bluuebunny/crossref_metadata_2025 huggingface dataset:
Vehicle Occupant Safety: The Pediatrician's Responsibility
Authors: Widome Mark D.
Published: December 2021

The preeminent position of the automobile as a childhood health hazard has been recently emphasized in both the medical and lay literature.1-2 Contrary to the common impression, of the approximately 5,000 Americans below the age of 15 who die in traffic accidents each year, a majority are vehicle occupants.3 Baker, in this issue of Pediatrics (p 860) reemphasizes the magnitude of this public health problem and provides us with important additional information regarding the epidemiology of this "disease." Her vital statistics analysis demonstrates that it is during the earliest months of infancy, those months when, presumably, children are most carefully supervised by their parents and most dependent on them for their survival, that they are most likely to die in the automobile.
The Right Not To Read Controversy
Authors: Lieberman Allan D.
Published: December 2021

"The Right Not To Read" (Pediatrics 63:791, 1979) does a great disservice to the majority of pediatricians who do not have special training in the understanding and care of the academically underachieving child. I was surprised that the Editorial Board would accept for publication such a negative and misleading article.

One doesn't have a "right" to be sick and handicapped. One accepts a handicap, trying to get help to correct it or compensate for it.
Dyslexia: It's Real
Authors: Cobrinik Ralph
Published: December 2021

Dr Levine's commentary1 is a disservice to children with dyslexia. While there are other reasons for learning problems, as he points out, many children suffer from this specific entity. It is of more than academic interest that dyslexia finally be recognized and accepted; failure to do so will serve to perpetuate the voo-doo "diagnoses" and "therapy" so many of these children are subjected to.

My definition,2 "A dyslexic child is one in whom there are no or almost no signs of neurological, intellectual, environmental, or primary psychological pathology, who has had adequate pedagogic exposure, and still is unable to read or spell with the same degree of success that he experiences in other areas," defines a large specific group of children who deserve to have their problems specifically addressed.
Blastomycosis in Children
Authors: Laskey Warren K. , Sarosi George A.
Published: December 2021

Four cases of blastomycosis in children selected from a larger series of cases seen over 36 months are presented. This infection in the pediatric age group is not often considered in the setting of a slowly resolving pneumonic illness. The morbidity and mortality of this disease in the adult warrant careful consideration of this entity in the pediatric age group, since effective therapy is available.
The Importance of Nonrenal Involvement in Hemolytic-Uremic Syndrome
Authors: Upadhyaya Kirti , Barwick Kenneth , Fishaut Mark , Kashgarian Michael , Siegel Norman J.
Published: December 2021

Fifteen children with the clinical manifestations of hemolytic-uremic syndrome are reported.Prompt recognition of the syndrome and effective therapy for acute renal failure including early dialysis were institured in each case. Analysis of the clinical course and histopathologic features in these patients indicated that early dialysis and effective management of acute renal failure may unmask evidence of nonrenal involvement; microthrombi may be found in a wide distribution of organs, including the brain and myocardium; and extent and severity of nonrenal involvement become an important determinant of ultimate prognosis.
Concentration of Human Chorionic Gonadotropin in the Cerebrospinal Fluid of Patients with Germinal Cell Hypothalamic Tumors
Authors: Jordan Richard M. , Kendall John W. , McClung Michael , Kammer Huldrick
Published: December 2021

Plasma and cerebrospinal fluid (CSF) specimens were measured simultaneously for human chorionic gonadotropin (HCG) in two patients with HCG- secreting choriocarcinoma. In the patients with hypothalamic tumors, the CSF HCG levels were higher than the plasma HCG concentrations. In the patient with gestational choriocarcinoma with no known cerebral metastases, the plasma HCG level greatly exceeded the CSF HCG concentration. The finding of a CSF HCG concentration that approaches or exceeds the plasma value would be a useful screening procedure in localizing a pathologic source of HCG secretion in patients with a suspected hypothalamic tumor. An unexpected finding in the patient who also had a hypothalamic embryonal cell carcinoma and hypocortisolism was an extremely high concentration of a biologically inactive adrenocorticotropic like substance in the CSF.
Premie Nipples: A Potential Aspiration Hazard
Authors: Scherz Robert G.
Published: December 2021

Nipples for dispensing milk to infants are sold throughout the United States and Canada in a diversity of retail outlets. The nipples have been designed in a variety of forms to include soft nipples for premature infants. The nipples for premature infants tend to be of thinner stock and more pliable than nipples designed for full-term infants. Although the nipples may well have labeling indicating that they have been prepared for premature infants, the adult who purchases them may not recognize that difference when they are displayed in an area that also provides standard nipples. The use of nipples designed for premature infants may present an aspiration hazard if they are used by a full-term infant.
Effect of Respiration on the Echocardiogram in Children with Cystic Fibrosis
Authors: Morin David P. , Cottrill Carol M. , Johnson Gregory L. , Wilson H. David , Vine Donald L. , Noonan Jacqueline A.
Published: December 2021

