bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pediatrician and Genetic Screening (Every Pediatrician a Geneticist)
Authors:   AAP Task Force on Genetic Screening
Published: December 2021

From time to time, the American Academy of Pediatrics has issued statements1-3 on the role of screening infants for certain types of hereditary disease. Although these statements remain valid in their broadest objective, some of the specific ways and means have altered with the passage of time. Moreover, society is now more concerned about genetic screening as a public endeavor with a potential not only for good but also for harm. There has been much debate about genetic screening-some of it informed, some of it emotional. In response to the growing concerns about genetic screening, the National Academy of Sciences (NAS) published a comprehensive report on the topic.4 Its recommendations are published as an Appendix to this statement. The American Academy of Pediatrics has convened a Task Force to consider the specific implications of the NAS report and its relevance for pediatricians and their associates. The Task Force's most important recommendation is that a standing committee be established to provide expert, ongoing advice on this pervasive and complex subject.

DEFINITIONS AND RATIONALE

Screening in the medical context can be informally defined as an investigation initiated for reasons other than in response to a patient's problem or request for help. The formal definition3-7 considers screening as "the presumptive identification of unrecognized disease or defect by the application of tests, examinations or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not." The screening may be large-scale, and encompass a whole population (mass screening); or it may be selective and directed at a high-risk subgroup.
Helpful Hint From a Sage
Authors: Lightwood Reginald
Published: December 2021

Most pediatricians question the wisdom of random use of antibiotics for upper respiratory tract infections in children. However, there are still many physicians who make routine recourse to such treatment, perhaps without awareness that most upper respiratory tract infections are viral illnesses unaffected by antibiotic treatment.

The results and conclusions by Soyka et al.1 provide good evidence. Their conclusions are that "Indiscriminate antibiotic therapy cannot substitute for proper diagnostic evaluation of the patient who may have a bacterial or, far more likely, a viral illness."
The American Board of Pediatrics: Reflections on its mission
Authors: Brownlee Robert C.
Published: December 2021

The American Board of Pediatrics has undergone monumental changes during the 25 to 30 years that I have been in pediatrics. From a small group, almost self-perpetuating, operating out of John and Nora Mitchell's den in suburban Philadelphia, this organization has become a complex force affecting child care the world over.

In the early days, examiners brought their own case materials for use at Board examinations. You may have heard the story of Professor Horton Casparis, then department chairman at Vanderbilt, who brought records of a patient whose X-ray films of the chest resembled tuberculosis. The child was not ill and nobody, including Casparis, ever made a correct diagnosis.
Unsuspected Pulmonary Vascular Abnormalities Associated With Diaphragmatic Hernia
Authors: Naeye Richard L. , Shochat Stephen J. , Whitman Victor , Maisels M. Jeffrey
Published: December 2021

The pulmonary vasculature of 12 newborn infants who died with unilateral diaphragmatic hernias was studied. Four developed severe ventilatory insufficiency after birth and promptly died. Their lungs were both hypoplastic and airless due to compression by displaced abdominal viscera and mediastinal shift. Corrective surgery permitted lung expansion and adequate ventilation for one to two hours in five infants. Subsequently, ventilatory insufficiency supervened and they died. Postoperative blood gases revealed a right-to-left ductus arteriosus shunt in one infant. Ten of the infants with hernias had a significantly greater mass of muscle in pulmonary arteries than did matched controls. This may partially explain the fetal-type circulatory pattern with right-to-left shunting which occurs in these infants.
Premature Commercialism
Authors: Rowe Jonelle C. , Belenky David A. , Flanagan William J.
Published: December 2021

We agree with Stein and Shannon1 who concluded in the May 1975 issue that continuous analog recording of respiration and heart rate in the premature infant has investigational value beyond that of conventional apnea monitoring.

It is most unfortunate that commercial interests have plunged prematurely into the area. We were surprised and disturbed by the advertising enclosure that we received with a reprint of Stein and Shannon's article, which itself was marked "Compliments of Clinical Data, Inc."
Dr. Janeway and American pediatrics
Authors: Smith Clement A.
Published: December 2021

Most readers of this journal need no commentary to tell them that Charles A. Janeway has contributed much to American Pediatrics. But they may not realize the full extent of those contributions, nor that they began nearly 40 years ago.

Pediatricians old enough to have been in training or practice in the late 1930's will surely never forget the advent of the sulfonamide drugs. Dr. Janeway, then a Research Fellow and Harvard Medical School Instructor in Bacteriology and Infectious Diseases, was a young yet well-trained authority on these amazing new tools. But even while his expert counsel on chemotherapy and the still newer antibiotics continued to be in demand at the Children's Hospital in Boston and by the medical world at large through review articles and postgraduate courses, we turned to him only a few years later for guidance on another broad advance, made possible by the separation and purification of the blood proteins.
Methotrexate and Azathioprine Treatment of Childhood Dermatomyositis
Authors: Jacobs Jerry C.
Published: December 2021

