bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERPRETATION OF THE BASAL METABOLIC RATE OF CHILDREN OF UNUSUAL BODY BUILD
Authors: ILIFF ALBERTA , LEE VIRGINIA A. , LEWIS ROBERT C.
Published: December 2021

The relative predictive value of six methods of reference frequently used to determine the BMR of children of unusual body build has been studied. The methods of reference based on the Child Research Council standards which were employed for this purpose were those for cal./hr./sq. m., cal./hr./kg. and cal./hr./cm., each referred to age, and cal./hr. referred to surface area, weight and height, respectively.

An analysis was made of 558 determinations of basal metabolism obtained on 86 healthy children of the Child Research Council, of 946 basal metabolism tests on 793 children described in the literature and of 80 basal metabolism tests on 74 children observed by Gordon. The study included children between 2 and 16 years of age whose weight or height or both weight and height fell above the 90th percentile or below the 10th percentile of all the children of similar age on whom the Council standards had been established.

The results of this analysis show that the methods of reference of cal./hr. referred to surface area and of cal./hr. referred to weight are reliable for the interpretation of BMR determinations on children of all six types of body build. This is also true of cal./hr./sq. m. referred to age except in the case of very small children or dwarfs for whom high BMR are found. These observations might well have been anticipated since height and weight and surface area increase with age in children, but weight and surface area give a better evaluation of body mass than does height.

The methods of reference of cal./hr./kg. referred to age, cal./hr./cm. referred to age and cal/hr. referred to height are not so reliable, either individually or collectively, for routine clinical use as are the other three methods of reference. Nevertheless, the deviations in the BMR obtained by these less satisfactory methods of reference may be of considerable importance in understanding the problems of a child of unusual body build. The use of the proper methods of reference based on reliable standards will result in trustworthy BMR for children of unusual body build.
VESICULAR PHARYNGITIS
Authors: K. DAVID J. , LEAVITT DANIEL , HOWITT BEATRICE F.
Published: December 2021

The Coxsackie group of viruses was recovered from 12 of 13 patients ill with vesicular pharyngitis.

These results strongly suggest a causal relationship between the viral agent recovered and the clinical disease.
Round Table Discussion
Authors: DARGEON HAROLD , BURCHENAL JOSEPH H. , DODGE CLAYTON T. J. , KIMBALL ERNEST R.
Published: December 2021

Neuroblastoma in common with many other tumors of the juvenile age period presents a diagnostic challenge to the clinician. The conditions should be included in the differential diagnosis of many acute and chronic syndromes in early childhood whether or not a tumor is clinically evident. The possibilities of a favorable result are not always determined solely by an early diagnosis but the prognosis in the occasional case of neuroblastoma may be favorably influenced by early recognition of the disease.
Annual Meeting of the Section on Pediatric Urology
Authors: GLASSBERG KENNETH I.
Published: December 2021

The Section of Urology of the American Academy of Pediatrics met for three days in conjunction with the 54th annual meeting of the Academy in San Antonio. Papers of interest to the pediatrician are summarized herein according to topic. The number of basic research papers is continuing to increase. The second annual Pediatric Urology Medal was awarded to Sir David Innes Williams for contributions made to the field.

ANDROLOGY

Testicular Torsion

Some recent studies suggest that individuals who undergo testicular torsion may have a higher incidence of infertility than the normal male population.1,2 A number of papers were presented at the 1984 meeting debating a possible immune response that is initiated by the torsed testicle and that plays havoc on the nontorsed testicle. One such paper presented this year by Howards and Turner could not find any contralateral testicular damage following surgically induced torsion on rats. Hadziselimoyic and co-authors studied biopsies taken from the nontorsed testicle in 38 boys who underwent surgery for unilateral testicular torsion. In 20 of the 38 patients (58%), preexisting contralateral testicular abnormalities could be identified, which suggests that the infertility in patients with unilateral testicular torsion may be a consequence of preexisting testicular pathology rather than an immunopathy.

Cryptorchidism

Contralateral Testicle. Three studies addressed the problem of infertility in patients with a history of cryptorchidism and the effect of the undescended testicle upon the contralateral testicle.

In one study, Kogan and associates set out to determine whether surgically induced cryptorchidism produces a deleterious effect upon the normally descended contralateral testicle.
School Performance and Theophylline
Authors: RAPPAPORT LEONARD , FENTON TERRANCE , TWAROG FRANCIS
Published: December 2021

To the Editor.—

In a recent article, Rachelefsky et al (Pediatrics 1986;78:1133-1138) described behavioral abnormalities and poor school performance due to oral theophylline preparations in children with asthma. There were a number of methodologic and reporting issues that we believe should be elucidated by the authors.

