bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Chronic Childhood Asthma With Beclomethasone Dipropionate Aerosols: II. Effect on Pituitary-Adrenal Function After Substitution for Oral Corticosteroids
Authors: Kershnar Harvey , Klein Robert , Waldman David , Berger William , Rachelefsky Gary , Katz Roger , Siegel Sheldon
Published: December 2021

The effects of beclomethasone dipropionate aerosol (BDA) (400 µg/day) on clinical course, pulmonary function, and pituitary-adrenal function was studied in 34 steroid-dependent asthmatic children. Asthma severity was assessed by daily symptom and medication scores, peak flow measured three times a day, and weekly spirometry. Pituitary-adrenal function was evaluated by diurnal cortisol levels, cortisol responses to intravenous (IV) corticotropin (ACTH), and steroid responses to IV metyrapone. After 12 weeks of BDA therapy, 30 of 34 patients no longer required prednisone. Mean weekly symptom and medication scores and the number of attacks decreased significantly (P < .01). A significant improvement was demonstrated in the patients' peak flow (P < .01), forced expiratory volume in one second, and maximum midexpiratory flow rates (P; < .01). Thirty of the 34 patients initially had abnormal metyrapone responses, 28 had abnormal diurnal cortisol levels, whereas only 14 had abnormal IV ACTH response tests. Although significant improvement was noted in the mean metyrapone and diurnal cortisol tests, only partial recovery of pituitaryadrenal function was observed in 20 patients, complete recovery in 5, and no change in 9. BDA was found to be therapeutically superior to oral steroids in the group of steroid-dependent asthmatic children and produced no serious adverse effects.
Otitis Media in the Neonatal Intensive Care Unit
Authors: Berman Steven A. , Balkany Thomas J. , Simmons Michael A.
Published: December 2021

Thirty-eight of 125 premature infants who were hospitalized in a neonatal intensive care unit (NICU) had abnormal tympanic membrane mobility compatible with otitis media. Twenty-five of these 38 had received antibiotics within one week of otoscopic examination and were considered to have either serous otitis or partially treated bacterial otitis media; tyinpanocentesis was not performed in them. Tympanocentesis was performed in the remaining 13 infants who had not received antibiotics. Bacterial otitis media was confirmed in ten of the 13. Either staphylococcal (six cases) or Gram-negative enteric organisms (four cases) were isolated in cultures obtained by tympanocentesis in these cases. The four cases of Gramnegative infections occurred in infants within six weeks of birth. Nasotracheal intubation for more than seven days was significantly correlated with impaired tympanic membrane mobility compatible with otitis media. Otitis media occurs frequently among premature infants who are hospitalized in an NICU, and it should be looked for in any infant in whom sepsis is clinically suspected.
Takayasu Arteritis and Renovascular Hypertension in Childhood
Authors: Wiggelinkhuizen J. , Cremin B. J.
Published: December 2021

Takayasu arteritis with renal artery involvement was the cause of severe persistent hypertension in eight children under 12 years of age. Features of severe hypertension dominated the clinical picture. Unequal or absent pulses were found in three patients. An irregular contour of the descending thoracic aorta on the chest roentgenogram was an early clue to the diagnosis. On aortography both renal arteries were affected in five patients, although a discrepancy in kidney size on excretory urography had suggested a unilateral lesion. Total aortography is mandatory to outline the full extent of the vascular abnormalities. All the patients had strongly positive tuberculin skin tests, and, although mycobacteria were not isolated, all patients received antituberculous as well as antihypertensive therapy. Nephrectomy of the worse kidney is contraindicated if the renal arteries are asymmetrically involved, for fear of later extension of the arteritis. Takayasu arteritis is an important cause of severe persistent hypertension in nonwhite children.
Use of the Placenta as a Teaching Model
Authors: Clarke Thomas A. , Levy Linda , Mannino Frank
Published: December 2021

The human placenta is a useful model for demonstrating and practicing the techniques of intravenous (IV) needle insertion and umbilical vessel catheterization in neonates.

MATERIALS AND METHODS

Placentas that do not require pathologic examination are utilized as the teaching model.

IV Insertion

The amnion is removed from the infant's side of the placenta for easier needle insertion. One placenta is sufficient for two students. The use of gloves is optional. Indications and complications of IV therapy are reviewed, and insertion sites and methods are discussed. A demonstration of inserting an IV needle is given by the instructor. As in the real-life situation, blood return occurs in the scalp vein tubing on entering the vessel.
The Education for All Handicapped Children Act of 1975: A pediatrician's viewpoint
Authors: Low Merritt B.
Published: December 2021

Integration of the handicapped child into the mainstream of society is a concept now heading toward the hurdle of implementation. It is intermeshed with other societal ferments, interplays between personalization and depersonalization, consumerism and professionalism, central authority and local autonomy, Federal activity in the area of the education of the handicapped has been increasing since the enactment of The Elementary and Secondary Education Act of 1965, generated from President Kennedy's panel on mental retardation. A synergism between local control and central guidelines has been sought. Title III of that Act provided for the allocation of funds to be used to support special instruction and equipment for "persons who are handicapped."
Evaluating Indirect Blood Pressure Measurement Techniques: A Comparison of Three Systems in Infants and Children
Authors: Reder Robert F. , Dimich Ivan , Cohen Myron L. , Steinfeld Leonard
Published: December 2021

