bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated Renin Levels in Normotensive Adolescents
Authors: Goldberg Samuel , Krishan Iqbal , Hames Curtis B. , Knight Melanie , Spierto F. W.
Published: December 2021

When plasma renin determinations were performed on a large group of adolescents (ages 12 to 15 years) and adults (ages 17 to 60 years), significantly higher levels (p < 0.05) of plasma renin were found in the adolescents (0.72 ng/ml/hr) than in the adults (0.49 ng/ml/hr).
Automated Multiphasic Screening
Authors: Allen C. M. , Shinefield H. R.
Published: December 2021

From our experience with automated multiphasic health tests in more that 20,000 children, we have formed the following tentative conclusions. Multiphasic testing, combining a group of tests for administration at a single session, is less costly in time and inconvenience to the patient and provides more useful information to the evaluating and treating physician than does an uncoordinated set of individual tests.

Automation of instruments, use of nonprofessional testers, and computer processing of data can markedly reduce the usual cost of acquiring standard data provided that (1) there is a large number of persons from which standardized data are to be acquired; (2) the acquisition of the data can be scheduled so that specialized equipment and personnel are fully utilized; (3) automated equipment is used only when there is a real advantage over manual equipment.

These potential benefits of automated multiphasic testing are severely limited by (1) the lack of knowledge and agreement about what standard information is useful for improving the health care of children; and (2) the problems involved in ensuring appropriate follow-up examinations.

Our purpose in presenting these conclusions is not to support or condemn automated multiphasic testing or screening, but rather to point out that a number of unsolved problems exist. They will not be solved unless all who engage in automated multiphasic screening, or any kind of screening, arrange their testing and data keeping procedures so that the new knowledge necessary for evaluating programs and resolving unsolved problems can be gained. Until we have such knowledge, we must be modest and tentative in our claims that automated multiphasic screening can contribute positively to the health care of children.
Familial Aggregation of Blood Pressure in Childhood Is Hereditary
Authors: Biron Pierre , Mongeau Jean-GUY , Bertrand Denise
Published: December 2021

Families with at least one adopted child constitute a useful epidemiological unit in which to study the relative contribution of genes and environment to the familial clustering of blood pressure, already observed in natural children aged 2 to 14 by Zinner's group in Boston.2

Provided that adoption occurs shortly after birth, both adopted and natural children are exposed to the same household living conditions such as dietary salt and calories, exercise habits, and psychological atmosphere, to mention a few.
Answers to Saintly Diseases
Authors: C. T. E.
Published: December 2021

1. St. Agnan's disease Ringworm

2. St. Anthony's fire Erysipelas

3. St. Avertin's disease Epilepsy

4. St. Blaize's disease Quincy

5. St. Erasmus' disease Colic

6. St. Gothard's disease Ancylostomiasis

7. St. Guy's dance Sydenham's chorea

8. St. Main's evil Scabies

9. St. Valentine's disease Epilepsy

10. St. Vitus' dance Sydenham's chorea

11. St. Zachary's disease Mutism
Pseudohermaphroditism, Nephron Disorder and Wilms' Tumor: A Unifying Concept
Authors: Barakat Amin Y. , Papadopoulou Zoe L. , Chandra Roma S. , Hollerman Charles E. , Calcagno Philip L.
Published: December 2021

Barakat, A. Y., Papadopoulou, Z. L., Chandra, R. S., Hollerman, C. E., and Calcagno, P. L.: Pseudohermaphroditism, nephron disorder, and Wilms' tumor: A unifying concept. Pediatrics, 54:366, 1974.

The authors inadvertently omitted to credit Figure 3 (p. 368) to Dr. Robert W. Miller.
Biliary atresia
Authors: Gellis Sydney S.
Published: December 2021

It is difficult for me to find fault with Dr. Lilly's presentation, especially since he refers to me as a fair-minded, clear-thinking man!

Dr. Thaler and I concluded in 1968 that the chance of encountering a patient with operable atresia of the extrahepatic biliary ducts was so small that our primary obligation was to protect the infant with neonatal hepatitis from unnecessary and potentially harmful anesthesia and exploration. Much of our data came from an era when surgeons conducting explorations to differentiate neonatal hepatitis from biliary atresia took an inordinate time to look for ducts, perform an operative cholangiogram, and take a liver biopsy.
Suprarenal Abscess in the Neonate: A Case Report and Review of Diagnosis and Management
Authors: Blankenship Willard J. , Bogren Hugo , Stadalnik Robert C. , Vitale Dennis E.
Published: December 2021

A case of unilateral suprarenal abscess is reported. This is the third such reported case, and the first reported case successfully treated with preservation of the kidney. Diagnosis and treatment were aided significantly by a thorough preoperative radiological evaluation, including angiography.
Compatible Transfusion Therapy for Paroxysmal Cold Hemoglobinuria
Authors: Rausen Aaron R. , LeVine Robert , Hsu Tony C. S. , Rosenfield Richard E.
Published: December 2021

Two children with paroxysmal cold hemoglobinuria (PCH) are described. Both cases were associated with cold-warm serum lysins having anti-Tja activity. Transfusion with compatible frozen-thawed red cells tided these children over the critical acute hemolytic phase of the syndrome. These are the first recorded examples of successful compatible transfusion therapy in PCH.
Iatrogenesis imperfecta—a new pediatric problem
Authors: Morrow Grant
Published: December 2021

