bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Hypnosis, Biofeedback, and Voluntary Peripheral Temperature Control in Children
Authors: Dikel William , Olness Karen
Published: December 2021

Forty-eight children, aged 5 to 15 years, were tested for their ability to raise and lower their index finger temperature with self-hypnosis and/or biofeedback. Group A (self-hypnosis only) and group B (self-hypnosis with biofeedback) were children who had previous successful experience with self-hypnosis (eg, for the treatment of enuresis, pain, asthma, or obesity). Group C (biofeedback only) were children with no experience with hypnosis. All three groups showed significant success with warming and cooling. The range of warming for the three groups was 0 to 3.7 F, and for cooling, 0 to 7.3 F or 0 to 8.8 F for attempts exceeding the ten-minute trial period. No significant difference in ability to warm or cool was noted when the children were compared by group, age, or sex. Some of the children in group A who had little or no success with hypnosis only were very successful with the addition of biofeedback monitoring, suggesting a synergistic effect between biofeedback and hypnosis. A significant temperature rise was also noted in groups A and B accompanying a neutral hypnotic induction relaxationimagery exercise in which no mention of temperature change was made. This rise varied from 0 to 6 F, averaging 1.7 F. Possible therapeutic implications include the treatment of migraine headaches, Raynaud's syndrome, sickle cell anemia, and the use of temperature monitoring as a diagnostic and therapeutic adjunct to clinical hypnosis.
Rickets
Authors: Lovinger Robert D.
Published: December 2021

Rickets is a disease of growing children. Historically, its winter prevalence and its occurrence among children confined to sunless sweat shops and smog-ridden cities during the industrial revolution implicated insufficient exposure to sunlight in its etiology.1-3 Despite the discovery of the anti-rachitic action of cod-liver oil more than 200 years ago, rickets remained a serious health problem until the early part of the 20th century when the identification, isolation, and finally almost ubiquitous addition of vitamin D to our food supply soon rendered conventional rickets a disorder of mere academic interest. Recently, however, a slow increase in the incidence of rickets in children with a variety of medical problems including renal tubular disorders, illness requiring chronic hemodialysis, cystic fibrosis, and as a complication of anticonvulsant therapy has been noted. Thus, the reappearance of rickets in new, more subtle forms, necessitates increased physician awareness of its incidence and its pathogenesis.

CALCIUM AND PHOSPHORUS HOMEOSTASES

Fundamental to the pathophysiology of rickets are calcium and phosphorus homeostases.4 Calcium plays a central role in many body functions and is an important cofactor in muscle contraction, neural transmission, enzyme activity, blood clotting, and other cellular processes. Calcium exists in a number of body pools of varying exchangeability or availability for immediate use. The nonexchangeable calcium pool includes the bones, which contain approximately 99% of the body's calcium, and certain body proteins to which it is tightly complexed. The rapidly exchangeable pool is made up of either ionized or loosely complexed calcium, present both in the body fluids and within individual cells.
CHARLES DICKENS DESCRIBES HIS IMPRESSION OF THE CHILDREN AT THE PERKINS INSTITUTION FOR THE BLIND
Authors: C. T. E.
Published: December 2021

In his American Notes, published in 1843, Dickens vividly described his six months' visit to the United States between January and June 1842. None of the public institutions that he visited made a more favorable impression on him than the Perkins Institution for the Blind, located in Boston.

He wrote:

I went to see this place [the Perkins Institution] one very fine winter morning: an Italian sky above, and the air so clear and bright on every side, that even my eyes, which are none of the best, could follow the minute lines and scraps of tracery in distant buildings. Like most other public institutions in America, of the same class, it stands a mile or two without the town, in a cheerful, healthy spot; and is an airy, spacious, handsome edifice.

The children were at their daily tasks in different rooms, except a few who were already dismissed, and were at play. Here, as in many institutions, no uniform is worn; and I was very glad of it, for two reasons. Firstly, because I am sure that nothing but senseless custom and want of thought would reconcile us to the liveries and badges we are so fond of at home. Secondly, because the absence of these things presents each child to the visitor in his or her own proper character, with its individuality unimpaired—not lost in a dull, ugly, monotonous repetition of the same unmeaning garb, which is really an important consideration.

The wisdom of encouraging a little harmless pride in personal appearance even among the blind, or the whimsical absurdity of considering charity and leather breeches inseparable companions, as we do, requires no comment.
Chronic Granulomatous Disease and McLeod Syndrome in a Black Child
Authors: Fikrig Senih M. , Phillipp Juana C. D. , Smithwick Elizabeth M. , Øyen Ragnhild , Marsh William L.
Published: December 2021

A 3-year-old black male child with X-linked chronic granulomatous disease and red cells of the rare McLeod phenotype is presented. The red cells showed acanthocytosis and did not react with anti-KL. Similarly the leukocytes were nonreactive with anti-Kx. The Xk and Xg linkage could not be investigated since all members of his family were Xg (a+).
Hyperbilirubinemia in Infants of Diabetic Mothers
Authors: Peevy Keith J. , Landaw Stephen A. , Gross Steven J.
Published: December 2021

