bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Polycythemia: II. Definition Related to Time of Sampling
Authors: Shohat Mordechai , Reisner Salomon H. , Mimouni Francis , Merlob Paul
Published: December 2021

The mathematical relationship between blood viscosity and hematocrit levels was studied in 93 venous blood samples drawn within the first 6 hours of life from 20 full-term infants with weight appropriate for gestational age. A highly significant linear correlation (r = .948) between the logarithm of the viscosity at all the shear rates examined and the Hct was found. This indicates an exponential relationship between the blood viscosity and the Hct levels for every value of the Hct greater than 42%. A new dynamic definition of neonatal polycythemia, which takes into consideration the time of sampling, is suggested. By determining the mean +2 SD, the upper limit of the normal Hct at the age of 2 hours was 71% and at the age of 6 hours was 68%.
Short Children and Growth Hormone
Authors: COPELAND KENNETH C.
Published: December 2021

To the Editor.—

The article by Bright et al1 was a provocative description of two subjects with short stature, normal growth hormone (GH) responses to provocative testing, and low somatomedin-C (SM-C) concentrations, which increased after administration of GH. The authors conclude that the short stature in these individuals may be due to a biologically inactive GH molecule or to decreased dose responsiveness to GH of SM-producing cells. Their data also seem compatible with a third possibility: normal short children respond to GH administration with increases in SM-C plasma concentrations and growth rates.
Diagnosis of Brain Death in Children by Radionuclide Cerebral Imaging
Authors: Schwartz Jan Arthur , Baxter John , BriIl David R.
Published: December 2021

Nine children with clinically suspected brain death were evaluated by radionuclide cerebral imaging and four-vessel dye contrast cerebral arteriography. The scans showing absence of cerebral blood flow were verified by arteniography in all children. There was complete agreement in all cases. It was concluded that failure to detect cerebral blood flow by radionuclide cerebral imaging in children is a valid demonstration of absence of cerebral circulation for purposes of determining brain death. The scan is significantly less expensive than dye-constast arteniograms. The test is portable, and thus it eliminates the need for transportation of extraordinarily ill patients. The scanning technique is noninvasive and may be particularly helpful in the diagnosis of brain death in patients in whom intravenous infusions of barbiturate might otherwise obscure the clinical and EEG examination.
Neonatal Polycythemia: I. Early Diagnosis and Incidence Relating to Time of Sampling
Authors: Shohat Mordechai , Merlob Paul , Reisner Salomon H.
Published: December 2021

The dynamic changes occurring in hematocrit and blood viscosity within the first 18 hours of life were studied in 50 full-term infants who were vaginally delivered and had weight appropriate for gestational age. In all cases, the cord was clamped within 30 seconds and cord blood was collected from the vein and artery. Subsequently, samples were taken from a peripheral vein at ages 15 minutes, and 2, 4, 6, and between 12 to 18 hours. Both the Hct and blood viscosity reach their peak at age 2 hours. The incidence of neonatal polycythemia varied greatly with age. Thus at the age of 2 hours, ten infants (20%) were polycythemic, whereas by age 6 hours only six (12%) of these infants were still polycythemic and by age 12 to 18 hours only one infant (2%) was polycythemic. A linear correlation was found between cord Hct levels and peripheral venous Hct levels by age 2 hours. None of the infants with cord blood Hct levels ≤56% had developed polycythemia, whereas ten of the 12 infants with cord Hct levels >56% developed polycythemia. In this particular group of infants, cord blood Hct levels may be used for the screening of neonatal polycythemia.
Estimation of Dietary Sodium Intake in Children
Authors: Luft Friedrich C. , Miller Judy Z. , Fineberg Naomi S. , Daugherty Sandra A. , Christian Joe C. , Weinberger Myron H.
Published: December 2021

To examine the utility of nocturnal urine collections in the estimation of dietary sodium intake in children, 29 families who agreed to lower their dietary sodium intake to <65 mEq/d were studied. A total of 58 adults and 95 children collected urine specimens weekly or biweekly before and after being instructed in a dietary sodium restriction regimen. Urine collections were fractionated into a diurnal and nocturnal portion. Sodium was measured directly, and estimated by measuring chloride excretion with a chloride titrator stick. Nocturnal chloride and 24-hour sodium excretion were highly correlated in adults (r = .75), and slightly less so (r = .56) in children. The slopes of the relationships were not different. Discriminant analysis showed that two or more chloride estimates permitted classification of both adults and children into the low sodium intake category with 100% accuracy, and into the normal sodium intake category with 75% accuracy. It was concluded that nocturnal chloride estimates are as useful in estimating compliance to a reduced sodium intake in children as in adults.
Cardiac Perforation from Central Venous Catheters: Survival After Cardiac Tamponade in an Infant
Authors: Agarwal Kishan C. , Khan M. A. Ali , Falla Anita , Amato Joseph J.
Published: December 2021