First, Table 4, which contains the only positive findings in the study, does not make sense. The legend says that the scores in this table are a sum of 53 items, each of which were scored as 1, 2, or 3.
Hemolytic Uremic Syndrome Epidemiology: A Population-Based Study in King County, Washington, 1971 to 1980
Authors: Tarr Phillip I. , Hickman Robert O.
Published: December 2021

We conducted a retrospective, population-based study of the hemolytic uremic syndrome of childhood in King County, Washington. The average annual incidence of hemolytic uremic syndrome between 1971 and 1980, inclusive, was 1.16 cases per 100,000 children younger than 15 years of age and increased during the decade and into the early 1980s. The highest annual incidence was in children less than 3 years of age (3.02 per 100,000 children) and was equal in black and white children. No demographic risk factors were associated with the incidence of this disease including population density, median family income, crowding in housing units, percentage of households with public water supply, and percentage of households with public sewers. Our data suggest that this disease is common, endemic, and increasing in incidence in King County, Washington.
Hospital Use Patterns for Children in the United States, 1983 and 1984
Authors: Kozak Lola Jean , Norton Catherine , McManus Margaret , McCarthy Eileen
Published: December 2021

The hospital discharge rate of children less than 15 years of age in the United States declined 12% from 1983 to 1984. This was the first time in the 20-year history of the National Hospital Discharge Survey that there was a statistically significant decrease in children's hospital discharge rates in a 1-year period. The change occurred during a period when prospective hospital payment systems were introduced and when prepaid group health plans and alternative systems of providing health care were expanding. The unprecedented decrease in children's hospital use was evaluated using data from the National Hospital Discharge Survey. This is a continuous survey in which data from a national sample of medical records of discharged patients are collected. Children's hospital use rates were reviewed by age, sex, region, and expected principal source of payment. Significant decreases in discharge rates were found for the age group 1 to 4 years and for all children with private insurance. The patterns and changes in hospital use by diagnostic category were also investigated. The major finding was a 19% decrease in children's discharge rate for diseases of the respiratory system. Mortality statistics and data from the National Health Interview Survey were evaluated for indications of changes in children's health status or use of physician services accompanying the decline in hospital use. Although there were fewer deaths due to respiratory diseases for children less than 5 years of age in 1984 than in 1983, most measures of health status were unchanged. The only significant change in physician use was a decrease in the percentage of acute conditions that were medically attended, also among children less than 5 years of age. It is important to continue monitoring children's hospital use patterns, as well as their health status and use of alternative health services, to further assess the impact of changes in the organization and financing of health services.
What's New in Pediatric Surgery
Authors: Touloukian Robert J.
Published: December 2021

Advances in the pathophysiology, diagnosis, and treatment of congenital malformations, trauma, tumors, and innovations in organ transplantation form the cornerstones of progress in pediatric surgery during the past year. Significant new contributions presented at the past year's meeting of pediatric surgical organizations, including the 56th Annual Meeting of the Surgical Section of the American Academy of Pediatrics, are summarized, and selected references from the pediatric and surgical literature are presented.

PRENATAL DIAGNOSIS/FETAL SURGERY

In the area of fetal surgery, Manning et al1 summarized the experience with 74 cases of catheter decompression for fetal hydronephrosis and hydrocephalus reported to the International Fetal Surgery Register. The center reported an overall survival rate of 41% for urinary obstruction with a procedure-related death rate of 4.6%. The results of ventriculoamniotic shunt procedure for obstructive hydrocephalus were even less encouraging with a procedure-related mortality of 10%; moreover, more than 50% of survivors had serious neurologic handicaps. Sauer et al2 studied the relative importance of an abdominal mass and oligohydramnios causing pulmonary hypoplasia in fetal rabbits. Animals having bladder outlet obstruction developed severe pulmonary hypoplasia, whereas other subjects having a synthetic mass inserted into the abdomen of a size equal to that of the obstructed bladder showed minimal signs of pulmonary hypoplasia. Results of the study suggest that prenatal catheter decompression be limited to the fetus with oligohydramnios.

The wisdom of planning the mode of delivery for babies with major congenital malformations referred to a maternal high-risk unit for evaluation remains controversial.
Recognizing the Common Problem of Child Automobile Restraint Misuse
Authors: MARGOLIS LEWIS H. , WAGENAAR ALEXANDER C. , MOLNAR LISA J.
Published: December 2021

The effectiveness of safety restraints in protecting children from motor vehicle injuries has been well documented,1 prompting all states to require that child passengers ride in appropriate restraints.2 Although the prevalence of child restraint device use has increased following the passage of child restraint device laws, many drivers use restraints incorrectly on their child passengers. For example, in a recent study of child restraint device use, we reported that, although 75% of children were riding in restraints on seat belts, 62.9% of those children were incorrectly restrained.3 In a 1984 study, Cynecki and Goryl4 reported a similar misuse rate of 64.6%.
Early Language Milestone Scale and Language Screening of Young Children
Authors: Walker Dewey , Gugenheim Susan , Downs Marion P. , Northern Jerry L.
Published: December 2021

The purpose of this project was to evaluate the use of the Early Language Milestone Scale (ELM) in screening language skills in young children. In this study, 657 children from birth to 36 months of age were evaluated with the ELM. The overall failure rate was 8%. Children who failed the ELM screening were evaluated with the Sequenced Inventory of Communication Development (SICD) that was used as the "gold standard" for diagnosing language disorders. In the 12-month age and younger group, there was poor agreement between the ELM Scale and the SICD. For infants 13 to 24 months of age, there was moderately good agreement between the SICD and a second ELM that was administered 1 to 2 weeks after the initial screening. In the 25- to 36-month age group, there was excellent agreement between the SICD and a rescreen ELM. The agreement between the two instruments indicated that the rescreen ELM correctly classified 79% of the 13- to 24-month-old infants and 89% of the 25- to 36-month-old toddlers.
EDITORIAL
Authors: L. J. F.
Published: December 2021