The systemic arterial blood pressures obtained in infants and children utilizing three indirect measuring devices—Arteriosonde 1010, Infrasonde 3000, Pedisphyg system—were compared to each other and to intra-arterial pressure measured directly. The results indicate that Arteriosonde performs considerably better than Infrasonde; nevertheless, the Arteriosonde values are often only approximations of true systole and diastole. The Pedisphyg system yields accurate, reproducible values for systole; however, the system is not designed to determine diastolic blood pressure.
Ultrasonic Diagnosis of Gynecologic Disorders in Children
Authors: Haller Jack O. , Kassner E. George , Staiano Shirley , Schneider Morton
Published: December 2021

During the last five years we have applied diagnostic ultrasound to more than 350 girls under the age of 15 for suspected obstetric and gynecologic disorders. More than 60% of these patients were pregnant and were studied before elective abortion. Many other children were studied for amenorrhea or for the evaluation of a pelvic mass. Sonography has allowed us to successfully distinguish pelvic masses of ovarian origin from those of uterine origin. We have also been able to rule out functioning endocrine tumors in children with precocious puberty. In cases of intersex, sonography has been useful in the older child prior to reconstructive surgery but has played an ancillary role to more invasive procedures in the infant.
Accident prevention and health education: Back to the drawing board?
Authors: Pless I. Barry
Published: December 2021

Some ancient Japanese ivory carvings consist of an intricate, often two-faced exterior shell within which a second or even a third, equally complex, figure is embedded. In like fashion, two of the most important questions confronting pediatrics today are closely related and contain within them several other equally profound puzzles. The first is how to prevent accidents—the leading killer of children in our time. The other is how to change health behavior, not only to reduce accidents or their consequences, but also in hope of promoting life-styles that will lead to positive health in other spheres. A second layer of questions pertains to the role and responsibilities of the health profession relative to others and, within health, to the role of practicing physicians relative to public health agencies, both in accident prevention and health promotion.
The Use of Psychotropic Drugs in Children
Authors: Werry John S.
Published: December 2021

The clinical use, methods of evaluation, safety and efficacy of psychotropic drugs in children are reviewed. It is concluded that only the stimulants have a clearly established place, but that the less studied antidepressant and antipsychotic drugs almost certainly have a place too. While the rather ill-defined hyperkinetic syndrome is the condition par excellence for drug therapy, other diagnostic entities, notably unsocialized, aggressive, and overanxious reactions, Gilles de la Tourette syndrome, school phobia, and the childhood psychoses appear to be drug responsive in some cases.
Les Chermignonards Désenchantés Reply
Authors: Désenchantés Les Chermignonards
Published: December 2021

"You don't expect me to know what to say about a play when I don't know who the author is, do you? ... If it's by a good author, it's a good play, naturally. That stands to reason" (Fanny's First Play by George Bernard Shaw, 1911).

We find it interesting that the letter in defense of data uses a legal metaphor ("...the concept of a somber judge"). In a courtroom, opposing lawyers use the adversary process in a search for the "truth."
Middle Ear Ciliary Defect in Kartagener's Syndrome
Authors: Fischer Thomas J. , McAdams James A. , Entis Gregory N. , Cotton Robin , Ghory Joseph E. , Ausdenmoore Robert W.
Published: December 2021

Patients with Kartagener's syndrome have shown electron photomicrographic abnormalities of nasal or bronchial cilia in addition to functional defects of mucociliary transport (immotile cilia syndrome). This report describes a boy with Kartagener's syndrome and chronic otitis media who demonstrates electron photomicrographic abnormalities of middle ear cilia, confirming the important role of cilia in providing protection against infection of the middle ear.
Mechanical and Chemical Damage to Lung Tissue Caused by Meconium Aspiration
Authors: Tyler Donald C. , Murphy Janet , Cheney Frederick W.
Published: December 2021

We investigated the effects of meconium on the lungs of an adult rabbit model to distinguish between mechanical obstruction of airways and chemical pneumonitis. After the rabbits were anesthetized and intubated, 20% human meconium in saline was instilled into the trachea. Arterial and mixed venous blood gases, functional residual capacity, cardiac output, vascular pressures, calculated venous admixture, and pulmonary vascular resistance were measured. Sections of affected lung tissue were examined microscopically. The results were consistent with an early mechanical obstruction of airways with gradual development of chemical pneumonitis over 48 hours.
Violaceous Discoloration in Pneumococcal Cellulitis
Authors: Thirumoorthi M. C. , Asmar Basim I. , Dajani Adnan S.
Published: December 2021

Two patients with periorbital cellulitis, one of whom also had buccal cellulitis, had violaceous discoloration of the skin. Blood cultures from both patients yielded Streptococcus pneumoniae. Therefore, pneumococci should be considered, in addition to Haemophilus influenzae, as possible causes of cellulitis with violaceous or bluish-red discoloration.
Amniotic Fluid Infections, Neonatal Hyperbilirubinemia, and Psychomotor Impairment
Authors: Naeye Richard L.
Published: December 2021