Large for gestational age (LGA) infants of insulin-dependent diabetic mothers (IDM), appropriate for gestational age (AGA) IDM, and infants of nondiabetic mothers were compared for the incidence of neonatal hyperbilirubinemia and related etiologic factors. At 60 hours of age, LGA IDM had significantly higher serum bilirubin concentrations (12.3 ± 2.1 mg/100 ml) than AGA IDM (7.6 ± 3.9 mg/100 ml) or control infants (7.8 ± 2.8 mg/100 ml) (P < .001). Peak serum bilirubin concentrations were also significantly higher in LGA IDM (14.4 ± 2.1 mg/100 ml) than in AGA IDM (8.4 ± 3.7 mg/100 ml) or control infants (8.6 ± 3.3 mg/100 ml) (P < .001). Mean percent of carboxyhemoglobin was used as an indicator of hemolysis and showed a significant elevation in LGA IDM (1.51 ± 0.19) when compared to AGA IDM (1.10 ± 0.27) and control infants (1.19 ± 0.33) (P < .05). No significant differences were found among the three groups with respect to mode of delivery, frequency of pitocin administration, 5-minute Apgar scores, incidence of isoimmunization, incidence of enclosed hemorrhage, hemoglobin concentration, bilirubin concentrations at 12 hours, and percent of weight loss. Our data suggest that only LGA IDM are at increased risk for hyperbilirubinemia and that increased heme turnover is a significant factor in the pathogenesis.
Congenital Central Hypoventilation and Sleep State
Authors: Fleming Peter J. , Cade Darlene , Bryan M. Heather , Bryan A. Charles
Published: December 2021

Congenital central hypoventilation (Ondine's curse) is described in an infant with persistant symptoms throughout the first nine months of life. Respiratory control was most severely affected in quiet sleep, although abnormalities were present in rapid eye movement (REM) sleep and while awake. Failure of metabolic control in quiet sleep led to profound hypoventilation. Behavioral or "behavioral-like" inputs in the awake state and REM sleep increased ventilation, but not to expected normal levels. The ventilatory response to inhaled 4% CO2 was markedly depressed in all states.
Comparison of Lumbar Puncture with Computed Tomography Scan as an Indicator of Intracerebral Hemorrhage in the Preterm Infant
Authors: Silverboard Gerald , Lazzara Anthony , Ahmann Peter A. , Schwartz James F.
Published: December 2021

Computed tomography (CT) scan is the most accurate method for diagnosing intracerebral hemorrhage in the high-risk preterm infant. The present study was undertaken to evaluate lumbar puncture (LP) as a reliable means of diagnosing such hemorrhages. Forty eight infants less than 35 weeks gestation, requiring intensive care, were evaluated by CT scan at 48 to 96 hours of life, and serial LPs were performed. The initial LP preceded the CT scan by one to four hours and repeat LPs were done three and five days later if the initial CT scan revealed intracerebral hemorrhage. The initial LP was successfully performed in 28 of 48 infants. Of these 48 infants, 15 had hemorrhage by CT scan. The initial LP was consistent with the diagnosis on scan in eight of these 15. In the other seven infants, initial LP was normal in three, traumatic in one, and unsuccessful in three. The second LP was consistent with hemorrhage in four of the latter seven. Thus, in only eight of 15 infants, in whom CT scans revealed intracerebral hemorrhage, was the initial LP useful in confirming the diagnosis. Furthermore, LPs showed bloody cerebrospinal fluid in 10 of 18 infants whose CT scans were normal. At the present time LP cannot be considered a reliable means of identifying infants with subependymal-intraventricular hemorrhage.
Renal Hypophosphatemic Rickets: Growth Acceleration After Long-Term Treatment with 1,25-Dihydroxyvitamin-D3
Authors: Chan James C. M. , Lovinger Robert D. , Mamunes Peter
Published: December 2021

Treatment with 1,25-dihydroxyvitamin-D3 and phosphorus supplementation for as long as 48 months was evaluated in six patients with renal hypophosphatemic rickets. Previous phosphorus supplementation of 1,800 to 4,000 mg/sq m of body surface area per day was continued while 1,25-dihydroxyvitamin-D3 at 17 to 80 ng/kg of body weight per day was given orally in place of vitamin-D2. The serum calcium concentration stayed within the normal range in the majority of patients, while the serum phosphorus concentration rose from 2.5 ± 0.4 to 3.4 ± 1.2 mg/100 ml after one month (P < .01). With rare exceptions, serum alkaline phosphatase and parathyroid hormone concentrations stayed normal throughout the study. Healing of rickets was demonstrated by radiography. In five patients, growth velocity was evaluated for 12 months before and after therapy. Growth accelerations were 123% to 235% of that expected for changes in chronologic age and 114% to 200% expected for changes in bone age after therapy. Orally administered, 1,25-dihydroxyvitamin-D3 increased renal calcium excretion and calcium retention was achieved by virtue of the decreased fecal calcium loss. In contrast, 1,25-dihydroxyvitamin-D3, even at doses up to 4 µg/day (80 ng/kg/day) did not significantly alter renal phosphaturia. The phosphorus retention was therefore achieved as the result of the decreased fecal phosphate excretion. The absence of hypercalcemia even at high doses of 1,25-dihydroxyvitamin-D3 and the enhanced linear growth support the long-term therapeutic value of 1,25-dihydroxyvitamin-D3 in renal hypophosphatemic rickets.
Effect of Application Force on Noninvasive Measurements of Intracranial Pressure
Authors: Horbar Jeffrey D. , Yeager Scott , Philip Alistair G. S. , Lucey Jerold F.
Published: December 2021