A 2,210-g infant suffered cardiac tamponade, which resulted from atrial perforation by a central venous catheter. The infant survived due to timely diagnostic and therapeutic intervention. Cardiac tamponade should be suspected in any patient with a central venous catheter whose condition deteriorates suddenly. Immediate chest roentgenogram and echocardiogram may be performed to support the diagnosis; but when the patient's condition is deteriorating, a diagnostic (and therapeutic as well !) pericardiocentesis should be performed without waiting for other diagnostic measures. A review of clinical recognition and diagnostic measures for cardiac perforation and tamponade is presented. Preventive measures to avoid this fatal complication of central venous catheters are suggested, and therapeutic interventions are outlined.
Social and Nonsocial Home Environments of Infants with Nonorganic Failure-to-Thrive
Authors: Casey Patrick H. , Bradley Robert , Wortham Betty
Published: December 2021

Nonorganic failure-to-thrive (NOFT) is a clinical syndrome that is poorly understood and inadequately studied. Because empirical data are lacking, an attempt was made to identify differentiating aspects of the mother-infant interaction and environment of infants with NOFT compared with those of matched infants who grew normally. Prospectively, 23 infants who were suffering from NOFT were chosen in a referral clinic. Each infant was matched with a control subject with normal growth by age, sex, and race of the infant and family income, maternal education, and number of people living in the household. An assistant who was unaware of infant growth status visited the homes of these infants within 3 weeks of diagnosis and gathered: the Home Observation for Measurement of the Environment (HOME); the Coddington Life Events Record; and the Index of Parent Attitude Scales. The total HOME Inventory and the subscales entitled Maternal Acceptance of the Child, Organization of the Physical Environment, and Emotional Responsivity were significantly less favorable (P < .05) in the NOFT group. There were no group differences in the Life Events Record and the Parent Attitudes Scales. A discriminant function analysis correctly placed 32 of the 46 infants into failure-to-thrive and control groups. It is concluded that certain aspects of the home environments of infants with NOFT differ from those of infants of similar socioeconomic status who grow normally.
Malpractice Issues
Authors: HECHT FREDERICK
Published: December 2021

To the Editor.—

With interest I read the correspondence between Turetsky and Carstensen (readers) and Brent (author) on "The Irresponsible Expert Witness," (Pediatrics 1983;71:990-991). I agree with their concerns and wish to add several observations and recommendations based upon service as an expert witness in malpractice and toxic tort cases:

1. Certain physicians and scientists appear recurrently as expert witnesses.

2. The fees for expert witnesses, as Brent notes, are soaring. Today an active expert witness can make a living from this pursuit or supplement his income handsomely.
Issues in Fertility Control for Mentally Retarded Female Adolescents: I. Sexual Activity, Sexual Abuse, and Contraception
Authors: Chamberlain Allan , Rauh Joseph , Passer Alice , McGrath Marianne , Burket Robert
Published: December 2021

Little information is available about sexual sexualactivity, sexual assault, and contraceptive use among mentally retarded adolescents. The experience in these areas among 87 mentally retarded females is reviewed. (A companion paper focuses on these patients' parental attitudes toward sterilization.) All subjects attended a multiservice adolescent clinic with a large developmentally disabled patient group. Charts were reviewed and 69 parents were interviewed. The patients had an age range from 11 to 23 years (mean 16.7). Forty-one subjects were mildly retarded (IQ 55 to 69), 23 were moderately retarded (IQ 41 to 54), and 23 were severely retarded (IQ less than 41). Half of the mildly retarded had had sexual intercourse, a proportion comparable to the general adolescent population. Thirty-two percent of the moderately retarded and nine percent of the severely retarded adolescents had had intercourse. One third of the mildly retarded and one fourth of the moderately retarded adolescents had been victims of rape or incest. Continued sexual activity correlated with sexual abuse, but the majority of victims had no prior or subsequent evidence of intercourse. Forty-two subjects (48%) had used contraception at some time; intrauterine devices and injectable medroxyprogesterone acetate were preferred to oral contraceptives. Six of the 14 patients (43%) who continued sexual activity became pregnant, suggesting that currently available contraception is not providing sufficient protection.
Issues in Fertility Control for Mentally Retarded Female Adolescents: II. Parental Attitudes Toward Sterilization
Authors: Passer Alice , Rauh Joseph , Chamberlain Allan , McGrath Marianne , Burket Robert
Published: December 2021

Knowledge of the issues involving sterilization for mentally retarded adolescents is limited. Data were obtained from 69 interviewed parents whose mentally retarded daughters were attending the Cincinnati Adolescent Clinic. (A companion paper focuses on the experience of these girls with sexual activity, sexual abuse, and contraceptive use.) Forty-six percent of the parents had considered sterilization for their daughters. Twenty-six percent were still seeking the operation. Interest in sterilization especially correlated with increased severity of retardation (P < .005) and with difficulty teaching menstrual hygiene (P < .005). Parents of mildly retarded females sought tubal ligation, and those with severely retarded daughters chose hysterectomy and stressed their concern about menstrual management. Eighty-five percent of the parents favored a state statute that would enable sterilization under certain conditions and limitations. In general, few parents supported either an extremely restrictive or permissive position about sterilization.
Hypercatecholaminemia in Reye's Syndrome
Authors: Faraj Bahjat A. , Caplan Daniel B. , Newman Stephen L. , Ahmann Peter A. , Camp Vernon M. , Kutner Michael
Published: December 2021