Respiration-related cyclic variation was noted in echocardiographic measurements of right and left ventricular end-diastolic dimension, D-E amplitude of the anterior mitral leaflet, and mitral valve E-F slope in 26 children with cystic fibrosis. The observed echographic changes seem to be an exaggeration of the normal physiologic variation seen with respiration. In children with advanced respiratory disease, airway obstruction, rather than cor pulmonale, may be responsible for this exaggeration.
Haemophilus influenzae Type b in a Day Care Center: Relationship of Nasopharyngeal Carriage to Development of Anticapsular Antibody
Authors: Granoff Dan M. , Gilsdorf Janet , Gessert Charles E. , Lowe Lawrence
Published: December 2021

We measured anticapsular antibody to Haemophilus influenzae type b by radioimmunoassay in sera from 55 children attending a day care center in which two cases of H influenzae type b disease had occurred. The children ranged in age from 2 months to 36 months. Serum antibody levels in children attending the day care center were significantly higher than in age-matched controls (P .001), but in two different surveys one month apart 38% and 43% of the contacts had levels 100 ng/ ml. Day care center children who were carriers of H influenzae type b had higher geometric mean antibody levels than noncarriers (478 ng/ml compared to 92 ng/ml, P .004). Nevertheless, six of 21 children (29%) with repeatedly positive cultures during four weeks of observation had concentrations of serum antibody 100 ng/ml when measured both by binding the 125I-derivative of the capsular antigen (polyribosyl-ribitol phosphate), or binding of 3H-polyribosyl-ribitol phosphate. These data may explain observations of H influenzae type b disease in contacts of cases more than 30 days after hospitalization of the index patient.
Psychosocial Adjustment of Latency-Aged Diabetics: Determinants and Relationship to Control
Authors: Grey Margaret J. , Genel Myron , Tamborlane William V.
Published: December 2021

The relationship of psychosocial adjustment, family functioning, self-esteem, and diabetic control was studied in 20 latency-aged diabetic children and their parents. Moderate to severe adjustment problems were found in 11 (55%) of the patients. Child self-esteem, parental self-esteem, and family functioning, as scored by standard instruments, were all significantly greater in the group of children considered to be well-adjusted as compared to the maladjusted group (P .05 to .001). Of these, parental self-esteem appeared to correlate most closely with the child's adjustment. Twenty-four-hour urinary glucose excretion was two- to threefold greater in maladjusted as compared to well-adjusted patients (71 ± 20 vs 20 ± 5 gm, P .05). These data suggest that psychosocial adjustment problems frequently occur in latency-aged children with diabetes, are associated with poorer chemical control, and require a family-centered approach to intervention and management.
Paroxysmal Choreoathetosis: Report of Five Cases and Review of the Literature
Authors: Kinast Morris , Erenberg Gerald , Rothner A. David
Published: December 2021

Paroxysmal choreoathetosis is a rare, involuntary movement disorder. Attacks occur spontaneously or may be induced by movement, startle, or anxiety. The movements are tonic, dystonic, or choreoathetotic. Sporadic and, more commonly, familial cases have been reported. Onset occurs most often during childhood, and the course is nonprogressive. Response to anticonvulsant therapy is usually excellent. Five cases of the sporadic form of paroxysmal choreoathetosis are reported. Three of the five patients had attacks after initiation of movements such as rising from a chair. Results of physical examination were normal in four patients. One child had mild hemiatrophy and unilateral hyper-reflexia. Results of laboratory studies, including determinations of serum calcium and ceruloplasmin levels, EEGs, and CAT scans of the head, were normal. The attacks ceased in all patients after treatment with either phenytoin or carbamazepine.
Phagocytic Dysfunction in Monocytes of Normal Newborn Infants
Authors: Schuit Kenneth E. , Powell Dwight A.
Published: December 2021

The kinetics of phagocytosis by monocytes isolated from cord blood and from the blood of adult volunteers was studied. Monocytes attached to glass coverslips were incubated with polystyrene spheres (1.1 µ diameter) for up to 120 minutes. In this system, the rate of phagocytosis was considerably slower in newborn monocytes than in those from adults. By the time phagocytosis had occurred in virtually all of the adult cells, only 38% of the neonatal monocytes had engulfed particles. However, this defect was not absolute, since ultimately all of the newborn cells contained engulfed spheres. Levamisole had no effect on normal adult monocytes but accelerated phagocytosis of newborn cells to a rate identical with that of adult cells. These data demonstrate that newborn monocytes are less efficient in the early stages of phagocytosis than are comparable cells from adults, raising the question of the impact of phagocytic kinetics in the development of neonatal sepsis. The correction of this defect by levamisole suggests that the differences in neonatal and adult monocytes may be evaluated more thoroughly by similar pharmacologic probes.
Value of Echocardiography in Assessing the Outcome of Bronchopulmonary Dysplasia of the Newborn
Authors: Fouron Jean-Claude , Le Guennec Jean-Claude , Villemant Didier , Bard Harry , Perreault Gilles , Davignon André
Published: December 2021