A large prospective study found that infants born with evidence of recent amniotic fluid infections subsequently had an increased frequency of mental, motor, visual, and hearing impairment. These infections also potentiated the neurotoxicity of neonatal hyperbilirubinemia. This potentiation of bilirubin neurotoxicity increased with the severity of the amniotic fluid infections. With or without such infections, an increased frequency of long-term mild mental retardation started at peak neonatal bilirubin levels of only 7 mg/dl in both term and preterm infants. Significant neurologic abnormalities began at peak bilirubin levels of 12 to 13 mg/dl.
Usher Syndrome in Four Hard-of-hearing Siblings
Authors: Davenport Sandra L. H. , O'Nuallain Sinead , Omenn Gilbert S. , Wilkus Robert J.
Published: December 2021

Retinitis pigmentosa (RP) and congenital deafness comprise the autosomal recessive Usher syndrome. The four affected siblings discussed here have audiometric curves characteristic of the 10% of patients with the syndrome who are not profoundly deaf. The oldest already has RP. Even though the younger three siblings have no visual symptoms, they do have auditory signs of the syndrome; they almost certainly will develop RP and become deaf-blind adults. Electroretinography indicates that the second oldest boy has early evidence of rod dysfunction. Special audiometric tests and electronystagmographic results support previous reports of a peripheral rather than central auditory lesion. The heterozygote parents show unilateral high-frequency hearing losses with normal retinal and vestibular function.
Hypertension Associated With the Guillain-Barré Syndrome
Authors: Stapleton F. Bruder , Skoglund R. R. , Daggett Robert B.
Published: December 2021

Guillain-Barré syndrome (GBS) is frequently complicated by hypertension, which has been ascribed to sympathetic nervous system hyperactivity. We report the case of a child with GBS and hypertension that appeared to be related to increased renin-angiotensin activity. Urinary catecholamine excretion was normal. Propranolol therapy successfully controlled the hypertension. Evaluation of the renin-angiotensin system and catecholamine excretion is indicated in patients with GBS and hypertension.
Transcutaneous P02 Monitoring in Infants With Persistent Fetal Circulation Who Are Receiving Tolazoline Therapy
Authors: Boyle Robert J. , Oh William
Published: December 2021

Tolazoline (Priscoline) hydrochloride has been suggested as an effective pulmonary vasodilator in infants with persistent fetal circulation.1.2 The drug can potentially cause systemic vasodilation, hypotension, and cutaneous flushing. Transcutaneous P02 (TcPO2) monitoring has been shown to be a reliable adjunct in the care of the critically ill neonate.3 Peabody et al.4 have reported that tolazoline adversely affects the correlation of TcPO2 and PaO2 and warned against relying on this technique during the administration of the drug. Since instantaneous TcPO2, monitoring in infants who have persistent fetal circulation and who are receiving tolazoline may be useful, we undertook this investigation to evaluate its reliability.
Car Seat Burns in Infants: Avoiding Confusion With Inflicted Burns
Authors: Schmitt Barton D. , Gray Jane D. , Britton Helen L.
Published: December 2021

Summertime drivers commonly experience annoyance, discomfort, or even exquisite pain from hot car seats. The fact that these hot surfaces can lead to second-degree burns in young infants is less well known. The purpose of this article is to report five cases of car seat burns in children, to review the data from a brief study on peak temperatures of car seats, to offer recommendations for preventing car seat burns, to review the diagnostic criteria of car seat burns, and to examine the problem of false accusations of child abuse in these cases.

CASE REPORTS

Case 1

An 8-month-old girl was admitted to the hospital for a clinically infected bum. Three days before admission her that her left arm was red and blistered.
Early Identification of Sepsis in Infants With Respiratory Distress
Authors: Boyle Robert J. , Chandler Barry D. , Stonestreet Barbara S. , Oh William
Published: December 2021

Prospective analysis in the first 24 hours of life of 116 consecutively admitted infants with respiratory distress allowed early identification of nine cases of earlyonset neonatal sepsis. The following significant differences (P < .05) between septic and nonseptic groups were observed: (1) leukopenia (WBC count ±SEM in septic infants, 6,370 ± 1,140/cu mm vs. 16,020 ± 710/cu mm in nonseptic infants; (2) absolute neutropenia (band forms plus polymorphonuclear cells, 2,840 ± 1,220/cu mm in septic infants vs. 9,100 ± 620/cu mm in nonseptic infants); (3) elevated band form/total neutrophil ratio (0.30 ± 0.09 in septic infants vs. 0.14 ± 0.01 in nonseptic infants); (4) increased nitroblue tetrazolium incorporation or absence of neutrophils on nitroblue tetrazolium smear in septic infants; (5) positive gastric aspirate Gram stain (5 of 7 septic infants vs. 23 of 83 nonseptic infants for polymorphonuclear cells, 5 of 7 vs. 18 of 83 for presence of bacteria); (6) an examination for buffy coats revealing organisms (4 of 4 in the septic group vs. 0 of 105 in the nonseptic group). Using leukopenia (WBC count < 10,000/cu mm) or neutropenia (polymorphonuclear cells plus band forms < 4,500/cu mm) as criteria, eight of nine septic infants and two suspect septic infants would be identified, 15 of 105 nonseptic infants would be so labelled. Hence, absolute leukopenia or neutropenia is a simple and reliable indicator for the identification of early-onset sepsis in infants who have respiratory distress in the first few hours of life.
Chronic Myelocytic Leukemia Terminating in Blast Cell Crisis with Lymphoblastic Characteristics
Authors: Walters Thomas R. , Minowada Jun , Tsubota Teruhiko , Kataoka Katsuko , Han Tin
Published: December 2021