Application of the Ladd fiberoptic sensor to the anterior fontanel of the human newborn has been used as a method for monitoring intracranial pressure noninvasively. This study measures the effect of varying the force with which the sensor is applied to the fontanel. The Ladd sensor readings of five preterm human infants were continuously monitored while sensor application force was increased in a stepwise manner. The Ladd sensor readings for each infant varied with the force applied. In one infant sensor application was gradually increased while direct measurements of lumbar CSF pressure were made. Ladd sensor readings in this infant increased with increasing application force, while lumbar CSF pressure remained unchanged. It is concluded that readings obtained with the Ladd sensor applied to the anterior fontanel of the human infant depend on the force with which the sensor is applied. The effect of application force must be taken into account if noninvasive measurements of intracranial pressure are to be made with the Ladd device.
Excellent Outcome of Bacteroides Meningitis in a Newborn Treated with Metronidazole
Authors: Law Barbara J. , Marks Melvin I.
Published: December 2021

Hydrocephalus has developed in all three reported cases of Bacteroides fragilis meningitis in newborns.1-3 One author suggested this complication was related to the documented persistence of Bacteroides in the CSF despite chloramphenicol therapy.3 In two of the cases metronidazole was tried late in the course, followed by prompt clinical and bacteriologic resolution.1,3 We report a newborn with B fragilis meningitis in whom metronidazole was used early, with rapid sterilization of the CSF, clinical cure, and no sequelae after 12 months of follow-up.

CASE REPORT

A 2,020-gm white male infant was delivered vaginally at 32 weeks gestation to a healthy primigravida, 52 hours after premature rupture of membranes.
Noonan's Syndrome: A Historical Perspective
Authors: Cole Roger B.
Published: December 2021

Pediatrics and fine art do not often cross paths, but such an example seems to have occurred with Noonan's (pseudo-Turner's) syndrome and a famous painting by Ivan Le Lorraine Albright.

In 1968 Noonan first described the syndrome that bears her name.1 These patients have characteristic facies: ptosis, antimongoloid palpebral slant, broad flat nose, webbed neck, as well as a high arched palate and malformed ears. They are usually of short stature and frequently have congenital heart disease, most often pulmonic stenosis secondary to a dysplastic valve with or without an associated shunt at the atrial level. Pectus excavatum, cubitus valgus, undescended testes, and impaired mental development are commonly found.
Contraception in the Adolescent
Authors: Klaus Hanna
Published: December 2021

The article "Contraception in the Adolescent: Current Concepts for the Pediatrician" by Donald E. Greydanus, MD, and Elizabeth R. McAnarney, MD (Pediatrics 65:1, 1980) was disappointing in one aspect. Of more than nine pages of text, only two brief paragraphs dealt with the human choice involved in the decision to have sexual intercourse. They were labeled "Rhythm Method (Periodic Coital Abstinence)" and "Abstinence." Today the rhythm method is largely of historic interest. Contemporary methods of periodic abstinence, are the ovulation method (mucus method of Billings), or the combination of mucus and temperature, the so-called sympto-thermal method.
Letter to the Editor
Authors: Greydanus Donald E. , McAnarney Elizabeth R.
Published: December 2021

We thank Dr Klaus for her interest in our paper and for her thoughts. We welcome the opportunity to address the issues which have been raised. It was clearly not possible to include all aspects of this very difficult and sensitive topic in such a review. The intent was to provide a basic fund of knowledge for the readers of Pediatrics. We chose to concentrate mostly on oral contraceptives, feeling this would be of greatest educational value for the pediatrician. Another article1 deals with barrier methods in more detail.
Letters to the Editor
Authors: Wysowski Diane K. , Flynt J. William
Published: December 2021

Lest there be any confusion, we would like to emphasize that in both of the epidemics of idiopathic neonatal hyperbilirubinemia which were reported in an article in this journal,1 one specific phenolic disinfectant detergent, LpH, was implicated as a cause of the epidemics. This highly acidic phenolic was frequently used in excessive concentrations by nursery staff who did not dilute it according to directions. In both epidemics it was used to clean incubators, bassinets, and mattresses, in addition to nursery walls and floors.
Chorea and Lupus Erythematosus
Authors: Herd J. Kenneth , Starr Mylena
Published: December 2021

We described two related male patients whose chorea heralded the onset of systemic lupus erythematosus (SLE), and reviewed in tabular form well-documented reports of 34 other patients with chorea and SLE from the world's literature including four reports not previously reviewed elsewhere.1 Since publication several additional instances of the coincidence of chorea and SLE have been personally called to my attention, suggesting it is more common than previously suspected. One report published in considerable detail by Vaccaro and Biscatti,2 was overlooked and is now cited; Their patient (case 23b in our Table 1) was a 9-year-old girl whose chorea appeared about four months after the first signs of SLE.
The Significance of Gastric Emptying Time Study
Authors: Blumenthal Ivan
Published: December 2021

I am surprised that your reviewers recommended publication of the paper on gastric retention in neonates.1 The rate of stomach emptying varies with the volume of its contents.2 In one study involving infants, a 10-ml increase in volume produced an average increase in the rate of emptying of 0.32 ml/min in the first 10 minutes when a 5% glucose solution was used.3 The study by Gupta and Brans1 varied volume with weight, gestation, and postnatal age. It should, therefore, be obvious that it is impossible to draw meaningful conclusions from this study. The claim that there is a "striking similarity" between their study and that of Yu4 is not true.
Letters to the Editor
Authors: Brans Yves W.
Published: December 2021

