bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Services in the Home
Authors: Bock Lewis L.
Published: December 2021

The Blackfan Memorial Lecture by Dr. Cicely Williams1 was read with keen interest and agreement. Pediatrics should be commended for its publication.

I trust that the increased rumbling that one hears, reads about and senses in maternal and child health care in our country will gather momentum and volume until we actually do implement the programs that will reduce infant mortality and morbidity and improve maternal care so that infants will be born into a society with far fewer deficiencies, deprivation and dependence.
Student Education in a University-Based General Pediatric Clinic
Authors: Berkelhamer Jay E. , Mendelsohn Janis , Madden John D.
Published: December 2021

Since effective education of medical students in general pediatric clinics has been the subject of much review lately,1-6 a survey of the General Pediatric Clinic of the University of Chicago was conducted. Medical students and patients appeared to be satisfied with their experience in our clinic. The clinic is a primary care facility where patients are seen on a nonreferral basis. Approximately 70% of the 12,000 patient visits per year are for continuous well child care.
Adaptation to Cold in the First Three Days of Life
Authors: Peristein Paul H. , Hersh Carol , Glueck Charles J. , Sutherland James M.
Published: December 2021

Newborn infants who were exposed to short periods of cold stress during the first two days of life demonstrated an enhanced ability to maintain their core body temperatures when subsequently challenged by exposure to a heat-losing environment. The relative thermal stability of these cold-experienced infants was associated with elevations in their plasma glycerol levels suggesting that lipolytic thermogenesis plays a prominent role in this demonstration of homeothermic competence. The data are interpreted as a demonstration of early postnatal adaptation to environmental stress.
Thyroid Function in Respiratory Distress Syndrome (RDS) of the Newborn
Authors: Redding Ralph A. , Pereira Celina
Published: December 2021

Preliminary evaluation of thyroid function, utilizing total serum thyroxine (T4) and triiodothyronine (T3) resin uptake, was assessed following delivery in three groups of babies and their respective mothers; 40 premature new-borns with respiratory distress syndrome (RDS), 39 prematures comparable by gestational age who failed to develop RDS, and 22 full-term normal babies. The group of premature newborn infants in whom RDS occurred, as compared to the other two groups, had significantly lower mean total serum thyroxine levels and "free thyroxine index" (T4 x %T3 uptake/100). When matched by gestational age, the differences were also significant. Two days following delivery, the total serum T4 in the surviving prematures with RDS as compared to prematures without RDS was also significantly lower. The mean values for total T4 and "free thyroxine index" in the respective mothers of the three groups were not significantly different. Since L-thyroxine has been shown to increase the production of lung surfactant, widely accepted as deficient in RDS newborn infants, an association between lung immaturity and fetal thyroid function is postulated.
Hiatal Hernia and Gastroesophageal Reflux in Infants and Children: Analysis of the Incidence in North American Children
Authors: Darling Donald B. , Fisher John H. , Gellis Sydney S.
Published: December 2021

Seventy-eight patients with hiatal hernia (partial thoracic stomach) and five cases of chalasia were identified by radiological examination from July 1971 through March 1973. The cases could be divided into two distinct groups: a larger group in which the clinical findings correlated with the radiologic findings and a smaller group in which there was no correlation. Both groups were followed and analyzed. The incidence of secondary esophageal stricture was similar to that reported in the foreign literature, indicating that the true incidence of hiatal hernia in American children is much higher than previously believed.
Reticulum cell sarcoma of the brain with Wiskott-Aldrich syndrome
Authors: Miller Robert W.
Published: December 2021

Congenital immunodeficiency predisposes patients with Wiskott-Aldrich syndrome to lymphoreticular neoplasia. A 19-year-old boy with the syndrome has recently been reported with reticulum cell sarcoma confined to the brain, a very rare site for this neoplasm (Heidelberger, K. P., and LoGolvan, D. P., Cancer, 33:281-284, 1974). The same rare neoplasm has been observed in 13 renal-transplant recipients on immunosuppressive therapy (Hoover, R. N., and Fraumeni, J. F., Jr., Lancet, II:55, 1973). The patient with Wiskott-Aldrich syndrome and reticulum cell sarcoma of the brain, unlike those with ataxia-telangiectasia and lymphoma, experienced no adverse reaction to radiotherapy or chemotherapy.
Transumbilical Balloon Atrial Septostomy in 16 Infants With Transposition of the Great Arteries
Authors: Newfeld Edgar A. , Purcell Clare , Paul Milton H. , Cole Roger B. , Muster Alexander J.
Published: December 2021

The accessibility of the umbilical vein for cardiac catheterization and BAS offers certain advantages over the use of the femoral vein in the newborn with transposition of the great arteries. The need for time-consuming dissection of the inguinal fossa is avoided and the femoral vein is spared for future studies. Complications such as infection and hemorrhage can be avoided by exercising proper caution. Our studies found essentially no difference in results when using the umbilical vein rather than the femoral vein approach for BAS in newborn infants with transposition of the great arteries.
Needle Aspiration in Hemophilus influenzae Type b Cellulitis
Authors: Goetz James P. , Tafari Nebiat , Boxerbaum Bernard
Published: December 2021