A child with chronic myelocytic leukemia (CML), Philadelphia chromosome positive, developed a non-T cell, non-B cell, acute lymmphocytic leukemia (ALL) during her blast cell crisis. The diagnosis was suggested by light microscopy and supported by histochemical stains and transmission electron microscopy. Immunologic studies showed the presence of a non-T, non-B leukemic blast population—indistinguishable from the most common form of ALL (null cell type). Markedly elevated terminal deoxynucleotidyl transferase (TdT) activity was found. The findings support the hypothesis that the primary cell involved in CML is a stem cell with pluripotential characteristics; frequently the blast cell proliferative phase terminates in acute myeloblastic leukemia, but it may also terminate in ALL. The TdT activity may be evidence of leukemic transformation and not necessarily related to the thymic origin of the lymphocytes.
Calcium Requirements in Infancy and Childhood
Authors:   Committee on Nutrition
Published: December 2021

Various aspects of calciutm metabolism and methods for estimating total body calcium content in man were reviewed. From the data available, it is possible to make an estimate of the retention of calcium that is needed to sustain normal growth in body composition. However, the dietary requirements for different periods of growth cannot be defined precisely.

Dietary calcium needs are most critical during those periods of life when requirements are known to be high. The low-birth-weight infant, the lactating woman, and the adolescent boy all have requirements. Individuals whose milk intake must be restricted should receive advice on nonmilk foods that are high in calcium.
The Chest Roentgenogram in Cystic Fibrosis: A New Scoring System
Authors: Brasfield Dana , Hicks Guy , Soong Seng-jaw , Tiller Ralph E.
Published: December 2021

A roentgenogram scoring system is presented that is useful in the evaluation and follow-up of patients with cystic fibrosis. The system has been shown to be reproducible by and between observers and to correlate significantly with results of pulmonary function tests, Shwachman-Kulczycki scores, and, in a short-term evaluation, morbidity.
Appendiceal Rupture: A Continuing Diagnostic Problem
Authors: Savrin Ronald A. , Clatworthy H. William
Published: December 2021

The mortality rate for appendicitis in children has remained relatively unchanged since the 1940s, when antibiotics were introduced in the treatment of appendiceal peritonitis. However, since this time the incidence of appendiceal rupture has increased appreciably, presumably owing to a failure of early recognition and treatment. At Columbus Children's Hospital, one half of all patients undergoing appendectomy for ruptured appendix in 1975 had been seen by another physician before admission, but the correct diagnosis had not been made. The history obtained by the primary physician and that given on admission were similar, yet differed from the histories given by patients whose disease had been correctly diagnosed. Findings on in-hospital physical examination of incorrectly diagnosed patients differed from those recorded by the primary physician, but were similar to those of patients whose disease had been correctly diagnosed. Since it is unlikely that the natural history of the disease has changed, the increased incidence of rupture must result either from early misinterpretation of physical findings or from greater delay by parents in responding to the child's illness. Physicians and parents must share the responsibility equally for the increasing incidence of appendiceal rupture in children.
Successful Treatment of Juvenile Chronic Granulocytic Leukemia With Marrow Transplantation
Authors: Sanders Jean E. , Buckner C. Dean , Stewart Patricia , Thomas E. Donnall
Published: December 2021

A 46-month-old boy with juvenile chronic granulocytic leukemia was treated intensively with hydroxyurea dimethyl myleran, cyclophosphamide, and total body irradiation. He then received a marrow transplant from an HL-A matched brother. Thirty-two months after the transplantation, he is hematologically normal and remains disease free on no-maintenance therapy. The successful outcome of this case suggests that a bone marrow transplant for any patient with a suitable histocompatible donor should be considered in the treatment of this disease.
Recurrent Pulmonary Disease in Children: A Complication of Gastroesophageal Reflux
Authors: Euler Arthur R. , Byrne William J. , Ament Marvin E. , Fonkalsrud Eric W. , Strobel Cory T. , Siegel Sheldon C. , Katz Roger M. , Rachelefsky Gary S.
Published: December 2021

To evaluate the role of gastroesophageal reflux (GER) as a possible cause of recurrent pulmonary disease, 30 children, aged 1 to 18 years, were studied prospectively with esophageal function tests. These included esophagram (30 patients), esophageal manometry (29 patients), pH probe (Tuttle) test (29 patients), and esophagoscopy with esophageal biopsy (23 patients). The patients studied had either chronic asthma or two or more documented pneumonias within a one-year period. Nineteen (63%) had GER based on two or more positive tests. Eighteen had positive Tuttle tests; 13 had abnormal manometry studies; nine had esophagitis on biopsy; six had esophagitis on esophagoscopy; and five had reflux on esophagram. Of those with GER, 17 had a history of nocturnal cough and eight vomited during infancy. Children with recurrent pulmonary disease should have esophageal function testing to exclude GER as the cause.
Thymic Deficiency in Down's Syndrome
Authors: Levin Stanley , Schlesinger Menahem , Handzel Zaev , Hahn Thalia , Altman Yehudit , Czernobilsky Bernard , Boss Jochanan
Published: December 2021