Although it is true that the rate of gastric emptying varies with the volume of its contents, it also varies with a number of other factors. The volume difference between preterm and term neonates in our study was dictated by practicality and in an attempt to reflect actual nutritional management of neonates. The feeding of 10 ml/kg to term babies might have resulted in almost complete gastric emptying by 30 minutes, but on the other hand we did not feel justified in exposing a small premature neonate to a bolus of 20 ml/kg.
Letters to the Editor
Authors: Swanson J.
Published: December 2021

In their letter, McLaughlin and Tso have misinterpreted the purpose of the short-term diagnostic drug trial we have proposed (Pediatrics 61:21, 1978). We developed our laboratory test procedure to screen out potential adverse responders, in order to prevent their mistreatment with stimulant drugs. We feel that this conservative bias is necessary, since there has been general agreement since Bradley's (1939, 1950) initial work that not all behaviorally hyperactive children have a favorable response to stimulant drug.1,2
Questioning Diagnosis of Kawasaki Disease
Authors: Leggiadro Robert J.
Published: December 2021

The diagnosis of Kawasaki disease should be made only if certain diagnostic criteria, including the exclusion of other known disease processes,1 are met. Slovis et al (Pediatrics 65:789, 1980) present four cases in their article regarding the use of sonography in the diagnosis and management of hydrops of the gallbladder occurring in Kawasaki disease. I do not believe the data reported for the first patient satisfactorily exclude the diagnosis of acute rheumatic fever.

The physical signs of a pericardial rub, large pericardial effusion, and gallop rhythm satisfy the requirements for the major manifestation of carditis in the modified Jones criteria scheme.
Clindamycin and Breast-feeding
Authors: Mann Cynthia F.
Published: December 2021

As breast-feeding becomes increasingly popular, physicians who prescribe drugs for the nursing mother must watch for adverse effects on the infant. At our hospital some mothers receive combination antibiotic treatment with ampicillin, gentamicin, and clindamycin for antepartum infections. None of these drugs has been reported to cause morbidity in the newborn following transfer in breast milk, and we have not routinely discontinued nursing when these drugs have been used. A recent case in our practice suggests a possible adverse effect of such maternal antibiotic therapy on the nursing neonate.
Letters to the Editor
Authors: Weitzman Michael , Lamb George A.
Published: December 2021

We would like to commend Fallot et al1 on their recent article attempting to demonstrate yet another advantage of breast-feeding, " ... that exclusively breast-feeding during the first three months of life significantly reduces the incidence of infections that ultimately require hospitalization of infants."1 Unfortunately, the data presented do not really add substantial support to the notion that breast-feeding reduces the incidence of hospitalization for infection.

What the authors have accomplished, (if their method of identifying exclusively breast-fed infants by chart audit of hospital clinic, inpatient, and private physician medical records is reliable and valid in this regard) is to demonstrate that breast-feeding and lower rates of hospitalization for infection in the first three months of life are statistically associated.
Letters to the Editor
Authors: Cromer M. , Collard S. B.
Published: December 2021

Fallot et al1 report fewer hospitalizations among breast-fed infants.

Since breast-feeding has been correlated with socioeconomic status,2 we believe caution should be exercised in interpreting this finding. Previously documented factors may be involved, eg, parental cigarette smoking,3 crowding,4 bottle propping,5 or numerous other variables as suggested in Sauls' thorough analysis.6

Close examination of Fallot's Table 1 fails to support the implication that breast-feeding had any beneficial effects among the "clinic" patients. Application of the X2 test to this group of patients shows no significant effect to be associated with breast-feeding (P > .5).
Blood Pressure Study
Authors: Gillum Richard F.
Published: December 2021

de Swiet and colleagues (Pediatrics 65:1028, 1980) are to be congratulated on their excellent study of systolic blood pressure in infants which supplies much needed data. I would like to make two important points, however, regarding this valuable study.

1. The authors have excluded for technical reasons approximately one third of the readings at age 6 months, and something over 5% at 1 year, thus opening the possibility of substantial bias in the reported data, particularly at the 6-month point.
Annual Summary of Vital Statistics—1979: With Some 1930 Comparisons
Authors: Wegman Myron E.
Published: December 2021

It seems fitting that in June 1980, concurrent with the celebration of the 50th anniversary of the American Academy of Pediatrics, the provisional infant mortality rate for the preceding 12-month period should have reached 12.8, the lowest point in US history.3 For calendar 1979, as shown in Table 1, the rate was 13.0, 6% below the rate for 1978. As to the other major vital indices, births and birth rate were up, as had been predicted, and so were both marriages and divorces. Total deaths were fewer and the crude death rate was down.