Three cases of H. influenzae type b cellulitis in infants are reported. The diagnostic importance of bacteriologic cultures of needle aspirates of the infected area as well as blood cultures is emphasized.
A New and Safe Method to Control the Depth of Endotracheal Intubation in Neonates
Authors: Loew Alexandra , Thibeault Donald W.
Published: December 2021

Endotracheal intubation in neonates is usually performed during emergency resuscitation. The most common and most serious complication of endotracheal intubation is placement of the tube in the right main bronchus followed by overventilation of the right lower lobe which is often associated with underventilation and atelectasis of the remainder of the lungs.1 If the inflation of the right lower lobe is excessive then alveolar rupture and interstitial emphysema may follow.2

The present technique of endotracheal intubation is to insert the tube into the trachea and then auscultate over both lung fields. If breath sounds are decreased over one lung field then the tube is slightly withdrawn.
Correction of Neutropenia Associated With Dysgammaglobulinemia
Authors: Rieger Christian H. L. , Moohr John W. , Rothberg Richard M.
Published: December 2021

Dysgammaglobulinemia type I (deficiency of IgG and IgA with normal or elevated IgM) is frequently associated with severe neutropenia, undue susceptibility to infection and recurrent or persistent mouth ulcers.1 The mechanism underlying the neutropenia is unclear and gamma-globulin treatment has in all but two cases2,3 failed to increase absolute neutrophil counts. This report describes the correction of severe neutropenia in a patient with dysgammaglobulinemia type I after administration of unusually high doses of gamma-globulin. It is shown that treatment is only effective if serum IgG levels are maintained above the level necessary to keep individuals with hypogammaglobulinemia and normal neutrophil counts free of infection.
Minor Physical Anomalies and Hyperactivity
Authors: Schain Richard J.
Published: December 2021

The paper by Quinn and Rapoport1 in the May issue of Pediatrics indicates a higher incidence of minor physical anomalies ("stigmata") in hyperactive boys compared to a control group. The authors believe that the presence of stigmata are a clue to the occurrence of insults affecting the fetus during early development. It is suggested that the hyperactive behavior disorder is also a result of the same insult affecting the central nervous system during early morphogenesis.
Dr. Holliday's Reply
Authors: Holliday Malcolm A.
Published: December 2021

The FDA regulations for infant formulas were directed to infants of normal birth weight and their nutritional requirements during the first 6 to 12 months of life. There are a number of problems relating to feeding of low-birth-weight infants that require the development of separate standards and separate formulas for those infants. The Committee on Nutrition presently is concerned with reviewing the nutritional knowledge relating to nutritional requirements for low-birth-weight infants. The copper requirement cited by Dr. Cordano is an example where the nutritional requirements of low-birth-weight infants differ significantly from those of the normal infant.
THE HECTIC WAY OF AMERICAN LIFE AS A CAUSE OF POOR HEALTH-AS VIEWED IN 1856
Authors: C. T. E.
Published: December 2021

One of the recurring themes of American history is the supposed relationship of our hectic way of life to various diseases. Robert Tomes (1817-1882), a journalist, was a careful observer of the American scene in the middle years of the last century. The following quotation from his article "Why We Get Sick," published in Harper's Monthly Magazine in 1856 might just as readily have been written today.

The Americans should be the healthiest people in the world; but, if we compare them with other nations, in the aggregate, they will be probably found to have no claim to this superiority. This, however, is not a fair comparison, as the condition of the masses with us more nearly approaches that of the prosperous classes than of the poor of foreign countries. Material advantages alone, apart from moral causes, have given the Americans a position far in advance of all other nations. Physical comfort is the rule with us, while it is but the exception elsewhere. If a potato patch, as in Ireland, were the only barrier between our people and starvation, there might be some excuse for our countrymen not being healthier; for a want of physical comfort is among the most powerful cause of disease. With abundance of food, and such liberal rewards of labor that humblest American can supply himself with those comforts of life which are only within the reach of the prosperous classes abroad, it is but fair to compare him with the latter. In this comparison he will be found very deficient on the score of health.
Selection for Early Treatment in Myelomeningocele: A Retrospective Analysis of Various Selection Procedures
Authors: Stein Sherman C. , Schut Luis , Ames Mary D.
Published: December 2021

The results of early surgical treatment in 163 children with open myelomeningocele 1963-1968 were reviewed. Based upon this review, a selection protocol is proposed. Lacunar skull deformity (LSD, lückenschädel), a common x-ray finding in newborns with myelomeningocele, is quite strongly associated with eventual mental retardation. Early surgery is not recommended for children having both LSD and multiple adverse physical findings or those with associated gross congenital anomalies. The proposed protocol is shown to be of considerably greater reliability in predicting outcome among our cases than existing selection criteria.
ANIRIDIA/WILMS' TUMOR SYNDROME: CHROMOSOMAL DELETION
Authors: Miller Robert W.
Published: December 2021