To evaluate the role of catecholamines in Reye's syndrome, a specific and sensitive radioenzymatic assay was used to study plasma and CSF concentration of dopamine, norepinephrine, and epinephrine in 14 patients with liver-biopsy-proven Reye's syndrome. The results (median and range) revealed significant (P < .04, P < .0024, and P < .030, respectively) elevation in plasma dopamine (131, 0 to 1,193 pg/mL), norepinephrine (1,455, 20 to 5,271 pg/mL), and epinephrine (345, 7.6 to 2,504 pg/mL) at the onset of the disease when compared with the level of these neurotransmitters in a group of hospitalized patients without hepatic disorders. There was a positive correlation between plasma catecholamines and stage of coma on admission (r = .54 to .86; P < .001 to .024). Furthermore, the concentration of dopamine, norepinephrine, and epinephrine in the CSF increased significantly during the development of cerebral edema in all patients with Reye's syndrome as compared with concentrations in a control population. Hypercatecholaminemia may contribute to the encephalopathy of Reye's syndrome.
Home Versus Hospital Phototherapy for Term Infants with Hyperbilirubinemia: A Comparative Study
Authors: Slater Lawrence , Brewer M. Frederick
Published: December 2021

Twenty-five term infants with hyperbilirubinemia were selected for phototherapy administered at home if they fulfilled clinical and laboratory criteria designed to exclude any pathologic cause of hyperbilirubinemia. Ongoing nursing surveillance of home phototherapy was provided to assure adequate nursing care. No phototherapy-related complications were noted in the study infants. Effectiveness of phototherapy at home was compared with results in a similar group of 33 infants who underwent standard hospital phototherapy. The average decrease in serum bilirubin concentration was similar for the two groups after the first day of treatment. Duration of phototherapy was longer for infants treated at home. The major motivating factor for study entry appeared to be avoidance of parent-infant separation.
Jaundice in the Full-Term Neonate
Authors: Osborn Lucy M. , Reiff Michael I. , Bolus Roger
Published: December 2021

Hyperbilirubinemia is the most common problem experienced by the full-term infant in the immediate neonatal period. The development of jaundice was prospectively investigated in 866 newborns. Significant correlations were found between the serum bilirubin level and the method of birth, perinatal complications, blood group incompatibilities, birth weight, and method of feeding. Breast-feeding was highly related to the development of exaggerated jaundice. The most common occurrence of jaundice requiring phototherapy was in breast-feeding infants in whom no cause for the jaundice could be determined. Study findings were most compatible with a theory of relative caloric deprivation as an explanation of the increased incidence of hyperbilirubinemia found in breast-fed newborns.
Serum Complement Changes During Double-Blind Food Challenges in Children with a History of Food Sensitivity
Authors: Martin Michael E. , Guthrie Lindsay A. , Bock S. Allan
Published: December 2021

Serum levels of C3, C4, factor B, properdin, total hemolytic complement and alternative-pathway hemolytic activity were measured before and after double-blind food challenge in 23 children with impressive histories of adverse reactions to foods. The 23 subjects had 11 positive food challenges and 12 negative food challenges. Nine patients with reagin-mediated positive food challenges showed increases in all six complement assays after double-blind food challenge, while the group with negative food challenges showed decreases in five of the six assays. The difference between the two groups for complement changes after double-blind food challenge was significant only for the alternative-pathway assay. Individual subject analysis revealed markedly heterogeneous changes in direction and magnitude within both groups for all complement assays. Therefore, it is concluded that measurement of serum complement levels is not a useful test for the clinical evaluation of a patient with suspected food sensitivity.
The Health of Children, A Crisis of Ethics
Authors: Miller C. Arden
Published: December 2021

A number of reviews emphasize the considerable extent to which infants and children of this country continue to be burdened with afflictions and risks of poor health.1-4 Persistent problems invite speculation that either the nation's wisdom or its resources are insufficient to serve fully the health needs of children. Neither of these explanations is well supported. A thoughtful policy paper5 published by the World Bank, dealing with the health of all children in the world, marshalls evidence that the most pressing health problems of children can be controlled or treated with presently known technologies. For this country, the Select Panel for the Promotion of Child Health found that the most pressing children's health problems were related to deficiencies of access to essential basic health services, and that the cost of providing those services as a public expense would be both small and cost effective.6 Services for children account for an exceedingly small portion of the federal health expenditures; out-of-pocket payments for children's health services are proportionally higher than for any other age group, even though a higher propontion of children than any other age group live in poverty-level households.7,8 Explanations other than lack of information or lack of national resources must be sought for the failure of this nation to address adequately the health needs of children. This paper attempts to serve two purposes. It first marshalls new testimony on the health status of children and then attempts to analyze barriers that thwart effort to address unmet needs. In the first instance, the circumstances quoted are intended to confirm that in spite of substantial progress over the past decade there are some persistent problems and some new warning signals about children's health.
The Prenatal Visit
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: December 2021

A visit to the pediatrician's office by the expectant couple makes good sense; yet, it appears to be the exception rather than the rule. In a recent survey, 73% of 118 practicing pediatricians reported that they conduct prenatal visits, but only 22% of their expectant couples had actually been seen before their infant's birth. This percentage is even lower in other settings.

