bluuebunny/crossref_metadata_2025 huggingface dataset:
DISCUSSION FOLLOWING PRESENTATION OF PAPER BY DR. GEZON IN WHICH EVIDENCE WAS PRESENTED INDICATING THAT HEXACHLOROPHENE IS EFFECTIVE
Authors: Gellis Sydney S.
Published: December 2021

Dr. Oliver: Quoted from the studies conducted at Ohio State in 1954-55 in which hexachlorophene bath gave a striking reduction in colonization with staph in the umbilicus and nares. No special attention was given to cleansing of the umbilical cord. In Pittsburgh, he noted high colonization rates which fell from 40% to almost zero, when hexachlorophene bathing was employed, supporting Dr. Gezon's findings.

Moderator: In Dr. Gezon's paper he stated that after studying hexachlorophene he felt he should look for some other agent to suppress colonization of staph. Was this because he had worries about hexachlorophene?

Dr. Gezon: Replied that he assumed that hexachlorophene resistance might occur. Perhaps it can, he stated, but there is no evidence of such resistance.

Dr. Gluck: Discussed his experience at Stanford with 5,500 newborn infants. He found that with hexachlorophene bathing one of every 70 babies was colonized with staph. He paid great attention to the washing of the cord, feeling that this is the most important reservoir for staph. When he moved to Yale, newborn infants received water baths only. Skin pustules were always endemic but there was no fulminating staph epidemic. The colonization rate, which was 30% before hexachlorophene bathing was instituted, dropped to 3%. When hexachlorophene was discontinued, the rate rose again to 30%. He feels strongly that hexachlorophene is very effective in reducing colonization by staph. He pointed to his New Haven study as an indicator of the benefits gained by having a newborn go home without colonization by staph.
WHAT IS THE EVIDENCE THAT HEXACHLOROPHENE IS NOT EFFECTIVE?
Authors: Light Irwin J. , Sutherland James M.
Published: December 2021

Routine daily bathing of newborn infants with hexachlorophene, if meticulously performed, can alter the frequency of colonization and endemic disease caused by Staphylococcus aureus. However, the recent decrease in the occurrence of epidemics of severe disease caused by Staphylococcus aureus 80/81 in newborn infants is related to a decrease in colonization of infants with this epidemic strain unrelated to the use of hexachlorophene bathing. In fact, in the presence of epidemic strains of staphylococci, hexachlorophene bathing has repeatedly been unsuccessful in either preventing or controlling disease. In addition, antistaphylococcal topical agents including hexachlorophene have a profound effect on the total bacterial flora permitting an increase in colonization with gram-negative bacilli. Routine daily hexachlorophene bathing of newborn infants results in an increase in both colonization and disease caused by gram-negative organisms. In view of the effects of hexachlorophene on the total well-being of the newborn infant, routine daily bathing with hexachlorophene should be used with caution.
HEXACHLOROPHENE AND THE CONTROL OF STAPHYLOCOCCAL SEPSIS IN A MATERNITY UNIT IN GEELONG, AUSTRALIA
Authors: Plueckhahn V. D.
Published: December 2021

This paper reports the occurrence and control of staphylococcal sepsis in 35,684 infants born in a maternity unit in Geelong, Australia, during the years 1956 to 1972. Antiseptic skin care of newborn infants with 3% hexachlorophene emulsions (pHisoHex) commenced in 1960 and since then 25,038 infants have been drywashed with 3% hexachlorophene emulsions on alternate days while in hospital with no toxic reactions.

A retrospective review of the macroscopic and microscopic findings in 233 neonatal and post neonatal deaths occurring in these 25,038 infants did not reveal any evidence of central nervous system damage as described due to hexachiorophene in animals.

A "double-blind" study of 10,001 infants showed that hexachiorophene was the effective agent responsible for the marked reduction in infant and maternal staphylococcal sepsis which occurred in this maternity unit following the introduction of drywashing in 1960. No increase in clinical infection due to gram-negative bacilli is reported since the commencement of drywashing newborn infants with 3% hexachlorophene emulsions.

Infant plasma hexachlorophene concentrations on the day prior to discharge home from hospital varied from 0.020 µg/ml to a maximum of 0.l50 µg/ml.

The Australian Drug Evaluation Committee accepted a strong recommendation from the author in March, 1971, that antiseptic skin care of newborn infants with 3% hexachlorophene emulsions should continue in maternity hospitals in Australia.
HEXACHLOROPHENE DECISIONS AT THE FDA
Authors: Lockhart Jean D. , Simmons Henry E.
Published: December 2021

Hexachlorophene has a 20-year history of widespread use as a topical bacteriostatic agent, primarily against Staphylococcus aureus strains. Its property of substantivity made it uniquely desirable for this purpose, in effect a sustained release topical dosage form. Use of hexachlorophene-containing products in the nursery developed in the absence of specific safety and efficacy protocols, the phase 1, 2, and 3 studies now so familiar in drug development. Whether the Food and Drug Administration would have requested data on neurotoxicity or percutaneous absorption, had such protocols for studies on the use of 3% emulsions been submitted to the FDA, is now a moot question. The practice became well established in hospitals. Studies on newborn infants, which were possible in the 1950's and 1960's, have become progressively more complicated because of problems of patient consent.