Small chromosomal deletions may escape detection even when new chromosomal banding techniques are employed. Through the use of a high-resolution microscope scanning system coupled to a computer, a small deletion on chromosome 8 has been detected in a child with aniridia/Wilms' tumor. The deletion apparently occurred during translocation from chromosome 11 to chromosome 8. Detection of the deletion raises the question: are there critical genetic loci within or near the missing segment of chromosome 8 that account for the development of the neoplasm and its associated malformations? Study of additional cases is required to resolve this question (Ladda, R., et al., Science, 185:784, 1974).
Gastrin Response to Calcium Infusion: An Aid to the Improved Diagnosis of Zollinger-Ellison Syndrome in Children
Authors: Schwartz David L. , White John J. , Saulsbury Frank , Haller J. Alex
Published: December 2021

Serum gastrin levels were equivocally elevated in a 9-year-old boy with suspected Zollinger-Ellison syndrome. He had copious hyperacidity on fasting gastric analysis which was increased insignificantly following histamine administration. A calcium infusion test produced diagnostically elevated serum gastrin values (average 400 pg/ml) which were sustained for the course of the four-hour infusion. A malignant islet cell tumor of the pancreas metastatic to a celiac lymph node was found, and total gastrectomy performed. The boy adjusted well and is gaining along his curves for height and weight one year postoperatively. The calcium infusion test, or its counterpart the calcium challenge, appears to be a helpful method for identifying the Zollinger-Ellison syndrome, particularly in children in whom fasting serum gastrin values may not be diagnostic by adult standards.
PKU and Beyond: When Do Costs Exceed Benefits?
Authors: Scriver Charles R.
Published: December 2021

The "first law of screening" stresses that effective measures must reduce "costs." 1As in all ventures, those who pay the piper can expect to call the tune. Whether the concept of cost effectiveness should dominate all decisions about screening for hereditary metabolic disease has been challenged both by the pipers and by those who pay; but to ignore all together this position would be to live again in Hamelin town. Therefore, I will try to clarify several views of cost which are of interest to those who plan or engage in screening for genetic disease.2-5

THE ECONOMIC VIEW OF COSTS

Cost avoidance receives the principal emphasis because the benefits of screening are hard to price. The monetary costs resulting from screening and treatment are to be weighed against those incurred when such preventive practices do not take place. We could, indeed, avert the monetary cost to society of phenylketonuria (PKU) by eliminating chronic care institutions for the mentally retarded; at one time PKU patients comprised 1% of their residents. Thankfully, no one has considered this to be an acceptable option. Instead we are pleased to find that one dollar spent for the screening and treatment of PKU is more than balanced by a saving of $4 in institutional and other care which would otherwise be given to non-screened, untreated, retarded PKU patients.6

In the economic view, only real costs are considered. These include the specific cost of screening and treatment which prevents the full expression of the disease; this cost should be weighed against the specific life cost of traditional or new methods of dealing with the disease without screening.
Screening to Prevent Lead Poisoning
Authors: Moriarty Richard W.
Published: December 2021

The absence of fully effective treatment for lead encephalopathy, and the suggestive evidence that lead poisoning may cause brain damage even in the absence of overt encephalopathy, have led to massive efforts to prevent such damage.

These preventive efforts have been directed toward screening to identify children who have absorbed an undue amount of lead from their environment, reducing their further exposure to lead, and removing already absorbed lead from those most in danger of developing ill effects. This approach has been codified in the Surgeon General's Report of 19701 which makes the following recommendations:

1. All young children who live in or visit old dilapidated buildings should have periodic blood lead determinations.

2. Any child with repeated blood lead levels over 40µg/100 ml whole blood should be considered to be at risk of lead poisoning, h ave current sources of exposure to lead investigated and corrected, and be followed closely to ensure that he does not develop higher blood lead levels or clinical symptoms.

3. All children with blood lead levels between 50 and 79µg/100 ml should have diagnostic tests for metabolic and clinical evidence of lead poisoning and be treated immediately if such evidence is present.

4. All children with blood lead levels over 80µg/100 ml should be hospitalized immediately and treated with chelating agents.

Many aspects of this approach are subjects of current controversey, and the last word will not be written until much better knowledge of the natural history and ecology of lead poisoning is available.
Zoster Immune Globulin Shortage!
Authors: Brunell Philip A. , Gershon Anne A.
Published: December 2021

The most significant datum presented in the paper by Judelson, et al (Pediatrics, 53:476, 1974) is that zoster immune globulin (ZIG) was made available to only a fraction of the children for whom it was requested. In the two years since these data were gathered, moreover, the supply of ZIG has not increased appreciably. This situation is particularly deplorable since the prognosis for children with leukemia, the major recipients of ZIG, is so much brighter.
THE COMMITTEE ON DRUGS REPLY
Authors: Freeman John
Published: December 2021

Stuttering in children is usually a benign disorder and is common and usually self-limiting in children during the third and fourth years of life. In many persistent cases it appears to be a manifestation of a more or less severe personality disorder. In some cases, particularly under stress, it may represent a serious problem to the individual child. Therapeutic efforts with tranquilizers have usually been unrewarding. Therapy has been directed toward alleviating anxiety and building up the child's confidence and in some cases psychiatric and speech therapy.
Photodistribution of Viral Exanthems
Authors: Gilchrest Barbara , Baden Howard P.
Published: December 2021

Gilchrest B., and Baden, H.P.: Photodistribution of viral exanthems. Pediatrics, 54:136, 1974.