Cardiac catheterization of infants with bron-chopulmonary dysplasia has shown right ventricular hypertrophy and pulmonary hypertension in the majority of the survivors. This study was planned to determine whether serial echocardiographic assessments of the pulmonary vascular bed could help to establish short-term prognosis of bronchopulmonary dysplasia and to evaluate myocardial function of the survivors. Ten preterm infants were included in this study. They were classified according to four radiologic stages. A total of 50 echocardiographs were recorded allowing serial measurements of the right systolic time intervals. All infants that eventually expired had a ratio of the preejection period to the ejection time of the right ventricle above 0.3 prior to death (five patients). Infants with normal right preejection period to right ejection time ratio had a good out-come despite persistence of abnormal lung x-rays (four patients). Persistence of O2 dependence with abnormal right systolic time intervals after three months of life eventually led to death (two patients) or serious pulmonary insufficiency (one patient). The lungs as seen on chest x-rays of this patient remained unchanged (moderate stage IV) during six months, while the echocardiograph showed a progressive increase in right preejection period to right ejection time ratio. This infant has now developed cor pulmonale. Myocardial function evaluated on the last echocardiograph of the four infants who were considered cured was within normal limits. In conclusion, indirect assessment of pulmonary pressure by echocardiography can be used for clinical evaluation and ultimate prognosis of bronchopulmonary dysplasia and should be part of the follow-up evaluation of infants suffering from this disease.
Theophylline-Induced Seizures in Accidentally Overdosed Neonates
Authors: Gal Peter , Roop Craig , Robinson Helen , Erkan N. Vildan
Published: December 2021

Theophylline-induced seizures are reported in two neonates. The serum theophylline concentrations during seizures were 51.0 mg/liter and 54.0 mg/liter. Toxic symptoms prior to seizures may be absent or undetected, supporting the necessity of blood level monitoring during theophylline therapy.
Factors Influencing Access to Primary Health Care via School Health Services
Authors: Nader Philip R. , Gilman Susan , Bee David E.
Published: December 2021

The school health and community primary health care contacts were studied for a group of elementary school children who have sociodemographic characteristics often associated with poor access to primary health services. The school system is engaged in a demonstration project that attempts to link the home with community and school services. Visits to the school health room accounted for 85% of all contacts. A visit rate of 1.13 visits/child/year occurred at primary care sites. Ethnicity is the single most important predictor of use of school health services, followed by family status and number of visits for primary health care in the community. In contrast, use of community primary care facilities is best predicted by socioeconomic status (SES), family status, and sex. The patterns of care received by the population were characterized. Children whose care was initiated, referred, or facilitated by the school were designated as receiving "interactive" care, which occurred mostly among minority and lower SES children. The data suggest that the school provides access to preventive health care for all children and facilitates care for segments of the population that usually have difficulty achieving access to the health care system.
Acute Urticaria Associated with Streptococcal Infection
Authors: Schuller Diane E. , Elvey Sharon M.
Published: December 2021

Eighty-one cases of acute urticana were treated in our institution over a two-year period. In 13 of 32 cases screened for streptococcal pharyngitis, either positive throat culture, significant streptococcal exoenzyme antibodies (Streptozyme test), or both were found. Other causative factors for the acute urticania had been excluded. It is our feeling that β-hemolytic streptococcal infection may be a causative agent in many cases of acute urticaria, and that the infection may not always be clinically apparent. We therefore recommend a throat culture and determination of streptococcal enzyme level as routine procedures in evaluating acute urticaria. We also suggest, based on the findings in one case, that discontinuing antibiotic therapy for a streptococcal infection when urticaria develops, even though necessary, might be inappropriate.
Valproate in Nonketotic Hyperglycinemia
Authors: MacDermot Kaye , Nelson William , Weinberg Joseph A. , Schulman Joseph D.
Published: December 2021

Severe intractable seizures are frequent manifestations of nonketotic hyperglycinemia. Because levels of urinary and plasma glycine have been reported to be elevated by valproate in patients with seizures but no evidence of hereditary hyperglycinemia,1,2 it has been assumed that the agent is contraindicated for the therapy of convulsive states associated wtih nonketotic hyperglycinemia. This conclusion was recently stated, for example, at an international congress on human genetics.3

We regard this assumption as unwarranted. We have administered valproate to two nonketotic hyperglycinemic patients and monitored glycine levels in their cerebrospinal fluid. It is the elevated CSF glycine which has been postulated to result in the encephalopathy in nonketotic hyperglycinemia.4
Infant Automobile Restraint Systems: Beware of the Sun
Authors: Hankin Fred , Vermeulen Fred
Published: December 2021

The use of infant safety seats in automobiles has become a standard recommendation of physicians, insurance companies, and various organizations. The efficacy of these devices in the prevention of serious motor vehicle trauma is well recognized.1-7 We report an adverse incident involving such a restraining device.

CASE REPORT

J.R. is a 12-week-old white female infant who was secured in such a restrainer seat in the recommended manner. The day of admission was an unusually sunny spring afternoon and the child was wearing only a T-shirt and a diaper. Persistent crying by the child for 15 minutes led to the discovery of a blister 3 cm in diameter on the exposed portion of the patient's anterior right thigh (Figure).
A Practical Technique for Tympanocentesis for Culturing Aerobic and Anaerobic Bacteria
Authors: Brook Itzhak
Published: December 2021

Tympanocentesis is a method frequently used to aspirate middle ear fluid from infected ears. There are some medical indications to perform tympanocentesis in certain clinical settings.1 This procedure could be beneficial in some patients in which determination of the etiology of the acute otitis media and relieving the pain and acute symptoms is of importance. The instrument frequently used by otolaryngologists is the Senturia ear specimen collector (Storz Instrument Company, St Louis) which operates by controlled suctioning using an external negative pressure. A simplified method for performing myringotomy and tumpanocentesis2 that avoids the use of complicated equipment and prevents contamination of the specimen is presented here.
The Puzzling Epidemiology of Neural Tube Defects
Authors: Mortimer Edward A.
Published: December 2021

Elucidating the cause of disease is often not easy and may require answers to many questions. Perhaps the most important questions have been rather simply stated in verse by Rudyard Kipling.1

I keep six honest serving men;

(They taught me all I knew)

Their names are What and Why and When and How and Where and Who.