In pointing out that the presently required safety and efficacy studies on the use of 3% hexachlorophene for bathing of newborn infants were never done, it should be added that, by the same token, no data were obtained on the relative merits of various concentrations of hexachlorophene products for this purpose. In reviewing the many clinical studies published in the past 15 years on the use of hexachlorophene-containing products in newborn nurseries, it is apparent that they were used in varying dilutions and according to varying techniques. This was less important at the time, when absorption was not known to be a consideration, than it is now.

Beginning in early 1971, several hexachlorophene absorption studies were made available to the FDA, some from industry and some in-house.
THE UNIQUE FETAL RED CELL AND ITS FUNCTION
Authors: Oski Frank A.
Published: December 2021

The red blood cells of the human fetus differ in many major respects from the red cells of the normal adult. These differences appear admirably suited for the acquisition, transport, and release of oxygen in the low oxygen atmosphere of intrauterine existence. These same differences appear to confer a handicap to the cell in the extrauterine environment, particularly under conditions of hypoxic stress. The rapid replacement of these cells by artificial means, such as early exchange transfusion, may offer an advantage to the newborn infant in certain clinical situations.
PSYCHOTROPIC MEDICATION WITH CHILDREN: AN EVALUATION OF PROCEDURAL BIASES IN RESULTS OF REPORTED STUDIES
Authors: Sulzbacher Stephen I.
Published: December 2021

A review was conducted of 753 studies on the effects of drugs on learning or behavior in children published between January 1937 and March 1971. The studies were arranged in categories based on research design, measures of behavior change, and whether clinical results were reported as significant. The analysis of these studies suggests that research design and the measure of behavior change exert a biasing influence on the degree of reported efficacy of the psychotropic medications. These factors should be taken into account when interpretations of published reports are used to decide upon treatment plans with such medications.
MONOCLONAL MACROGLOBULINEMIA AND CYTOMEGALIC INCLUSION DISEASE
Authors: Weinberg Arthur G. , McCracken George H. , LoSpalluto Joseph , Luby James P.
Published: December 2021

An 8-month-old infant with cytomegalovirus infection and monoclonal macroglobulinemia is described. The abnormal IgM reached levels of 2,700 to 3,200 mg/100 ml in serum, had no demonstrable antibody activity and contained kappa light chains only. Cytomegalovirus was recovered from throat and urine throughout life and the infant had histopathologic evidence of disseminated cytomegalovirus and pulmonary Pneumocystis carinii infections at postmortem examination. The presence of an underlying defect of the immune system could not be established with certainty. To our knowledge, this is the first documented case of cytomegalovirus infection and monoclonal macroglobulinemia.
Oculoglandular Tularemia in an Inner City Child
Authors: Bloom Marshall E. , Shearer William T. , Barton Leslie L. , Mallinckrodt Edward
Published: December 2021

Since the 1968 Vermont epidemic of tularemia, human disease has been reported in all of the 50 states.1 This brief report draws attention to tularemia as a contemporary pediatric problem, highlights the recent advances in diagnosis,2,3 and points out that it may occur in city as well as in country children.

Case Report

A 6-year-old boy (SLCH-88133) from the city of St. Louis was admitted to St. Louis Children's Hospital on January 12, 1972, because of preauricular and cervical lymphadenopathy. Two months prior to admission he developed epiphora, erythema, and edema of his right eye. Within two days, lethargy, fever (104 F) and painful swelling of the entire right side of his face and neck were noted.
Electron Microscopic Demonstration of Adenovirus in Appendix Vermiformis in a Case of Ileocecal Intussusception
Authors: Yunis Eduardo J. , Hashida Yoshie
Published: December 2021

Viral particles identical to those of adenovirus were demonstrated in the intranuclear inclusion bodies of the epithelial cells of an appendix vermiformis removed from a boy with a recent history of intussusception. Viral particles were demonstrated by electron microscopy following reprocessing of a formaldehyde-fixed, paraffin embedded and hematoxylin-eosin stained section. This simple method permits precise selection of the tissue for electron microscopy and in instances such as this gives sufficient tissue preservation to demonstrate viral particles. Our findings support the idea that some cases of intussusception may be the result of the adenovirus infection.
Primary Pituitary Dysgenesis
Authors: Willard Daniel
Published: December 2021

A year ago the authors observed a newborn boy with no anterior pituitary; other skull or brain malformations were absent.

Findings included maternal estriol insufficiency of nine days' duration, early repeated attacks of hypoglycemia and respiratory distress, a small sella turcica with a persistent cranio-pharyngeal canal, hypothyroidism, and ectopic testes. No electrolyte disorder was present. Death occurred at the age of 27 days.

An elder female sibling is in good health. A 2-week-old brother is alive but shows the same symptoms as his deceased brother before death.
L-Arginine and Cystic Fibrosis
Authors: Cotton Ernest K. , Solomons Clive C. , Dubois Reuben , Coburn Michael D. , Kattwinkel John , Di Sant'Agnese Paul A.
Published: December 2021

Kattwinkel et al.1 state that "arginine is contraindicated in the treatment of cystic fibrosis." We do not accept this statement because their investigation was improperly controlled for studying arginine therapy in cystic fibrosis. Arginine enhances the activity of lipase and trypsin, and since pancreatic enzymes were completely absent in Kattwinkel's patients, it is not surprising to us that they failed to reduce steatorrhea. All they have proved is that their regimen of arginine without pancreatic enzyme supplements in older patients is ineffective in individuals who have complete pancreatic insufficiency.
THE NBT TEST IN STREPTOCOCCAL PHARYNGITIS
Authors: Randall John E. , Perriello V. , Hendley J. Owen
Published: December 2021