The legends for the two illustrations were reversed. Figure 1 is a patient with chickenpox and Figure 2 is a patient with echovirus 9 infection.
Pulmonary Interstitial Emphysema in a Newborn Infant Treated by Lobectomy
Authors: Fletcher Barry D. , Outerbridge Eugene W. , Youssef Sami , Bolande Robert P.
Published: December 2021

A case of pulmonary interstitial emphysema in a premature newborn infant with hyaline membrane disease is reported. The interstitial emphysema at first involved both lungs, then became localized to the left upper lobe. There was an associated pneumopericardium which resolved spontaneously. The increasing amount of air in the interstitium of the left upper lobe resulted in severe respiratory embarrassment which necessitated surgical removal at 29 days of age. Pathologic examination of the resected lobe showed chronic pulmonary interstitial emphysema and dilated, thick-walled lymphatic vessels.

See Image in the PDF file
T and B lymphocyte subpopulations
Authors: Seeger Robert C. , Stiehm E. Richard
Published: December 2021

The two major subpopulations of lymphocytes, T cells (thymus-dependent lymphocytes) and B cells (bursal equivalent or thymus-independent lymphocytes) have multiple roles in the immune system. In general, T cells are the functioning cells in the cellular immune system (delayed hypersensitivity, graft rejection, graft-versus hostreaction); and B cells, the precursors of plasma cells which form specific antibodies, are the functioning cells in the antibody immune system. It is now well recognized, however, that these cell types and immune systems usually do not function independently, but interact with one another in multiple ways and also with other, cells such as macrophages. For example, T cells may increase or suppress the production of antibodies by the B cell system, and macrophages may increase or suppress the response of T and B cells to antigens.
WHO INVENTED THE ESKIMO PIE?
Authors: Dickson Paul
Published: December 2021

Taken together the Eskimo Pie, the Good Humor bar, and the Popsicle have had a tremendous impact on the ice cream industry. All three were invented between 1919 and 1924 and there has not been a significant new ice cream novelty since.

One afternoon in 1919 a young boy entered a candy store in Onawa, Iowa, and ordered an ice cream sandwich but then changed his mind and ordered a candy bar. Christian Nelson, the proprietor, asked the boy if he really knew what he wanted, to which he replied, "Sure I know—I want ‘em both, but I only got a nickel." The lad's comment prompted Nelson, a Danish-born schoolteacher who ran the candy store as a sideline, to conclude that there was probably a market for a confection that combined chocolate candy with ice cream. He experimented with the idea but got nowhere because he was unable to make chocolate stick to ice cream. Weeks later he learned from a candy salesman that cocoa butter improves the clinging ability of chocolate, and he tried again. He succeeded on the first try and dubbed his chocolate-covered creation the "I-Scream Bar." The first five hundred bars were taken to the Onawa Firemen's Tournament, and all were sold.

Convinced that his was a money-making creation, Nelson applied for a patent and set out to sell it in Omaha. In 1921, after months of failure during which he was reduced to racking balls in a pool hall for $20 a week, he met an Omaha ice cream company superintendent named Russell Stover who liked the idea, and a partnership was established.
Mucocutaneous Lymph Node Syndrome (MLNS) in Athens, Greece
Authors: Valaes Timos
Published: December 2021

In the last paragraph of their commentary on mucocutaneous lymph node syndrome (MLNS), Fetterman and Hashida1 expressed the expectation that the geographical limits of this disease will be clarified in the next one to two years. I hope this letter will help start this process. The commentary and the articles of Kawasaki et al2. and Yanagisawa et al3. published in the same issue of Pediatrics helped me to recognize as MLNS a small epidemic of identical cases of an unusual combination of symptoms that I experienced in Athens during June and July this year (I left Athens on July 20, and, therefore, I cannot say whether more cases have occurred afterwards.).
Fatalism in Ghetto Adolescents
Authors: Kuhr Murray D.
Published: December 2021

Fatalism is defined as "the doctrine that all things are preordained and predetermined by fate." A true believer would hold that his life and his actions are beyond his control. The doctrine has its origin in despair and serves to perpetuate failure and further despair. It is the purpose of this communication merely to identify a pathogenic agent, not to define its epidemiology or propose a therapy for it.