ACCURACY OF HISTORICAL DATA

Since the 50th anniversary calls for some historical references it is important to note some of the shortcomings in US data for 1930, the year of the Academy's founding, and for prior years.
Lack of Predictive Indices in Kernicterus: A Comparison of Clinical and Pathologic Factors in Infants With or Without Kernicterus
Authors: Kim Mae Hee , Yoon Jing Ja , Sher Joanna , Brown Audrey K.
Published: December 2021

A review of 398 neonatal autopsies at Downstate Medical Center revealed 27 cases of kernicterus during the seven-year period from 1971 through 1977. With the current intensive care of the sick newborn, kernicterus continues to occur, mainly in premature infants with relatively low levels of serum bilirubin (mean of 11.5 mg/100 ml). To understand the factors contributing to the development of kernicterus, clinical and pathologic findings in 27 infants with kernicterus were compared to 103 "control" infants retrospectively. Birth weight, gestational age, sex, and Apgar scores were comparable in both groups. The duration of survival was significantly shorter in infants with kernicterus than in the control infants. The clinical signs and symptoms of kernicterus were nonspecific and the premortem diagnosis of kernicterus was not suspected in most of the cases. There were no significant differences in the peak serum bilirubin values, incidence of hypothermia, hypoglycemia, convulsions, anemia, infection, use of phototherapy, transfusion and exchange transfusion in the two groups. Serum albumin values and bilirubin binding capacity measured by 2-(4-hydroxybenzeneazo)benzoic acid were significantly lower in the kernicteric group although the bilirubin-albumin molar ratio was equal in both groups. The incidences of severe acidosis and hypoxic encephalopathy were significantly higher in the kernicteric infants. In this study, acidosis, hypoxia, hypoalbuminemia, and low bilirubin binding capacity were seen more often in kernicteric infants than in control infants. However, analysis of previously suggested risk factors failed to identify any single factor or combination of factors which could be predictive to the development of kernicterus.
Reye's Syndrome and Salicylate Use
Authors: Starko Karen M. , Ray C. George , Dominguez Lee B. , Stromberg Warren L. , Woodall Dora F.
Published: December 2021

During an outbreak of influenza A, seven patients with Reye's syndrome and 16 ill classmate control subjects were evaluated for characteristics of the patients' prodromal illness and the control subjects illness and for medication usage. Patients during the prodrome and control subjects had similar rates of sore throat, coryza, cough, headache, and gastrointestinal complaints except for documented fever which occurred significantly more often in patients than in control subjects (P = .05). While medications which did not contain salicylate were taken as frequently by patients as control subjects, patients took more salicylate-containing medications than did control children (P < .01). All seven patients took salicylate whereas only eight of 16 control subjects did so (P < .05). Patients took larger doses of salicylate than did the entire control group (P < .01). When the eight control subjects who took salicylate were compared with the patients, the patients still tended to take larger doses (P = .08). Patients with fever took salicylate more frequently than control subjects with fever (P < .01). In addition, salicylate consumption was correlated with severity of Reye's syndrome (P < .05). It is postulated that salicylate, operating in a dose-dependent manner, possibly potentiated by fever, represents a primary causative agent of Reye's syndrome.
Kwashiorkor in the United States
Authors: Chase H. Peter , Kumar Vijay , Caldwell Richard T. , O'Brien Donough
Published: December 2021

Kwashiorkor, with typical edema and skin rash is occasionally seen in affluent countries as a result of severe protein restriction. Treatment is with a lactose-free formula after rehydration and sometimes after a period of parenteral alimentation. Complications of therapy included: diarrhea, congestive heart failure, infections, a bleeding tendency, and seizures. Two of the 14 children in this series died.
Longitudinal Assessment of Children with Enteroviral Meningitis During the First Three Months of Life
Authors: Wilfert Catherine M. , Thompson Robert J. , Sunder Theodore R. , O'Quinn Aglaia , Zeller Joan , Blacharsh Jill
Published: December 2021

Nine children who had enteroviral meningitis during the first three months of life and nine matched control children were evaluated for possible sequelae of their infection. The mean age of the children with meningitis was 46.67 months at the time of testing and that of the control subjects was 47.33 months. The mean IQ level of 89.67 in the children with meningitis was comparable to 92.78 obtained in the control children. Receptive vocabulary testing suggested that the receptive language functioning of the group with meningitis was significantly less than that of the control group. There was no significant difference in head circumference, no detectable sensorineural hearing loss, and no detected difference in intellectual functioning between the meningitis group and matched control subjects.
Orbital Infarction in Sickle Cell Disease
Authors: Blank John P. , Gill Frances M.
Published: December 2021

Bone infarction is a common occurrence in sickle cell disease. Described are three cases in which frontal headache, proptosis, and lid edema were seen with infarction of the orbital bone. Radionuclide scanning was useful in distinguishing bone infarction from orbital infection in one case.
The Bowel Cocktail
Authors: Bowie M. D. , Mann M. D. , Hill I. D.
Published: December 2021

Infantile gastroenteritis or infectious diarrhea of infancy remains a serious pediatric problem worldwide. It has been estimated that during 1975 500 million episodes of diarrhea occurred among the babies and young children of Asia, Africa, and Latin America, killing between 5 million and 18 million of them.1 Only improvements in the socioeconomic conditions, housing, education, and nutritional status of these communities will result in diarrheal disease receding from its present position as the major cause of death of infants and young children. In the interim an attempt must be made to reduce the high mortality which is due firstly, in the acute phase, to water and electrolyte loss and secondly, in the later stages, to the diarrhea leading to further debility, malnutrition, and the well-known vicious cycle of undernutrition and gastroenteritis.
Competitive Athletics for Children of Elementary School Age
Authors: Schaffer Thomas E. , Coryllos Elizabeth , Dyment Paul G. , Flynn Thomas G. , Luckstead Eugene F. , Smith Nathan J. , Strong William B. , Van Rooy Clemens W. , Baker Frederick W. , Burkett Lucille , Levison Henry , Malacrea Richard
Published: December 2021

Competitive sports sponsored by schools or other community agencies are now so universally played by boys and girls 13 years old and younger that there is a compelling need for positive and realistic guidelines to govern participation.