Children with Down's syndrome (DS) often have small and abnormal thymuses, with lymphocyte depletion, diminution of the cortex, and loss of corticomedullary demarcation—a picture resembling thymic involution. Besides this, they have markedly enlarged Hassall's corpuscles, some surrounded by a sheath of lymphocytes. Patients with DS are known to have increased numbers of respiratory infections; they also have a higher incidence of lymphaic leukemia than do individuals who do not have DS. Studies of cell-mediated (thymic-dependent) immunity demonstrate that children with DS have both diminished numbers of T cells as well as functional deficiency of these cells.
Treatment of Chlamydial Pneumonia of Infancy
Authors: Beem Marc O. , Saxon Evelyn , Tipple Margaret A.
Published: December 2021

Infants with untreated chlamydial pneumonia shed Chlamydia trachomatis and are symptomatic for many weeks. We used sulfisoxazole, 150 mg/kg/day, or erythromycin ethyl succinate, 40 mg/kg/day, for approximately 14 days to treat 32 patients with chlamydial pneumonia of infancy, and observed them for nasopharyngeal shedding of C trachomatis and changing clinical status. All infants stopped shedding chlamydiae soon after treatment was started. After treatment, three of the 25 infants tested again became culture positive (but did not have clinical relapse). All infants improved clinically. In 24 (83%) of 29 infants, where the onset of improvement could be timed, improvement began within seven days of starting treatment. Progression to complete recovery was observed in 27 of 28 infants examined between two weeks and two months of treatment completion. Neither the existence of concomitant viral infection nor the duration of illness or hospitalization before starting treatment influenced the interval between initiation of treatment and onset of clinical improvement. While these observations do not prove, they are at least compatible with the hypotheses that C trachomatis plays a central etiologic role in this illness and that termination of chlamydial infection is beneficial clinically. Pending the availibility of data from controlled studies, we believe that either of the treatment programs outlined warrant consideration in the clinical management of patients with chlamydial pneumonia of infancy.
Sickle Cell Anemia in Two White American Children: Essential Laboratory Criteria for Diagnosis
Authors: Noronha Peter A. , Honig George R.
Published: December 2021

A number of hematologic disorders share diagnostic and clinical features of sickle cell anemia but have significantly different genetic implications and prognosis. Because of these differences, the establishment of a precise diagnosis is essential for the child in whom any form of sickle cell disease is identified. To illustrate the requirements for a definitive laboratory diagnosis of sickle cell anemia, this report presents the approach to establishing this diagnosis in two white American patients. From a review of the literature, these patients appear to be the only white Americans with sickle cell anemia in whom this diagnosis has been unequivocally established.
Neonatal Herpes Simplex Infection Possibly Acquired via Maternal Breast Milk
Authors: Dunkle Lisa M. , Schmidt Rose Rita , O'Connor Dennis M.
Published: December 2021

A newborn infant with disseminated herpes simplex virus type 1 (HSV-1) infection was determined serologicallv to have acquired the infection postnatally; his mother was found to have HSV-1 in her breast milk but had no history of genital lesions and negative viral cultures of cervix, vagina, and throat. We suggest that HSV-infected maternal breast milk may be a source of this infection for susceptible infants.
The Pharyngeal Effect of Partial Nasal Obstruction
Authors: Tonkin Shirley L. , Partridge J. , Beach D. , Whiteney S.
Published: December 2021

The case history and cinematoradiographic findings of a baby with partial nasal obstruction are presented. This infant's restriction to air entry at the nose led to severe airway obstruction during inspiration by a forward movement of the posterior pharyngeal wall and backward movement of the tongue and lower jaw. At the height of inspiration, there was total airway occlusion in the pharynx. These events can be explained by the pressure drop that takes place behind a restriction if air is sucked through it forcibly from an area of atmospheric pressure. Studies of postpalatal pressures in adults and infants demonstrate such a drop in pressure during nasal breathing if the nose is partly obstructed. If the adult or infant is able to respond to the diminished nasal airway by mouth breathing, there is no postpalatal pressure drop. It is suggested that partial nasal obstruction in a sleeping obligatory nasal-breathing infant could result in a sucking back of the tongue over the larynx in this "cafe coronary" type of situation. This could be the mechanism of the obstructive type of apnea recorded by Steinschneider, and of the asphyxial type of death that is suggested by autopsies on some " cot death" victims. This hypothesis is consistent with the frequency of infection of rhinitis and pharvngitis in victims of sudden infant death syndrome and with the seasonal incidence. Prevention of this obstructive type of apnea would depend on the recognition of infants showing inspiratory and expiratory changes in pharyngeal airway size as can be seen externally by the movements in the carotid triangle of the neck and confirmed by roentgenography or cinematoradiography.
Hydrops of the Gallbladder in a Child: Diagnosis by Ultrasonography
Authors: Kumari Sheila , Lee Won J. , Baron Murray G.
Published: December 2021

Hydrops of the gallbladder is a rare cause of right upper quadrant mass in children. A case of acute hydrops of the gallbladder in a 5-year-old child is reported. A specific and accurate diagnosis can be made preoperatively only by sonography. Characteristic sonographic findings are described.
Taking Medications in School: Committee Report Challenged
Authors: Stern Robert C. , Boat Thomas F.
Published: December 2021