The NBT test was used in 81 pediatric outpatients with pharyngitis to determine whether streptococcal etiology of pharyngitis could be predicted. The test was successfully modified to use capillary blood instead of venous blood. A positive NBT test was found in 38% of 37 children with pharyngitis associated with beta-hemolytic streptococci and 14% of 44 children in whom beta-hemolytic streptococci were not isolated. Although significantly more patients with streptococcal pharyngitis had a positive test, more than half the patients who had beta-hemolytic streptococci isolated from throat cultures had negative NBT tests. The test was not useful in predicting the presence of streptococcal pharyngitis in outpatients.
THYMIC ALYMPHOPLASIA WITH HYPER-IgE-GLOBULINEMIA
Authors: Kikkawa Yumio , Kamimura Kikuro , Hamajima Tokiro , Sekiguchi Tokihiko , Kawai Tadashi , Takenaka Michiko , Tada Tomio
Published: December 2021

The clinical and autopsy findings of a 5-month-old patient with thymic alymphoplasia and increased serum IgE levels are reported. A congenital heart lesion was diagnosed at 15 days of age, eczema at 1 month of age, and infections of the skin, ears, and respiratory tract recurred until death.

Peripheral lymphocytopenia and eosinophilia, and increased concentrations of serum IgE (16.2µg/ml) and IgM were present. The serum contained normal levels of IgG and IgA. Isohemagglutinins and viral neutralizing antibodies were not present in the serum. Bacterial and drug antibodies were present, as demonstrated by PK reaction. At autopsy the thymus was hypoplastic and without Hassall's corpuscles. There were few small lymphocytes but follicular lymphocytes and plasma cells were relatively normal in lymph nodes. IgE forming cells were found in the lymph nodes and lamina propria of intestine by fluorescent antibody technique. Peripheral lymphocytes showed blastlike transformation but not mitosis. The findings suggest that the thymus plays a role in the regulation of IgE synthesis.
Letters to the Editor
Authors: Haggerty Robert J.
Published: December 2021

Dr. Haggerty replies as follows:

Dr. Darby makes a very important point about the U.S. overdependence on foreign medical graduates that I neglected. I believe that we should continue to provide educational opportunities for such graduates but not be dependent upon them for our own population's needs. If my calculations that we have increased recruitment by at least 50% during the past five years are correct, an increase that is just now beginning to be seen in the cohort entering practice, the 20% of pediatricians who are graduates of foreign medical schools will be more than compensated for.
Do We Need More Pediatricians? Effect of Group Practice
Authors: Klevit Harvey
Published: December 2021

We appreciate being cited as a model efficient primary care system by D. Haggerty1 in his commentary which questions the existence of a pediatric manpower shortage. Readers might be interested in some of our statistical data.

Our group of 20 pediatricians (18 when corrected for research and administrative activities), has provided primary services to a known Kaiser Health Plan (Oregon Region) population of 55,000 children under age 17 in 1972. We have been able to function at a ratio of one pediatrician per 2,800 to 3,200 patients since 1965, when we began "keeping score."
Letters to the Editor
Authors: Steinschneider Alfred
Published: December 2021

Dr. Steinschneider commented as follows:

By pointing out a potential value for obtaining electrocardiographic recordings, Dr. Bachman directs our attention to the more general need for describing and determining those variables influencing the pattern (and magnitude) of physiological changes occurring in conjunction with or as a consequence of periods of prolonged sleep apnea. This concern is consistent with the conclusion reached by Daily et al.1 that, ". . . cardiocirculatory adjustments are an integral part of the apneic response . . ." (p. 516) and the hypothesis that prolonged sleep apnea is part of the physiologic process resulting in SIDS.
Phenylketonuria: and Some Other Inborn Errors of Amino Acid Metabolism, Biochemistry, Genetics, Diagnosis and Therapy, edited by Bickel, H., Hudson, F. P., and Woolf, L. I. New York: Intercontinental Medical Book Corporation, 1971, 336 pp., no price given
Authors: Scriver Charles R.
Published: December 2021

This volume reports the proceedings of a Heidelberg conference on the subject of phenylketonuria and other inborn errors of amino acid metabolism. Although the conference was held in June 1969, and the book published in February 1971, this belated review should not detract from its value.

The book is divided into several sections which coven background material on phenylketonuria, with descriptions of the clinical and biochemical phenotype, discussions of genetic heterogeneity and the inheritance of phenotypes, and an extensive documentation of the success of postnatal screening and treatment in neutralizing the effects of the mutant allele.
HISTORY AND DEMOGRAPHY OF CHILD ABUSE
Authors: Solomon Theo
Published: December 2021

A Historic and demographic discourse at a gathering of this nature is usually provided for three purposes:

1. To offer an informational background to those who are not aware of or are not up to date about a particular phenomenon.

2. To ring the alarm of crisis pointing to the seriousness and pervasiveness of the phenomenon discussed.

3. To provide a perspective from which to initiate discussion.

As to the first two purposes your attendance demonstrates your concern and your alarm. Moreover, other speakers shall provide particulars on these points.

I shall attempt to provide the perspective for subsequent discussion.