My colleague, Dr. Edward Wallach, made a depressing observation at a recent meeting of the Maryland Obstetrical and Gynecologic Society. At the meeting it was noted that today's students are concerned about litigation, advertising, competition, AIDS, drug abuse, paperwork, and corporate encroachment in medical care while students 30 years ago had none of these concerns; rather they worked to make their professors, mentors, and themselves proud of their achievements. Is this true only for obstetricians?
HOW DID YOU COME TO CHOOSE THE VALUE OF N?
Authors: Student
Published: December 2021

The set of possible results [in a clinical trial] on which the power depends is not an objective quantity but is created by the experimenter's intentions. Did he plan to draw a sample of n, or did he intend to sample until he tired and just happened to arrive at a sample of size n, or did he use some other "stopping rule"? Such questions, which are intuitively quite irrelevant as evidence, are crucial to evaluating the outcome space of the trial and hence the power of the test.
Experiences With Sickle Hemoglobin Testing in the Texas Newborn Screening Program
Authors: Therrell Bradford L. , Simmank Jennifer L. , Wilborn Mae
Published: December 2021

Since Nov 1, 1983, we have tested more than 1 million infants for sickling hemoglobinopathies. The laboratory procedures used for analysis of the filter paper blood spots include a combination of cellulose acetate and citrate agar electrophoresis. Isoelectric focusing offers an alternative screening procedure. Satisfactory interpretations of electrophoretic patterns are generally acceptable on specimens analyzed within five days of collection. Specimen age does not seem to be as critical a factor with isoelectric focusing. Consumable supply costs are slightly more with isoelectric focusing protocol (approximately $0.50 v $0.25), however, and the technical complexity and time involved are also somewhat higher.

We have found the incidences to be as expected. Annual births in Texas number approximately 42,000 blacks, more than 90,000 Hispanics, and more than 175,000 whites. The newborn screening program is detecting approximately 100 cases of sickle cell anemia, 40 cases of SC disease, and 4,200 sickle hemoglobin carriers annually. Although the morbidity and mortality data demonstrating the effectiveness of this program will take some time to accumulate, support for its continuation from the physician community and the general public appears widespread. Follow-up of disease conditions is an integral part of the protocol, and the involvement and recommendations of an advisory committee, including qualified pediatric hematologists, have proven extremely beneficial. Both educational literature and treatment protocols have been addressed by the department and its advisers. Although the program still lacks a strong genetic counseling effort, and there are considerable communication and transportation problems associated with the state's geography, the Texas Department of Health remains dedicated to improving the public health of infants throughout the state with its quality newborn screening program.
Northern California's Experience
Authors: Hurst Deborah
Published: December 2021

Future plans involve continued expansion of cord blood screening in the Bay Area until no babies with hemoglobin diseases are missed. Modification of screening and trait follow-up procedures will continue as necessary to allow screening of increased numbers despite limitations in funding. To reduce the need for intensive trait follow-up by the center, we will continue to develop community resources. There must be more general public information about hemoglobin traits, more well-run prenatal testing and counseling programs, and continued education of health care professionals.

It is also essential to assess the effect of hemoglobin trait notification on the involved families. A definitive trait follow-up study could help state public health departments design optimal screening programs that provide satisfactory trait follow-up without detrimental psychologic effects or prohibitive expense. Historical studies of the effects of trait screening at other times or in other ethnic groups for different diseases may not be applicable to our population. For example, in trait follow-up today, initial parental anxiety when notified of an abnormal blood test in the baby more often involves fear of acquired immunodeficiency syndrome than fear of sickle cell disease. Most people now can be reassured about the difference between trait and disease and about the fact that their baby with trait is healthy. Clearly, the level of public knowledge has increased since the early years of screening because of the sickle cell center's educational outreach as well as general exposure to information on television and in public school curricula. These impressions should be documented by studies to assess the levels of understanding and anxiety in families before and after counseling.

In addition, information concerning the 17% of individuals who make appointments but never appear for counseling and the 28% who are not contacted by either telephone or mail would be useful. There is no way of knowing how many of these people simply do not need or want counseling, how many never receive the information, and how many avoid further contact because of inappropriate anxiety. Tracking these individuals would be a major undertaking, beyond the scope of current staffing, but an important future study.
MARKET FOR RECYCLED NEWSPAPERS IN UNITED STATES COLLAPSES, ADDING TO SOLID WASTE WOES
Authors: M. R. J.
Published: December 2021

The bottom has fallen out of the market for recycled newspapers, exacerbating the nation's already critical garbage problems.

The market's collapse stems from a sudden deluge of old newspapers, the result of new recycling programs by several Eastern states. In response, Korean and other foreign and domestic paper companies have greatly lowered the price they are willing to pay for old papers.