On their first contact with the pediatrician, expectant parents should be encouraged to make an appointment for an office visit. This visit, which usually takes place during the eighth or ninth month of pregnancy, represents an opportunity for the pediatrician to gather data, give information, initiate a continuing relationship, and enhance the parents' competency in decision making. The session helps the parents select a pediatrician with whom they are comfortable and enables them to feel that they are meeting their responsibility to provide skilled care for their infant.

In the beginning of the prenatal visit, the pediatrician should convey a personal interest in the prospective parents by asking questions that provide an opportunity for him or her to become acquainted with the parents and their expectations: "How long have you lived in the community?" "What kind of work do you do?" "What are your interests and hobbies?" "How have you been feeling?" "How do you expect to deliver?" How do you plan to feed your baby?" "Have you obtained an infant car seat to take the baby home in?" "Is it a boy or girl?" Prenatal discussions with the pediatrician may augment the expectant couple's confidence in their feelings about breast-feeding, circumcision, and rooming-in.
Treatment of Disabled Infants
Authors: HEALY ALFRED
Published: December 2021

Formal "statements of understanding" can serve several purposes. The process of writing such statements helps clarify issues and offers opportunities to resolve areas of conflict existing between the involved parties. The signing itself serves a symbolic function, announcing that previous areas of disagreement have been resolved and accord has been achieved. The statement, "Principles of Treatment of Disabled Infants," recently written and approved by nine professional associations and voluntary organizations,1 has served these varied punposes.

However, the value of such statements in accomplishing change is dependent upon the status as well as the integrity of the signatories. Fortunately, the individuals and organizations involved with this statement possess both the status to assist substantially in accomplishing its tenets, and the integrity to use this and future opportunities to influence the care and treatment of infants with disabilities.
Early Management and Decision Making for the Treatment of Myelomeningocele: A Critique
Authors: FREEMAN JOHN M.
Published: December 2021

In a recent article, Gross et al1 have set out to do something about early decision making and the management of children with myelomeningocele. They have set out to evaluate a program that they have developed, claim is workable, and claim addresses the present ethical dilemma surrounding this issue. Have they done something worthwhile? Have they done it well?

First, let us look at what they have done. Of 68 babies with myelomeningocele, they have selected 33 babies (48%) for supportive care only. Twenty-six families accepted the team's recommendation and left their child in a special children's shelter. Of these babies, 24 died (mean 37 days). Two babies were treated later at the parents' request.
Sudden Infant Death Syndrome
Authors: SOUTHALL D. P. , ALEXANDER J. R.
Published: December 2021

To the Editor.—

By attempting to examine the hypothesis that abnormalities in the pattern of apneic pauses in the neonatal period could predict all, or most cases of sudden infant death syndrome (SIDS), Steinschneider et al1 may have missed a valuable opportunity to determine a small proportion of cases with more definite abnormalities. Moreover, some measurements made in this study could reflect differences in variables other than apnea. For example, the measurement "A.O/D%", that is the duration of apnea/obstruction events divided by the duration of all sucking bursts x 100, is critically dependent on the duration of sucking.
Everybody Needs Reeducation
Authors: MICHAEL JOHN D.
Published: December 2021

To the Editor.—

De Carvalho et al1 reinforce the knowledge, which was practiced at the turn of the century and recommended in pediatric textbooks until formula feeding came into common usage, that breast-feeding infants do best when fed between eight and ten times per 24 hours. They need not be required to feed that frequently but the offering should be made for those infants who are interested.

The newborn is entitled to ten nursings in twenty-four hours.
Cerebral Infarction Related to Neck Position
Authors: BODENSTEINER JOHN B.
Published: December 2021

In Reply.—

Adventitial tears of the vertebral arteries during a breach or otherwise difficult delivery may well result in hypoplasia of the vertebral arteries as suggested by Yates.1 It is doubtful, however, that such an injury would result in the anomalous cerebral vascular supply demonstrated in our patient.2 It seems more likely that the origin of the right posterior cerebral artery from the right internal carotid may represent persistance of the fetal vascular pattern. This concept might be supported by the absence of the posterior communicating artery.
Development of Posterior Subcapsular Cataracts in Asthmatic Children
Authors: Bhagat R. G. , Chai H.
Published: December 2021