Young children are not miniature adults; they are boys and girls in the process of maturing into adults. They seek and can profit from suitable play opportunities, but the benefits do not come without prudent planning. High quality supervision and a broad range of physical education activities, including sports adapted to the needs and capacities of growing children, are required for a full realization of benefits.

A sound physical education program includes a variety of competitive and recreational sports to guarantee that all children in the school system or community have a fair share of available funds, facilities, instruction, and leadership. A varied sports program provides a meaningful experience for all children, not just the physically gifted, the well developed, or the precocious.

Sports have important effects on stamina and physiologic functioning, and some have lifelong value as recreational activities. These positive aspects should be emphasized in athletic programs by encouraging sports that are appropriate for children of elementary school age. These sports include bowling, golf, skating, swimming, tennis, and running.

There is no physical reason to separate preadolescent children by sex in sports, physical education, and recreational activities. However, girls should not participate against pubertal and postpubescent boys in heavy collision sports because of the risk of serious injury due to their lesser muscle mass per unit of body weight.
Letters to the Editor
Authors: Turkel Susan Beckwitt
Published: December 2021

We too have been interested in the phenomenon of yellow hyaline membrane disease (YHMD) and have surveyed its incidence at our institution.1,2 It rose from an incidence of 8% of all cases of hyaline membrane disease in 1970 to 43% in 1977, during the same period as our kernicterus study. We evaluated all 64 infants in the study, 32 with kernicterus and 32 without, and found the same number of cases (approximately one third) of YHMD in both groups which did not necessarily occur in corresponding matched pairs. We found no correlation between the occurrence of kernicterus and YHMD, contrary to the findings of Doshi and associates.
Height Predictions in Girls with Idiopathic Precocious Puberty by the Bayley-Pinneau Method
Authors: Kirkland John L. , Gibbs Ann R. , Kirkland Rebecca T. , Clayton George W.
Published: December 2021

Eleven girls with idiopathic precocious puberty had height predictions determined at various ages prior to obtaining mature heights. The Bayley-Pinneau method of height prediction produced both overestimation and underestimation. Height predictions were more accurate at chronologic ages approaching mature heights.
Biochemical Aspects of Urea Cycle Disorders
Authors: Snodgrass P. J.
Published: December 2021

In this paper I will review the biochemistry of the urea cycle of mammalian liver and point out the important clinical implications of this biochemistry. Second, I will consider some problems that arise in the use of human liver enzyme assays for evaluating deficiencies of urea cycle enzymes. Finally, I will comment on our own research concerning enzyme induction of the urea cycle of mammalian liver.

In Fig 1 the urea cycle is reviewed. Within the mitochondrion of the liver cell, ammonium cation combines with bicarbonate anion and 2 moles of adenosine 5'-triphosphate (ATP) in the presence of an activator, N-acetylglutamate, to form carbamylphosphate. Enzyme 1, which carries out this reaction is carbamylphosphate synthetase I (CPS1). There is also another enzyme, CPS2, in the cytoplasm of liver cells about which more will be said later. Once carbamylphosphate is formed, the carbamyl group is transferred to the δ-amino group of ornithine to form citrulline. The enzyme in this reaction, enzyme 2, is ornithine transcarbamylase (OTC). Citrulline escapes, by a process other than active transport, into the cytoplasm where it is conjugated with aspartate to form argininosuccinate; this is accomplished by enzyme 3, argininosuccinate synthetase (AS). Argininosuccinate, a double amino acid, is then cleaved to yield fumarate, and the nitrogen of aspartate moves to arginine. The enzyme in this reaction, enzyme 4, is argininosuccinate lyase (AL); its trivial name is argininosuccinase. Finally, arginine undergoes cleavage of its ureido group by enzyme 5, arginase, to form urea and regenerate ornithine. Ornithine is then taken up into the mitochondria by an active transport process to combine again with carbamylphosphate.
Clinical Aspects of Disorders of the Urea Cycle
Authors: Snyderman Selma E.
Published: December 2021

SYMPTOMS

All of the defects of the urea cycle may result in the accumulation of ammonia. This is manifested clinically by episodes of vomiting, lethargy, seizures, coma, and ultimately in death if the hyperammonemia is not controlled. In older children these symptoms may be preceded by a period of irritability and hyperactivity. It has usually been considered that the severity of the hyperammonemia depends on the site of the block; the nearer it is to ammonia, the greater the accumulation. There are, however, exceptions, as hyperammonemia leading to neonatal death has been observed in arginino-succinate lyase deficiency,39,40 the fourth step in the cycle. Death due to hyperammonemia has been observed in all the defects except arginase deficiency.41-43 There are variations in the severity of the clinical course of all of these syndromes; the exact reason for this has not been ascertained, although it is quite possible that this is related to the degree of residual enzyme activity. Thus, carbamylphosphate synthetase deficiency has been associated both with death in the newborn period or survival without specific treatment but with physical and mental retardation for a number of years.42-44

The clinical features of ornithine transcarbamylase deficiency have been the most completely described.45,46 As this anomaly is inherited as a sexlinked dominant, males are most severely affected, and neonatal death has been almost universal.13 Males who have survived without the most vigorous treatment have had a variant of the disease,47,48 the enzyme having different kinetic properties. Females who have various degrees of residual enzyme activity usually do not manifest symptoms until sometime after the neonatal period, often in response to some stress.
Pneumocystis
Authors: Meuwissen Hilaire J.
Published: December 2021

The authors of "Pneumocystis carinii Pneumonitis in Young Immunocompetent Infants" (Pediatrics 66:56, 1980) are to be congratulated on the development of a rapid test for demonstrating circulating antigens of Pneumocystis carinii and its application to the problem of pneumonia in young infants.