The result: Municipalities that just two or three months ago were receiving as much as $25 a ton for their newspapers from brokers now are having to pay these brokers $5 to $25 a ton just to haul the old papers away. . .

Worse is yet to come, according to the American Paper Institute, the industry's trade group. It predicts that so much old paper will soon flood the market that some of it may have to be dumped in landfills. . .

To be sure, nobody predicts the end of recycling because, especially on the East Coast, landfills are full, and many new incinerator projects are stalled by citizen's groups worried about possible adverse health effects. . .

Michael Koplik, president of Percy H. Koplik & Sons, Inc., which buys old newspaper for paper companies, says the current depression in the market could last a year or longer. But he also calls the downturn an opportunity, in that he expects paper companies to commit to building more plants that use recycled paper.

Joseph Salomondo, editor of Recycling Times, also foresees new uses for recycled newsprint—in particular, as housing insulation and as animal bedding. . .
GEOGRAPHIC BASED INCIDENCE
Authors: Student
Published: December 2021

In the absence of any system of general reporting of all diseases by all physicians to any central health authority, I can think of no way in which we can arrive at any approximate idea of the morbidity of this city.
Prenatal Exposure to Alcohol: Effect on Infant Growth and Morphologic Characteristics
Authors: Day Nancy L. , Jasperse Dorcie , Richardson Gale , Robles Nadine , Sambamoorthi Usha , Taylor Paul , Scher Mark , Stoffer David , Cornelius Marie
Published: December 2021

In this prospective study of alcohol and other substance use during pregnancy, a cohort of 650 women was interviewed at each trimester of pregnancy. Data are presented concerning the status of 595 live singleton births. A relationship was demonstrated between prenatal maternal alcohol use and growth and morphologic abnormalities in the offspring. Low birth weight, decreased head circumference and length, and an increased rate of fetal alcohol effects were all found to be significantly correlated with exposure to alcohol during the first 2 months of the first trimester.
CRISIS IN NICUS
Authors: Student
Published: December 2021

Since 1985, the rate of admissions to our neonatal intensive care unit has risen from 14 percent of live births to 22 percent—more than three times the national average. A lot of this is due to crack. . . .The system is so overloaded that we can't handle the babies we are getting anymore.
ART OF ThE TAPED MESSAGE ON ANSWERING MACHINES
Authors: Student
Published: December 2021

The telephone answering machine is ushering in the age of the personal sound bite making it possible for each of us to declare ourselves and advertise ourselves to an at least theoretically vast audience. . .One subscriber [motivated by security considerations] makes this point blatantly in his introduction to the beep. It says: "No one is home right now except for the Doberman pinscher and the pit bull who have not been fed for some time. . ." The muse of taped messages doles out inspiration sparingly. . .on the third ring, her throaty voice declares, "At the beep we will be united electronically."
THEN TENSION BETWEEN CREATIVITY AND SKEPTICISM
Authors: Student
Published: December 2021

The traits of creativity and skepticism are necessary complements in science. Although excessive skepticism in the earliest stages of theorizing inhibits creativity and often kills potential successes, once a theoretical or exprimental result is announced, a scientist's sworn duty is to try to shoot it down as fast as possible. The history of science is littered with the corpses of nonsensical theories and false discoveries. It is sad to think that most of us devote our careers to dead ends. But it is better than the alternative. If we were forced to live in an overpopulated slum dwelling of ridiculous theories and experiments, science would have progressed as far as astrology.
Age- and Gender-Related Differences in Clinical Productivity Among Canadian Pediatricians
Authors: Rieder Michael J. , Hanmer Sandra J. , Haslam Robert H. A.
Published: December 2021

The desire to control health care costs in Canada has led to reductions in postgraduate training posts and physician immigration. To determine the possible effects of these cutbacks on pediatric manpower, a country-wide study was conducted to assess the practice patterns and productivity of Canadian pediatricians. Of the 1960 pediatricians in Canada, 69% completed and returned our questionnaire. Practice descriptions were as follows: 37% practice primary, 25% secondary, and 38% tertiary care. A total of 70% of Canadian pediatricians are men, although this will change with time because 49% of pediatricians younger than 35 years of age are women. Clinical productivity was assessed by five indices: number of clinical hours, patients seen, consultations provided, and hours on call per week, and number of hospital admissions per year. Younger pediatricians were significantly less clinically productive than older pediatricians. Age-matched groups of female pediatricians were significantly less clinically productive than their male counterparts in three of the five indices assessed. Overall, female pediatricians were significantly more likely to work part-time than were male pediatricians (22% vs 16%, P < .05). When the clinical productivity of parttime pediatricians was assessed, there was no male to female difference noted. However, among full-time pediatricians, men worked significantly more clinical hours per week and saw significantly more patients than did women (P < .05). According to results, women pediatricians were more satisfied with their practice now than when starting practice than were men (47% vs 41%). A dramatic decline has been projected in the number of tertiary care pediatricians in the province of Ontario during the next two decades as a result of government cutbacks in pediatric trainees and reduced physician immigration. When coupled to a slightly lesser clinical productivity, a sharp decline in accessibility of subspecialty care for Canadian children in the future is likely to occur.
Characteristics of Narcolepsy in Preteenaged Children
Authors: Kotagal Suresh , Hartse Kristyna M. , Walsh James K.
Published: December 2021