Modern treatment of childhood dermatomyositis with corticosteroids has resulted in greatly improved prognosis and style of life. The immunosuppressive drugs methotrexate and azathioprine have been utilized as ancillary agents in life-threatening disease and in children whose disease could not be adequately controlled with prednisone alone. Two patients are completely well without medication two and seven years after onset; two have received no medications for more than two years and have only subtle signs of any residual illness although they had been profoundly ill for two to three years after the onset of dermatomyositis. A fifth patient, completing the third year of disease, remains ill and continues to require medications but has improved sufficiently to return to regular class in school.
PLAYING
Authors: Mortimer Penelope , Gering Stanley A.
Published: December 2021

Children are supposed to busy themselves with a curious occupation called "playing." "Go out and play," "Run along and play," "They're playing in the garden," or even, absurdly, "They're playing in the playroom." I never knew what "playing" was supposed to be and I don't know now. A child has the same pursuits as anybody else: planning, investigating, moving from place to place with or without purpose, manufacturing objects and concoctions, thinking, reading, singing, hopping; in relation to its size, it also spends a proportionate amount of time in boredom, misery, or transports of happiness. Why all this should be skittishness, I can't imagine. A child's life is hard work, for which, financially, it receives, if anything at all, a mere pittance.
DYING
Authors: Illich I. ,   Student
Published: December 2021

Traditionally the person best protected from death was the one whom society had condemned to die. Society felt threatened that the man on Death Row might use his tie to hang himself. Authority might be challenged if he took his life before the appointed hour. Today, the man best protected against setting the stage for his own dying is the sick person in critical condition. Society, acting through the medical system, decides when and after what indignities and mutilations he shall die.
Microcephaly in a Normal School Population
Authors: Sells Clifford J.
Published: December 2021

Heights, weights, and head circumferences were obtained on 1,006 students, ages 5 to 18 years, attending regular classes in four schools in a suburban Seattle school district. From the 1,006 students initially examined, 19 (1.9%) had a head circumference two or more standard deviations below the mean for age and sex.

Intelligence quotients and academic achievement scores were obtained on these children and compared with normal controls. No significant difference was found between mean IQs of the study subjects and the controls (99.5 vs. 105), but mean academic achievement scores were significantly lower in the study subjects (49 vs. 70; P < .001). In addition, although mean IQs were not significantly different between those subjects whose head circumference was proportional and those whose head circumference was relatively small, mean academic achievement scores were significantly higher (60 vs. 39; P < .02) in those subjects whose head size was proportional.
Cricoarytenoid Arthritis and Airway Obstruction in Juvenile Rheumatoid Arthritis
Authors: Jacobs Jerry C. , Hui Robert M.
Published: December 2021

Laryngeal arthritis is a rare manifestation of JRA. The difficulty of indirect laryngoscopy in small children has precluded the type of study which has demonstrated this manifestation in up to one quarter of arthritic adults. Recognition of cricoarytenoid arthritis in the patient reported might have prevented the need for tracheostomy, and eventually led to satisfactory reduction of corticosteroid medication and healing of the tracheostomy stoma.
ON THOMAS ARNOLD, THE CELEBRATED HEADMASTER OF RUGBY SCHOOL, AND HIS VIEWS ON THE EDUCATION OF BOYS
Authors: C. T. E.
Published: December 2021

Thomas Arnold (1795-1842), Mathew Arnold's father, served as headmaster of Rtigby School from 1828 until 1841. During his stiperintendence Rugby attained a widespread reputation as a place of intellectual, moral, and religiotis discipline, where healthy characters were formed, and young men were trained for the duties, struggles, and responsibilities of life.

Lytton Strachey in his Eminent Victorians1 writes as follows about Arnold's ideas of education:

He was convinced of the necessity for reform. But it was only natural that to one of his temperament and education it should have been the moral rather than the intellectual side of the question which impressed itself upon his mind. Doubtless it was important to teach boys something more than the bleak rigidities of the ancient tongues; but how much more important to instil into them the elements of character and the principles of conduct! His great object, throughout his career at Rugby, was, as he repeatedly said, to "make the school a place of really Christian education." To introduce "a religious principle into education," was his "most earnest wish," he wrote to a friend when he first became headmaster; "but to do this would be to succeed beyond all my hopes; it would be a happiness so great, that, I think, the world would yield me nothing comparable to it." And he was constantly impressing these sentiments upon his pupils. "What I have often said before," he told them, "I repeat now: what we must look for here is, first, religious and moral principle; secondly, gentlemanly conduct; thirdly, intellectual ability."
Abnormal pulmonary vasoconstriction in the newborn
Authors: Rowe Richard D.
Published: December 2021

Since the classic perinatal lamb experiments of Dawes and associates1 led to the description of a transitional circulation of the newborn, pediatricians have responded by an increasing appreciation of this concept. Independent studies indicating both indirectly and directly the existence of this normal intermediate circulatory pattern for the human were reported shortly thereafter.2-4 These investigations were later supplemented by elegant studies5 so that a very clear understanding of the usual and normal time sequence of the change over from fetal to adult circulatory pathways in the healthy term infant has been with us for over a decade. The essential part of this change is one of a reduction in tone of the pulmonary vascular bed during the first six hours after birth followed by an increase in tone of the ductus arteriosus.
Morbidity of Childhood Near-Drowning
Authors: Peterson Bradley
Published: December 2021

An assessment of morbidity in near-drowning was made from a review of emergency room and hospital records of 72 patients, ages 9 months to 20 years, who suffered near-drowning during the period January 1972 through June 1974. Fifteen patients (21%) evidenced severe anoxic encephalopathy; the remainder had no detectable neurologic deficits. Hypoxemia was demonstrated in 56 patients. Severe acidosis was not present unless respiratory failure occurred. Neither electrolytes, red blood cell hemolysis, nor cardiac arrhythmias presented a problem. Respiratory complications included pulmonary edema, aspiration pneumonia, atelectasis, shock lung, pneumothorax, and pneumomediastinum.