However, their statement "The findings of this prospective study clearly indicate, however, that P carinii is also etiologically linked to pneumonitis in young immunocompetent hosts without underlying illnesses" is open to challenge.

The study infants were between 2 and 12 weeks of age.
Letters to the Editor
Authors: Stagno Sergio , Pifer Linda L. , Hughes Walter , Brasfield Dana M. , Tiller Ralph E.
Published: December 2021

Because of the prospective nature of our studies we have had the opportunity to examine a total of 19 patients with pneumonitis associated with Pneumocystis carinii antigenemia. In order to respond to Dr Meuwissen's comments we elected to analyze the data from the total group rather than from the original nine.

Two previous studies clearly show that at least 75% of presumably healthy children and adult blood donors have antibody to P carinii. This infers that infection occurred early in life.
Diaper Rash
Authors: Wiener Fred
Published: December 2021

The article by Weston et al (Pediatrics 66:532, 1980) is an excellent resume of current concepts of diaper dermatitis. This is not to say, however, that previous concepts were necessarily in error. If my memory serves me rightly, there have been at least three changes in the nature and incidence of various types of diaper rash in the past 30 to 40 years, and I strongly suspect that these may be related to technologic changes in the diaper itself.
Febrile Child Evaluation
Authors: Mangravite Donald N.
Published: December 2021

I believe that Drs Baron and Fink (Pediatrics 66:171, 1980) have made an important contribution to the office evaluation of the febrile child. However, although their proposed screening test (ie, three of the following four findings: WBC count ≥15,000/cu mm, total segmented neutrophils ≥10,000/cu mm, total band cells ≥500/cu mm, and total polymorphonuclear leukocytes ≥10,5000/cu mm) is both sensitive (0.875) and specific (0.924); its predictive value is positive,1 ie, the likelihood that a child with three of the four criteria has bacteremia is low, 0.41 [true positive (7)/true positive (7) plus false positive (10)].
Complete Blood Cell Counts and Infection
Authors: Karniski Walt
Published: December 2021

I remember reading Todd's article1 as a medical student and feeling that he had simplified medical practice considerably, by "proving" that a complete blood cell count (CBC) could accurately distinguish between any child with bacteremia and a child with a viral illness. The article by Baron and Fink2 brought that memory to mind again, and therefore necessitates words of caution.

When considering the efficacy of a test, it is helpful to consider a two-by-two table as follows, in which the Baron and Fink data are presented:
PRESIDENT OF YALE ASSAILS AS ‘EXCESSIVE’ US REGULATIONS ON RESEARCH
Authors: L. J. F.
Published: December 2021

A. Bartlett Giamatti, the president of Yale University has deplored the "mounting wave of regulation" and "requirements for massive amounts of paperwork" that he said Federal agencies heaped upon researchers supported by Government grants. Echoing a strong note of discontent voiced by many active in university-based scientific research, Mr Giamatti said "excessive or unthinking regulation" had damaged the relationship between government and universities. "There is a powerful resentment on all sides, and distrust," he told 500 people at the opening dinner of the annual Association of Yale Alumni assembly. "A radical skepticism bordering on open contempt for our centers of learning surfaces again."

Researchers at universities across the country have been protesting strongly against a government regulation, put into effect three months ago, that requires them to complete detailed "personnel activity reports" before they are reimbursed for "indirect costs"–overhead expenses–incurred during their work. Of $68 million Yale received in federal funds last year, Mr Giamatti said, $21 mfflion was for "indirect costs."

Under the new rule, researchers at Stanford University say they will have to complete 80,000 reports instead of the present 3,000, at a cost of between $250,000 and $300,000, Mr. Giamatti told the assembly, quoting from an article in Science magazine.

Critics also point to a 1968 Bureau of the Budget report evaluating time and effort reports when the original A-21 regulation, written in 1958, was revised in 1967 to include these reports. "Time or effort reports now required of faculty members are meaningless and a waste of time," the 1968 report says.
BCG VACCINE
Authors: BEAVEN PAUL W.
Published: December 2021

It is evident that the time has arrived when pediatricians in this country should have expert advice on the use of BCG in the control of tuberculosis in children. Other parts of the world are now confronted with an increase in this disease. They are establishing programs to resist this infection, and their respect for the value of BCG is attested to by the fact that its use forms a major part of such programs. Physicians returning to America from these countries are advising us to accept this additional technic in our attempt to eradicate tuberculosis.

This symposium is the result of many requests from our members. In order to obtain divergent viewpoints, four speakers have been chosen whose opinions each of us respects but who have come to different conclusions.