HISTORY

In order to provide this perspective, I wish to define some basic terminology regarding acts performed in concert and/or individually upon children.

Infanticide has been practiced in almost every nation, both civilized and uncivilized, since recorded time. This act has been responsible for more child deaths than any other single cause in history, other than possibly bubonic plague.

Its two characteristics have been the tacit acceptance or active participation by elements in the society in which it was found, and a rationale for its existence, which is generally woven into the fabric and culture of that society. In most cases, infanticide has involved the infliction of body trauma upon a newborn child so as to willfully and knowingly cause death. This does not exclude the less common practices of intentional neglect at birth, or the ritual killing of older children. The rationales for this practice have generally been (1) religious appeasement and reactions to prophecies of doom; (2) collective or individual acts of faith and proofs of worthiness; (3) Darwinian survival and Maithusian population control.
THE ETIOLOGY OF CHILD ABUSE
Authors: Helfer Ray M.
Published: December 2021

In summary, we must recognize the total situation long before abuse occurs. The way this is done is to recognize the potential: how they were reared, how they used other people, how the marriage or the interspouse relationship is working, and most important, how they see their child. What do they expect of their child? Are these expectations realistic?

Then try to identify in a given family whether there might be or is indeed a child who could be abused.

Finally, crises should be recognized and something be done about them so they don't recur. Solving the crisis alone is not enough; this will only put out the fire for a short period of time.
ATHLETIC ACTIVITIES BY CHILDREN WITH SKELETAL ABNORMALITIES
Authors: Diamond Eugene F. , Heffelfinger John C. , Kennell John , Poncher John R. , Shackleford E. C. , Shaffer Thomas E. , Thornton Melvin L.
Published: December 2021

A physician's recommendations concerning athletic activity for normal, healthy children must take into account a wide range of individual differences in size, age, coordination, stage of maturation, and level of physical and mental development. However, when the child has a skeletal abnormality, the physician must also consider the broad spectrum of variations of the disorder itself. For example, a child with rheumatoid arthritis may be in acute pain with systemic symptoms, may have no evidence of activity, may have mild monarticular arthritis that terminates after two or three years, or may have every joint involved without let-up for ten years.

The following principles will serve as a guide to the physician as he discusses athletic competition with the child and his parents.

It is important to distinguish between participation in athletic activities and participation in competitive sports. Competition is often highly motivating and may be a means for promoting self-satisfaction and developing muscles and coordination. But, this is so only if the child is successful in his competitive efforts. If a child is condemned to constant failure because of limitations in strength, endurance, range of motion, coordination, or for any cause, participation in competitive activities can be destructive to his self-image. A child with limited ability should be guided to an appropriate level of activities with no competition or with a goal of competition against one's previous performance. A child with a serious handicap usually recognizes that he has no opportunity to succeed; however, the child with a mild handicap which keeps him from ever being first or causes him always to come in last may experience considerable frustration and discouragement.
Letters to the Editor
Authors: Liggins G. C. , Howie R. N.
Published: December 2021

Dr. Holm's interesting hypothesis has as its core the action of catecholamines on the pulmonary and bronchial vasculature. Our perusal of the reference cited in support of the assertion that norepinephrine causes pulmonary artery vasoconstriction and bronchial artery vasodilation failed to find the expected evidence. In fetal lambs, the response to both methoxamine1 (an α-receptor stimulant) and isoprenaline2 (aβ-receptor stimulant) is pulmonary vasodilation. We are unaware of studies of fetal bronchial arterial responses to catecholamines.
Intravenous Diazepam in Status Epilepticus: A Correction
Authors: West James R.
Published: December 2021

A question has arisen over the recommendation made by Dr. Sidney Carter1 that diazepam be diluted 10 mg in 8 ml distilled water prior to its intravenous administration in status epilepticus.

We have noticed that the resulting solution appears turbid, and have had second thoughts about giving such a solution. The package insert for Valium suggests that it not be mixed with other solutions. On the other hand, if it is injected into an aqueous intravascular medium it would seem likely that the same physical change is occurring there.
Letters to the Editor
Authors: Carter Sidney , Gold Arnold
Published: December 2021

It has been brought to our attention that the addition of Valium to sterile water results in a cloudy mixture. Since Valium is insoluble in water, and might result in an unequal dispersion of the compound, the manufacturer recommends that injectable Valium not be diluted.

For this reason our recommendation should be modified to state that injectable Valium should only be administered in the undiluted form.
Clinical Paediatric Endocrinology, by William Hamilton, M.D., F.R.C.P. (Glasgow and Edinburgh) D.P.H., D.C.H. (Postgraduate Paediatric Series under the General Editorship of John Apley, C.B.E., M.D., B.S., F.R.C.P., J.P.). New York: Appleton-Century-Crofts, 1972, 209 pp., $12.75
Authors: Bongiovanni Alfred M.
Published: December 2021

This small volume is one in a series of postgraduate pediatric publications, and according the book jacket, is not offered to specialists but is prepared rather as a working guide for the practicing clinical pediatrician. Although the author is a truly distinguished pediatrician and endocrinologist, this contribution leaves much to be desired.