The rigid recommendations concerning the administration of medication during school hours, presented by the Committee on School Health of the American Academy of Pediatrics (Pediatrics 61:115, January 1978), are understandable in the light of recent major problems with drug abuse and the ever-increasing panic about potential liability of school officials and teachers. We believe, however, that these recommendations could be substantially modified without undue risk to allow many older children with chronic diseases to assume increasing responsibility in the management of their own illnesses.
Glucose Disposal of Low Birth Weight Infants: Steady State Hyperglycemia Produced by Constant Intravenous Glucose Infusion
Authors: Cowett Richard M. , Oh William , Pollak Arnold , Schwartz Robert , Stonestreet Barbara S.
Published: December 2021

Tolerance for glucose was studied in 35 well, appropriate for gestational age, low birth weight (LBW) infants (mean birth weight, 1,216 gm; mean gestational age, 30 weeks) between 3 and 38 days of age. Infants were given a graded dose of glucose at 8.1, 11.2, or 14.0 mg/kg/min for three hours by continuous peripheral intravenous infusion. Plasma glucose and insulin, and timed urine glucose and volume were measured. A steady state of plasma glucose concentration was noted by one hour at all infusion rates. In the nine infants receiving 8.1 mg/kg/min, plasma glucose and insulin were similar to the baseline values during the steady state, and none of these infants evidenced glucosuria. In the 16 infants receiving 11.2 mg/kg/min, the plasma glucose concentration significantly increased (140 to 166 mg/dl) during the steady state but the plasma insulin levels were not significantly different compared to baseline. Half of these infants developed hyperglycemia (plasma glucose 150 mg/dl) and glucosuria. Ten infants receiving 14.0 mg/kg/min developed a significantly higher plasma glucose and plasma insulin response in colmparison to those infants who received 8.1 and 11.2 mg/kg/min, and all evidenced hyperglycemia and glucosuria. Glucosuria did not exceed 6.4 mg/kg/hr (0.1 mg/kg/min) so that glucose disposal (retention) exceeded 99% of intake, and an osmotic diuresis was not noted in those infants who had glucosuria. Our data suggested that in well LBW infants, a three-hour infusion of glucose up to 14.0 mg/kg/min (approximately 80 kcal/kg/day) did not produce an osmotic diuresis, but in the highest infusion group (14 mg/kg/min), hyperglycemia did occur. The effect of hyperglycemia in the neonate is unknown and needs to be investigated.
Haemophilus influenzae Type B Disease in a Day Care Center: Eradication of Carrier State by Rifampin
Authors: Granoff Dan M. , Gilsdorf Janet , Gessert Charles , Basden Millie
Published: December 2021

Two cases of invasive Haemophilus influenzae type B disease (meningitis and cellulitis) occurred during a 60-day period among 69 children (median age 18 months) attending a day care center in Fresno, Calif. Nasopharyngeal colonization rates for H influenzae type B were 49% in the children, 8% in family contacts of culture-positive children, and 0% in staff. Colonization by H influenzae type B was infrequent in two control populations of children: those attending day care centers in Fresno without known H influenzae type B disease, and healthy children not enrolled in day care centers. The isolates from the children in the index day care center were inhibited in vitro by low concentrations of trimethoprim-sulfamethoxazole, but therapy with this combination for seven to ten days was ineffective in eliminating H influenzae type B carriage in 73% of 26 treated children. In a second clinical trial, treatment for four days with rifampin eradicated H influenzae type B carriage in 14 of 16 culture-positive individuals, whereas carriage persisted in 6 of 7 children whose families initially declined rifampin therapy (X2c; = 8.5, P .004). When systemic H influenzae type B infection occurs in a closed population of young children, the risk of serious illness among contacts may be appreciably higher than in similar age children in the general population. Our data indicate that rifampin is effective in this clinical setting, and support the need for a larger, controlled clinical trial.
The Chemiluminescence Response and Bactericidal Activity of Polymorphonuclear Neutrophils From Newborns and Their Mothers
Authors: Mills Elaine L. , Thompson Theodore , Björkstè Bengt , Filipovich Dana , Quie Paul G.
Published: December 2021

Cheiniluminescence (CL) was measured in the polymorphonuclear neutrophils (PMN) of 18 normal term infants, their mothers, and controls during phagocytosis of opsonized zymosan particles. Chemiluminescence was significantly lower in the PMN of newborns in comparison with the PMN of their mothers and of the controls. Depressed bactericidal activity was demonstrated in newborn PMN, in comparison with the activity of the PMN of their mothers and controls, when challenged with Escherichia coli at large bacteria-PMN ratios. Uptake of radiolabeled bacteria by PMN was identical in newborns, mothers, and controls, which indicates that reduced CL was not a result of impaired ingestion. Therefore, PMN of normal term infants have both depressed oxidative metabolic responsiveness as measured by CL and depressed bactericidal capacity.
Ototoxicity in Neonates Treated With Gentamicin and Kanamycin: Results of a Four-Year Controlled Follow-Up Study
Authors: Finitzo-Hieber Terese , McCracken George H. , Roeser Ross J. , Allen Delores A. , Chrane Dale F. , Morrow Jaunita
Published: December 2021