In terms of neural tube defects, many of these servants of Mr Kipling have provided valuable epidemiologic clues as to the cause of neural tube defects (NTDs),2 but the specific mechanism responsible for this disabling birth defect has so far escaped definition.
Marijuana
Authors: Segal Sydney , Anyan Walter R. , Hill Reba M. , Kauffman Ralph E. , Mofenson Howard , Pruitt Albert W. , Shinefield Henry R. , Singer Harvey S. , Weinberger Miles M. , Ballin John C. , Catz Charlotte , Farchione Louis , Freeman Martha M. , Herrmann Arthur P. , Licata Sam A. , Oakley Godfrey , Sawchuk Steven , Schneider Jack M. , Soyka Lester F.
Published: December 2021

In 1971 and 1975, the Committee on Drugs provided information about marijuana for the Academy membership.1,2 Since that time, marijuana use by children and adolescents has continued to increase. Investigations of the biologic effects of the agent have expanded, and there is justification for concern about frequent, chronic use by youth. In addition, marijuana use and experimentation with other drugs are now being promoted to children in subtle and insidious ways which need to be identified (Figs 1 to 5).

Pediatricians should be aware of the changing pattern of marijuana use in this country. Whereas occasional use by an adult may have little health consequence for the individual, frequent use by large numbers of children and adolescents raises different concerns. The National Institute on Drug Abuse (NIDA) conducts annual surveys of marijuana use in this country and reported in a recent publication3 that 10% of all high school seniors smoke marijuana daily. In the 12- to 17-year old group, 16% of those surveyed in 1977 used marijuana in the month preceding the survey. Even if the incidence figures are not entirely accurate, an increase in use by these two groups from 1976 to 1977, as determined by similar annual sampling techniques, is clear. Nationwide data since 1977 are not yet available, but in two states surveyed in 1978, 16% of high school seniors smoked marijuana daily (R. C. Peterson, PhD, personal communication, 1979). This information supports the conclusion that use in youth had increased each year since 1975. Extrapolation of additional data collected by NIDA revealed that in 1977 about 16 million Americans were current users of marijuana (ie, used the drug during the month preceding the survey).3
Interrelationships between Nutrient Intake and Plasma Lipids and Lipoproteins in Schoolchildren Aged 6 to 19: The Princeton School District Study
Authors: Morrison John A. , Larsen Rhea , Glatfelter Lenora , Boggs Donna , Burton Kathryn , Smith Charlene , Kelly Kathe , Mellies Margot J. , Khoury Philip , Glueck Charles J.
Published: December 2021

Relationships between nutrient intakes and plasma lipids and lipoproteins were studied in 1,669 schoolchildren, aged 6 to 19 years; 948 were selected by random recall and 721 because of elevated plasma cholesterol or triglyceride (hyperlipidemic recall). Nutrient intake data was collected by using a 24-hour dietary recall. Median dietary cholesterol intakes for 6 to 9-year-old boys and girls in the random recall group were 222 and 230 mg/day, with polyunsaturated/saturated fat ratios of 0.34 and 0.33. For boys and girls, aged 10 to 12 years, median dietary cholesterol intakes were 296 and 235 mg/day, for 13 to 15 year olds, 343 and 237, and for 16 to 19 year olds, 418 and 221 mg/day. The dietary polyunsaturated/saturated fat ratios did not change appreciably with age. Partial correlation coefficients describing relationships between lipids, lipoproteins, and nutrients after adjustment for age, sex, race, and Quetelet index (W/H2) were calculated for all children (random and hyperlipidemic recall) after excluding children having plasma cholesterol, triglycerides, and calories less than or equal to the first or greater than or equal to the 99th percentiles for the random recall children. Plasma cholesterol was inversely and triglyceride positively correlated with dietary sucrose. Plasma low density lipoprotein cholesterol was inversely correlated with the dietary polyunsaturated/saturated fat ratio, total carbohydrate, and sugar. Potential relationships between nutrients and lipids-lipoproteins were also examined in children having low (first to tenth percentile), intermediate (45th to 55th percentile), and high (90th to 99th percentile) nutrient intake, after covariance adjustment for age, race, sex, and Quetelet index. Total plasma cholesterol fell as sucrose intake increased. Triglyceride rose along with caloric intake, total carbohydrate intake, and sucrose intake, while high density lipoprotein cholesterol levels fell with increasing caloric and sucrose intake. As dietary polyun-saturate ingestion rose from low to intermediate to high, plasma low density lipoprotein cholesterol increased. Nutrient intake may play a small but significant role relative to lipids and lipoproteins in children and, as such, may have importance relative to pediatric precursors of atherosclerosis.
The Gynecologic Examination of the Prepubertal Child with Vulvovaginitis: Use of the Knee-Chest Position
Authors: Emans S. Jean , Goldstein D. P.
Published: December 2021