All facets of the subject are succinctly described, from diseases of the hypothalamus through the several other hormone-secreting organs. Appropriate clinical tests and recommended further reading are included.
Achondrogenesis
Authors: Jimenez Roberto B. , Holmes Lewis B. , Kaiser John S. , Weber Alfred L.
Published: December 2021

Until recently the newborn infant with a large head and short limbs who died soon after birth was assumed to have achondroplasia. This assumption has been shown to be incorrect by the delineation of at least two additional disorders, thanatophoric dwarfism1 and achondrogenesis,2 which also cause this physical appearance. Of the two, achondrogenesis has more definite genetic significance to the family in that it is an autosomal recessive disorder.3 Recent reviews4,5 indicate that at least 22 infants with achondrogenesis have been reported. Because of the importance of proper recognition of this disorder by pediatricians, this additional case of achondrogenesis is being reported.
Hepatic Encephalopathy Treated With L-Dopa, Recovery Followed for 18 Months
Authors: Colón A. R. , Sandberg D. H.
Published: December 2021

Six cases of hepatic encephalopathy (HE) treated with L-Dopa have been described in the literature1-3 but no substantial follow-up is available regarding the surviving patients.

We treated a young girl in HE with L-Dopa and have had an 18-month follow-up to date.

Case Report

A. 13-year-old Negro girl with a one-year history of recurrent urinary tract infections was admitted with anasarca and ascites. She was normotensive and neurologically stable. Hematuria was observed but serum electrolytes, blood urea nitrogen (BUN) and creatinine levels were normal.
Nutrition and Infant Mortality
Authors: Brewer Tom
Published: December 2021

In your December 1972 issue,1 Myron Wegman presents some "provisional" data on infant mortality in the United States, 1970 and 1971. These data are allegedly received from state health department offices, "a 10% sample of material received . . . between two dates, one month apart, regardless of when the event occurred."

What is the practical significance of such data? What bearing do these statistical manipulations have on the problem of improving human maternal, fetal, and newborn infant health in our nation in the 1970s? How accurately does this sample reflect the real events?
Paediatric Fluid Therapy, by F. Harris, M.D., M.Med. (Paed.), M.R.C.P. (Ed.). Philadelphia: F. A. Davis, 1972, 154 pp., $8
Authors: Finberg Laurence
Published: December 2021

Dr. Harris has compiled a "how to do it" book for pediatric house officers and medical students, with material taken from standard sources and well synthesized. The author and his publisher have been a little lax in not always giving credit where it is due. For example, one of Dr. Gamble's diagrams appears on page 6 uncredited. In other sections, for example, Chapter 4, this reviewer was surprised to find himself in such total agreement until he realized that he had, in essence, written it.
DELIVERY OF CARE TO HEMOPHILIC CHILDREN: HOME CARE VERSUS HOSPITALIZATION
Authors: Strawczynski Hanna , Stachewitsch Andrew , Morgenstern Gert , Shaw Marjorie E.
Published: December 2021

Medical, economic, and social aspects of home care versus hospitalization in treatment of hemophiliacs were assessed in a two-year study. Thirty-six children were divided into two groups. During the first year of study half the patients were hospitalized when bleeding was reported, the other half were treated at home by Home Care, a team of physicians and paramedical personnel. During the second year groups changed assignments, thus each served as its own control. Home Care provided a 24-hour telephone service; treatment was carried out by a nurse at home or school.

Results showed that great majority of bleedings did not require hospitalization. No complications were noted. While on Home Care more bleedings were reported and they were reported faster; school attendance was better. Home Care, preferred by children and parents, provided an excellent model for teaching and a new role for a nursepractitioner. Hospital days were reduced by 85%.
CONTINUOUS POSITIVE AIRWAY PRESSURE DELIVERED BY FACE MASK IN INFANTS WITH THE IDIOPATHIC RESPIRATORY DISTRESS SYNDROME: A CONTROLLED STUDY
Authors: Rhodes Philip G. , Hall Robert T.
Published: December 2021

A controlled trial of the use of CPAP delivered by face mask was conducted in infants with IRDS. A significant difference in survival (p < 0.05) was noted in treated (all of 13) compared with control patients (seven of 11) with birth weights greater than 1,500 gm. Groups were comparable according to birth weight, gestational age, initial blood gases, and age of entry into the study. The mean duration of therapy was 32.4 hours. Complications were confined to difficulties with mask fit and local skin care.
THE VALUE(?) OF ROUTINE CHEST RADIOGRAPHY IN CHILDREN AND ADOLESCENTS
Authors: Brill Paula W. , Ewing Margaret L. , Dunn Albert A.
Published: December 2021

Analysis was made of the findings on routine chest radiographs of 1,000 healthy children in a preventive pediatric clinic which serves a low-income area of New York City. Six percent of the patients had radiographically reportable findings, most of which were minor skeletal anomalies. None required treatment. The lack of significant positive findings suggests that chest radiography is not indicated as part of a screening evaluation in healthy children.
Opsonic Activity in the Newborn: Role of Properdin
Authors: Stossel Thomas P. , Alper Chester A. , Rosen Fred S.
Published: December 2021

Relative to pooled adult serum, most cord sera have normal or slightly diminished opsonic activity. Fifteen percent of the cord sera had markedly impaired opsonic power. This activity did not correlate with immunoglobulin or C3 levels but was associated with significantly subnormal concentrations of GBG, a component of the properdin system. The deficient opsonic activity of some cord serum is thus due to hypofunction of the alternate complement pathway.
TOTAL INTRAVENOUS NUTRITION BY PERIPHERAL VEIN IN NEONATAL SURGICAL PATIENTS
Authors: Fox Howard A. , Krasna Irwin H.
Published: December 2021

A solution for intravenous nutrition which contains amino acids, glucose, electrolytes, and vitamins was infused during long periods through peripheral veins in five neonatal surgical patients. Weight gain and tissue healing were obtained while this solution represented the sole source of nutrition for as long as 51 days. The need for long-term central venous catheterization and its attendant risks were eliminated by the infusion of large volumes (200 to 250 ml/kg/24 hr) of a solution whose solute concentration (total solute 500 to 850 mOsm/kg of water) was significantly lower than that of conventional "hyperalimentation" solutions.