All children requiring cardiopulmonary resuscitation in the emergency room suffered anoxic encephalopathy. The occurrence of seizures, fixed and dilated pupils, flaccid extremities, and lack of response to deep pain in the emergency room had almost universal correlation with resultant severe anoxic encephalopathy, as did a submersion period of six or more minutes.

The morbidity of near-drowning is significant with regard to the number of children affected and the severity of the central nervous system insult received. The statement by the American Heart Association that resuscitative efforts in children should be continued for periods longer than ten minutes needs reevaluation, since neurologic recovery did not occur in any child requiring cardiopulmonary resuscitation (CPR) in the emergency room. More importantly, new methods of cerebral resuscitation need to be developed and established. In short, medical personnel need to think in terms of cardiopulmonary cerebral resuscitation (CPCR) rather than in terms of CPR.
Remarks on Receiving the C. Anderson Aldrich Award
Authors: Provence Sally
Published: December 2021

I should like to take the first few moments to express my thanks to the members of the Child Development Section of the American Academy of Pediatrics for this honor. I can think of no recognition of my interest and work in the field that would mean as much to me as this one. Though I can no longer claim to be an up-to-date pediatrician in the treatment of physical illness, in my own mind I remain a pediatrician.

I am firmly convinced of the importance of what I call clinical child development to the practice of pediatrics. I will give an illustration of its relevance. This is a clinical observation I began to make years ago about which I have not heretofore reported, except in discussions with trainees and staff. Because of the ease of observing this phenomenon and its diagnostic implications I should like to share it with you at this time. One might call it "The Toddler's Kiss" or alternatively, phrased as a question, "Can He Pucker?"

By somewhere around 18 months the healthy, well-cared for toddler is well established in the process of giving and receiving affection. Months earlier he has learned to give a hug upon request and by 18 months most toddlers are able to purse their lips and plant a kiss on the adult's cheek. It is easy, when you have child and parents together, to determine the presence or absence of this ability. It gives you certain kinds of information about the child's development and its absence at age 2 years should lead you to ask yourself certain questions.
Remarks on Receiving the C. Anderson Aldrich Award
Authors: Parmelee Arthur H.
Published: December 2021

I have described several coincidental changes in behavior, neuroanatomy, and neurophysiology. All reflect in some way the rapid development of cybernetic systems that permit greater control over external stimulation by suppression of extremes of reaction. The result is more organization and focus of behavior. In Figure 9, left, there is the baby the pregnant mother and expectant father dream they are going to have when their baby is born; at right is the baby they will actually get and will have to put up with until they get past the 6-week nodal point when many aspects of behavior begin to improve. Not until 3 or 4 months will they have the baby they expected at birth (Fig. 9, left).

With our knowledge of the maturational transformation of normal babies in the first 4 months, we can guarantee parents that if they can survive this period the outcome will be good. They will not fail as parents nor will the baby fail to fulfill their expectations.
Ineffectuality of Hexachlorophene Bathing Reexamined
Authors: Haley Robert W.
Published: December 2021

In the article entitled, "Recurrence of Skin Disease in a Nursery: Ineffectuality of Hexachlorophene Bathing," Ghelbach et al.1 interpreted their data as showing that hexachlorophene (HCP) bathing was ineffective in controlling an epidemic of skin disease in their newborn nursery. Upon reexamination, however, it appears that the data contained in the article more strongly support the opposite conclusion.

The authors' paradoxical interpretation seems to have resulted from a confusion between the concepts of epidemic skin disease and asymptomatic colonization with staphylococci or group A streptococci.
In Reply: Ineffectuality of Hexachlorophene Bathing Reexamined
Authors: Gutman Laura
Published: December 2021

Dr. Haley correctly identifies two separate but related issues which are explored in our article. First, how does hexachlorophene (HCP) bathing affect the rate of colonization with Staphylococcus aureus? Second, how does HCP bathing affect the occurrence of disease caused by S. aureus? Evidence that the risk of disease increases when rates of colonization increase has been available for many years. See, for example, the article by Hardyment et al., which was written in an era when staphylococcal disease among newborns was widespread.1
REVIEW OF UROLOGY IN CHILDHOOD. Edited by Innes Williams. New York, Springer-Verlag. 1974, $57.00; 458 pp
Authors: Smith Arthur M. , Lattimer John K.
Published: December 2021

A competent, modern textbook on pediatric urology must encompass more than just a description of morphological anomalies and techniques for surgical repair. To reflect the true state of the art, it must contain a sophisticated integration of information from many disciplines. The present-day pediatric urologist thinks in terms of genetic, metabolic, endocrinologic, neurologic, psychologic, oncologic, and nephrologic disease factors. A new text devoted to pediatric urology muust therefore incorporate a huge volume of information in order to justify its relevance.
Efficient Office Practice
Authors: Katcher Avrum L.
Published: December 2021

Application of management principles to the problems of solo and group pediatric practice can bring rewards to the interested pediatrician. These principles are accessible and comprehensible to the pediatrician. Combining management theory and practice with considerate dealings with parents on terms of mutual respect may increase effectiveness and efficiency.