In the course of rap sessions with black ghetto adolescents a horrifying truth was discovered.
Prenatal exposure to stilbestrol and adenocarcinoma of the female genital tract: The pediatrician's responsibility
Authors: Soyka Lester F.
Published: December 2021

In 1970 Herbst and Scully1 reported seven cases of adenocarcinoma of the vagina in adolescents, of which six were of the clear-cell type. In a followup paper,2 an association was proposed between the occurrence of this previously rare tumor in young women and their exposure in utero to diethylstilbestrol (DES). This startling conclusion was immediately strengthened by reports of additional cases, and soon adenocarcinoma of the cervix also was linked to in utero DES exposure.3 These reports have been popularized by the media, and some obstetricians have recommended routine, repeated vaginal examination, biopsy, culposcopy, etc. for all females who were exposed in utero.4-6
Growth Retardation in Children With Ulcerative Colitis: The Effect of Medical and Surgical Therapy
Authors: Berger Michael , Gribetz Donald , Korelitz Burton I.
Published: December 2021

The growth patterns of 37 children with ulcerative colitis have been analyzed. While conventional growth charts showed only percentile changes in height, height data plotted on Tanner et al.'s growth charts showed increases and decreases in growth velocity. Growth retardation is a prominent complication of ulcerative colitis with onset in childhood and may be manifest for years prior to onset on bowel symptoms. Both ulcerative colitis and "high-dose" steroid therapy (≥ 12 mg/sq m/day of cortisol) can hinder growth but in some instances there is a growth spurt after high-dose steroid therapy. "Low-dose" steroid therapy does not retard growth. Colectomy is more effective than high-dose steroid therapy in reversing the growth retardation caused by ulcerative colitis and is of greatest value if not delayed too long. Growth following subtotal colectomy with ileorectal anastomosis (Aylett procedure) is not likely to be as much as that after subtotal colectomy with ileostomy. Growth retardation is infrequently the only indication for surgical intervention but ileostomy and colectomy are appropriate for this complication of ulcerative colitis in itself when not improved by adequate medical treatment.
The Risks of Paracervical Anesthesia: Intoxication and Neurological Injury of the Newborn
Authors: Guillozet Noel
Published: December 2021

Obstetrical pain during routine vaginal delivery has prompted many therapeutic approaches over the decades with agents gaining and losing favor. The risks of local anesthesia have seemed negligible and mishaps have seemingly been rare. Teramo and Widholm remarked in 1967 that paracervical block had become the most popular method of relieving obstetric pain during the first stage of labor over most of the world.1 It is now an even more popular choice in large and small hospitals in the United States, and the fact that it can be administered without an anesthetist by the obstetrician is certainly contributory.

The safety of local anesthetics in routine vaginal deliveries was questioned in a number of articles published between 1963 and 1968 describing paracervial block and epidural routes using several agents.2-5
GALEN ON WHY THE FEMALE IS MORE IMPERFECT THAN THE MALE
Authors: C. T. E.
Published: December 2021

Galen (A.D. 131-201), one of the greatest figures in medicine, was the principal authority in the medical schools of medieval and Renaissance Europe. Galen was so venerated by his contemporaries that many regarded him as a God and even formed a religious cult for his worship.1

His biologic views concerning women were not seriously challenged until the seventeenth century. In the Oeuvres de Galen(Paris, 1854-1856) one reads this about women:

The female is more imperfect than the male. The first reason is that she is colder. if, among animals, the warmer ones are more active, it follows that the colder ones must be more imperfect . . . .

Just as man is the most perfect of all animals, so also, within the human species, man is more perfect than woman. The cause of this superiority is the [male's] superabundance of warmth, heat being the primary instrument of nature . . . .

The male's testicles are all the stronger because he is warmer. The sperm born there, on reaching the final degree of concoction, is the formative principle of the animal. From a single principle wisely imagined by the Creator— that whereby the female is less perfect than the male—follow all the conditions useful for the generation of animal: the impossibility for the female genitalia to emerge externally, the accumulation of a superfluity of useful nourishment, an imperfect sperm, a hollow organ capable of receiving perfect sperm.

In the male, instead, everything is the reverse: an elongated member suitable for copulation and emitting sperm, and an abundance of this same thick warm sperm . . . .
Lettrt To The Editor
Authors: Thompson Ian M.
Published: December 2021

In reply to Drs. Say and Coldwell, six of our patients were female but there were no siblings or near relatives who were known to have this congenital abnormality from the family histories in these patients.

I think the comment is worthwhile and would refer the authors to Dr. David Innes Williams at the Great Ormond Street Hospital in London for his comment due to his large experience with this disorder.
The Need for Control Study in Reye's Syndrome
Authors: Albers William H.
Published: December 2021

The article by Samaha et al.1 concerning the use of peritoneal dialysis in Reye's syndrome illustrates the importance of appropriately controlled observations in the evaluation of any new therapeutic technique. The authors report nine survivors of 11 patients treated by peritoneal dialysis and only two survivors of 13 patients treated without dialysis. Unfortunately, the two groups are not comparable, since the non-dialyzed patients were treated between 1968 and 1971 and the group treated with dialysis entered the hospital in 1971 to 1972.
"Neonatal" Is the First 28 Days of Life
Authors: Addy D. P.
Published: December 2021

You will no doubt agree that it is highly desirable in scientific communications to use words precisely and with an agreed meaning. The word neonatal is by common convention applied to the first 28 days of life, yet there has been a tendency recently to extend that definition to include a later part of the infant period. This seems to have become particularly common in reports of so called neonatal hepatitis associated with the Australia antigen and the most recent example is in the report by Dr. Kattamis and colleagues.1
Question About Fluoride in Formulas
Authors: Balasubramaniam M.
Published: December 2021

The articles on dental caries in children in the August 1974 issue of Pediatrics are interesting and made me think about the following aspect of fluoridation. As far as I can find out, none of the presently available formulas have any fluoride in them. Would it not be a good idea to add an appropriate quantity of fluoride to all the formulas so that we can make sure that babies do get fluoride from birth? Even though a majority of the babies live in areas where the water is fluoridated, the amount of daily water intake (as plain water) in the first six months of life is negligible.
Photodistribution of Viral Exanthems
Authors: Cherry James D.
Published: December 2021

The recent paper on photodistribution of viral exanthems1 was of great interest to me and has stimulated the following comments.

