For this reason the following patient is presented.

CASE REPORT

V.R. is a black girl who was admitted to The Children's Hospital at 12 years of age for evaluation of pericarditis. The tuberculin skin test (PPD-5 T.U.) was positive with 20 mm of induration. Further studies, including cultures of pericardial fluid, eventually failed to prove a tuberculous etiology for the pericarditis. However, antituberculous therapy for at least one year was considered desirable.
The Meaning of Crying
Authors: Eisenberg Nancy , Main Mary
Published: December 2021

In the February 1975 issue Kearsley et al.1 make the point that, beginning at about 9 months of age, infants cry when left alone and that this is true regardless of rearing circumstance (day-care vs. home-rearing). We agree with their second interpretation of these results–that this response to "isolated" separation represents cognitive growth ("psychological processes").

We are concerned, however, that this phenomenon is alternately referred to as "separation protest" and that it is discussed as bearing on the effects of day-care on the quality of the mother-child relation.
Reliability of Transcutaneous Po2 With Roche Oxygen Monitor 5300 at 44 C in Newborn Infants With RDS
Authors: Mieth Diego , Micheli Jean L. , Duc Gabriel , Ferdico S.
Published: December 2021

Since the publication of our letter,1 further data have been assembled with the Roche Oxygen Monitor 5300. Our earlier investigations and those reported by others2,3 have shown that the poor correlation between arterial Po2 and cutaneous Po2 is obtained in patients with RDS, if this type of skin electrode4 is warmed to 42 C. Since these results were possibly due to an insufficient local arterialization of the skin, tests were repeated at a sensor core temperature of 44 C.
The Academy Replies
Authors: Frazier Robert C.
Published: December 2021

Dr. Davis' letter raises issues that are real but not new. Pediatrics, like most other journals sponsored by medical organizations, has been supported by a combination of subscription and advertising income since its beginning. The change in advertising policy in the last two years is an effort to continue to obtain the same kind of support from advertising income that has been possible in the past. Dr. Davis chooses to interpret financial data supplied at his request to indicate a profit to the Academy in the publication of the journal Pediatrics.
DIMENSIONS OF SCHOOL HEALTH. Edited by V. Eisner, M.D., and L.B. Callahan, PhD. Springfield, Illinois, Charles C Thomas, Publisher, 1974, $10.75;176 pp
Authors: Stackpole J. Ward
Published: December 2021

When asked to review the book, Dimensions of School Health, as a practicing pediatrician, I was somewhat skeptical. I had just finished four years of working with the education and school health people throughout the state of Vermont trying to establish a unified state health service program. Having read many books in order to work out this plan, I expected another book on school health to be theoretical and wordy but without much practical information for the physician who takes care of children on a day-by-day basis and who faces the problems of dealing with school authorities in regard to his patients' health.
Effect of Activated Charcoal on Acetaminophen Absorption
Authors: Levy Gerhard , Houston J. Brian
Published: December 2021

Acetaminophen intoxication can cause hepatic, renal, and myocardial necrosis which is often fatal. These lesions develop very rapidly, perhaps during the first pass of the drug through the liver. In case of acute ingestion of an overdose it is therefore essential to employ measures for reducing the absorption of acetaminophen. The effect of activated charcoal on acetaminophen absorption by normal volunteers was determined as a function of the dose of charcoal, the dosage form of acetaminophen, and the charcoal-to-acetaminophen dose ratio. The results indicate that activated charcoal can be an effective antidote for acute acetaminophen intoxication, if administered promptly and in sufficient quantity.
Are the Results Worth the Price?
Authors: Brown Richard E.
Published: December 2021

After reading the informative two-part article by Wray on "Child Care in the People's Republic of China,"1 I felt compelled to make the following observation.