Dr. J. A. Myers is the first speaker. He has spent his professional life in combatting tuberculosis in children and young adults. Following him, Dr. Sol Roy Rosenthal will speak. He is Director of the Tice Laboratories affiliated with the University of Illinois. This institution is one of the main distributors of BCG in this country. The next speaker is Dr. Milton Levine, Chief Consultant on BCG vaccination to the New York State Health Department. The concluding paper on the symposium will be given by Dr. Robert Anderson, Chief Medical Director, Division of Tuberculosis, of the U. S. Public Health Service.
Acute Hyponatremia and Seizures in an Infant After a Swimming Lesson
Authors: BENNETT HOWARD J. , WAGNER TEEKIE , FIELDS ALAN
Published: December 2021

There have been a number of recent reports describing water intoxication in infants.1-4 In each case, hyponatremia followed an excessive intake of free water, either as the result of feeding mismanagement1-3 or vigorous hydration with water during a febrile illness.4 This report describes an infant who developed hyponatremia and seizures after swallowing an unknown volume of water during a swimming lesson. We will discuss the case and comment on present recommendations for preschool swimming instruction.

CASE REPORT

An 11-month-old girl was in excellent health until the day of admission. During a 60-minute swimming lesson, she was noted to swallow more water than usual, but exhibited no unusual symptomatology while in the pool.
Revisited: Aerosol Corticosteroids in the Treatment of Childhood Asthma
Authors: RACHELEFSKY GARY S. , SIEGEL SHELDON C.
Published: December 2021

Systemic corticosteroids were introduced in the 1950s for the treatment of asthma. Usually, excellent results were obtained although a number of side effects became apparent. Prolonged use of corticosteroid therapy for asthma remains quite controversial, and it is often regarded as an inappropriate treatment modality. Inasmuch as complications from corticosteroids are largely dependent on dose and duration of therapy, it was reasoned that by topically administering the corticosteroids, the amount of drug necessary to control symptoms would be reduced and, in turn, lessen the number of adverse effects. Initially developed corticosteroid aerosols produced variable effectiveness with associated systemic side effects.1
More on Newborn Screening for Phenylketonuria: Recommendations of the Committee on Genetics
Authors: SCRIVER CHARLES R.
Published: December 2021

In Reply.—

In the 12 months subsequent to publication of the statement by the Committee on Genetics,1 there has been no adverse correspondence with the Journal or the Academy on the issues raised in the statement. Nonetheless, Schoen now raises a question of potentially broad relevance; it concerns the recommendation about repeat testing for hyperphenylalaninemia in the newborn discharged from the nursery before the third day of life. Schoen is critical of the data that the Committee used to reach its conclusions.
Infant Drownings in Toilets!?
Authors: NEHAMEN DENNIS A.
Published: December 2021

To the Editor.—

Because of a growing recognition of fatalities or near-fatalities resulting from infants drowning in toilets, I am conducting a broad research survey. I am seeking brief capsule reports of noted incidents and would like to add that in the event the research is ultimately published, honorariums will be paid to contributors.
Some Pediatricians Uninformed
Authors: WEISS JEFFREY C. , DE JONG ALLAN R. , CALLAHAN CLARA
Published: December 2021

To the Editor.—

Policy statements and articles that appear in Pediatrics, Pediatrics in Review, and News and Comment of the American Academy of Pediatrics attempt to disseminate information about various legal and social issues that are important to pediatricians. Because we were interested to learn whether or not our house officers were knowledgeable in these areas, we administered a quiz to the 22 residents and to the 15 full-time faculty members in our department. The physicians could respond by marking "true," "false," or "don't know."
Sexually Transmitted Diseases in Sexually Abused Children
Authors: White Susanne T. , Loda Frank A. , Ingram David L. , Pearson Anna
Published: December 2021

Over a 4-year period, 409 cases of suspected sexual abuse of children were reviewed to study sexually transmitted disease (STD). Sexually transmitted disease was identified in 54 (13%) of the 409 children: 46 cases of gonorrhea, six cases of syphilis, four cases of trichomoniasis, and three cases of condyloma acuminata. Nine of the 46 children with cultures positive for gonorrhea did not have a history of discharge. Four of the six children with syphilis also had a gonococcal infection. One child with syphilis had condyloma. Only one child had clinical features of syphilis. Sexually transmitted disease was more likely to be transmitted by an extended family member or a nonfamily member than by a father/stepfather (P < .001). Laboratory tests that identify sexually transmitted disease may aid in the diagnosis of sexual abuse.
Neonatal High-Frequency Jet Ventilation
Authors: Pokora Thomas , Bing Dennis , Mammel Mark , Boros Stephen
Published: December 2021

Ten neonates with intractable respiratory failure were treated with high-frequency jet ventilation (HFJV). Nine had progressive pulmonary air leaks with either bronchopleural fistulas or pulmonary interstitial emphysema as the primary cause of their respiratory failure. Following HFJV, x-ray film evidence of pulmonary air leaks decreased in seven of the nine neonates. Pao2/FIO2 increased in eight of the ten patients (P <. 05), and Paco2 values decreased in nine of the ten patients (P < .01). Five patients survived. Three of the six patients exposed to HFJV for more than 20 hours developed significant tracheal obstruction. From this experience, it may be concluded that HFJV can successfully ventilate certain neonates with intractable respiratory failure secondary to progressive pulmonary air leaks. In its present form, long-term neonatal HFJV carries a risk of airway obstruction and/or damage.