The large fluid volumes were well tolerated and the infants maintained normal serum osmolalities, serum electrolytes, and acid-base status.
Letters to the Editor
Authors: Duff Raymond S. , Rowe Daniel S. , Anderson Frederic P. , Green Morris
Published: December 2021

The following comments on the two preceding letters were received from the contributors referred to above:

By emulating great pediatricians in betterorganized outpatient departments, Dr. Brem suggests the art of pediatrics may be taught better. Paradise et al. seem to agree when they state that teaching and patient care are better when properly supported "ambulatory faculties" of "full-time, pediatric generalists . . . are available."

Lacking such faculties, Paradise et al. describe an accommodation, also used at Yale, in which students with faculty support often act as "primary physicians."
Allergy, Milk, and Otitis Media
Authors: Bergner Renee K.
Published: December 2021

In an earlier letter to the editor,1 Dr. Jerome Glaser cities Dr. Tonkin's report on Maori infant health2 as "conclusive" in its suggestion that cow's milk allergy predisposed these infants to otitis media. A significant aspect of this "conclusive" evidence was based on the fact that no baby had otitis media while it was breast-fed, and of the five babies breast-fed for three months, two had otitis media but not until 12 months of age.
STUDIES OF THE SUDDEN INFANT DEATH SYNDROME IN KING COUNTY, WASHINGTON: IV. IMMUNOLOGIC STUDIES
Authors: Clausen Carla R. , Ray C. George , Hebestreit Nancy , Eggleston Peyton
Published: December 2021

Prospective and retrospective studies of immunologic responses in the sudden infant death syndrome (SIDS) revealed the following:

The concentrations of IgM in cord or death bloods from patients with SIDS did not differ significantly from values found in cord blood from healthy infants or death blood from infants dying of explained causes. Similarly, IgE in death blood of patients was not elevated as compared to controls nor was the third component of complement depressed. Specific antibody titers in cord or death serum to 14 common viral antigens did not reveal any aberrant characteristics in the SIDS infants. Other immunological parameters investigated included antinuclear factor and antiantibodies, also with negative results, indicating that immunological mechanisms may not be of primary significance in the pathogenesis of SIDS.

Although this study represents generally negative findings, it is our hope that it will be a useful guide to other interested workers who are planning projects related to this problem.
THE EVALUATION OF RACEMIC EPINEPHRINE IN THE TREATMENT OF INFECTIOUS CROUP
Authors: Gardner H. Garry , Powell Keith R. , Roden Vernon J. , Cherry James D.
Published: December 2021

The effectiveness of racemic epinephrine in the treatment of croup was evaluated by a retrospective review, a prospective protocol, and a controlled study. Although the majority of children who were treated with racemic epinephrine and evaluated prospectively had significant immediate clinical improvement, the therapeutic regimen did not seem to affect the overall duration of hospitalization or the incidence of tracheotomy during the study period. Ten of the 20 children who participated in the double-blind controlled study had significant improvement; five received racemic epinephrine and five received the placebo. These findings suggest that the apparent effectiveness of racemic epinephrine might be due to the nebulization of moisture rather than a direct effect of the drug.

The present study points out the critical need for controlled studies in the evaluation of therapeutic procedures in the treatment of croup.
FACTORS AFFECTING THE DEVELOPMENT OF SERUM IMMUNOGLOBULIN LEVELS IN INFANTS
Authors: Vlahović Vlasta , Rede Tihomir , Beleznay Otmar , Pavěsić Danko , Rački Višnja
Published: December 2021

The humoral immunological status of the newborn is recognized as a combination of (1) immune globulin G derived from the mother and (2) competence for developing active immunity. To these current concepts, the data in the present study add indications that the level of transplacentally acquired IgG may play a role in controlling the time of onset of the infant's own IgG production. Increases of IgG levels occurred much later in infants born with normal adult levels of serum IgG than in infants born with relatively low serum IgG concentrations.
OUTCOMES OF DRUG EDUCATION: FOUR CASE STUDIES
Authors: Tennant Forest S. , Weaver Sue C. , Lewis Charles E.
Published: December 2021

Due to a need to find educational means to prevent drug abuse, drug education programs in one elementary and three secondary schools were studied. Drug education given to three different groups of secondary children could not be definitely shown to decrease illegal drug use among the students. Following two of these programs, available evidence indicates that some students experimented with illegal drugs. In a group of 70 fifth and sixth graders a drug education program given by a specially trained teacher evoked a positive change in attitude in many students who previously intended to smoke cigarettes or use illegal drugs. This program provides cautious encouragement and may indicate that drug education is more effective in grade schools than secondary schools.
ANTIBACTERIAL EFFECTIVENESS OF ROUTINE HAND WASHING
Authors: Sprunt Katherine , Redman Winifred , Leidy Grace
Published: December 2021

A broth rinse method was used to determine the indigenous bacteria of the hands of nursery personnel and to demonstrate its stability under the test conditions. The efficacy of five wash agents in removing infant-acquired organisms from the hands was then explored. All agents were equally effective including water when followed by drying on a paper towel.