See table in the PDF file
Prevention of Recurrent Urinary Tract Infections in Girls
Authors: Lohr Jacob A. , Nunley Donna H. , Howards Stuart S. , Ford Raymond F.
Published: December 2021

Eighteen girls between the ages of 3 and 13 years—with a history of at least three culture-documented episodes of bacteriuria in the previous year, but without radiologic evidence of major urinary tract abnormality—were placed on a double-blind, crossover study comparing the effectiveness of nitrofurantoin macrocrystals against a placebo in preventing the recurrence of bacteriuria. Each child was placed on a daily low dose of nitrofurantoin (1.2 to 2.4 mg/kg/day) or an identical-appearing placebo for six months. Each child was then placed on the opposite capsule for a similar period.

There were 35 episodes of bacteriuria (4.2 episodes/patient/yr) in the patients taking the placebo, which compared with a rate of 3.8 episodes/patient/yr during the year prior to the study. Only two episodes (0.2 episodes/patient/yr) occurred in the patients taking the drug. The difference in the rate of recurrent bacteriuria between the girls on placebo and on medication is significant at the 0.01 level using the Wilcoxin matched-pairs test. There were no adverse reactions to the drug.

Nitrofurantoin macrocrystals in a single daily low dose appear to be a safe, effective method of preventing recurrent bacteriuria in girls at high risk.
Postnatal Head Shrinkage in Small Infants
Authors: Williams John , Hirsch Norma J. , Corbet Anthony J. S. , Rudolph Arnold J.
Published: December 2021

The fronto-occipital circumference, fronto-occipital and biparietal diameters, degree of suture overriding, and weight were measured daily during the first week of life in 50 infants of birth weight under 2,000 gm. In a second similar group of 21 infants, fronto-occipital circumference, weight, and sodium balance were measured daily during the first week of life. Head volumes were estimated from the circumference and diameters of the head.

The parameters of head size and derived volumes changed maximally and significantly in the direction of intracranial shrinkage around 3 days of age. The degree of shrinkage was significantly correlated (P < .005) with the degree of weight and cumulative sodium losses, and decreasing gestational age.

We postulate that postnatal head shrinkage results from shift of sodium and water outward from the intracranial cavity as a transient phenomenon during the first week of life. The significance of head shrinkage is discussed.
Familial Aggregation of Blood Pressures Among Aleut Children
Authors: Torrey E. Fuller , Torrey Martha S.
Published: December 2021

It has recently been shown in Boston and in Montreal that there is a definite correlation between the blood pressure of parents and that of their natural children.1,2 In an effort to extend these findings to another population group, a study was undertaken on St. Paul Island, Alaska (population 450), an isolated island in the Bering Sea and the largest remaining Aleut village. Genetically it is thought that the Aleuts migrated from Asia with the Eskimos, but then split off and became a separate group. From 1747 to 1867 the Aleutian Chain was colonized by the Russians, and present-day Aleuts contain a liberal sprinkling of Russian genes.
Try Another View
Authors: Cunningham Nicholas
Published: December 2021

The "Overview Statement on Medical Records," which appeared in the August 1975 issue, overlooks the needs of patients and parents. The Committee on Standards of Child Health Care has noted that patients may have multiple sources of care and that the population is more mobile. It seems not to have observed that people want to know and learn more about their state of health and care. The doctor, clinic, or any one institution that owns the medical record is unlikely ever to be "the one institution which gives a complete and continuous documentation of the patient's medical history."
More on T & A
Authors: Paradise Jack L.
Published: December 2021

The treatment of three important issues relating to tonsillectomy and adenoidectomy (T & A)—(1) the essential nature of the T & A research question, (2) certain ethical requirements of clinical trials of T & A, and (3) the advisability of T & A in the light of current knowledge—in the review by Shaikh et al.1 calls for comment.