In this medical age which relies heavily on electronic and technologic advances, the physician is often willing to place unwarranted confidence in laboratory data regarding his patients. In those unusual situations in which the patient is not directly examined, e.g., prospective screening or prenatal diagnosis, treatment errors can be made. These acts of commission are initiated by interpretation of laboratory data and can result in detrimental effects to the patient. The term iatrogenesis imperfecta has been designated to describe this situation.
Lettrt To The Editor
Authors: Leonard Martha F. , Landy Gail
Published: December 2021

Dr. Hook's comments about our study are received with appreciation. Children with abnormalities of the sex chromosomes are so rare that it is difficult for any one center to see enough of them to make valid conclusions about differences in their development. However, it is possible that pooling of data from several centers will show significant trends. In fact, in June 1974, investigators from a number of centers where prospective studies of such children are being conducted met to share their data and consider a plan for some ongoing collaboration.
What Is the Prognosis in Subarachnoidal Bleeding in Infants?
Authors: Gresham Edwin L. , Schreiner Richard L.
Published: December 2021

Prod'hom et al.1 presented their results concerning the quality of survival of newborns with respiratory distress. They found 7 of 355 patients with hydrocephalus or porencephaly, apparently secondary to an intracranial hemorrhage. They conclude "it seems fully justified to stop all reanimation practices including mechanical ventilation, once the diagnosis of ventricular or subarachnoidal hemorrhage has been made."

Most physicians caring for sick newborns would agree that massive intraventricular hemorrhage in the newborn almost always results in death or severe long-term neurologic impairment.
Can Neonatal Assessment Predict Withdrawal Symptoms?
Authors: Maniello Robert L.
Published: December 2021

The data presented by Soule et al1. on the clinical application of the Brazelton Neonatal Scale in differentiating addicted infants from a control group is reminiscent of studies that our group reported on the effects of obstetric meperidine on neonatal status assessment.2 A one-month follow-up of these infants (Brackbill et al.2, Table 2) has revealed persistent habituation abnormalities. Indeed, the Assessment Scale is clinically useful in predicting the physiologically distressed infant.

However, its influence on the therapeutic management of the addicted newborn is somewhat tenuous.
Cues for Screening Language Disorders in Preschool Children
Authors: Schwartz Arthur H. , Murphy Michael W.
Published: December 2021

This article has described procedures and criteria a pediatrician may employ during office evaluation to identify children suspected of having a developmental language disability. Disruptions in vocabulary comprehension, vocabulary production, sentence organization, use of word forms, and articulation patterns are important cues signaling the need for referral for a speech and language evaluation. The 1970 NINDS1 estimate that no less than one out of every 170 children has a developmental disability affecting the development of language suggests that one or more such children with such a disability enter the pediatrician's office each week. Many of the negative consequences of this problem may be prevented or greatly reduced by early detection and appropriate referral based upon the information described in this article.
Treatment of Acrodermatitis Enteropathica With Zinc Sulfate
Authors: Robertson Alex F. , Sotos Juan
Published: December 2021

Dr. Moynahan reported recently the successful treatment of acrodermatitis with zinc sulfate. He informed us that nine of his patients have continued in remission with this treatment and that approximately 20 patients in Scandinavia are responding to this treatment. Since the use of diiodohydroxyquin is sometimes complicated by optic atrophy2 and since zinc treatment has not been reported in this country, we felt it important to describe the successful use of zinc sulfate in two patients and to urge physicians in the United States to try this treatment.

CASE REPORTS

Case 1

C.R. is an 8-year-old white girl diagnosed at 1 month of age as having acrodermatitis and subsequently studied for fatty acid metabolism3 and tryptophan metabolism.4
Comments and Questions on the Neurotoxicity of Hexachlorophene
Authors: McCarl G. W.
Published: December 2021

The following comments are offered in response to the recent article by Shuman et al. in Pediatrics.1

The selection of the population is biased since it is not a representative sample. Over 165 cases with unknown pathology were excluded. Consequently, the histopathology was not representative of the overall experience. Furthermore more, information from the same institution by Alden et al.2 is significant. This paper describes the fate of the infants born at the University Hospital in Seattle.
Group G Streptococcal Sepsis
Authors: Brans Yves W.
Published: December 2021

I have read with interest Dr. Baker's report of a case of neonatal septicemia due to group G Streptococcus.1 Over a period of 11 months, this unusual organism was responsible for systemic infections in two neonates from this nursery.