The data show that the routine-type quick hand wash usually employed by busy aides and nurses is effective in removing patient-acquired organisms and provide additional emphasis on the importance of the hand wash procedure in prevention of spread of bacteria from patient to patient.
Definition of the Russell-Silver Syndrome
Authors: Szalay Glenn C.
Published: December 2021

Haslam et al.1 appear to accept the concept of the combined "Russell-Silver syndrome" postulated by a number of authors. I do not, and I believe that the study of craniofacial proportions allows one to differentiate three types of intrauterine drawfs (Table I).2,3

See the Table in PDF File

Finally, Haslam et al.1 do not tell us what the asymmetry is in their first two patients; as an example, should unilateral ptosis or unilateral cryptorchidism qualify a patient for inclusion under the category of body asymmetry?
Communicable and Infectious Diseases, ed. 7, edited by Franklin H. Top, Sr., A.B., M.D., M.P.H., F.A.A.P., F.A.C.P., F.A.P.H.A., and Paul F. Wehrle, B.S., M.D., F.A.A.P., F.A.P.H.A. St. Louis: The C. V. Mosby Company, 1972, 803 pp., $35.00
Authors: Mortimer Edward A.
Published: December 2021

This new edition of a well-known text begins with approximately 100 pages of general information regarding immunity, epidemiology, preventive measures, and chemotherapy in infectious disease. This section is useful because most of it is succinct and accurate, and gives the reader an overall view of certain important aspects of infectious disease control. The part on chemotherapy is excellent but it is lengthy and detailed, and therefore serves more as a reference than as a chapter one would sit down to read in an evening.
Shigellosis in the First Week of Life
Authors: Barton Leslie L. , Pickering Larry K.
Published: December 2021

The diagnosis of shigellosis is only rarely considered in the infant whose diarrhea commences during the first week of life. Haltalin1 reported six cases and reviewed seven others that had appeared in the literature up until 1967. Three other cases have been reported.2-4 We would like to describe an additional infant with onset of diarrhea due to Shigella flexneri infection on her second day of life.

Case Report

Patient C.E. (SLCH #72-6528) was admitted to St. Louis Children's Hospital at 36 hours of age with fever and bloody diarrhea. The mother had a third trimester urinary tract infection treated with parenteral ampicillin. No diarrhea was noted during her pregnancy.
Safety of Infants in Automobiles
Authors: McDonald Quentin H.
Published: December 2021

At the recent Academy Meeting in Boston, we had a most unusual experience. Although we have exhibited the Bobby-Mac Baby Chair at Academy Meetings during the past three years as a safe infant seat-car seat-high chair, we were surprised to have an Academy member state that he "always recommends that the very young baby be held in the mother's arms even in a car," and "did not approve of car restraints for infants".

In view of the available research on car seat safety for infants and children, it is difficult to believe that a physician counseling young mothers could maintain such an attitude.
School Absenteeism and Child Health
Authors: Blumenthal Daniel S.
Published: December 2021

Drs. Moore and Frank have reported that the rate of school absenteeism in Charlestown, Massachusetts, increased subsequent to the establishment of a comprehensive health center in the area.1 One might speculate that the presence of the center itself was responsible for part or all of this increase. Many children who were not acutely ill and who would not ordinarily have visited the doctor might have been absent from school in order to keep appointments for follow-up or maintenance care or for social or other ancillary services.
Letters to the Editor
Authors: Moore Gordon T. , Frank Kenneth
Published: December 2021

The possible confounding association between health center utilization and absenteeism for well child problems is similar to some of the possible causes of bias which we outlined in the discussion of our article. A condition of selection for the study was that each child have a complete checkup at the health center prior to inclusion in the study. To some degree, this may have decreased the effect of the bias which Dr. Blumenthal describes. However, we agree that this is a possible cause of our findings and support his contention that medical care may occasionally serve to disrupt the child's daily activities.
NEWER CONCEPTS IN EMERGENCY CARE OF CHILDREN WITH MAJOR INJURIES
Authors: Haller J. Alex
Published: December 2021

Childhood trauma and other life-threatening emergencies require facilities operational on a 24-hour basis, with surgical and medical components, x-ray facilities, and blood and chemistry laboratories organized to provide primary resuscitation and initial management for extensive and multiple injuries in children. Staffed to provide high quality treatment for simpler injuries and emergency illnesses in children, a trauma unit should represent a complete emergency treatment center for children; it should be tied administratively and professionally to the intensive care units within the larger medical complex.