1. Figures 1 and 2 are apparently reversed and the reference to viral size on the same page is off by a factor of 1,000.

2. A quick review of the literature on echo 9 viral exanthems reveals one patient whose rash was confined to areas of sunburn; after exposure to the sun it became much brighter in color.2
The xanthine treatment of apnea of prematurity
Authors: Luckey Jerold F.
Published: December 2021

Some things have to be discovered twice. Such is the case with the use of aminophylline in treating apnea. Vogi first described the use of aminophylline for the treatment of Cheyne-Stokes respiration in 1927.1 His observations were amply confirmed2,3 but no interest in this therapy occured in pediatrics. Kuzemko and associates first introduced rectally administered aminophylline as a treatment for apnea of prematurity in 1973.4-5 This publication initially attracted little attention. Bednarek and Roloff6 and others have confirmed Kuzemko's findings (J.F. Lucey, unpublished data). Shannon et at.7 introduced the use of orally administered theophylline and their successful results have also been confirmed.8
Chemoreceptor Reflexes in Preterm Infants: I. The Effect of Gestational and Postnatal Age on the Ventilatory Response to Inhalation of 100% and 15% Oxygen
Authors: Rigatto Henrique , Brady June P. , de la Torre Verduzco Rafael
Published: December 2021

We studied 16 "healthy" preterm infants (birthweight, 1,000 to 2,000 gm) 94 times during postnatal life to define the effect of gestational and postnatal age on the ventilatory response to 100% and 15% oxygen. They were given air, then 100% oxygen for two and five minutes respectively (No. = 63) or 21%, 15%, and then 21% oxygen for five minutes each (No. = 31). We measured respiratory minute and tidal volumes, frequency, heart rate, and alveolar Pco2 and Po2. We used the magnitude of the immediate change in ventilation during 100% and 15% oxygen breathing to test peripheral chemoreceptor function. The immediate decrease in ventilation with 100% oxygen and the immediate increase in ventilation with 15% oxygen were statistically similar at different gestational and postnatal ages. The late increase in ventilation (five minutes) with 100% oxygen was also similar at different ages. However, the late decrease in ventilation with 15% oxygen was not present at 18 days of age. These findings suggest that: (1) the peripheral chemoreceptors are active at least from 28 weeks of gestation and are probably not important in triggering periodic breathing or apnea in preterm infants; and (2) the preterm infant matures his response to hypoxia and is able to sustain hyperventilation with low oxygen by 18 days of age.
Rapid Diagnosis of Sickle Cell Disease at Birth by Microcolumn Chromatography
Authors: Powars Darleen , Schroeder Walter A. , White Linda
Published: December 2021

Accurate specific diagnosis of sickle cell disease can now be made at birth on routinely obtained cord blood samples by microcolumn chromatography. The method uses a small column of a cation ion exchange resin, CM-Sephadex, and a single developer that allows definitive rapid distinction of hemoglobin SS, AS, AC, SC, and CC, within two hours. Seventy-five samples or more per day have been analyzed by one technician in a laboratory without special precautions or equipment. In a program which has been initiated on a large, totally unpredictable obstetrical service in Los Angeles, 10,401 consecutively born infants have been studied for hemoglobin type without regard to racial origin. Three SS infants, I SC, 143 AS infants, and 37 AC infants as well as several with other abnormal hemoglobins have been identified without interfering with the routine operation of the delivery rooms of the obstetrical service. The diagnosis of sickle cell disease has been confirmed on subsequent examinations of the infants. The feasibility of using microcolumn chromatography as a rapid, accurate, inexpensive, and easy method for the rapid diagnosis of sickle cell disease in newborns has now been established.
Relationship of Diet to Lead Poisoning in Children
Authors: Mooty Joyce , Ferrand Charles F. , Harris Paul
Published: December 2021

Forty-six children, aged 24 to 47 months (25 controls and 21 subjects) chosen according to low and high blood lead levels respectively, were studied to ascertain the presence or absence of a relationship between dietary intake and the occurrence of plumbism (in children of low-income families). Through single-blind interviews by a nutritionist, dietary intakes were gathered, and the average daily intake of calories, protein, and iron was calculated. Hemoglobins, hematocrits, heights, weights, blood lead levels, and social and demographic data had been gathered during the routine check for lead poisoning and at registration at the clinic. The mean caloric and protein intake as percent of recommended dietary allowances were equal and adequate for both controls and subjects. There was no statistically significant difference between the controls and subjects with respect to iron intake which was low in both groups. Mean hemoglobin and hematocrit levels were in the anemic range for both groups. The subjects were shorter and weighed less than the control group. Pica was more prevalent among children with plumbism. The findings of this study suggest that some factors other than dietary intake must account for the occurrence of lead poisoning in the subjects and that Blacks have a higher prevalence of plumbism in our area.
Citrobacter diversus Meningitis: A Case Report
Authors: Tamborlane William V. , Soto Emilio V.
Published: December 2021