Vulvovaginitis is a common complaint in the prepubertal child. The proximity of the vagina to the anus and the thin uncornified vaginal epithelium make the young child especially susceptible to vulvovaginal infection. Not only is hygiene often suboptimal in this age group, but pinworm infestations, bubblebaths, harsh soaps, and tight-fitting nylon tights can all contribute to the vulvar irritation. Because children are frequently sent to gynecologists, traumatized by a rectal examination as the first part of the evaluation, or sent for an x-ray of the vagina with the hope of excluding a radiopaque foreign body, we believed it would be useful to present our approach to the gynecologic evaluation of the prepubertal child in which the kneechest position is used for visualizing the vagina.

METHODS

The evaluation of a prepubertal child with vulvovaginitis in the Gynecology Clinic of Children's Hospital is done in the following order: (1) history; (2) inspection of the perineum with the child supine; (3) visualization of the vagina and cervix in kneechest position; (4) cultures; and (5) a rectal examination in girls with vaginal bleeding or abdominal pain.

The knee-chest position (Figure) provides a particularly good view of the vagina and cervix without instrumentation. The little girl is asked "to lie on her tummy with her bottom in the air." She is reassured that the examiner plans "to take a look" but "will not put anything inside her." The child rests her head to one side on folded arms and supports her remaining weight on bended knees (6 to 8 in apart).
The Etiology of Bullous Myringitis and the Role of Mycoplasmas in Ear Disease: A Review
Authors: Roberts Donald B.
Published: December 2021

A critical review of the literature concerning bullous myringitis has found one case of possible mycoplasmal, one of possible viral, and 43 of bactenal, etiology. The bacteria were Streptococcus pneumoniae, Haemophilus influenzae, and β-hemolytic Streptococcus, in the same percentages as found in (nonbullous) otitis media. One of 858 attempts to isolate Mycoplasma from cases of (nonbullous) otitis media was successful. The evidence that Mycoplasma are a cause of otitis media with or without bullae is weak. Bullous myringitis probably is not a separate clinical entity, but merely acute otitis media with blisters on the eardrum.
Familial Cholestatic Cirrhosis Associated with Kayser-Fleischer Rings
Authors: Kaplinsky Chaim , Sternlieb Irmin , Javitt Norman , Rotem Yaacov
Published: December 2021

A brother and sister who suffered from pruritus since infancy developed hepatic cirrhosis early in life. Although this clinical picture has never been seen in Wilson's disease, Kayser-Fleischer rings in the boy made further studies necessary. Oral radiocopper loading tests administered to both children and to their parents served to exclude Wilson's disease conclusively. Determinations of the concentrations and patterns of bile acids in the serum indicated that the abnormalities observed in these children are not related to errors in bile acid synthesis. Although a defect in bile acid transport is present, it appears to have occurred as a consequence of the liver disease.
Sonography in the Diagnosis and Management of Hydrops of the Gallbladder in Children with Mucocutaneous Lymph Node Syndrome
Authors: Slovis Thomas L. , Hight Donald W. , Philippart Arvin I. , Dubois Reuben S.
Published: December 2021

Acute hydrops of the gallbladder is described in four patients who had mucocutaneous lymph node syndrome. Diagnosis was readily made with grayscale ultrasound, and the patients were followed with this technique. The gallbladder returned to normal size in all of the patients within 15 days, and none of the patients needed surgery. The role of surgery in acute hydrops of the gallbladder is for the complications of the hydrops and not for distension alone.
Moderation, the Noblest Gift of Heaven
Authors: Barness Lewis A.
Published: December 2021

Improving the outcome of pregnancy is a long sought goal of perinatologists. Observations that starvation during pregnancy could lead to disturbances in newborns, and in some cases to low birth weight infants, particularly if starvation occurrred late in the pregnancy, led to studies of food supplementation of pregnant women.

One of the most carefully designed studies is that of Rush and co-workers,1 part of which is described in this journal. They found that supplementing the diet of the pregnant woman, particularly with protein but also with calories, resulted in increased fetal wastage and few if any good effects. There was apparently a neutralization of some deleterious effects of smoking, an effect also recently observed in obese gravidas.2
Prenatal Nutritional Supplementation
Authors: Hegsted D. Mark
Published: December 2021

My first reaction to this report (pp 683 to 697) is that something must be wrong and I assume many others will react the same way. If feeding pregnant women has an unfavorable effect upon the outcome of pregnancy we are really in a bad way! We need to examine possible reasons for this unanticipated result. I will comment on several of these.

First, the effect observed is small and if the distribution of four or five of the 823 outcomes of pregnancy had been different or distributed differently among the three groups, there would not be much to discuss or question.
Swimming Instructions for Infants
Authors: Flynn Thomas G. , Kennell John H. , McLeod Robert N. , Shaffer Thomas E. , Strong William B. , Thornton Melvin L. , Van Rooy Clemens W. , Burkett Lucille , Malacrea Richard , Wilkins Kaye E.
Published: December 2021

Children less than 3 years old are most vulnerable to drowning, and organized efforts to reduce the toll are indicated.