Nature of the Research Question. For health professionals concerned with the T & A problem, clarity about the scientific status of T & A is important.
Growth, Course, and Prognosis After Surgery for Crohn's Disease in Children and Adolescents
Authors: Homer Daryl R. , Grand Richard J. , Colodny Arnold H.
Published: December 2021

Surgery is often performed because of growth failure when Crohn's disease occurs in children and adolescents, but the long-term responses of such therapy are not known. Thirty-seven children and adolescents were followed from 2 to 26 years after resections for Crohn's disease. Twenty-eight patients had disease that involved both the colon and terminal ileum; disease was limited to the small intestine in eight patients and to the stomach in one. At the time of surgery 16 patients were at or below the third percentile for weight and only 16 had reached puberty (all of these were older than 14.5 years). Fourteen patients (11 prepubertal, 3 pubertal) had severe impairment of linear growth; height was at or below the third percentile or linear growth was absent for more than a year. At the time of the first operation, seven patients had incomplete resections and have had persistent disease. The remaining 30 patients had complete resections as determined by gross and histological criteria. Of these, 12 have had recurrences and 18 have been free of disease. Of the 11 prepubertal patients with preoperative linear growth failure, only two had catch-up growth after surgery. The remaining nine and all of the pubertal patients have either failed to grow or have maintained their height in their preoperative percentile. Catch-up growth after surgery for Crohn's disease occurs only in those children who are operated on before puberty and in whom there is no early recurrence. The recurrence rate for this group of patients was 30%; most recurrences occurred within two years of the initial resection. Growth failure, therefore, may be considered an important indication for surgery in the prepubertal child with Crohn's disease, but it probably is not an indication after onset of puberty.
Hyperthermia From Malfunctioning Radiant Heaters
Authors:   Committe on Environmental Hazards,   Committee on Fetus and Newborn,   Committee on Accident and Poison Prevention
Published: December 2021

The use of infant radiant warmers poses a hazard of neonatal hyperthermia. Serious overheating can result from mechanical failure of the controls, from dislodgment of the sensor probe, or from manual operation without careful monitoring. Deaths have been associated with hyperthermia induced by radiant warmers (reports will be published).

Therefore, when a warmer is purchased, adequacy of the safety mechanisms to prevent overheating should be given prime consideration. Radiant warmers should be used with caution and awareness of this lethal potential.
TRUE SCIENCE
Authors: Nossal G. J. V.
Published: December 2021

. . . Medicine . . . is a great science, for all its failings. I reject completely the conventional view which says that mathematics and physics are the true, basic sciences; that other sciences enjoy merit and intellectual vigour only to the extent that they rest on mathematics and physics. It is true that one can work "down" from medicine through pathology to genetics and cell biology, to biochemistry, to chemistry, and thence to physics and mathematics. Equally one can work "up" from biology and medicine to demography, sociology, economics, and political science. But these hierarchies represent descriptive conveniences and conventions, classifications of components in terms of size. They cannot be listings of value or of intellectual achievement. Biologists and doctors have nothing to be ashamed of in front of their colleagues in the physical sciences.
POINT OF VIEW
Authors: Postman N.
Published: December 2021

I cannot vouch for the story, but I have been told that once upon a time, in a village in what is now Lithuania, there arose a most unusual problem. A curious disease afflicted many of the townspeople. It was mostly fatal (although not always), and its onset was signaled by the victim's lapsing into a death-like coma. Medical science not being quite so advanced as it is now, there was no definite way of knowing if the victim was actually dead when it appeared seemly to bury him. As a result, the townspeople feared that several of their relatives had already been buried alive and that a similar fate might await them-a terrifying prospect, and not only in Lithuania. How to overcome this uncertainty was their dilemma.

One group of people suggested that the coffins be well stocked with water and food and that a small air vent be drilled into them just in case one of the "dead" happened to be alive. This was expensive to do, but seemed more than worth the trouble. A second group, however, came up with an inexpensive and more efficient idea. Each coffin would have a twelve-inch stake affixed to the inside of the coffin lid, exactly at the level of the heart. Then, when the coffin was closed, all uncertainty would cease.

There is no record as to which solution was chosen, but for my purposes, whichever it was is irrelevant. What is mostly important here is that the two different solutions were generated by two different questions.
Serum Concentration and Serum Half-Life of Digoxin in Premature and Mature Newborns
Authors: Lang Dieter , von Bernuth Götz
Published: December 2021

Serum concentrations and half-life times of digoxin were determined in ten mature and nine premature newborns. Median serum digoxin concentration was 2.3 ng/ml (1.2 to 3.5 ng/ml) in mature newborns and 2.4 ng/ml (1.5 to 4.5 ng/ml) in premature newborns. Median serum digoxin half-life was 35 hours (17 to 52 hours) in mature newborns and 57 hours (38 to 88 hours) in premature newborns. The difference in serum digoxin half-life between the two groups is statistically significant. The relatively long serum digoxin half-life in premature newborns is probably due to immature renal function in this group. The data emphasize the need for cautious digoxin administration, especially in premature infants.
Bullous Pemphigoid in Infancy: A Case Report
Authors: Gould William M. , Zlotnick David A.
Published: December 2021

Bullous pemphigoid occurs rarely in children. Bean and Jordan1 found only eight cases reported as of 1974 and the youngest of these patients was 2 years of age. Presented here is the case of a 3½-month-old infant who developed this disease.