Posterior subcapsular cataracts (PSCC) are known complications of systemic steroid therapy. Previous studies have not clearly identified the asthmatic children at risk for the development of PSCC. The possible factors associated with systemic steroid administration that may influence the development of PSCC in asthmatic children were evaluated: (1) duration of administered steroids, (2) dose, (3) number of steroid "bursts" in the preceding year, (4) degree of retardation of bone age, and (5) mode of administration (daily or alternate day) of steroids. Of the 40 asthmatic children requiring steroids, seven (17.5%) had PSCC. All of the children with PSCC had been receiving steroids on a daily or alternate-day basis for at least 2 years and all had markedly delayed bone age. Only one child with the concurrent occurrence of these two factors did not develop PSCC. None of the other risk factors considered could distinguish the group of patients with PSCC. It is concluded that asthmatic children receiving steroids for 2 years or longer and having markedly delayed bone age are at a greater risk for the development of PSCC.
Ultrastructure of Carotid Bodies in Sudden Infant Death Syndrome
Authors: Perrin Donald G. , Cutz Ernest , Becker Laurence E. , Bryan A. Charles
Published: December 2021

Recent studies have implicated an abnormality in carotid body structure and function in the pathogenesis of sudden infant death syndrome (SIDS). In the present investigation, the light and electron microscopic findings in carotid bodies from ten victims of SIDS were compared with those in six control infants and five infants dying of congenital heart disease. The cross-sectional area of carotid body chemoreceptor cells and the frequency, distribution, and size of neurosecretory granules were assessed morphometrically. The area of carotid body occupied by chemoreceptor cells (the functional area) was comparable in SIDS victims, control infants, and infants with congenital heart disease. By electron microscopy, the carotid body chief cells from all groups contained numerous electron-dense neurosecretory granules. Distribution, frequency, and size of neurosecretory granules in SIDS victims and control infants did not differ significantly. Morphology of carotid bodies from SIDS victims was found to be normal. The presence of neurosecretory granules in chemoreceptor cells of SIDS victims suggests that the cellular mechanism of neurotransmitter synthesis and storage is not altered.
Further Delineation of the l0p Deletion Syndrome
Authors: Elstner Christopher L. , Carey John C. , Livingston Gordon , Moeschler John , Lubinsky Mark
Published: December 2021

Nine children with a partial deletion of the short arm of the number 10 chromosome have been described in the medical literature. In two new cases of lop-, the children have several features in common with those previously reported; these features include downslanting short palpebral fissures, ear anomalies, anteverted nostrils, a short neck, and psychomotor delay. At this stage in the delineation of this condition, the phenotypic expression is variable. However, the craniofacial features of the two children with recently reported l0p- and others display a constellation of individually nonspecific but consistent findings that together form a recognizable gestalt. Pediatric practitioners should consider performing karyotypes in children with developmental disabilities accompanied by multiple structural defects and/or multiple physical variations not part of the family background.
A Decreased Incidence of Necrotizing Enterocolitis After Prenatal Glucocorticoid Therapy
Authors: Bauer Charles R. , Morrison John C. , Poole W. Kenneth , Korones Sheldon B. , Boehm John J. , Rigatto Henrique , Zachman Richard D.
Published: December 2021

In a large multicentered, collaborative randomized and blinded trial utilizing antenatal corticosteroids, the goals included determining the effectiveness of these agents in accelerating lung maturation, as well as monitoring any short-term or long-term adverse effects of this treatment on the parturient, fetus, and/or infant. More than 100 specific items, pertaining to diagnoses, complications, and outcomes were recorded for the 696 mothers enrolled in the study and their 745 infants. A significantly decreased incidence of necrotizing enterocolitis (P = .002) was found in the infants treated with steroids. The possibility of accelerated intestinal maturation induced by antenatal maternal steroid therapy exists. This treatment regimen is particularly attractive as adverse aspects of steroid therapy at the dosage utilized have not been demonstrated.
Fire Ant Envenomation in Children
Authors: Ginsburg Charles M.
Published: December 2021

Fire ants (Solenopsis richteri and Solenopsis invicta) have received scant attention from individuals other than agriculturists, entomologists, and victims of the bite and sting. Since their original importation into Mobile, Alabama, these small, seemingly benign, creatures have slowly migrated throughout most of the southern United States. Not unexpectedly, physicians working in the southern portions of the United States have been confronted with increasingly large numbers of patients, particularly children, who have been bitten and envenomated by these insects. Information regarding the pathogenesis of fire ant bite reactions and an approach to treatment are provided.
Pediatrics and the Unwanted Child in History: Foundling Homes, Disease, and the Origins of Foster Care in New York City, 1860 to 1920
Authors: English Peter C.
Published: December 2021

In recent years, America's present means of providing for unwanted children, the foster care system, has come under severe criticism from many child-serving professional groups. The Committee on Adoption and Dependent Children of the American Academy of Pediatrics notes that children in foster care are not likely to receive routine health care, such as immunizations and screening for hypertension, dental caries, or vision or hearing problems.1 Yet these vulnerable children frequently have significant health problems, and they may require more medical attention than the average child. In Massachusetts, 33% of the children in foster care have emotional handicaps, 13% suffer from serious physical illnesses, 19% are mentally retarded, and 15% have multiple handicaps.2 Children in foster care often lack a single health provider and they have few health advocates. Despite criticism from pediatricians about the sorry state of health care provided to these children, pediatricians frequently find themselves in the uneasy position of recommending foster care placement to social service workers in intransigent cases of child abuse and neglect.