Heretofore, swimming instruction has concentration on school-aged children, but in recent years some emphasis has been placed on teaching younger children to swim, even during the first year of life. Although it may be possible to teach young infants to propel themselves and keep their heads above water, infants cannot be expected to learn the elements of water safety or to react appropriately in emergencies. No young child, particularly those who are preschool aged, can ever be considered "water safe." Parents may develop a false sense of security if they feel their young child can "swim" a few strokes.

Additional problems may be associated with admission of infants to public swimming pools. Incontinent infants pose an aesthetic problem and make it difficult to maintain the effectiveness of chlorination.

The Committee recognizes the increasing populaity of swimming programs for infants and the enjoyment of the parent and child in this shared activity, and makes the following recommendations:

1. If a parent wishes to enroll his/her infant in a water adjustment and swimming program, it should be on a one-to-one basis with the parent or a responsible adult. Organized group swimming instruction should be reserved for children more than 3 years old.

2. Instruction should be carried out by trained instructors in properly maintained pools.

3. Infants with known medical problems should receive clearance from their physician.

4. Controlled studies clarifying the possible risks to infants from swimming programs should be carried out as soon as possible.
Human Milk Banking
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W.
Published: December 2021

The experience of Finnish workers, as well as that of others, shows that the banking of heattreated and frozen human milk is a practical and safe means of feeding low-birth-weight newborn infants. The continuous and exclusive use of human milk is associated with a low incidence of infection and with a rate of survival which is among the highest reported.4 The rate of growth and weight gain is also considered satisfactory, although there is some controversy about whether weight gain is quite as rapid as in formula-fed infants.28 Long-term studies should be carried out to see if these infants grow and develop as well, or better than, those on formula feedings.

It is still uncertain whether banked human milk will prove sufficiently superior to formula with respect to its nutritional and immunologic characteristics to compensate for the difficulties of maintaining bacteriologic control and to warrant the cost of setting up and running a milk bank for premature infants. At this time, the Committee considers it optimal for mothers of low-birth-weight newborn infants to collect their milk for feeding their own infants fresh milk.29 Once home, the mothers can freeze the expressed milk and organize for transportation of samples on a regular basis. However, since this procedure will be impossible or impractical for many infants, bacteriologically safe milk from a donor seems a reasonable alternative for these infants.
Selenium and Glutathione Peroxidase Levels in Cystic Fibrosis
Authors: Lloyd-Still John D. , Ganther Howard E.
Published: December 2021

Whole blood selenium and glutathione peroxidase levels were measured in 20 infants and children (aged 6 months to 15 years) with cystic fibrosis. The whole blood selenium concentration in cystic fibrosis was 0.122 ± 0.025 µg/gm. Although the levels of selenium in cystic fibrosis children were below the levels found in a study of healthy children (0.223 ± 0.007 µg/gm), they are comparable to those found in children with phenylketonuria treated dietetically and exceed the blood selenium level of healthy children in New Zealand. Levels of the selenoenzyme glutathione peroxidase in children with cystic fibrosis (0.042 ± 0.007 units/mg Hb) were in the normal range (0.035 ± 0.003 units/mg of Hb). These results do not support the hypothesis that deficiency of selenium is responsible for cystic fibrosis.
Pericardial Effusions in Bacterial Meningitis Are Not Common
Authors: Bass John L. , Kaplan Edward L.
Published: December 2021

We read with interest the paper entitled "The Frequency of Pericardial Effusions in Bacterial Meningitis" by Laird and colleagues (Pediatrics 63:764-770, 1979). In our view, the authors' conclusions that "pericardial infection is common in patients with meningitis, but that it is usually of no clinical significance and resolves with antibiotic therapy" are unjustified from the evidence presented. It is well recognized that echocardiography is a sensitive method for detecting the presence of a pericardial effusion, but unfortunately, there are no echocardiographic features which define the etiology of the effusion.
Oral Antibiotic Therapy of Skeletal Infections in Children
Authors: Kolyvas E. , Ahronheim G. , Marks M. I. , Gledhill R. , Owen H. , Rosenthall L.
Published: December 2021

Oral and intravenous (IV) antibiotic regimens were compared in 15 children with etiologically defined osteomyelitis and/or septic arthritis. On admission all children were started on standard IV therapy; seven were changed to oral antibiotics within 72 hours and the remaining eight continued on IV therapy for four weeks. Oral antibiotic doses were adjusted to achieve a peak serum bactericidal titer of [unknown]1:8 against the patient's own pathogen. All patients were treated in hospital for four weeks; therapy continued for a minimum of six weeks or until the erythrocyte sedimentation rate (ESR) fell below 20 mm/hr. The clinical course and outcome were similar in both groups. There were no treatment failures nor any relapses during a 12-month follow-up period. This prospective study supports, with controlled data, the concept that acute skeletal infections can be safely and successfully treated with carefully monitored oral therapy.
An After-Hours Pediatric Walk-In Clinic for an Entire Urban Community: Utilization and Effectiveness of Follow-Up Care
Authors: Weitzman Michael , Moomaw Margot S. , Messenger Katherine P.
Published: December 2021