CASE REPORT

A 3½-month-old boy developed a progressively spreading bullous eruption (Fig. 1 and 2). Within a week the hands and feet were covered with large, tense bullae lying on a base of erythema, and scattered vesicles appeared on the back of the neck, the trunk, and the rims of the ears. There were no oral lesions. The child was fussy and irritable but had no fever.
A Simple Noninvasive Technique of Measuring Intracranial Pressure in the Newborn
Authors: Vidyasagar D. , Raju T. N. K.
Published: December 2021

A noninvasive approach to measuring intracranial pressure in newborns based on optical principles and devoid of electrical hazards is described. This monitoring technique can be used to detail subtle changes in measurements in ill newborns and to predict hydrocephalus. The mean anterior fontanel pressure in normal infants was 10.14 ± 0.39 cm H2O. Increased pressure was noted in sick neonates and in infants with hydrocephalus. Good correlation was noted between anterior fontanel pressure and CSF pressure.
Vitamin E and Neonatal Hemolysis
Authors: Gross Steven J. , Landaw Stephen A. , Oski Frank A.
Published: December 2021

A study was designed to determine if the presence of vitamin E deficiency during the first week of life played a contributory role in the shortened red cell life span observed in the premature infant. Carboxyhemoglobin values were used as an index of hemolysis. Ten infants received vitamin E administered intramuscularly in a total dose of 125 mg/kg during days 3 to 7 of life; ten infants served as controls. The mean percent carboxyhemoglobin level fell significantly from day 3 to day 8 in the treated group (1.08% to 0.78%) whereas the mean value remained unchanged at 0.96% in the control group. The administration of vitamin E appears to reduce but not eliminate the accelerated red cell destruction that characterizes the preterm infant.
Persistence of Antibody Following Immunization of Children With Groups A and C Meningococcal Polysaccharide Vaccines
Authors: Lepow Martha L. , Goldschneider Irving , Gold Ronald , Randolph Martin , Gotschlich Emil C.
Published: December 2021

Persistence of antibody following immunization with groups A and C meningococcal polysaccharides was studied in two groups of children. Cohort 1 (20 children, 2 to 11 years of age) received two doses of A vaccine three years apart; cohort 2 (1,345 children, 6 to 8 years of age) received A or C vaccine initially and the heterologous vaccine one year later. No significant reactions were observed. Geometric mean anti-A concentrations one month after primary and booster immunizations in cohort 1 were 8.77 and 13.08 µg/ml, respectively. Mean anti-A concentration declined 32% one year after booster immunization, but then stabilized. Mean anti-A and anti-C concentrations in cohort 2 were 9.35 and 9.12 µg/ml, respectively, one month after primary immunization. Mean anti-A concentration declined to 5.54 and 3.62 µg/ml while anti-C levels fell to 2.35 and 1.47 µg/ml one and four years after immunization. The proportion of children in cohort 2 with ≥ 2.0 µg/ml of anti-A and anti-C four years after immunization were 80% and 40%, respectively. An antibody concentration ≥2.0 µg/ml has been associated with protection against meningococcal disease. The results suggest that routine immunization of young infants with group A vaccine may result in long-lasting immunity. The usefulness of the presently available group C vaccine appears to be limited to the control of epidemics.
Electrocardiograph Monitor Artifacts in a Neonatal Intensive Care Unit
Authors: Stanger Paul , Lister George , Silverman Norman H. , Hoffman Julien I. E.
Published: December 2021

A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care unit. Many of the artifacts resemble arrhythmias, and unless they are recognized as artifacts they may lead to serious errors of diagnosis and therapy. Many of the artifacts are caused by patient movement such as seizures, tremulousness, or hiccups. Others may be introduced by the monitor itself or be caused by electrical equipment in the vicinity. A group of ECC tracings is presented to illustrate the various artifacts encountered. Features that distinguish the artifacts from the arrhythmias they mimic are described, as are suggestions for elimination of the artifacts.
Reye's Syndrome: Clinical Progression and Evaluation of Therapy
Authors: Corey Lawrence , Rubin Robert J. , Hattwick Michael A. W.
Published: December 2021

The hospital course and therapy of 369 patients with Reye's syndrome were evaluated. Eighty-three percent of patients had deepening coma during hospitalization. Stage of coma on admission, evidence of increased intracranial pressure, and blood ammonia levels greater than 300 µg/100 ml were all significantly associated with increasing mortality. Among survivors of Reye's syndrome, 30% of those who developed either decerebrate posturing or seizures during hospita1ization had serious neurologic sequelae upon discharge. When analyzed by (1) stage of coma during admission, (2) progression of coma during hospitalization, (3) degree of blood ammonia level elevation, and (4) presence of increased intracranial pressuring, no significant differences were noted between patients receiving intensive supportive care and those receiving exchange transfusions and/or peritoneal dialysis.
Oxygen and retrolental fibroplasia: The questions persist
Authors: Les Chermignonards Désenchantés
Published: December 2021

The Cooperative Study of Retrolental Fibroplasia (RLF) conducted in 1953 and 19541 was notable for successfully utilizing a newly developed tool, the randomized clinical trial, in finding an answer to an urgent clinical question. It is timely to recall the details of the question that was addressed by that pioneering effort: "Will curtailment2 of supplemental oxygen reduce the risk of RLF without an unreasonable increase in mortality in infants weighing 1.5 kg or less at birth and who survive longer than 48 hours?" Although the results supported an affirmative reply to the specific question posed, a number of additional questions of considerable practical importance emerged from analyses of the large body of data collected in the study.
Caution about statistics of retrolental fibroplasia study
Authors: Tooley William H. , Hoffman Julien I. E.
Published: December 2021