CASE REPORTS

Baby N.G. was a 2,520 gm, white boy born after an uncomplicated 34-week gestation. Delivery was uneventful with a one minute Apgar score of 9. Membranes had ruptured spontaneously eight hours before delivery. Grunting, retractions, and cyanosis were first noted 15 minutes after delivery.
Varicella in Children With Cancer: Seventy-Seven Case
Authors: Feldman Sandor , Hughes Walter T. , Daniel C. B.
Published: December 2021

The purpose of this study was to characterize varicella in childhood cancer patients. Seventeen of the 77 patients reviewed were in remission and off all therapy for 3 to 22 months. No one in this group died from varicella or had evidence of visceral dissemination. Among the remaining 60 patients, all of whom were receiving anticancer therapy when they developed vancella, 19 (32%) had visceral dissemination and 4 died, for a mortality rate of 7%. Each of the deaths was associated with primary varicella pneumonitis, with or without acute encephalitis. Visceral dissemination was not related to type or status of malignancy or to duration of specific anticancer therapy. Varicella was more likely to disseminate in children with absolute lymphopenia, less than 500 cells per cubic millimeter, than in patients with higher lymphocyte counts. Cessation of anticancer therapy prior to the onset of lesions appeared to lessen the risk of dissemination. These results show that varicella is more severe in cancer patients on therapy than in the general population or in patients who have completed therapy, but is not highly fatal.
Dr. Sweet Replies
Authors: Sweet Avron Y.
Published: December 2021

The tabular material of the cooperative study' referred to by Scratcher is as quoted. He's right. And when I am scratched, I bleed.

Our mode of operation back in 1964 through most of 1968 was based on the assumption that 48 hours of liberal oxygen therapy was proper because it would provide most infants with RDS great benefit and, according to the cooperative study, little risk of eye damage when given over that two-day period.
Visual Following and Pattern Discrimination of Face-like Stimuli by Newborn Infants
Authors: Goren Carolyn C. , Sarty Merrill , Wu Paul Y. K.
Published: December 2021

Forty newborn infants, median age 9 minutes, turned their eyes and heads to follow a series of moving stimuli. Responsiveness was significantly greater to a proper face pattern than to either of two scrambled versions of the same stimulus or to a blank.

The demonstration of such consistent response differences suggests that visual discriminations are being made at this early age. These results imply that organized visual perception ion is an unlearned capacity of the human organism. The preference for the proper face stimulus by infants who had not seen a real face prior to testing suggests that an unlearned or "evolved" responsiveness to faces may be present in human neonates.
Free Running Test for Exercise-Induced Bronchospasm
Authors: Pierson William E. , Blerman C. Warren
Published: December 2021

The free running test has been successfully carried out in patients from 5 to 21 years old. It has the following advantages: (1) it simulates normal exercise pattern; (2) it is readily performed in any health care setting; (3) it is simple to perform and noninvasive in nature; and (4) it reveals a maximum decrease in forced expiratory volume at one second at five minutes after the exercise period. There seems to be a seasonal variation that may alter outcome of tests.
YOUTH: TRANSITION TO ADULTHOOD
Authors: H. R. J.
Published: December 2021

The Coleman Report on inequality of education in the mid 1960's was one of the most influential reports of that decade. Now, in the mid-1970's, a second Coleman report, this time on youth, has appeared, together with a thoughtful appraisal of this report by over a dozen critics. Taken together they stake out the formidable problems faced by youth today, and of course these problems are those of our whole society. Coleman II and the critiques should receive as wide distribution and discussion as Coleman I. As Havighurst says in his review, ". . . the 10 year period 1974-1984 will be one of major constructive attention by American society to its young people and their problem of growing to maturity in a society which at present does not have adequate institutions to support and facilitate transition from youth to adulthood." The report recommends that society develop new environments for youth "designed to develop not only cognitive learning but other aspects of learning as well."
Studies on the Pathophysiology of Encephalopathy in Reye's Syndrome: Hyperammonemia in Reye's Syndrome
Authors: Shannon Daniel C. , De Long Robert , Bercu Barry , Glick Thomas , Herrin John T. , Moylan Fergus M.B. , Todres I. David
Published: December 2021

The initial acid-base status of eight survivors of Reye's syndrome was characterized by acute respiratory alkalosis (Pco2=32 mm Hg; Hco3-= 22.0 mEq/liter) while that of eight children who died was associated with metabolic acidosis as well (HCO3-=10.0 mEq/liter). Arterialinternal jugular venous ammonia concentration differences on day 1 (299 mg/100 ml) and day 2 (90 mg/ 100 ml) reflected cerebral uptake of ammonia while those on days 3 and 4 (-43 and -55 mg/100 ml) demonstrated cerebral release. Arterial blood hyperammonemia can be detoxified safely in the brain as long as the levels do not exceed approximately 300µg/100 ml. Beyond that level lactic acidosis is observed, particularly in cerebral venous drainage. Arterial blood hyperammonemia was also related to the extent of alveolar hyperventilation. These findings are very similar to those seen in experimental hyperammonemia and support the concept that neurotoxicity in children with Reye's syndrome is at least partly due to impaired oxidative metabolism secondary to hyperammonemia.
Pseudomonas cepacia in an Intensive Care Nursery
Authors: Rapkin Richard H.
Published: December 2021

A small epidemic of Pseudomonas cepacia infection in an intensive care nursery was associated with contaminated, distilled water. This appeared to have occurred because of a leak in the distiller, contaminating its effluent. The distilled water was not subsequently sterilized, nor were the bottles used to distribute it. The epidemic was promptly terminated by substitution of sterile, distilled water distributed in sterile containers. Both professional and nonprofessional hospital personnel failed to oversee the appropriateness of handling of patient care materials.
DR. SAMUEL NESBITT'S CASE REPORT OF DYSENTERIC SYMPTOMS FROM WORMS IN A TWO-YEAR-OLD CHILD–PUBLISHED IN 1788
Authors: C. T. E.
Published: December 2021

In 1788 the Medical Society of New Haven County published a pamphlet of eighty-six pages entitled Cases and Observations: By the Medical Society of New-Haven County. This volume is of historical interest because it was the first volume of transactions published by a Medical Society in the United States.1

Dr. Nesbitt, the author of the case report below, was a Scot who probably was trained at Edinburgh. He practiced medicine in New Haven for about 12 years. Modern readers will appreciate the author's candor in admitting his mistaken diagnosis. Dr. Nesbitt's spelling and punctuation have not been changed.