One can only marvel at the accomplishments in health care described in the article, but one also wonders what the human cost might have been to accomplish those ends. The statement, for instance, that "It appeared, in all our conversations, that there is a remarkable coherence in the basic value system prevalent in China today," brings to mind previous reports on how such "coherence" has been accomplished.
Should We Speak of Prevention?
Authors: Diamond Eugene F.
Published: December 2021

Dr. Henry Nadler has very succinctly reviewed the current status of the prenatal diagnosis of open neural tube defects.1 It may be that α-fetoprotein analysis may eventually lead to therapeutic measures to be employed in utero for the affected fetus. Currently, however, no such measures are available and the only implication of a positive finding is the option of terminating the life of the affected fetus prior to birth by either saline or hysterotomy abortion.
PNP Speaks Up
Authors: Jefferson Ann
Published: December 2021

In regard to the AAP statement "Academy Policy in Relation to the Pediatric Nurse Associate,"1 I feel there are some important aspects that need to be addressed.

(1) The emphasis of PNP education is aimed at well-child/parent teaching, counseling, and health maintenance. The "traditional domain of medicine," i.e., physical examination, is a learned tool by which wellness can be assessed.

(2) Nurses as health care professionals are interdependent and independent practitioners (Darling vs. Charleston Community Memorial Hospital, 33 Ill. 2d 326, 211 N.E. 2d 253 [1966]).
Why No Intrathecal Therapy?
Authors: McWilliams Nancy B. , Maurer Harold M.
Published: December 2021

The case of intracranial extension of nasopharyngeal rhabdomyosarcoma reported by Brown et al.1 in the July 1975 issue certainly defied the laboratory, the radiologist, the angiographer, the library computer, and the busy lumbar tapper. With such rapid progression of symptoms and given the original diagnosis, it seems odd that some intrathecal chemotherapy and/or radiation was not used as a therapeutic trial.
Primary Epstein-Barr Virus Infections in Children
Authors: Sumaya Ciro Valent
Published: December 2021

During a seroepidemiologic survey of a community, 13 (6.2%) of 209 children were found to be experiencing a current or recent primary Epstein-Barr virus (EBV) infection. The sera contained elevated antibody titers to viral capsid antigen of EBV, antibodies to early antigen (EA) of EBV, and specific IgM. The frequency of primary infections was highest in the first decade of life. The primary EBV infections were usually asymptomatic. The antibody to EA was directed predominantly to the R component. A heterophil antibody response was not detected.
Custom-Made Tracheostomy Tube To Relieve Lower Tracheal Obstruction in Infants and Young Children
Authors: Galvis Antonio G. , Heller Richard M. , Haller J. Alex
Published: December 2021

Two case histories are presented in which special difficulties were encountered in the management of lower tracheal obstruction in children. These problems were successfully overcome by the use of a tracheostomy tube which was custom-made from a standard thin wall polyvinyl chloride endotracheal tube sufficiently long to relieve this obstruction.
Pathophysiologic Basis for Symptomatic Treatment of Fever
Authors: Stern Robert C.
Published: December 2021

Fever is one of the most obvious clues which allow one person to determine that another is sick. In pediatrics, it accounts for many telephone calls and upwards of 30% of all visits.1,2

Fever was long thought to require treatment as a disease in its own right. Sanctorius3 introduced the thermometer into clinical medicine shortly after its invention by Galileo4 early in the 17th century. Almost 200 years later, Wunderlich began his classic studies on medical thermometry.5 This ended fever's masquerade as a disease and relegated it to its proper role as a sign. The patient's anxiety and demand for treatment and the physician's desire to render antipyretic therapy have not been greatly affected by our rapidly increasing understanding of the regulation of central body temperature and the pathogenesis of fever. In fact, our present information already suggests that some common therapy directed at this symptom is unnecessarily uncomfortable, ineffective, or even dangerous.

Nowhere in medical education is there greater disparity between the frequency of a clinical problem and the amount of formal teaching devoted to its pathophysiology and management. The major pediatric texts6,7 scarcely take any note of the symptom, fever, at all and offer virtually no information on its treatment.

Rational treatment requires an understanding of temperature regulation, heat production and conservation, an appreciation of the pathophysiology of different febrile states, and knowledge of the mechanisms by which various therapeutic measures lower body temperature. Finally, some thought should be given to the possibility that fever is in some way a useful defense mechanism and should not be treated at all.