"PaO2 Levels and Retrolental Fibroplasia: A Report of the Cooperative Study" (p. 655) presents a great deal of data on a very important subject. There is considerable evidence that hyperoxemia and retrolental fibroplasia (RLF) are related, and the story of how this association was identified along with the history of the use of oxygen in sick newborn infants have recently been reviewed.1 The study reported here was designed to answer two questions. What level of PaO2 and what length of exposure to high PaO2 would cause RLF? It was hoped that a "safe" level of PaO2 in immature infants could be established.
Case Reports Are Valuable
Authors: Shaw Edward B.
Published: December 2021

The excellent case report "Mucocutaneous Lymph Node Syndrome (MLNS) in the Continental United States" by Goldsmith et al. (Pediatrics 57:431, March 1976) is an example of the importance of the report of a single case. This should alert others to this syndrome in their own practices.

I am reminded of a note by Roger Lee1 in 1952: "Are three cases enough to make a series? Parenthetically I have a fondness for the carefully reported single case, which in the days before mass production was a feature of a medical journal .... a series of three cases leads to statistical atrocities and aberrations and deductions."
Effects of Cigarette Smoking on the Fetus and Child
Authors: Burch P. R. J.
Published: December 2021

I was deeply disturbed to read the following passage in the report of the Committee on Environmental Hazards (Pediatrics 57:411, March 1976): "Yerushalmy protested that the effect [decrease in birth weight of infants] was due not to smoking but to constitutional differences in smokers as compared with nonsmokers." This statement implies that the late Professor Yerushalmy had no doubts on this issue. Although I never had the privilege of meeting him, the Committee, in my view, seriously misrepresents his opinions.
Drug Toxicity From Breast Milk?
Authors: Mortimer Edward A.
Published: December 2021

Recently I was consulted about a 3-month-old girl with a curious but distinct story of irritability, excessive crying, and disturbed sleeping patterns of five days' duration. These phenomena represented a striking change from her normal behavior. There were no other symptoms, and she was feeding normally at breast. Examination by her pediatrician on the second or third day of the episode yielded no abnormal findings.

On close questioning it turned out that a day or so before onset of these symptoms in the infant a long-acting oral decongestant had been prescribed twice daily for the mother because of allergic rhinitis.
Role of the Nurse in Peripheral Vein Needle Replacement
Authors: Babson S. Gorham , Benda Gerda I. , Shenai Jayant P.
Published: December 2021

We agree with Taeusch and Heafitz in their letter to the editor (Pediatrics 57:977, June 1976) that total or near total parenteral nutrition can be given through needles placed in peripheral veins for weeks and even months. Whether one uses the "Usher" needles or the "butterfly" model, the success in maintaining infusions depends on the ability and availability of the operator.

In the NICC at the University of Oregon Health Sciences Center, neonatal nurses have had the responsibility of maintaining peripheral intravenous infusions in both medical and surgical infants for nearly ten years, involving several thousand neonates referred for critical care.
Regional Obstetric Anesthesia and Newborn Behavior
Authors: Fanaroff Avroy A. , Kennell John H. , McClelland Charles Q. , Mortimer Edward A.
Published: December 2021

We have read the study of regional obstetric anesthesia and newborn behavior by Tronick et al. (Pediatrics 58:94, July 1976) with interest. However, we are concerned that a methodologic defect exists in the study that invalidates the conclusion that the effects of these drugs on the behavior of the infants were minimal.

The investigators excluded infants born following complicated pregnancies of various types. The problem is that they also excluded infants whose behavior after birth included Apgar scores less than 7 at one and five minutes or severe illness during the study (including seizures).
Fiberoptic Endoscopy Endorsed
Authors: Liebman William M.
Published: December 2021

I would like to report two cases of the endoscopic removal of foreign bodies from the esophagus and stomach in addition to those reported in the article by Christie and Ament (Pediatrics 57:931, June 1976).

Both patients were girls, 2 years old. Patient 1 had ingested a quarter which remained in a fixed position on the greater curvature of the stomach for almost four weeks. Fiberoptic endoscopy under general anesthesia with the standard adult instrument (Olympus GIF-D1) demonstrated the quarter.
α1-Antitrypsin and Membranoproliferative Glomerulonephritis
Authors: Roy L. P. , Webster H. L.
Published: December 2021

Although associations of apparently disparate diseases are worthy of reporting, the possibility of chance associations warrants examination. The report of Moroz et al. (Pediatrics 57:232, February 1976) of an association between α1-antitrypsin (α1AT) deficiency and membranoproliferative glomerulonephritis (MPGN) is such a situation.

Levels of α1AT were measured by radial immunodiffusion in eight patients with MPGN. Seven patients, including two with partial lipodystrophy, are persistently hypocomplementemic. Five have "dense deposit disease," two have subendothelial deposits with mesangial interposition, and one has not had electron microscopy study.
Why Don't American Authors Read the European Literature?
Authors: Fontaine Pr. G.
Published: December 2021

I read with interest the article by Paxson and Brown, "Post-Traumatic Anterior Hypopituitarism" (Pediatrics 57:893, June 1976). I find, as is usual in American articles, a mistake concerning a missed reference.1 I am afraid that American authors are affected by severe blindness for European bibliography!