In the winter of 1784, I was called to visit a child of the Rev. Bela Hubbard, Aged two years.
Removal of Foreign Bodies From Esophagus and Stomach With Flexible Fiberoptic Panendoscopes
Authors: Christie Dennis L. , Ament Marvin E.
Published: December 2021

Accidentally swallowed foreign bodies were removed from the esophagus or stomach in six children using flexible panendoscopes. Complications did not occur. The increased flexibility of these new instruments allows removal of objects from the stomach that would previously have required gastrotomy. Our experience suggests that fiberoptic endoscopy should be used for removal of foreign bodies.
Toxic Megacolon of Ulcerative Colitis in Infancy
Authors: Karjoo Manouchehr , McCarthy Brian
Published: December 2021

A 12-week-old white male infant with ulcerative colitis and toxic megacolon is described. His diarrhea and rectal bleeding responded to prednisone. He subsequently developed toxic dilatation of the transverse colon while on salicylazosulfapyridine and one week after discontinuation of prednisone. His toxic megacolon disappeared during close medical observation, readministration of prednisone, and avoidance of repeated abdominal examinations. One year later sigmoidoscopy showed only friable mucosa and the barium enema showed the presence of ulcerative colitis but with improvement from the initial study. Currently he is taking 375 mg of salicylazosulfapyridine daily. Growth and development are normal and he is asymptomatic.
Calcium Accumulation by the Human Fetus
Authors: Forbes Gilbert B.
Published: December 2021

Shaw has characterized the calcium content of the fetus by means of an exponential equation in which the independent variable is gestational age.1,2 However, a plot of his data shows a rather large amount of scatter about the calculated regression line, but no estimate of the magnitude of the deviation from regression is given.

The following is another method of dealing with these data, based on the principle of heterogonic, or allometric, growth,3 which states that body calcium content is a power function of body weight.
The endurance of uncertainty
Authors: Berwick Donald M.
Published: December 2021

In the debate about cholesterol and coronary heart disease (CHD), the score seems perpetually tied. In 1972, the Intersociety Commission for Heart Disease Resources recommended pervasive dietary changes to lower cholesterol levels for all Americans.1 In the same year, partially in response, the Committee on Nutrition of the American Academy of Pediatrics published its opinion that "dietary intervention, at present, is experimental and...[the committee recommends]...against dietary changes for all children."2 Contradictory recommendations about pediatric intervention issue from two equally prestigious oracles.

This issue of Pediatrics contains two additions to the weighty files of evidence on the relationships between cholesterol and CHD.3,4
Gonococcal Periappendicitis and Salpingitis in a Prepubertal Girl
Authors: Auman George L. , Waldenberg Leopold M.
Published: December 2021

Gonorrhea is the most frequently reported infectious disease in the United States. Salpingitis and periappendicitis secondary to vaginal gonorrhea are not unusual in the mature woman, but are rare in the prepubertal girl. We are reporting a case of vaginal gonorrhea, acute salpingitis, and periappendicitis in a 5-year-old girl.

CASE REPORT

An acutely ill 5-year-old girl with a two-week history of a thick, nonpruritic vaginal discharge and an 18-hour history of fever, vomiting, and severe abdominal pain was admitted for evaluation. There was a negative history of dysuria, constipation, diarrhea, introduction of vaginal foreign body, coitus, and molestation.

Vital signs on admission were: temperature, 39.7 C orally; pulse, 120 beats per minute; respiration, 36 breaths per minute; and blood pressure 100/60.
Studies of Anabolic Steroids: V. Effect of Prolonged Oxandrolone Administration on Growth in Children and Adolescents With Uncomplicated Short Stature
Authors: Moore Dan C. , Tattoni Diana S. , Limbeck George A. , Ruvelcaba R. H.A. , Lindner Diana S. , Gareis Frank J. , Al-Agba Saad , Kelley Vincent C.
Published: December 2021

A total of 130 patients with uncomplicated short stature (4 to 17 years of age) were treated with oxandrolone, 0.25 mg/kg/day, for up to four years. Oxandrolone therapy resulted in a two-fold increase in mean growth velocity in the first six months of therapy and was an effective growth stimulant for the full four-year period. There was no overall adverse effect of oxandrolone on post-treatment mean growth velocity or on skeletal maturation relative to height gain. There were 37 patients with greater increase in height age than bone age and 22 patients with greater increase in bone age than height age. Assessment of the contribution of oxandrolone therapy to the latter group is difficult because of inadequate methodology and the wide variation in individual growth patterns. Taken in their entirety, the data suggest that oxandrolone is useful in the prolonged treatment of uncomplicated short stature and is not associated with undesirable acceleration of skeletal maturation.
Growth of Hyperkinetic Children Taking Methylphenidate, Dextroamphetamine, or Imipramine/Desipramine
Authors: Gross Mortimer D.
Published: December 2021