Narcolepsy is rarely diagnosed in preteenaged children. Its clinical and polysomnographic manifestations, some of which are unusual, are described in four children who were observed prospectively. The mean age at onset of hypersomnia was 10.2 years (range 8.4 to 11.2 years). Daytime naps among these children were lengthy, ranging from 20 to 120 minutes, and generally were considered unrefreshing. Cataplexy was present at the onset in all four children. Three of the four children were obese, with the concurrent nocturnal snoring prompting a misleading concern about obstructive sleep apnea syndrome in two children. The histocompatibility DR2 antigen was present in all four children. Significant behavioral manifestations appeared in all of them. The response to stimulant medications was, at best, modest. Narcolepsy may be difficult to diagnose in this age group. However, a careful history eliciting sleep/wake dysfunction (including cataplexy), leukocyte assays for the histocompatibility DR2 antigen, and serial polysomnographic studies may enable early recognition and treatment of this disease.
Embolization of Ectopic Kidney to Control Incontinence
Authors: DE GROOTE B. , VAN LAER P. , MAURUS K. , VAN BIERVLIET J. P. , MEEUS L.
Published: December 2021

Ureteral ectopy in girls can cause dribbling incontinence if the ectopic ureter ends below the continence mechanism of bladder neck and external sphincter. Approximately 25% of ectopic ureters drain into the vagina. The corresponding renal tissue is often hypoplastic or dysplastic. Surgery used to be the treatment of choice. Depending on the quality of the corresponding renal tissue, one had the choice between ureter reimplantation or partial or total nephrectomy. We succeeded in treating a girl with a hypoplastic kidney and an ectopic ureter nonsurgically by embolizing the corresponding renal artery.

CASE REPORT

A 5-½-year-old girl had leakage of urine in spite of a normal voiding pattern.
Drug Screening
Authors: FOST NORMAN , SCHONBERG S. KENNETH , SCHYDLOWER MANUEL
Published: December 2021

In Reply.—

The writers raise a number of issues involving process, fact, and ethics. We can only respond to a few of the main points.

Regarding process, a major impetus for the statement was requests from private practitioners seeking the Academy's support to help them resist demands, from school districts and parents, that they screen athletes and patients surreptitiously. There was extensive involvement by private practitioners in the writing, review, and approval of the statement by three committees, the Council on Child and Adolescent health, and the Executive Board, which is comprised predominantly of private practitioners.
Early Treatment for Congenital Hypothyroidism
Authors: DUSSAULT JEAN H. , FARRIAUX J. P.
Published: December 2021

To the Editor.—

We would like to respond to the allegation of Fisher et al1 that 10% to 15% of our treated hypothyroid children did not attain a normal development because they were undertreated at the time of therapy initiation. First, the Quebec cohort of patients do not include those who were treated with triiodothyronine (T3) because this clinical trial was accomplished early in our program (1974 to 1975). Thus goes the argument for the deleterious effect to T3 treatment vs thyroxine (T4) (ie, the majority of the T3 in brain originates from T4 to T3 conversion.
Sports Deficit Disorder
Authors: BURKE BRYAN L. , MCGEE DANIEL P.
Published: December 2021

In Reply.—

Our report on Sports Deficit Disorder has struck a responsive chord among your readers. Each letter which we have received has been from yet another pediatrician who feels that he is a victim of this disease.

Dr Crook understands that part of the reason we wrote this satire was to help deal with our own personal frustration concerning Attention Deficit Disorder, a disorder whose diagnosis and proper treatment are frustratingly nebulous. Like Dr Crook, our subjective impression is that Ritalin is prescribed too frequently, with not enough emphasis placed on treating the underlying problems of the child and family in a nonpharmacologic manner.
Behavior in Klinefelter Syndrome, or Where There Is Smoke There May Not Be a Fire
Authors: MILLER MARVIN E. , SULKES STEPHEN
Published: December 2021

In Reply.—

Drs Hecht and Hecht smell smoke but see no fire. They also may not see the forest for the trees.

When we became aware of four individuals with Klinefelter syndrome in our clinical practice who had significant fire-setting behavior, we thought this was likely more than a coincidence. Our primary reason for reporting this observation was not for counseling issues in Klinefelter syndrome, but for alerting health care providers who evaluate firesetters that Klinefelter syndrome rome may be a small subset of firesetters.
Periventricular Leukomalacia (PVL) and Myelination
Authors: VAN DE BOR MARGOT
Published: December 2021

In Reply.—

The hypothesis of our study was that periventricular-intraventricular hemorrhage may damage the glia precursors in the subependymal germinal layer, the site of origin of the hemorrhage. Our results showed that glia precursors in the subependymal germinal layer are not so severely damaged that the subsequent production of myelin by oligodendroglia is impaired.1 Our prime goal was not to study the local effects of a `parenchymal extension' of the hemorrhage. Volpe2 suggests that parenchymal extension of an intraventricular hemorrhage as described by Papile et al3 is not merely an extension of the hemorrhage but a hemorrhagic infarction secondary to obstruction of venous flow by a large quantity of intraventricular blood.
Are We Becoming a Two-Class Society Based on Neonatal Circumcision?
Authors: NEIBERGER RICHARD E.
Published: December 2021