I'd suggest the authors read Fontaine et al.1
Craniosynostosis Associated With Limb Reduction Malformations and Cleft Lip/Palate: A Distinct Syndrome
Authors: Ladda Roger L. , Stoltzfus Elam , Gordon Stanley L. , Graham William P.
Published: December 2021

Craniosynostosis associated with short stature, radial and fibular aplasia, and cleft lip and/or palate represents a distinct syndrome. One original case and one previously undiagnosed case from the literature were found to have many distinct features in common, permitting them to be separated from craniosynostosis with radial or fibular aplasia, Robert's syndrome, pseudothalidomide or SC syndrome, and the hypomelia-hypotrichosis-facial hemangioma syndrome. Each had multiple craniofacial abnormalities: dysplastic ears, hypertelorism, strabismus, and malocclusion. Ulnae and humeri were hypoplastic; tibiae were bowed and hypoplastic. Testes were small. Associated mild to moderate mental retardation may be related to early institutionalization.
A tale of two doctors
Authors: Fisher Julian H.
Published: December 2021

The recent shift of funding emphasis on the part of the World Health Organization, turning from research orientation to provision of practical delivery systems, highlights the divergence of goals which must be established for the medical "haves" and "have-nots"—the developed and the developing world countries.

The same orientation applies as well to schema for medical education in these two worlds, and the implications were impressed upon me last year in what I would somewhat facetiously label a tale of two doctors, reviewing experiences I had with two American-trained native physicians in a Latin country.

Having reflected at length on a year away from familiar North American medicine, weighing the new experiences in the light of the old, I find that these two professional pathways illustrate the developed world's gifts of foreign medical aid (educational assistance) and the developing world's utilization of those grants.
Nonvenereal Transmission of Gonococcal Vaginitis
Authors: Ris Hania W.
Published: December 2021

I read with great interest the timely article by Drs. Auman and Waldenberg, "Gonococcal Periappendicitis and Salpingitis in a Prepubertal Girl" (Pediatrics 58:287, August 1976), which deals with the important problem of Neisseria gonorrhoeae as an etiological factor of vaginitis and its complications in a 5-year-old girl. Vaginal discharge and penile discharge in young children, irrespective of age, should be cultured in appropriate media for N. gonorrhoeae in addition to those for other organisms.

According to Kotcher et al.,1 the gonococcus was the only significant bacterial etiological agent in 57 cases of vulvovaginitis in prepubertal girls.
Questions on Serum Levels of Theophylline
Authors: Tinkelman David G.
Published: December 2021

In commenting on the article by Ellis et al.1 on the pharmacokinetics of theophylline, Dr. Bierman advocated that in patients receiving theophylline, "serial measurement of theophylline concentrations must be obtained during one dosing interval to determine the child's theophylline dosage and the proper interval between doses" (Pediatrics 58:623, October 1976). While an important commentary, it contains certain oversimplifications which give the clinician a false sense of security in the treatment of his asthmatic patients.

Dr. Bierman initially states that with theophylline there is a "narrow therapeutic range of 10 and 20 µg/ml," and thus implies we should keep all of our patients who are receiving theophylline within this range.
In Reply: Questions on Serum Levels of Theophylline
Authors: Bierman C. Warren
Published: December 2021

I thank Dr. Tinkelman for his thoughtful letter, which brings out special points concerning the proper use of theophylline and the treatment of asthma in children. The treatment of asthma must indeed be individualized to fit the needs of the individual child. The child whose asthma is induced only by strenuous exercise or by colds, who is otherwise asymptomatic between attacks, does not need constant theophylline or other bronchodilator therapy. In such a child, the administration of theophylline 1½ to 2 hours prior to exercise in sufficient dosage to produce a therapeutic serum theophylline concentration at the time of exercise is sufficient to enable many children to participate actively in sports.
Liver Abscess in Normal Children With Fever of Unknown Origin
Authors: Balfour Henry H.
Published: December 2021

The article by Kaplan and Feigin (Pediatrics 58:614, October 1976) is a useful reminder that pyogenic liver abscesses do occur in children with normal immune function, and should be included in the differential diagnosis of fever of unknown origin. In both of their patients there was no history of abdominal trauma, blood cultures were sterile, the clinical diagnosis was confirmed by liver scan, and Staphylococcus aureus organisms were isolated from the abscess drainage at surgery.
Comparative Study: Ampicillin and Cephalexin in Otitis Media
Authors: Mclinn Samuel E.
Published: December 2021

The conclusion of Stechenberg et al. in their article "Cephalexin Compared to Ampicillin Treatment of Otitis Media" (Pediatrics 58:532, October 1976), that cephalexin is not warranted in the treatment of otitis, is questionable for several reasons.

The dose of 50 mg/kg/day of cephalexin has been unsuccessful in our experience and in that of others. That is why the recommended dose for treatment of Haemophilus influenzae is 100 mg/kg/day. The mean cephalexin level in the treatment of middle ear effusion is about 5 mg/ml.