Child psychiatrists, such as Anna Freud and Albert Solnit, have joined pediatricians in criticizing foster care. They point out that a child cannot develop emotionally in a rotating system of foster homes. With each move, the foster child becomes less open, attachments less intense. As a result, children emerge from foster care with significant emotional handicaps.3

Social workers, those professionals who work most closely with unwanted children, have added to the chorus of concern over foster care. They point to the difficulty of early identification of the family in trouble and then successful intervention.
Vitamin K Deficiency in Newborns: A Case Report in α-1-Antitrypsin Deficiency and a Review of Factors Predisposing to Hemorrhage
Authors: Payne Nathaniel R. , Hasegawa Duane K.
Published: December 2021

A 4-week-old, breast-fed female infant appeared healthy until signs and symptoms of CNS deterioration suddenly occurred. At presentation the infant was found to have a left-sided parietal intracerebral hematoma, markedly prolonged prothrombin time, and partial thromboplastin time, normal platelet count, and jaundice with a total and direct serum bilirubin level of 5.4 mg/dL and 2.6 mg/dL, respectively. Vitamin K1 and fresh frozen plasma returned the prothrombin time and partial thromboplastin time to normal values within 18 hours, suggesting that the infant had severe vitamin K deficiency complicated by intracerebral hemorrhage. Evaluation of the infant's direct hyperbilirubinemia led to the diagnosis of homozygous (pi-type ZZ [PiZZ]) α-1-antitrypsin deficiency. The clinical circumstances predisposing to vitamin K deficiency in newborns and infants are discussed. Based on our observations in this case, we suggest that cholestatic liver disease should be suspected when unexplained vitamin K deficiency occurs in early infancy. The role of vitamin K in hemostasis and the laboratory diagnosis of vitamin K deficiency are discussed as they apply to the evaluation of hemorrhage in newborns and infants.
Medical Therapy for Suppurative Renal Infections
Authors: GLASER JOY H. , CASPE WILLIAM , KOENIGSBERG MORDECAI
Published: December 2021

Focal suppurative infections of the kidney are unusual in children and their variable presentations may lead to a delay in their diagnosis. However, the ease with which noninvasive diagnostic tests, such as ultrasound and computered tomography can be performed should improve our ability to make an early diagnosis. Our two patients, one with a segmental renal infection and the other with a subcapsular abscess, were successfully treated only with antibiotics. For these patients a variety of noninvasive techniques were used to make the diagnosis and renal sonograms were helpful in monitoring the efficacy of their treatment.

CASE REPORTS

Case 1

An 8-year-old boy with no previous urologic problems was admitted to the hospital with temperature 39.7°C (104°F), pulse rate 108 beats per minute, blood pressure 110/70 mm Hg.
Ineffectiveness of Historical Data in Predicting Measles Susceptibility
Authors: Scott Robert McN. , Butler Adrienne B. , Schydlower Manuel , Rawlings Peter
Published: December 2021

The Immunization Practices Advisory Committee (ACIP) has devised noninvasive, historical criteria for determining individuals who are susceptible to measles. These criteria, which involve proof of vaccination, are incorporated into school entrance regulations and are used to indicate people who require vaccination during outbreaks. In a recent measles epidemic in El Paso, TX, 120,000 records were screened using these criteria, and as a result 13,000 students were vaccinated. During this outbreak, 91 adolescents, who were susceptible to measles by ACIP criteria, were serologically tested for measles antibody. Although none of these students had documentation of vaccination, only 11.0% of them lacked measles hemagglutination-inhibiting (HAI) antibody at a titer of 5. Assuming a minimum cost for vaccine of $2.60 per dose, a conservative estimate of the cost to the El Paso Health Department for 20,000 doses of measles vaccine would be $52,000. If these data can be extrapolated to the total student population, then upwards of 85% of vaccinated students were already immune. Thus, $44,200 was spent unnecessarily. In addition, as the ACIP criteria did not select for measles susceptibility, an estimated 12,000 students in El Paso were not protected against measles. Other methods to determine measles susceptibility should be developed for optimal control of future outbreaks.
Does Pediatric Home Care Make a Difference for Children with Chronic Illness? Findings from the Pediatric Ambulatory Care Treatment Study
Authors: Stein Ruth E. K. , Jessop Dorothy Jones
Published: December 2021