A retrospective record review was used to examine utilization of a pediatric walk-in clinic available to an entire urban community and to evaluate the effectiveness of follow-up care for a sample of the users of this facility who receive their regular pediatric care at a local comprehensive child health center. Results indicate that this walk-in facility is used extensively for the care of nonemergency conditions. The findings did not, however, support the generally accepted belief that a disproportionate number of Medicaid-supported and minority children overuse emergency type facilities. Utilization did not differ by race or medical care financing. Only 35.6% of the children who were advised to make a follow-up visit to the health center actually did so. White children complied significantly more often than black children (48.0% vs 15.8%). A larger percentage of patients for whom follow-up was optional (48.5%) than for whom follow-up was recommended (35.6%) made a return visit. Noncompliance with recommendations concerning follow-up care of adult users of emergency type facilities is a well recognized problem; the present study demonstrates a similar problem among children.
Infant Feeding Practices of Families Belonging to a Prepaid Group Practice Health Care Plan
Authors: Andrew Elizabeth M. , Clancy Katherine L. , Katz Marcella G.
Published: December 2021

A survey of the infant feeding practices of 270 families who belonged to a prepaid medical insurance program revealed extensive use of commercially prepared infant formulas during the first months of life, introduction of beikost before 3 months of age and introduction of cow milk into the diet at 3 to 5 months. Ethnic, as well as socioeconomic differences, were observed in the use of milks and formulas, timing of introduction of beikost, and method of feeding solid foods. Average calorie intakes approached or were greater than the recommended dietary allowances. With the exceptions of vitamin D and iron, most infants received much greater than the recommended intake of all nutrients examined. Average sodium intakes were well above advisable intakes. Many infants received supplements of vitamins A, B1, B2, B6, and C in addition to adequate dietary intakes. Results of this survey indicate that many mothers look to pediatricians for advice on how to feed their infants and several findings indicate that nutrition education efforts directed toward pediatricians and parents must be more vigorous than they have been in the past.
Prolonged Use of Large Intravenous Steroid Pulses in the Rheumatic Diseases of Children
Authors: Miller John J.
Published: December 2021

Nineteen children with rheumatic diseases refractory to standard treatment were given repeated large "pulses" of corticosteroid therapy. The pulses consisted of four repeated doses of 500 mg of hydrocortisone given intravenously over 20 to 30 minutes at six-hour intervals or of single intravenous injections of 30 mg/kg of methylprednisolone. All patients had temporary relief of signs or symptoms of inflammation. Complications were mild and only one child was removed from therapy because of a complication. Two children were judged to be treatment failures. Five patients have been weaned from all steroid treatment, and eight have required continued pulses at one- or two-week intervals as outpatients to maintain control. All of these have been able to reduce oral prednisone doses. Effects of the two forms of pulse appear similar. However, two children responded to the series of injections of hydrocortisone but not to single doses of methylprednisolone. Pulses have been given for periods up to three years without evident toxicity. Further work to define doses, schedules, and optimal drug is needed since this approach to steroid use appears effective and relatively nontoxic.
Echocardiographic Studies of the Human Fetus: Prenatal Diagnosis of Congenital Heart Disease and Cardiac Dysrhythmias
Authors: Kleinman Charles S. , Hobbins John C. , Jaffe C. Carl , Lynch Diana C. , Talner Norman S.
Published: December 2021

During obstetrical ultrasound examinations, 200 M-mode and 35 real-time two-dimensional echocardiographic studies were performed on 180 fetuses of high-risk pregnancies. Fetal gestational ages ranged from 18 to 41 weeks. M-mode "sweeps" demonstrating mitral- and septal-aortic fibrous continuity were obtained in 115 studies. Paradoxic septal motion in 50 fetuses suggested relative right ventricular volume loading. Congenital cardiac malformations were accurately diagnosed in a 34-week fetus with pulmonary atresia and hypoplastic right ventricle and in a 28-week fetus with a univentricular heart. Congenital complete atrioventricular block was diagnosed in a 28-week fetus and atrial flutter with variable atrioventricular block was diagnosed in a 38-week fetus. The use of echocardiographic studies to evaluate cardiac structure and rhythm in utero assists in counseling prospective parents and in planning postnatal management for their offspring.
Pediatric Urolithiases: A Ten-Year Review
Authors: Walther Peter C. , Lamm Donald , Kaplan George W.
Published: December 2021

Sixty-one children who presented with urinary calculi between 1967 and 1977 were reviewed. The overall incidence of calculus disease in our patients was higher than reported previously from other centers in this country. Because presenting symptoms varied, a high index of suspicion was often required for diagnosis. Stones of infection were the most common type identified. Inasmuch as the recurrence rate of calculi in children was low (6.5%), careful consideration of time and cost is warrented before extensive evaluation for metabolic causes of stone formation is undertaken. Immobilization was an important factor in the etiology of stone disease. Most stones less than 5 mm in size passed without surgery.
Anemia with Haemophilus influenzae Meningitis
Authors: Kaplan Karen M. , Oski Frank A.
Published: December 2021