To the Editor.—

In 1975, an Ad Hoc Task Force on Circumcision of the American Academy of Pediatrics reported that "there is no absolute medical indication for routine circumcision of the newborn."1 In 1983, both the American Academy of Pediatrics and the American College of Obstetrics and Gynecology jointly published Guidelines to Perinatal Care in which routine neonatal circumcision was discouraged.2

Since 1983, many public tax-supported hospitals simply stopped performing neonatal circumcision. Circumcision is no longer an option at many major public hospitals.
More on Meconium Aspiration
Authors: KARLOWICZ M. GARY
Published: December 2021

To the Editor.—

The report by Wiswell et al in the May 1990 issue of Pediatrics1 provides valuable insight into meconium aspiration syndrome. However, I am concerned that there is a possible cause of meconium aspiration syndrome in the vigorous neonate which has not received enough emphasis, either in this or other reports. Namely, vigorours babies who develop meconium aspiration syndrome may be insidiously aspirating regurgitated meconium in the first few hours after leaving the delivery room.
Child Health Care Policy and Delivery in France
Authors: Manciaux M. , Jestin C. , Fritz M. , Bertrand D.
Published: December 2021

Medical and social protection of mothers, infants, and children began in France more than a century ago. A number of laws and regulations have improved the system, which is discussed in detail. The discussion includes an overview of health policy, service delivery, and the financing of care. Is the current French system of Maternal and Child Health responsible for the good health of today's children? This question is addressed through selected examples. Finally, failures and shortcomings of the system are described, including the persistence of underserved groups, unequal access to care, and other problems. Solutions are feasible, and some are now being implemented.
Amino Acid Concentrations in Plasma and Urine in Very Low Birth Weight Infants Fed Protein-Unenriched or Human Milk Protein-Enriched Human Milk
Authors: Polberger Staffan K. T. , Axelsson Irene E. , Räihä Niels C. R.
Published: December 2021

Preprandial plasma and urine amino acid concentrations were measured in 28 growing, very low birth weight, appropriate-for-gestational-age infants randomly assigned to either protein-unenriced (n = 14) or human milk protein-enriched (n = 14) human milk. The two groups of infants had similar birth weights (900 to 1500 g) and gestational ages (26 to 32 weeks). The study was initiated at a mean age of 19 days when the infants tolerated full feeding volumes and lasted for a mean time of 28 days. Mean protein intake values were 2.1 ± 0.3 and 3.6 ± 0.3 g/kg per day (mean ± SD) and weight gain values were 26.6 ± 7.4 and 35.1 ± 3.6 g/day in the protein-unenriched and the protein-enriched groups of infants, respectively. Human milk protein enrichment resulted in significantly increased concentrations of all plasma amino acids except serine, taurine, and histidine. Most urine amino acid concentrations correlated with protein intake and with the plasma concentrations, suggesting that the effects of protein quality and quantity can be evaluated by measuring urinary amino acid concentrations alone, thereby making such studies less invasive. Infants fed protein-unenriched human milk had growth rates below the estimated intrauterine rate as well as low plasma and urine amino acid concentrations, indicating suboptimal protein intake levels. When the plasma concentrations of the essential amino acids in tenrichedhe protein-enriched infants from the present study were compared with concentrations found in the literature in fetal and umbilical cord plasma, both were found to be much higher. The plasma essential amino acid concentrations in the well-growing, protein-supplemented infants from the present study corresponded best to plasma concentrations found in breast-fed, growing, term infants at 1 to 3 months of age. It is suggested that preprandial plasma amino acid concentrations found in healthy, growing, breast-fed, term infants can be used as reference standard values when evaluating preprandial plasma amino acid concentrations in appropriate-for-gestational age, very low birth weight infants.
Interleukin-2 Immunotherapy in Children
Authors: Chien Chih-Hao , Hsieh Kue-Hsiung
Published: December 2021

Immunotherapy with interleukin (IL)-2 possesses great potential in the treatment of immdiatedne-mediated diseases and cancers. However, only a few reports on a small number of children have appeared in the literature. From March 1988 to March 1989, 11 children and adolescents were treated with IL-2. They included 1 patient with hepatocellular carcinoma, 1 with hepatoblastoma, 6 with childhood atopic dermatitis, and 3 with juvenile rheumatoid arthritis. The dosages ranged from 10 000 to 50 000 U/kg every 8 hours by intravenous drip. The following side effects were observed: anorexia, fever, and chillness (100%), general malaise (82%), irritability (64%), diarrhea (100%), nausea and vomiting (73%), weight gain (82%), edema (82%), abdominal distension (73%), oliguria (82%), cough (91%), dyspnea (27%), pleural effusion (40%), hypotension (82%), skin eruption (82%), oral ulcer (18%), enlarged liver (73%) liver function abnormalitis (82%), renal function impairment (36%), electrolyte imbalance (73%), anemia (91%), thrombocytopenia (54%), leukopenia (18%), and eosinophilia (73%). Immunologically, numbers of natural killer cells were increased and natural killer and lymphokine-activated killer cell activities were augmented after IL-2 treatment. There was a tendency for serum levels of IL-2 and receptor IL-2 to decrease, especially in patients with atopic eczema. Ten patients (91%) completed one course (9 to 12 days) of therapy, and the remaining patient interrupted the treatment because of intolerable adverse effects. Clinically, complete remission for 3 months was obtained in 1 juvenile rheumatoid arthritis patient, transient improvement (2 to 6 weeks) in all atopic dermatitis patients, minor response in the hepatoblastoma patient, and no response in the patient with hepatocellular carcinoma.
After Teen Suicide: Issues for Pediatricians Who Are Asked to Consult to Schools
Authors: Adler Richard S. , Jellinek Michael S.
Published: December 2021