Citrobacter is a member of the Enterobacteriaceae family presently grouped with Salmonella and Arizona. Most reported isolates of these organisms have been in adults where they have been considered as either normal bowel flora, of indeterminate clinical significance, or as secondary invaders in mixed cultures in compromised hosts. Occasionally they have been isolated in adult patients in pure cultures in urine and blood. Positive cerebrospinal fluid cultures, on the other hand, have been restricted to the newborn period as a very rare cause of neonatal meningitis.

Recently Citrobacter diversus has been recognized as a distinct species in the larger group of hydrogen sulfide-negative Citrobacter by Ewing and Davis.1
The Timing of Elective Surgery on the Genitalia of Male Children With Particular Reference to Undescended Testes and Hypospadias
Authors: Kelalis Panayotis , Bunge Raymond , Barkin Martin , Perlmutter Alan D. , Friedman David B. , Work Henry H. , Lucas Alexander
Published: December 2021

Psychologic considerations suggest that the optimal time for elective surgery on the genitalia is either the first 6 months of life or sometime during the fourth year. In the child with cryptorchidism, physiologic considerations are of paramount importance and the timing of treatment should be based on these considerations. Despite the conflicting views on the subject, there is suggestive evidence that early orchiopexy—during the first year of life or soon afterwards—may be the most optimal time for orchiopexy, but further investigation would be necessary to confirm this. Currently, timing of operation is based more on psychologic rather than physiologic factors (although both are taken into account), and should remain unchanged until further evidence accumulates.

The Committee feels that the later the orchiopexy after age 6, the more likely germinal epithelial failure will occur. However, it should be pointed out that 5 or 6 has not proven to represent optimal age in respect to germinal function but only the latest recommended age for orchiopexy.

In patients with hypospadias, technical considerations have the greatest bearing on timing, but, depending on the individual surgeon, the precise timing varies. The period after the third birthday is preferred by the majority; this certainly is consistent with psychologic considerations unless the correction of chordee justifies a separate cedure, which then should be corrected by age 2.
Dr. Tingelstad Replies
Authors: Tingelstad Jon B.
Published: December 2021

We wish to thank Dr. Shakibi for his comments on the controversial subject of single ventricle. The references quoted in his correspondence share in common the definition of single ventricle which excludes tricuspid and mitral atresia. Other authors, however, have included atresia of the atrioventricular valves in their descriptions of the malformation.1-3 We chose to follow Engles's terminology in our case discussion. She states that " patients with single ventricle may have a common atnoventricular valve or two AV valves, either of which may be stenosed or even atretic."
Familial Cryptorchidism
Authors: Pardo-Mindan F. J. , Torcal F. Vargas , Julian G. Garcia , Ruiz M. T. Vitro
Published: December 2021

Familial cryptorchidism is a poorly understood and infrequently reported condition.

We have had the opportunity of studying three different families. In the first family, the father, his twin 3-year-old sons, and their 6-year-old sibling had undescended left testes. In the second family, left-sided cryptorchidism occurred in the father, his brother, and his 7-year-old son. In the third family, twin brothers, 2 years of age, had cryptorchidism on the left side. There was no family history of cryptorchidism. In all cases the testes were located in the inguinal canal.
Exercise, the School, and the Allergic Child
Authors: Ghory Joseph E.
Published: December 2021

We have met the challenge! The poet of Ecclesiastes is turning over in his grave, conceding the fact that there is something new under this Seattle sun. This selected panel of world-wide experts has deliberated at length and exercised its best judgment in coming up with some positive answers to difficult questions pertaining to exercise and asthma. The duration of our exercise has left us panting, if not wheezing!

Our next challenge must be to communicate this information to the patient who needs help and to the responsible peopele involved in his care. This includes not only his personal physician but also his family, his school authorities, and his recreation leaders. The successful management of any recurrent or chronic illness demands education and understanding of the natural course of the disease, its etiologic factors, its treatment, and its long-term prognosis. This process of education must involve not only the patient himself but, in addition, all those entrusted with his care.