The ongoing care needed by children with chronic physical illness is a topic of national concern. The Pediatric Ambulatory Care Treatment Study (PACTS) is a classic pretest-posttest randomized experiment designed to evaluate a Pediatric Home Care (PHC) program in which an interdisciplinary team provides comprehensive primary health care, support, coordination, patient advocacy, and education to chronically ill children and their families. Home interviews were conducted by an independent research team with the 219 families at enrollment, 6 months, and 1 year; 80% completed all three interviews. Analyses indicate that pediatric home care is effective in improving the satisfaction of the family with care, in improving the child's psychological adjustment, and in lessening the psychiatric symptoms of the mother. The functional status of the children was equally well maintained in both groups, and there was no significant difference in the impact of the illness on the family between the two groups. There are indications that there may be a dose-related effect with respect to the child's psychological adjustment with those in the program for the longest period of time showing the greatest benefit. Such a home care program can be an effective intervention for minimizing the social and psychological consequences of chronic illness.
Changing Infant Mortality: The Need to Spend More While Getting Less
Authors: Bloom Bernard S.
Published: December 2021

A steady decline of infant and maternal mortality has been recorded for as long as these statistics have been collected. Much of the improvement has been due to reductions in infectious diseases and to social, economic, and public health improvements over the years. The major portion of mortality reductions took place before there were any important effects of medical care. However, there is increasing evidence suggesting that important benefits, can still be gained from medical technology. But, with infant mortality at low levels (between 7 and 12/1,000 live births in high-income countries) the wide use of high technology to effect further reductions guarantees escalating medical care expenditures. With pressures mounting to control costs, what will society be willing to give up in order to make this care available? From where will funds come to utilize costly existing and new medical technology so that all expectant mothers and newborns needing it may have essentially unlimited access in order to reap potential benefits?
Usefulness of Screening for Hypertension
Authors: GROSSMAN NATHAN
Published: December 2021

To the Editor.—

I have read with interest the article by Fixier and Laird on the value of mass blood pressure screening in children (Pediatrics 1983;72:459-463). I must strongly disagree with the conclusion reached by the authors in this study.

Among the criteria for any screening procedure is the requirement that the disease, for which the screening procedure is designed, be either prevalent enough or severe enough, or both, to justify screening for it in the first place.
Effects of Megavitamin Therapy on Children with Attention Deficit Disorders
Authors: Haslam Robert H. A. , Dalby J. Thomas , Rademaker Alfred W.
Published: December 2021

The effectiveness of a megavitamin regimen utilizing a two-stage trial in 41 subjects with attention deficit disorders was studied. Stage 1 was a 3-month clinical trial of vitamins (daily maximum: 3 g of niacinamide and ascorbic acid, 1.2 g of calcium pantothenate, and 0.6 g of pyridoxine). State 2 consisted of four, 6-week, double-blind repeated crossover periods. Twenty-nine per cent of the subjects showed significant behavior improvement during stage 1, and these subjects were used in the double-blind crossover phase of the study to evaluate megavitamin therapy. Using analysis of variance methods for crossover studies, there was no significant difference (P > .05) in most behavior scores between children receiving vitamin and those receiving placebo during stage 2. Children exhibited 25% more disruptive classroom behavior when treated with vitamins v placebo (P < .01). There was no significant difference in serum pyridoxine and ascorbic acid levels between subjects and control subjects. Forty-two per cent of subjects exceeded the upper limits of serum transaminase levels while receiving vitamins. It is concluded that megavitamins are ineffective in the management of attention deficit disorders and should not be utilized because of their potential hepatotoxicity.
Toxic Shock Syndrome in Children Aged 10 Years or Less
Authors: Wiesenthal Andrew M. , Todd James K.
Published: December 2021

Eight children aged 10 years or less had toxic shock syndrome, and medical records were reviewed for seven of them. There were four boys and three girls, ranging in age from 55/12 to 108/12 years; all seven met the Centers for Disease Control case definition of toxic shock syndrome. One boy died. The illness was generally characterized by fever, followed by erythroderma, gastrointestinal complaints, and mucous membrane hyperemia. Based on the need for supplemental oxygen or mechanical ventilation, the girls tended to have milder courses than the boys. In four of four cultures performed prior to the institution of antibiotic therapy, Staphylococcus aureus grew from one or more sites. One boy also met the case definition of Kawasaki syndrome and has had multiple coronary artery aneurysms demonstrated in early and late follow-up. Toxic shock syndrome in these children was similar to published descriptions of toxic shock syndrome in series of adult patients, except that, as a group, the children had a greater incidence of respiratory embarrassment.
Increased Frequency of Cytomegalovirus Infection in Children in Group Day Care
Authors: Pass Robert F. , Hutto S. Cecelia , Reynolds David W. , Polhill Rutherford B.
Published: December 2021