Every suicide is a unique tragedy. This article has attempted to provide a framework for understanding suicide as it impacts on the scmunity.ool community. Given this background, we have listed 10 frequent dilemmas faced by pediatricians (and others) who consult to schools. The central themes of the approach offered are to avoid inadvertently glorifying suicide, target high-risk groups for interventions, and consider suicide prevention as part of the broad, ongoing task of providing a caning environment for adolescents in which the collaboration of the school community is essential.
Normative Sexual Behavior in Children
Authors: Friedrich William N. , Grambsch Patricia , Broughton Daniel , Kuiper James , Beilke Robert L.
Published: December 2021

A large-scale, community-based survey was done to assess the frequency of a wide variety of sexual behaviors in normal preadolescent children and to measure the relationship of these behaviors to age, gender, and socioeconomic and family variables. A sample of 880 2-through 12-year-old children screened to exclude those with a history of sexual abuse were rated by their mothers using several questionnaire measures. The frequency of different behaviors varied widely, with more aggressive sexual behaviors and behaviors imitative of adults being rare. Older children (both boys and girls) were less sexual than younger children. Sexuality was found to be related to the level of general behavior problems, as measured by the Achenbach Internalizing and Externalizing T scores and to a measure of family nudity. It was not related to socioeconomic variables.
Perpetual Poverty: Child Health and the Underclass
Authors: Kliegman Robert M.
Published: December 2021

Poverty is a predominant social precursor to poor health.1-9 The disadvantaged health status among the poor is associated with reduced life expectancy and a high risk of death from preventable illnesses.2,10-12 Child health is affected particularly, as exemplified by excessive rates of low birth weight, prematurity, and neonatal, infant, and postneonatal mortalities. Specifically postneonatal deaths among poor children are often due to preventable or treatable illnesses such as diarrhea, pneumonia, influenza, and accidents. (New York Times. July 17, 1990: A10; New York Times. August 6, 1990:A1).2,3,11,16-18 In addition rates of teenage pregnancy, drug dependence, and death due to intentional and unintentional injuries are excessively high among poor, urban adolescents (New York Times. July 17, 1990:A10; New York Times. August 6, 1990:A1).7,17-18

UNDERCLASS STATUS AS A RISK FACTOR

Related risk factors that adversely affect pregnancy or neonatal outcome include, single parent status, adolescent age, minority status, limited education, unemployment, and alcohol and illicit drug use. However, between 80% to 90% of poor women with these factors have healthy infants. It has become apparent that all poor women are not equally at risk or even equally financially disadvantaged despite having in common the traditional poverty-associated risk factors (Newsweek. May 28, 1990:78).7,15,19 The subpopulation of poor people which has the highest risk for infant mortality and other health complications, includes the most disadvantaged people, known collectively as the underclass. Although use of this term has been considered controversial and may have negative implications, the idea that there is a group of the most disadvantaged citizens has been accepted for some time (Newsweek.
Chronic Fatigue Immune Dysfunction Syndrome: An Epidemic?
Authors: KMINEK MUDR ALEŠ , SIMUNEK MUDR IVO
Published: December 2021

To the Editor.—

We read with great interest the article "Chronic Fatigue in Adolescents" by Smith et al in the August 1991 issue.1 We appreciate the statement by the authors that "the CDC-recommended criteria for case definition of the chronic fatigue syndrome (CFS) were developed mainly from adult populations and may not be appropriate for children and adolescents."

We have studied children suffering from unexplained fatigue, mild fever, nonexudative pharyngitis, lymphadenopathia, etc, since 1987, ie, prior to publication of CDC-recommended criteria of CFS.2
Ethical Aspects of Pediatric Home Care
Authors: Lantos John D. , Kohrman Arthur F.
Published: December 2021

This essay is a discussion of ethical issues that arise in the provision of home health care to technology-dependent children. Different ethical norms, especially with regard to the degree of professional responsibility for outcomes, traditionally have applied to home care and hospital care. In particular, parents generally are expected to do their best, but are not expected to have the same specialized knowledge of risks and benefits with regard to particular interventions as health professionals. When home health care involves the use of advanced medical technology, it strains traditional conceptions of parental responsibilities to care for the health of their children at home. It can also strain traditional concepts of professional responsibilities to care for critically ill children in hospitals. We discuss some of the tensions that arise as medical, psychological, and economic forces lead to the increasing use of high technology in the care of children outside of traditional health care institutions.
Lessons from an Adolescent with Pectus Excavatum
Authors: ASNES RUSSELL S.
Published: December 2021