This article reports the results of a four-year follow-up study initiated in 1970 on the long-term effects of gentamicin and kanamvcin use in newborn infants. Audiometric, vestibular, and psychometric evaluations were performed on gentamicin-treated, kanamycin-treated, and untreated, matched control infants and children. No substantial sensorineural hearing loss or vestibular dysfunction was identified in these patients that could be attributed to aminoglycoside therapy. Performances on the Illinois Test of Psycholinguistic Abilities, Beery Test of Visual Motor Integration, the Peabody Picture Vocabulary Test, and on fine and gross motor examinations were comparable for the three study groups.
Postnatal Acquisition of Herpes Simplex Virus by the Newborn Infant: A Review of the Literature
Authors: Light Irwin J.
Published: December 2021

The literature relating to the hazards of herpes simplex virus acquired by newborn infants after birth is reviewed. A total of 24 infants has been reported who have acquired the infection in this manner; 66% of these infants expired. Transmission of virus from mothers, adults (inctuding personnel) other than the mother, and other infants has been reported. In order to prevent this infrequent but life-threatening illness, separation of the newborn infant from any person with active lesions caused by herpes simplex virus is recommended.
A Decongestant-Antihistamine Mixture in the Prevention of Otitis Media in Children With Colds
Authors: Randall John E. , Hendley J. Owen
Published: December 2021

One hundred four preschool-age patients in a private pediatric practice were treated prospectively during colds with either decongestant-antihistamine or placebo to determine if the decongestant-antthistamine mixture was effective in the prevention of otitis media. Each child received a standard dosage of the study medicine according to a double-blind, crossover design. Otitis media was diagnosed on the basis of clinical criteria.

Fifteen (6.4%) of 234 colds treated with placebo and 14 (5.8%) of 241 colds treated with the study drug were followed by otitis. The decongestant-antihistamine mixture was not useful in preventing development of otitis media in children with colds.
Emergency Room Utilization in the First 15 Months of Life: A Randomized Study
Authors: Paneth Nigel , Bell Deborah , Stein Ruth E.K.
Published: December 2021

The impact of a system of primary pediatric care on emergency room use in a municipal hospital was measured by comparing that use in two randomly selected populations. The population that was offered participation in a primary care program consistently used the emergency room less than did the control group. Analysis of the pattern of utilization revealed that the differences were limited to patients who actually participated in the program, and to weekday use of the emergency room. Unusually heavy (greater than ten visits per year) use of the emergency room was virtually eliminated among participants in the primary care program.
Transcutaneous Oxygen Monitoring With the Roche 5301 Device in Newborn Infants
Authors: Malloy Michael H. , Morriss Frank H. , Adcock Eugene W. , Denson Susan E.
Published: December 2021

As participants in the clinical field trials in the United States for the Roche 5301 transcutaneous oxygen monitor, we report here the results of our experience for comparison with that reported by Meith and colleagues in an earlier Letter (Pediatrics 58: 299, August 1976). The Roche model 5301 differs from the previously tested model 5300 in that the oxygen sensor has been modified and the electrode operates at 44 C instead of 42 C.

Thirty-two newborn infants of 28 to 39 weeks' gestational age and 560 to 3,700 gm birth weight were monitored while they experienced respiratory illness caused by idiopathic respiratory distress syndrome, pneumonia, or apnea.
Jimson "Loco" Weed Abuse in Adolescents
Authors: Shervette Robert E. , Schydlower Manuel , Fearnow Ronald G. , Lampe Richard M.
Published: December 2021

Over a three-year period, 29 adolescent patients were hospitalized because of intentional Jimson weed ingestion. Their records were reviewed for the presence of signs and symptoms of atropine/scopolamine toxicity, clinical course, treatment, and outcome. Twentytwo were male and seven were female. All had mydriasis, hallucinations, and were disoriented. Tachycardia (heart rate >95), dry mucous membranes, and flushed facies were often present. Urinary retention requiring catheterization was present in five patients. Sixty-five percent (17/26) had detectable atropine or scopolamine in their urine. The average length of hospitalization was 1.8 days. No serious complications were encountered during hospitalization and full recovery was noted in all patients. Gastric lavage and hospital admission for close monitoring and medical support are essential phases of management. Physicians who care for adolescents should be aware of this relatively new form of drug abuse and its management.
A Rapid, Simple Acetaminophen Spectrophotometric Determination
Authors: Miceli Joseph N. , Aravind M. K. , Done Alan K.
Published: December 2021

To meet the current need for a fast, simple, reliable assay procedure for acetaminophen blood level determination, a method is presented that can easily be adapted by any hospital clinical laboratory with no special equipment.
Dystonia Associated With Carbamazepine Administration: Experience in Brain-Damaged Children
Authors: Crosley Carl J. , Swender Phillip T.
Published: December 2021

Carbamazepine is an anticonvulsant most effective in treating complex partial and generalized tonicclonic seizures. We have cared for three children in whom four episodes of dystonia proceeding to opisthotonus occurred in association with carbamazepine use. The patients, a 4-year-old with microcephalv and severe retardation, a 1-year-old with cerebral dvsgenesis, and a 5-year-old with spastic quadriplegia and mild retardation, all had seizures unresponsive to multiple anticonvulsant combinations. In all three patients carbamazepine was introduced and gradually increased to a maximum dosage of 25 mg/kg of body weight per day. Dvstonic symptoms began two to three weeks after introduction of therapy and subsided within three weeks after discontinuation. In one child, a second course of carbamazepine resulted in a return of the dystonia. The currently available clinical and neuropharmacologic data suggest that carbamazepine may be an antagonist of dopamine and that this property is responsible for the production of dystonia.
Variations in Utilization of Health Services by Children
Authors: Starfield Barbara , van den Berg Bea J. , Steinwachs Donald M. , Katz Harvey P. , Horn Susan D.
Published: December 2021