One hundred children with the hyperkinetic syndrome or minimal brain dysfunction syndrome were treated with medication: 60 with methylphenidate (Ritalin), 24 with dextroamphetamine (Dexedrine), and 16 with either imipramine or desipramine. The duration of treatment was for a minimum of two years, and averaged five years, with an average follow-up of six years from the onset of treatment. Their weight and height had been measured prior to treatment, and these and subsequent measurements were converted to percentiles, using the tables of norms of the Iowa City study. Initially there was a diminution in expected weight, but not height, but after a few years the growth in weight and height was found to be greater than predicted from the norms to a statistically significant degree. Gains in weight and height were greater for those whose medication had been stopped prior to the final measurements than for those still taking medication; but these differences did not reach statistical significance. No correlations were found between dosage level and changes in weight and height percentiles. It is concluded that there is no stunting of growth from the long-term use of methylphenidate, dextroamphetamine, or imipramine/desipramine in children. Any slowing of growth when treatment is first started is compensated for later on, both while the patient is still taking the medication, and after discontinuing it.
Childhood Hypersensitivity Pneumonitis Due to Dove Antigens
Authors: Cunningham Allan S. , Fink Jordan N. , Schlueter Donald P.
Published: December 2021

A case of hypersensitivity pneumonitis due to doves is reported and compared with other cases due to dove or pigeon antigens reported in children. The diagnosis is substantiated by the presence of precipitating antibody to dove and pigeon serum, clinical improvement after contact with the doves was broken, and a positive response to inhalation challenge with pigeon serum. The insidious nature of this disease is emphasized as well as the importance of having detailed environmental information in children with unexplained respiratory disease.
Evaluation of Gastroesophageal Reflux Surgery in Children
Authors: Johnson Dale G. , Herbst John J. , Oliveros Miguel A. , Stewart David R.
Published: December 2021

Fifty-five infants and children with complications of gastroesophageal reflux required operative management for control of symptoms. All patients, except those with severe esophageal stricture, received a six-week trial with 60-degree constant elevation before an operation was considered necessary. The operation was performed to control (1) persistent vomiting, (2) vomiting with growth retardation, (3) esophagitis, (4) esophagitis with stricture, and (5) recurrent aspiration pneumonia. Preoperative and postoperative evaluation involved both X-ray fluoroscopy and esophageal manometry with pH studies. A good surgical result was not dependent upon an increase in the lower esophageal pressure following operation. The Boerema anterior gastropexy is simple and effective for controlling gastroesophageal reflux for cases uncomplicated by esophagitis, stricture, or previous operation. Complex cases with inflammatory or operative changes in the lower esophagus are more effectively treated by Nissen fundoplication.
YOU ARE WHAT THEY SEE
Authors: Rhodes P. H.
Published: December 2021

The value judgments about medicine are contributed to by the public image. Formerly this has been one of a devoted, caring, self-sacrificing, somewhat unworldly group of people, dedicated to their work for the suffering and diseased. But the doctors are not separate from society and they are affected by its values. These have been adopted by the profession so that it is coming to be seen as no worse and no better than any other group of comparable education and training. Its status has diminished and this has called into question its compensation at a high level. Status cannot be maintained when its base has been eroded.
Phagocyte Function in the Neonate: Selected Aspects
Authors: Miller Michael E.
Published: December 2021

It has become evident that a number of developmental deficiencies exist in the function of neonatal phagocytes. Although the degree to which each contributes to the recognized impairment of host defenses in the normal human neonate is yet unclear, we have derived much valuable information from the study of neonatal polymorphonuclear leukocytes (PMNs) and monocytes (MNLs). In this discussion, we focus upon three functional components of PMN—phagocytosis, bactericidal activity, and movement. This is followed by a brief consideration of correlative studies between neonatal PMNs and MNLs. A more detailed discussion of monocyte functions is found elsewhere in this symposium.

PMN PHAGOCYTOSIS

As with many in vitro systems, phagocytic assays vary considerably in design. Included among the important variables are cell concentration, opsonic concentration, type of particle being ingested, and phagocyte:particle ratio. Despite these differences, results obtained by most investigators studying neonatal PMNs have been reasonably consistent. The data fall into two groups. In the first, PMN phagocytosis has been studied in the presence of normal, or approximately normal plasma (or serum) concentration.1-5 In general, such experiments have yielded data suggesting that the neonatal PMN is equal to the adult PMN in phagocytic ability. A number of particles have been utilized in these studies, including Staphylococcus aureus 502A, Serratia marcescens, Sta pyogenes, Diplococcus pneumoniae, and Pseudomonas aeruginosa. The second group of studies has been carried out under "stress" conditions in vitro or in vivo, and suggest that the neomatal PMN is deficient in phagocytic ability when compared with that of the adult PMN.
Febrile Seizures: A Consensus of Their Significance, Evaluation, and Treatment
Authors: Freeman John M.
Published: December 2021

The National Institutes of Health recently convened experts from this country and abroad to present current knowledge about febrile seizures and their consequences, and about the risks and benefits of therapy. This information was presented to a panel under the chairmanship of Dr Edwin Kendig, former president of the American Academy of Pediatrics. The panel consisted of both academicians and practitioners. The accompanying statement represents the consensus of that panel.