To the Editor.—

Of the many factors which contribute to the challenge, excitement, and satisfaction derived from pediatric practice, the continuing education we receive from our patients is among the most significant. I would like to share a recent poignant "lesson" provided by Adam, a 17-year-old. Adam sent me the following copy of his response to a college application question: "What condition have you been forced to deal with mentally, physically, and emotionally, and how has it had an impact on your life?" "I was born with a hole in my chest.
Effects of In Utero Cocaine Exposure on Newborn Acoustical Cry Characteristics
Authors: Corwin Michael J. , Kayne Herbert , Lester Barry M. , Sepkoski Carol , McLaughlin Sarah , Golub Howard L.
Published: December 2021

As part of a large, multicenter study of newborn cry analysis and Sudden Infant Death Syndrome, we examined the effects of in utero cocaine exposure on ten acoustical cry characteristics. Newborn cry recording and medical record review was performed for 23 948 newborns. Cocaine use during pregnancy (determined by record review) was identified in 438 (1.8%) women (310 by self-report only; 128 newborns also had positive urine assay). A demographically similar group of 373 newborns, selected from the 23 510 newborns without known cocaine exposure, made up the comparison group. Cry analysis was technically possible for 768 recordings: 404 cocaine-exposed and 364 non-exposed controls. Comparison of cocaine-exposed vs control newborns, after adjustment for potential confounding variables, found significant differences including: fewer cry utterances (P = .001), more short cries (P = .02), and less crying in the hyperphonation mode (P = .01), for the cocaine-exposed neonates. As reported in other studies, cocaine-exposed newborns also were significantly lower in birth weight, length, and head circumference. Newborns who had positive urine tests for cocaine suffered the greatest effects on both cry and growth parameters. These findings suggest a pattern of underaroused neurobehavioral function and are consistent with the emerging picture of the adverse neurobehavioral effects of cocaine. Developmental outcome studies are in progress to determine if acoustical analysis of the newborn cry can be used to identify cocaine-exposed newborns who are at highest risk for poor outcome.
Design of ICUs
Authors: WHITE ROBERT , WHITMAN THOMAS
Published: December 2021

To the Editor.—

Most newborn intensive care units (NICUs) today stand as monuments to the technology and efficiency that dramatically improved survival of premature newborns during the last two decades. Beginning as small "premie nurseries" which held five or six newborns per room, NICUs evolved in the late 70s and the early 80s into large, bright, noisy, high-tech wards housing 30, 40, or even 60 newborns. State building codes and recommendations for NICU design were formulated during this era which emphasized cleanliness and efficiency, but largely neglected the impact of the NICU environment on the premature newborns themselves.
Round Table Discussion
Authors: CLIFFORD STEWART H. , SNELLING CHARLES ERNEST , LATHROP A. S. , BOULWARE JAMES R.
Published: December 2021

I. Responsibilities of the Hospital

Chairman Clifford: The swing from the home to the hospital as the scene of childbirth is almost complete. In 1948 85% of all births in the United States took place in hospitals. In 13 states 98% of births were in hospitals. This rapid shift created a major problem for our hospitals as they were caught with an increased patient load without a commensurate increase in physical plant and personnel and without time to develop adequate technics of management. The trend toward a shortened period of hospitalization helped in permitting the institutions to care for a greater number of patients. The Standards and Recommendations for the Hospital Care of Full-term and Premature Infants of the American Academy of Pediatrics were of undoubted help to the hospitals in safeguarding the newborn.

A. Medical Service Responsibilities

I feel very strongly that for a Newborn Service to function so as to best protect the interests and welfare of its patients, it should be made the direct responsibility of a qualified pediatrician. Further, this individual must be so trusted by the trustees and the obstetric, nursing and administrative departments that he be given adequate authority to do the job. Practically every man attending this Round Table has signified that he works in or is in charge of a newborn nursery in his home area. In your hospitals is there a problem of trying to educate the hospital administration and medical administration as to the wisdom of appointing a pediatrician interested in the newborn infants to the job of being responsible for the service? Are you satisfied that in your various hospitals this problem is well taken care of?
ADRENOCORTICOTROPIC HORMONE IN THE THERAPY OF RETROLENTAL FIBROPLASIA
Authors: LANMAN JONATHAN T. , GUY LOREN P. , DANCIS JOSEPH
Published: December 2021

Five premature infants thought to be developing retrolental fibroplasia were treated early, vigorously and persistently with ACTH from a single Armour lot. Activity of the ACTH employed was evidenced in each case by physiologic changes in the recipient.

One of the five treated patients died during therapy. The mode of death and possible relationship to ACTH administration are discussed.

Retrolental fibroplasia progressed in the four remaining treated cases to cicatrix formation behind the lens.

ACTH as employed in this study was an ineffective therapeutic agent in retrolental fibroplasia.