The prevalence of cytomegalovirus (CMV) infection in 103 children attending a single day care center was compared with that of 62 children kept at home. Demographic features of the day care group were similar to those of the home care group; in both groups, most of the children were white, were from middleincome families with two or fewer children, and had parents with 15 or more years of education. Ten of 57 (18%) children in home care had serum antibody to cytomegalovirus (CMV) and 2/25 (8%) had viruria. In contrast, 59/103 (57%) of children from the day care center were shedding CMV in urine or saliva. Although less than 10% of infants aged less than 1 year were excreting CMV, 78% of infants studied between 12 and 18 months of age had CMV isolated from a saliva or urine specimen. Group day care appears likely to result in early acquisition of CMV. Excretion of CMV by children in day care centers could result in transmission of the virus to susceptible day care workers or mothers, with the potential risk of fetal infection.
Orthotopic Liver Transplantation in Children: Two-Year Experience with 47 Patients
Authors: Gartner J. Carlton , Zitelli Basil J. , Malatack J. Jeffrey , Shaw Byers W. , Iwatsuki Shunzaburo , Starzl Thomas E.
Published: December 2021

During a 24-month period (May 1981 to May 1983), 47 pediatric patients (ranging in age from 7 months to 18 years) underwent orthotopic liver transplantation using cyclosporine and prednisone. Major indications were biliary atresia/hypoplasia, and metabolic liver disease. Thirty-two of 138 patients evaluated for the procedure died prior to transplantation. Thirty patients are alive from 6 to 29 months later including 7/15 patients who required retransplantation. Twenty-one of 32 patients are alive at 1 year following initial transplantation. All 30 survivors are clinically well and living at home; only one has an abnormal bilirubin level. Serious, life threatening medical and surgical complications were common during the early months following transplantation. With one exception, deaths and major rejection episodes occurred early (before 120 days). All survivors are relieved of the stigmata of chronic liver disease, and many have demonstrated catch-up growth. Liver transplantation is an effective treatment for end-stage pediatric liver disease.
The Asthmatic Child's Participation in Sports and Physical Education
Authors:   Committee on Children with Disabilities and Committee on Sports Medicine
Published: December 2021

Asthma is a chronic pulmonary disorder, frequently allergic in nature, and characterized by paroxysms of dyspnea, wheezing, tightness in the chest, and bronchospasm. Asthmatic attacks may be minor and short in duration with little discomfort, or very severe and of long duration, producing the characteristic picture of intractability. During symptomatic periods, it is usually possible to demonstrate change in certain aspects of pulmonary function, notably expiratory flow rate and forced expiratory volume. With mild symptoms or between the episodes of severe asthma, the individual may be at little or no disadvantage in most activities. Continuous exercise for five to eight minutes in cold air often causes dyspnea, wheezing, and bronchospasm (exercise-induced asthma) in an asymptomatic individual who may or may not have a history of having had asthma or hay fever. When symptoms of pulmonary distress become severe or prolonged, they may lead to interruption of the child's daily routine, including school attendance. Occasionally, such children may become home or hospital bound for periods of time.

Between the two extremes of no symptoms and severe asthma, there is a spectrum of respiratory or pulmonary disability—the nature and severity of which require that each child receive individual consideration and evaluation in the matter of his daily activity. Control of asthma in children has significantly improved during the past decade. However, asthma may contribute to inefficiency in schoolwork because of associated chronic fatigue, irritability, decreased attention span, and emotional factors.

Physical activities are useful to asthmatic children. The majority of asthmatic children can participate in physical activities at school and in sports with minimal difficulty, provided the asthma is under satisfactory control.
Promoting the Use of Car Safety Devices for Infants: An Intensive Health Education Approach
Authors: Berger Lawrence R. , Saunders Stephen , Armitage Karen , Schauer Linda
Published: December 2021

Efforts to promote the use of infant car seats through health education techniques have been disappointing when strict criteria for evaluation are used. Low-income families were targeted and were provided with educational sessions in the prenatal, postdelivery, and infant follow-up periods. Free car seats were given to 179 clients. Base-line and follow-up observations were performed at 4 months after delivery. The proportion of correctly restrained infants increased from 9% to 38%. The number of infants who were lap held decreased from 38% to 18%. The proportion of clients who had an approved car seat but who were using it incorrectly increased from 11% to 23%.
Timing and Antecedents of Intracranial Hemorrhage in the Newborn
Authors: McDonald Marilyn M. , Koops Beverly L. , Johnson Michael L. , Guggenheim Mary Anne , Rumack Carol M. , Mitchell Sharon A. , Hathaway William E.
Published: December 2021

Fifty newborn infants of less than 33 weeks' gestation were followed prospectively from birth to evaluate the temporal relationships of various clinical factors to the onset and progression of intracranial hemorrhage (ICH) in an inborn population given maximal support. ICH was diagnosed and followed with bedside ultrasound every eight hours. The incidence of intraventricular hemorrhage was 30% and of any ICH was 40% with onset from less than 2 hours to 8 days of age. Grades 2, 3, and 4 ICH correlated with Apgar scores of less than 5 at five minutes, vaginal delivery, longer labors, and intrapartum hemorrhage. There was a significant correlation between ICH and both blood pressure fluctuations of greater than 100% and rapid colloid infusions. Slow transfusions of packed red cells did not appear to precipitate episodes of ICH. In a setting of optimal care, ICH appears to be more related to prenatal stresses than to specific postnatal complications.