In this longitudinal study in two prepaid group practices, many more children stayed at the same level of use of services over a six- to ten-year period than would be expected if use of services had distributed randomly. Overall, about 13% remained consistently in the highest third of the distribution of use, and another 13% remained consistently in the middle or lowest third. If use of services had distributed randomly, 4% and 7%, respectively, would have been in these groups. Conversely, many fewer children (25%) showed fluctuating patterns of use over time than would be expected by chance alone (37%). Although the reasons for this phenomenon are unknown (and may be multiple), the findings have implications both for clinical care and for development of policy regarding the organization and financing of health services for children.
Adolescent Smoking: Onset and Prevention
Authors: Mcalister Alfred L. , Perry Cheryl , Maccoby Nathan
Published: December 2021

Despite the systemic and conceptual barriers to effective preventive actions, some progress is beginning to be made in preventing adoption of self-destructive behaviors during adolescence. Application of the concept of psychological inoculation against social environmental factors that influence young people to adopt unhealthy life-styles is showing promise in short-term results of ongoing longitudinal studies. Researchers in pediatrics who are interested in prevention as a means of health promotion should become acquainted with these techniques to provide effective leadership in the field.
Antacid Bezoar in a Newborn
Authors: Portuguez-Malavasi Ana , Aranda Jacob V.
Published: December 2021

Antacid therapy is commonly used in the medical management of peptic ulcers and massive gastric bleeding. A similar approach has been employed in newborn infants with stress ulcers in order to reduce the total load and concentration of gastric hydrochloric acid during massive acute gastric bleeding.1 Antacid therapy may cause aluminum hydroxide "bezoar" in a newborn infant. This report confirms this possibility and suggests a rationale for its occurrence and therapy.

CASE REPORT

This newborn infant was born at 40 weeks' gestation with a birth weight of 3.3 kg, following an uneventful pregnancy and labor. A large left diaphragmatic hernia caused severe anoxia requiring resuscitation in the delivery room.
What Pediatricians Say to Mothers of Sick Newborns: An Indirect Evaluation of the Counseling Process
Authors: Clyman Ronald I. , Sniderman Susan H. , Ballard Roberta A. , Roth Robert S.
Published: December 2021

We examined what physicians tell mothers about their premature infants' chances of survival in the first hours after birth and how mothers interpret the physicians' remarks. Thirty-seven physicians (8 neonatologists, 29 pediatric house officers) and 21 mothers completed forms about hypothetical situations; from these forms, quantitative information was obtained about what each physician thought the chances of survival for a hypothetical infant were, what each physician would tell a parent about the child's chances of survival, and how a mother would interpret the physician's statement about her child. Mothers heard poorer prognoses for their infants than current nursery survival rates would predict; in addition, mothers heard poorer prognoses when counseled by house officers than by neonatologists. The physicians' lack of appreciation of their own nursery's survival rates was the major factor that accounted for the mothers' poorer estimation of the prognoses. House officers, inexperienced in newborn care, had a significantly worse estimation of an infant's actual prognosis than did neonatologists; this difference in knowledge of actual survival rates accounted for the worse prognosis that mothers heard when counseled by a house officer versus a neonatologist. Training programs in neonatology need to ensure that their physicians are aware of the changing experiences that are occurring in the field so that they have the information to counsel parents appropriately.
Inheritance of Uncomplicated Hypospadias
Authors: Page Lyman A.
Published: December 2021

Isolated first-degree hypospadias in three generations of one family and in two generations of two families is reported and the literature reviewed. Pedigree information suggests autosomal-dominant, sex-limited inheritance in these cases although other inheritance patterns are possible. Mendelian transmission of hypospadias may be more frequent than commonly believed and implies that the abnormality is potentially definable in molecular terms.
Lactational Reflex Recovery in Breast-Feeding Failure
Authors: Weichert Carol E.
Published: December 2021

This article describes the course of lactational reflex recovery in four patients who had symptoms of breast milk insufficiency. Following an initial history and physical examination, patients were evaluated at weekly intervals for response to treatment. In the mother, response to treatment was indicated by the onset of one or more of the following signs of reflex function: (1) areolar distention prior to a feeding, (2) tingling sensation in the breast during a feeding, and (3) contralateral milk ejection at the onset of a feeding. A return of lactational sufficiency was also monitored by weekly observation of weight gain in the infant.
Reading Failure and the Learning-Dyslabeled Child
Authors: Levine Melvin D.
Published: December 2021

It is easier to be an adult than a child. In middle life, there are multiple options for the consummation of strengths; vocational and avocational niches offer refuge to the most divergent of functional profiles. During childhood, academic and social demands are rigid, allowing for little or no eccentricity, and sometimes alienating those youth who are destined to become better adults than children. A child may be made to feel guilty if he or she does not demonstrate high levels of attainment or working capacity in language arts, quantitative thinking, motor activities, and social adaptability. There is the expectation that a young brain can be a "perfect machine."