The statement bears reading in its entirety, for it should influence the way that a pediatrician thinks about the child who has had a seizure with fever, how he evaluates and treats that child, and what he tells the parents.

The panel found that there were only two significant risks associated with febrile seizures: a 30% to 40% risk of recurrent febrile seizures and a slightly increased risk of later epilepsy. They found no evidence of mental or neurologic impairment due to the febrile seizure.

The panel concluded that daily phenobarbital in sufficient dosage to produce a blood level of 15 µg/ml could prevent recurrence of febrile seizures, but that there was no evidence that either the administration of phenobarbital or the prevention of recurrences prevented later epilepsy.

Phenobarbital was noted to produce side effects or toxic reactions in up to 40% of children. These included behavioral changes, sleep disturbances, and possible interference with learning. Valproic acid was also effective in preventing recurrences, but in view of the rare, but reported fatal hepatitis, liver function tests should be closely monitored.
Adult Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: Predisposing Conditions, Clinical Course, and Outcome
Authors: Lyrene Raymond K. , Truog William E.
Published: December 2021

Adult respiratory distress syndrome, commonly seen in adults, is not well recognized in children. A retrospective chart review was carried out to determine the relative incidence, predisposing conditions, clinical course, and outcome of children with adult respiratory distress syndrome. Fifteen patients were identified. The most common predisposing conditions were near-drowning and near-strangulation with a noticeable absence of major trauma. Mortality was 60%. Death was most often secondary to central nervous system complications. Air leak was the most common complication of treatment. Two of six survivors suffered major neurologic handicaps. Long-term pulmonary sequelae were minimal.
Acute Interstitial Nephritis in Children: A Report of 13 Cases and Review of the Literature
Authors: Ellis Demetrius , Fried William A. , Yunis Eduardo J. , Blau Edward B.
Published: December 2021

Clinical and pathologic data of 13 children, aged 5 to 16 years, with acute interstitial nephritis (AIN) are presented. The cause of AIN in these children was assessed as being related to infection in ten and methicillin in one; no infection, drug, or toxin could be implicated in two other patients. In addition to having various degrees of acute renal failure, all patients had systemic symptoms, most common of which were fatigue, fever, sore throat, and gastrointestinal disturbances. In six patients, the diagnosis of AIN was clinically suspected on the basis of tubular dysfunction such as low urinary specific gravity and glucosuria; in seven others the diagnosis was made after examination of the renal biopsy. Two patients had the nephrotic syndrome which resolved only after cytotoxic agents were added to corticosteroid therapy. The remaining 11 patients were given supportive therapy including peritoneal dialysis in one case. Complete recovery of renal function occurred in all patients within a mean interval of 69.5 ± 34.7 days from the onset of symptoms, and all patients continue to have normal renal function during a follow-up period ranging from 1.5 to 10 years. We conclude that, in children, AIN is underdiagnosed, is most often associated with streptococcal infection, and carries an excellent prognosis.
Prevention of Suicide
Authors: Behar David , Stewart Mark A.
Published: December 2021

The report on teenage suicide by the Committee on Adolescents (Pediatrics 66:144, 1980) was timely and worthwhile. We question their conclusions concerning prevention of adolescent suicide and management of those who have attempted suicide.

Successful suicide by adults is almost always associated with a readily diagnosed condition: depressive illness, alcoholism, dementia, schizophrenia, or antisocial personality.1,2 Unfortunately it is not yet clear which disorders in children or adolescents are likely to lead to suicide, although Shaffer3 has reported a strong association with conduct disorder.
Letters to the Editor
Authors: Cashore William J. , Oh William , Blumberg William E. , Lamola Angelo A.
Published: December 2021

We are not surprised that three methods, each determining the saturation of serum albumin with bilirubin by the addition of excess bilirubin, should correlate with each other. We have shown a similar correlation of bilirubin binding capacity by peroxidase and Sephadex methods in a previous article.1 We would be surprised if the addition of 2-( 4'-hydroxybenzene)azobenzoic acid (HABA) or another dye possibly bound to nonbilirubin sites on albumin would give a better correlation than the addition of bilirubin itself in different methods.
Down with Fragmentation
Authors: Low Merritt B.
Published: December 2021

Traditionally general practicing pediatricians and physical/occupational therapists have worked in the same world, but in separate hemispheres, with different languages being spoken and often little understood by one another. Perhaps the fault lies more with pediatricians than therapists, though often for good reasons (time, interests, priorities). A special article in this issue entitled "Communication Between Physician and Physical and Occupational Therapists: A Neurodevelopmentally Based Prescription" (p 208) points out some of the classic guidelines concerned with the issue of prescriptions for therapy. The physician needs help in writing the prescription, the therapist in finding firm, medically credible bases for courses of action.
What We Don't Know About Water Beds and Apneic Preterm Infants
Authors: Korner Anneliese F.
Published: December 2021