Just as his parent is the allergic child's most important person in his home, so his teacher is the most important person in his school. The parents must cooperate freely with their child's teacher in providing all the necessary information about his allergies. Similarly, the teacher, like the parent, must be alerted to warning symptoms of distress so that proper medications can be administered early. The schoolteacher should be provided with the telephone numbers of the mother's home, the father's business, and the child's physician, so that someone responsible can be contacted if a major problem arises.
Central Nervous System Infection With Eikenella corrodens: Report of Two Cases
Authors: Rubenstein James E. , Lieberman Marc F. , Gadoth Natan
Published: December 2021

Two cases of central nervous system infections from which E. corrodens has been isolated are reported. The portals of entry, clinical course, and antimicrobial responses conform to other reports in the literature. The importance of obtaining careful anaerobic cultures is emphasized.
Current Status of Ampicillin-Resistant Hemophilus influenzae Type b
Authors: Katz Samuel L. , Calderon Ernesto , Carver David H. , Cramblett Henry G. , Frothingham Thomas E. , Klein Jerome O. , Quie Paul G. , Steigman Alex J. , Stiehm E. Richard , Yow Martha D. , Krugman Saul , Mortimer Edward A. , Dull H. Bruce , Larke R. P. Bryce , Meyer Harry M. , Witte John J.
Published: December 2021

At its meeting on April 16, 1975, the Committee on Infectious Diseases reconsidered the problem of ampicillin-resistant strains of Hemophilus influenzae type b. The following facts were noted:

(1) Strains of H. influenzae type b highly resistant in vitro to ampicillin have been reported from 20 states and the District of Columbia.1

(2) These strains were isolated from children with sepsis, meningitis, cellulitis, epiglottitis, suppurative arthritis, and pneumonia. Some of the children died when the resistance of the etiologic strain was not appreciated.

(3) The prevalence of these strains is still uncertain but appears to be at a low level in most communities. Epidemiologic studies, however, indicate these strains may infect many children in closed communities, such as day-care centers.2

The Committee believes a modification of its prior statement3 is warranted based on the wide-spread occurrence of these strains:

(1) Initial management of children with documented or suspected severe infection due to H. influenzae type b (including meningitis, epiglotitis and sepsis) should include a parenteral penicillin (penicillin G or ampicillin) and intravenous chioramphenicol.

(2) All strains of H. influenzae type b should be tested for susceptibility to ampicillin as early as possible.

(3) Ampicillin alone as initial therapy for children with severe infections that may be due to H. influenzae should be considered only in areas of the country where ampicillin-resistant strains of H. influenzae type b have not appeared and where active programs of bacterial surveillance and rapid laboratory diagnosis of susceptibility to antimicrobial agents are available.

The dosage schedules, rationale for combined therapy as initial management, and description of susceptibility tests for H. influenzae are given in the initial Committee Report.3
Food for inefficient thought
Authors: Levine Melvin D. , Liden Craig B.
Published: December 2021

The notion that "even an unwholesome diet" may have an impact upon the function of the central nervous system has been a recurring theme in the history of medicine and the study of human behavior. In the current issue of Pediatrics, Conners et al.1 present an important exploration of a comtemporary hypothesis regarding this association. Ultimately, their and other studies on the subject may modify our approach to the inefficient school-age child, or, alternatively, such pursuits may form another unfulfilling flirtation in the on-going romance between behaviorists and food faddists.

THE POPULATION CONSIDERED

In recent years, there has been growing awareness that there exists a population of children whose performance in life is handicapped significantly by intrinsic or constitutional inefficiencies.
Accidental Quinidine Poisoning in Two Children
Authors: Dellocchio Teresio , Pailli Franco , Testa Oreste , Vergassola Rossano
Published: December 2021

Two cases of acute accidental quinidine poisoning in two children are presented. Both cases are characterized by the same ECG abnormalities consisting of rhythm disorders and AV and intraventricular conduction defects. It is suggested that there is a causal relationship between the electrophysiologic cardiac effects of quinidine and the ECG abnormalities observed. Both patients were successfully treated by continuous intravenous infusion of a hypertonic sodium chloride solution and lidocaine.
Disagreement on Two Points With Commentary on Hypertension
Authors: Fowler R. S.
Published: December 2021

The commentary entitled "The Pediatrician and Hypertension"1 deals with a very important problem in pediatrics that has only recently come into prominence. The concluding paragraphs are particularly timely to practicing pediatricians, stressing the careful follow-up of blood pressure in children beyond the 95th percentile for age and early investigation of those with severe hypertension.

I disagree with two items in the commentary:

1. Cuff Size: In a recent editorial in the American Journal of Cardiology,2 Steinfeld et al. summarize their own experimental and clinical work and other work, indicating that the pneumatic bladder should completely encircle the limb.
An Influenza B Epidemic Among Children in Day-Care
Authors: Klein Joel D. , Collier Albert M. , Glezen W. Paul
Published: December 2021

An outbreak of influenza virus type B infections occurred in the Frank Porter Graham Day Care Center from February to April, 1974. During the epidemic there were 27 isolations of influenza B virus from 20 children. One half of these were obtained from children who were well at the time of culturing. Attack rates as determined by virus isolation and seroconversion for most age groups approximated the 40% rate for the entire population. Clinical and microbiological data from this study were compared to those obtained in the center during the same three months in 1973. Increases in the incidence of otitis media and temperatures over 38 C were seen during the 1974 study. Intensive continuous microbiological surveillance for bacteria, viruses, and mycoplasmas failed to reveal predominance of any other potential pathogen to account for these clinical findings. The analysis permitted by the nature of this study design in a day care setting revealed several unexpected findings: high attack rates unrelated to age; common inapparent infections; and frequent association with otitis media.