From this type of organizational framework and a physically separate trauma unit for children, improved teamwork and more efficient management of multiple injuries should result. The basic principles of rapid, careful evaluation and sequential correction of altered physiology remain the back-bone of successful therapy in children. The unique metabolic demands and miniature anatomic relationships, especially of small children, present the physician with a special challenge and a tremendous responsibility. Rewards for the successful management of multiple trauma are high–the younger the injured child, the greater is our total investment in his welfare and in his future.
DEVELOPMENT OF NEUROPHYSIOLOGICAL INDICES OF MENTAL RETARDATION: I. INTERHEMISPHERIC ASYMMETRY OF THE AUDITORY EVOKED CORTICAL RESPONSE
Authors: Richlin Milton , Weinstein Sidney , Giannini Margaret
Published: December 2021

Auditory evoked cortical responses (AECR) were studied in three groups of children (8 to 15 years old): normal dextrals, retarded dextrals, and retarded sinistrals. Hemispheric asymmetry of the maximum amplitude of the AECR was found in the following pattern: left greater than right in normal dextrals, right greater than left in retarded dextrals, and no difference in the retarded sinistrals.

If this preliminary sign based on AECR asymmetry were employed for the 15 subjects, there would have been one false positive, and two false negatives (both sinistrals).
BACTERIAL MENINGITIS
Authors: Smith David H. , Ingram David L. , Smith Arnold L. , Gilles Floyd , Bresnan M. J.
Published: December 2021

Prior to the introduction of specific antibacterial therapy, bacterial meningitis was a disease with a universally fatal or disastrous outcome. The introduction of typespecific antiserum, and then of the antibacterial drugs, improved this situation dramatically.

Improvements in the general medical care of acutely ill children, and the introduction of a series of more potent antibiotics against its bacterial causes helped to generate an attitude that bacterial meningitis was, or soon would be, a disease of the past. The experience of the past two decades belies this thesis. Today, interest in many facets of this disease has been renewed by many physicians concerned with the health of children: the epidemiology, pathophysiology, diagnosis, and treatment. This symposium attempts to summarize for the practitioner the highlights of current knowledge in this area, and to outline certain areas in which recent advances can be anticipated, or will be studied.

Tuberculous meningitis will be omitted for the sake of brevity, as will the special problems of meningitis in the newborn infant.

There has been a resurgence of interest in developing vaccines to prevent Hemophilus influenzae b, pneumococcal, and meningococcal Group A, B, and C meningitis. These organisms cause almost all the bacterial meningitis after the first two months of life. If, as now seems possible, vaccines against most or all of these organisms will soon become available, those children having the greatest risk must be defined to determine who, and at what age should have priority in receiving the vaccine(s).

A. THE CURRENT MAGNITUDE OF THE PROBLEM
The Significance of Pulmonary Petechiae in Crib Death
Authors: Guntheroth Warren G. , Breazeale Donald , McGough George A.
Published: December 2021

Intrathoracic petechiae have been regarded as a characteristic postmortem finding in crib death, suggesting to some that upper airway obstruction was involved. Ninety rats were asphyxiated in various ways, and the frequency of petechiae was determined. Abrupt and unremitting tracheal occlusion produced petechiae in only 7%, whereas breathing 100% nitrogen produced petechiae in more than 80% of the animals. Respiratory paralysis with succinylcholine caused petechiae in only 20%, and cardiac arrest with potassium chloride in 27%.

We conclude that hypoxia, prior to cardiac arrest, and vigorous respiratory movements are necessary to produce intrathoracic petechiae, and that unremitting airway obstruction is unlikely as the cause of SIDS. Instead, we propose that crib death is due to primary apnea, secondary to moderate hypoxia.
Fatal Coxsackie B2 Infection In One Dizygous Twin
Authors: Nankervis George A. , Rome Leonard P.
Published: December 2021

Devastating coxsackie B virus infection has been reported in a number of neonates during the past several years.1-4 Although transplacental infection may occur, characteristically the viral infection is acquired during passage through the birth canal or shortly thereafter. The neonate is usually asymptomatic until 4 to 5 days of age when the onset of lethargy, poor feeding, and temperature instability are noted. Significant morbidity or mortality frequently ensues. This report describes a fatal case of neonatal coxsackie B2 infection in one dizygotic twin.

CASE REPORT

E. D. was the first of twins delivered to a 29-year-old gravida 3, para 2, white female after 37 weeks' gestation.
In Reply: Phenergan® Is No Longer Available for Topical Use
Authors:   Committee on Drugs
Published: December 2021

The Committee on Drugs is happy to acknowledge the removal of promethazine hydrochloride (Phenergan®) topical preparations from the market. It would hope that the other manufacturers of topical antihistamine preparations will remove theirs as well.
RESPONSES OF CHILDREN IMMUNIZED WITH THE CAPSULAR POLYSACCHARIDE OF HEMOPHILUS INFLUENZAE, TYPE b
Authors: Smith David H. , Peter Georges , Ingram David L. , Harding A. Lynn , Anderson Porter
Published: December 2021

One hundred forty-one children of 5 to 59 months of age were immunized with a single intramuscular dose of 0.67, 3.3, 17, or 67µg polyribophosphate (PRP), the capsular antigen of Hemophilus influenzae, type b. The immunizations were well tolerated, particularly at doses of .67 to 17µg. Antibody activity was measured by radioactive antigen binding, using 3H-labelled PRP. Doses of 3.3 and 17µg produced significant antibody rises in nearly 90% of recipients; 0.67 and 67µg in approximately half. The geometric mean titers were similar at three and six weeks after immunization and were greater with the middle doses.

The net antibody increase in responding children was strongly age dependent, but was not related to the preimmunization antibody concentration. Rises in serum bactericidal activity against H. influenzae type b generally accompanied rises in antibody concentration as measured by the antigen-binding assay.