In recent years, we undertook two studies1,2 that showed that gently oscillating water beds significantly reduced apnea in preterm infants diagnosed as having apnea of prematurity. In the first study, randomly assigned experimental and control groups were used; in the second study, each infant served as its own control on and off the water bed. With one exception, all infants experienced less apnea on the water bed. From these two studies, it was not clear whether it was the continuous, irregular oscillations of the water bed that reduced apnea or whether it was the water bed per se that produced this effect.
A Prospective Study of Free Bilirubin and Other Risk Factors in the Development of Kernicterus in Premature Infants
Authors: Ritter Dorothy A. , Kenny John D. , Norton H. James , Rudolph Arnold J.
Published: December 2021

To assess the value of free bilirubin (FB) measurements in predicting kernicterus (KI) in sick premature infants, 91 newborns weighing less than 1,500 gm at birth were observed during the first week of life with twice daily FB and total bilirubin determinations. Autopsies were performed on 30 of the 53 infants who died. Seven had KI and 23 did not. There were no differences between infants with and without KI in the maximum FB level (KI 18.2 ± 4.5 [SEM] nm/liter, no KI 11.1 ± 0.9 nm/liter, P not significant) or the total bilirubin level (KI 7.3 ± 1.3 mg/100 ml, no KI 6.1 ± 0.5 mg/100 ml, P not significant). In fact, three kernicteric infants had very low maximum FB levels (<10 nm/liter). These three infants had prolonged episodes of acidosis, hypoxemia, or hypothermia during the 24 hours preceding their maximum level of FB. Although elevated levels of FB may be predictive of KI in some infants, other factors may make the blood-brain barrier more permeable to low levels of FB. This may limit the clinical applicability of FB measurements.
Interlaboratory Bilirubin Variability
Authors: Schreiner Richard L. , Glick Melvin R.
Published: December 2021

Stabilized liquid quality control sera, some with elevated bilirubin concentrations, were distributed to laboratories for total and conjugated (direct) bilirubin analyses. Interlaboratory variability was high; for example, results ranged from 10.9 to 24.0 mg/100 ml for a serum with a mean bilirubin concentration of 18.1 mg/ 100 ml. Coefficients of variation were typically 10% to 12% for total bilirubin and approximately 24% for conjugated bilirubin analyses. It is believed that these stabilized sera, when used as quality control materials, can help reduce the unacceptably large interlaboratory variability found in this study.
An Evaluation of the Poison Prevention Packaging Act
Authors: Walton William W.
Published: December 2021

This study investigated the effectiveness of child-resistant closures, required under the Poison Prevention Packaging Act of 1970, in reducing the incidence of accidental ingestions of 15 regulated substances among children less than 5 years of age. The regulated substances include aspirin, acetaminophen, prescription drugs, and household chemicals. Data from the National Electronic Injury Surveillance System and the National Center for Health Statistics were analyzed to determine ingestion and death rates associated with these substances over a five-year period. The ingestion rate for all substances that require child-resistant closures has declined from 5.7/1,000 children in 1973 to 3.4/1,000 children in 1978. It is estimated that child-resistant closures have prevented nearly 200,000 accidental ingestions since 1973. Over the past 20 years, the death rate due to poisonings of children has declined from 2.0/100,000 children to 0.5/100,000.
DIGESTION OF PROTEIN BY PREMATURE INFANTS
Authors: FEINSTEIN MYRON S. , SMITH CLEMENT A.
Published: December 2021

Absorption of N from cow's milk mixtures supplemented with equal amounts of N as casein and casein hydrolysates was determined in 20 metabolic periods on five premature infants.

The supplemental protein or hydrolysate furnished from 33.3 to 46.2% of the nitrogen intake and total N fed was equivalent to 4.22 to 8.49 G. protein/kg. body weight. With either supplement from 86 to 94% of the dietary N was absorbed and neither resulted in consistently superior nitrogen absorption.

Weight gains were not consistently better during either type of supplemental feeding.

The evidence of equally satisfactory nitrogen absorption and weight gain would substantiate the prevailing belief that protein digestion is not impaired after premature birth.
THE PEDIATRICIAN AND THE PUBLIC
Authors: DICH JORGEN S.
Published: December 2021

The subject of this talk concerns social medicine in the Scandinavian countries, not socialized medicine. The term socialized medicine has a political bias which is not in conformity with the conception of social medicine in Scandinavia. Every step in the development of the Scandinavian social medicine program has been adopted unanimously by all parties, irrespective of their attitudes toward socialism itself. Political parties have advocated liberalism and opposed socialism with the same ardor with which they have supported the expansion of social medicine. In Scandinavia, therefore, it is not necessary to advise us to "Keep politics out of this picture." Politics have always been omitted, even to the extent that a phrase corresponding to the American "socialized medicine" has never been used in Scandinavia. And if you were to try introducing it, it would not be understood.

What is social medicine? It can be defined as an organization of the medical services according to a certain conception of individual or human rights and public obligations in a modern society. In all countries it is accepted that there are some basic needs which everyone has the right to satisfy, irrespective of income. Protection of personal freedom belongs to this group; so does education of the children.
CONGENITAL ANOMALIES
Authors: WARKANY JOSEF
Published: December 2021

I AM greatly honored by the Award which the American Academy of Pediatrics has bestowed upon me and I am certain that this recognition of our studies will stimulate my co-workers and myself to further efforts in the line of work which we began about 12 years ago.