The hematologic values in patients with Haemophilus influenzae meningitis were contrasted with those of patients with other types of bacterial meningitis and aseptic meningitis in an attempt to determine whether anemia is either specific for or more common in patients with H influenzae meningitis. Patients with H influenzae meningitis had significantly lower admission hemoglobin values because they were significantly younger than the other two groups. The H influenzae meningitis patients with the lowest hemoglobin values on admission had been sicker for longer periods prior to diagnosis and had higher initial white cell counts. Patients with H influenzae meningitis, aged 3 to 24 months, developed lower hemoglobin values during hospitalization than did patients with other forms of meningitis. Anemia occurs with all forms of bacterial meningitis but is uncommon in aseptic meningitis. The anemia observed in patients with H influenzae meningitis, particularly those less than 2 years of age, is generally more severe than that observed in other forms of bacterial meningitis.
Treatment of Salmonella Gastroenteritis with Ampicillin, Amoxicillin, or Placebo
Authors: Nelson John D. , Kusmiesz Helen , Jackson Lula Hinton , Woodman Edythe
Published: December 2021

In a randomized, prospective, double-blind study infants and children with uncomplicated Salmonella gastroenteritis were treated with ampicillin (15 patients), amoxicillin (15 patients), or placebo (14 patients). The dosage of antibiotics was 100 mg/kg/day in four equally divided doses given for five days. There was no significant benefit from antibiotic therapy on the duration of diarrhea (means 8.8, 7.3, and 7.2 days, respectively) or on the duration of recovery of Salmonella from stool cultures (means 41.3, 37.0, and 20.9 days, respectively). Bacteriologic relapse was not observed in placebo-treated patients but eight patients given ampicillin (53%) and eight given amoxicillin (53%) had relapse (P = .003). Salmonella isolated in relapse were still susceptible in vitro to the antibiotics. Of the 16 patients with bacteriologic relapse six (38%) had concomitant recurrence of diarrhea. It is concluded that ampicillin or amoxicillin therapy provides no benefit to patients with uncomplicated Salmonella gastroenteritis and substantially increases the risk of bacteriologic and symptomatic relapse.
Pulmonary Excretion of Carbon Monoxide in the Human Infant as an Index of Bilirubin Production IV. Effects of Breast-feeding and Caloric Intake in the First Postnatal Week
Authors: Stevenson David K. , Bartoletti Albert L. , Ostrander Clinton R. , Johnson John D.
Published: December 2021

Measurements of the pulmonary excretion rate of carbon monoxide (VEco) as an index of bilirubin production in the first several days of life were taken from 64 breast-fed or bottle-fed infants. Twenty-one infants (≥37 weeks of gestation) were breast-fed; 43 infants (28 to 42 weeks of gestation) were bottle-fed a commercially prepared formula. Information pertaining to their caloric intake during the 24-hour period preceding VECO determination was taken from 38 of the 43 infants who were bottle-fed and they were placed into three groups based on their caloric intake: (1) ≤60 kcal/kg/day (19 infants); (2) 61 to 100 kcal/kg/day (7 infants); and (3) > 100 kcal/kg/day (12 infants). There was no significant difference in bilirubin production between bottle-fed and breast-fed infants. No effect of caloric deprivation on bilirubin production was demonstrated. The mean VECO values were 18.5 ± 0.9 (SE) for group 1, 17.7 ± 1.8 (SE) for group 2, and 16.2 ± 1.1 (SE) µl/kg/hr for group 3.
Neonatal Hyperammonemia
Authors: Tollefsen Sherida E. , McCabe Edward R. B. , Goodman Stephen I.
Published: December 2021

Goldberg et al1 described 12 infants with hyperammonemia in association with severe perinatal asphyxia, characterized by low Apgar scores and prolonged resuscitation, in premature, term, and postmature neonates. Ballard and colleagues2 reported five preterm infants with transient hyperammonemia and respiratory distress. We wish to summarize briefly the course of an infant who exhibited transient hyperammonemia without evidence of perinatal asphyxia or primary respiratory distress.

This 2,520-gm female infant was the product of an uncomplicated pregnancy in a 21-year-old primigravida.
Comparison of the Effects of Inhaled SCH 1000 and Fenoterol on Exercise-Induced Bronchospasm in Children
Authors: Yeung R. , Nolan G. M. , Levison H.
Published: December 2021

The effect of 40 µg of SCH 1000 (ipratropium bromide, an anticholinergic agent) on bronchodilation and suppression of exercise-induced bronchospasm (EIB) was compared with 400 µg of fenoterol and a placebo in a single-blind controlled study. Twenty-seven randomly selected asthmatic children performed a standardized treadmill exercise challenge and the 17 children who were shown to have EIB continued in the study. Pulmonary function was evaluated before and after drug administration and exercise. When individual results were analyzed and grouped according to the responsiveness of EIB to the drugs, two patterns emerged: (1) the EIB was more severe in those (6/17) children who did not respond to either drug than in the rest of the children; (2) the resting pulmonary function was significantly better in the children (4/17) who responded to both drugs than in those (7/17) who responded to fenoterol alone. In conclusion SCH 1000 was shown to be an effective bronchodilator comparable to, but no better than, fenoterol. It had minimal side effects. As an EIB inhibitor it depended on relatively normal base line pulmonary function and only a moderate deterioration following exercise, whereas fenoterol depended on the exercise response alone. Although anticholinergic drugs are not very extensively used, SCH 1000 may be useful in some patients where the β2 adrenergic drugs cause significant side effects or are contraindicated.