I have repeatedly had the privilege of presenting our experimental work to meetings of the American Academy of Pediatrics and it is not necessary, therefore, to describe to you again in detail the congenital anomalies induced in animals by maternal dietary deficiency. It seems preferable to give you today a brief summary of the general aspects and results of our studies and to present to you some of the conclusions which may be drawn from them.

The incentive to our experimental work was a marked interest in congenital anomalies of children. Adverse factors acting in prenatal life contribute appreciably to the mortality of infants and many children go through life deformed or crippled because of unfavorable intrauterine conditions. Congenital anomalies are at the root of many chronic and of some intractable diseases of childhood, a fact which is brought out with increasing certainty by improved diagnostic methods. Without going into details I wish to point out how many congenital anomalies of the urinary tract are now recognized intra vitam, which only one or two decades ago puzzled us by their nonspecific symptoms. Congenital anomalies of the intestinal tract which were previously diagnosed as "vomiting," "malnutrition," etc., are now better understood and often accessible to surgical treatment.
ACTION OF ALLOXAN ON A HYPOGLYCEMIC INFANT
Authors: GRIFFITH J. EDWIN , JACKSON ROBERT L. , JANES RALPH G.
Published: December 2021

A case report is presented of an eight month old white female who had a severe spontaneous hypoglycemia with associated convulsions. This condition was not appreciably improved with medical management and a subtotal pancreatectomy gave only temporary relief. The administration of alloxan monohydrate caused a cessation of convulsions, elevated the blood sugar and improved the glucose tolerance. The response noted in this child with alloxan therapy indicates that the initial dose should be approximately 55 mg/kg. body weight given by rapid intravenous injection. The dose should be increased by 5 mg./kg. body weight daily until a mild hyperglycemia is produced. Fourteen months after the last injection of alloxan the child had remained free of convulsions and her social developmental age was considered to be within normal limits. Blood sugar values obtained during the 14 month interval were improved over the pre-alloxan picture. However, values below the normal fasting level have been observed.
AUREOMYCIN IN THE TREATMENT OF RUPTURED APPENDICES IN CHILDREN
Authors: JOSLIN BLACKBURN S. , DRAKE MILES E.
Published: December 2021

A report is given on the use of aureomycin as the sole antibiotic therapeutic agent in 16 cases of peritonitis or abscess complicating appendicitis occurring in children. In four of the cases surgery was postponed because of the child's condition. There were no deaths in this series.

Aureomycin appears to be the drug of choice when combined with surgery in treating appendicitis with abscess or peritonitis or to be used alone when surgery must be postponed. A satisfactory dosage schedule for aureomycin is given.
THE PEDIATRICIAN AND THE PUBLIC
Authors: WATSON E. H.
Published: December 2021

George Wheatley's letter reminding us of the frightful toll of child life exacted by accidents prompts me to mention a practice I have tried to make routine. Probably many other Academy members have done about the same. The one year check-up, practically universally practiced by pediatricians, is a strategic time to bring up the danger of accidents which are so frequent in the preschool period. Before giving the routine booster of triple vaccine and tuberculin test, I like to make a point of reminding the mother that her child has safely passed one of the most dangerous periods of life—the first year. I believe it impresses the mother when I tell her that from now on the principal danger to her child is not poliomyelitis, not scarlet fever, diphtheria, whooping cough or pneumonia, but that if she should lose her child, it is more likely to be through accidental injury. She is reminded that many household cleaning powders and liquids may fatally poison her child or horribly disfigure him, that a few aspirin tablets or two or three of grandmother's heart pills might kill him. This statement is reinforced with the true statement that I have seen children die from exactly these causes.
Acute Psychogenic Stridor in an Adolescent Athlete Treated with Hypnosis
Authors: Smith Mark Scott
Published: December 2021

A psychogenic basis for laryngeal stridor has rarely been reported1,2 and, indeed, is often not considered in the differential diagnosis of this problem.3 We report the successful use of hypnosis in the treatment of an adolescent with psychogenic stridor.

CASE REPORT

A 1611/12-year-old white boy, who had been in good health previously, awoke with the sudden onset of inspiratory stridor. He had experienced no antecedent upper respiratory tract infection, cough, or other recent illness. Past medical history was unremarkable, and he was generally in excellent physical condition, competing as a high school wrestler. Family history revealed a younger brother who had recurrent episodes of spasmodic nocturnal croup.
Letter to the Editor
Authors: Maisels M. Jeffrey
Published: December 2021

Thornbery has a point. Obviously we would prefer to err on the side of safety whenever using a screening technique. Having done the initial study, however, guidelines for screening could only be suggested by post facto analysis. We did provide alternatives for different transcutaneous bilirubin (TcB) indices and different serum bilirubin levels.

We also adopted a TcB index of 21 as a cutoff point for the clinical screening of infants in our "well-baby" nursery. We have now analyzed a further 184 measurements in 121 infants, none of whom received phototherapy prior to the time that the TcB index was obtained.
Letter to the Editor
Authors: Cassady George
Published: December 2021

Robertson and I are in total agreement that a major medical challenge of this decade will be to assure available personnel to provide "high-quality neonatal intensive care" to all babies who need it. We also agree that it is unimportant who provides the care, so long as the quality remains uncompromised. My belief is that critical, objective, and scientific criteria must be used to judge not only what "meds and methods" are used but also what skills and successes the caretakers have.