bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased Carrying Reduces Infant Crying: A Randomized Controlled Trial
Authors: Hunziker Urs A. , Barr Ronald G.
Published: December 2021

The crying pattern of normal infants in industrialized societies is characterized by an overall increase until 6 weeks of age followed by a decline until 4 months of age with a preponderance of evening crying. We hypothesized that this "normal" crying could be reduced by supplemental carrying, that is, increased carrying throughout the day in addition to that which occurs during feeding and in response to crying. In a randomized controlled trial, 99 mother-infant pairs were assigned to an increased carrying or control group. At the time of peak crying (6 weeks of age), infants who received supplemental carrying cried and fussed 43% less (1.23 v 2.16 h/d) overall, and 51% less (0.63 v 1.28 hours) during the evening hours (4 PM to midnight). Similar but smaller decreases occurred at 4, 8, and 12 weeks of age. Decreased crying and fussing were associated with increased contentment and feeding frequency but no change in feeding duration or sleep. We conclude that supplemental carrying modifies "normal" crying by reducing the duration and altering the typical pattern of crying and fussing in the first 3 months of life. The relative lack of carrying in our society may predispose to crying and colic in normal infants.
Computed Axial Tomographic Scanning of the Thigh: An Alternative Method of Nutritional Assessment in Pediatrics
Authors: Lemer Aaron , Feld Leonard G. , Riddlesberger M. M. , Rossi Thomas M. , Lebenthal Emanuel
Published: December 2021

In this study we compared the findings of computed axial tomographic (CT) scanning of the thigh with the findings of arm anthropometry and urinary creatinine determinations to assess nutrition in children with inflammatory bowel disease receiving total parenteral nutrition. All 14 children received our standard solution for total parenteral nutrition as well as prednisone and sulfasalazine (Azulfidine) therapy. All patients were assessed by arm anthropometry, 24-hour urine collections for creatinine clearance, and CT scanning of the thigh during total parenteral nutrition. Arm muscle and fat area were estimated by anthropometry, and those in the thigh were estimated by CT scanning. Our results show the total muscle area from the CT scan can predict muscle mass calculated from the urinary creatinine excretion rates. In addition, there is a close correlation between the thigh muscle area as measured by CT scanning and the muscle area calculated from urinary creatinine excretion rates. In addition, the comparison of thigh muscle area and thigh fat area to the midarm muscle area and midarm fat area, respectively, showed that the thigh is a better predictor of muscle than fat in the midarm. We conclude that the total thigh muscle area is a better predictor of muscle mass as compared to the midarm muscle area. In addition, the CT scan cut at the level of the thigh in children and adolescents with inflammatory bowel disease can provide valuable information about the thigh compartment and analyses of different cross-sectional areas of the thigh.
Intramuscular Penicillin
Authors: WEIR MICHAEL. R.
Published: December 2021

To the Editor.—

Stollers and Losey's report of vascular damage with intramuscular benzathine penicillin argues that the delivery system obscures the safeguard against intravascular injection,1 an argument made previously but less colorfully.2 The millions of doses used worldwide attest to the efficacy of persistent low penicillin blood levels in therapy and prophylaxis. The occasional reports of vascular complications including avascular necrosis of the gluteal region, the perineum, and the ipsilateral or contralateral foot, sciatic nerve palsy, and transverse myelopathy raise questions about safety as well as mechanisms of injury.
Vitamin E: What Should We Do?
Authors: POLAND RONALD L.
Published: December 2021

In Reply.—

Dr Newport's questions present us with an excellent opportunity to clarify our statement on the use of vitamin E for the prevention of retinopathy of prematurity. The Committee reviewed all of the available information and concluded that protocols for the use of vitamin E as a prophylaxis against retinopathy of prematurity had not been evaluated in a large enough population to give us a valid estimate of the risks v the benefits. Our statement was published about the time that Johnson and her associates1 reported significant risks associated with the administration of vitamin E to increase the serum concentration well above the 1- to 2-mg/dL that has been generally accepted as normal.
Light and Transcutaneous Po2 Device = Problem?
Authors: HERMANSEN MARCUS C. , MOONEY LAURA , HINES CASEY
Published: December 2021

To the Editor.—

We would like to call attention to a recently recognized and potentially dangerous interaction of a skin surface Po2/Pco2 monitor with a phototherapy device.

A five-day-old, 1,200-g infant was receiving mechanical ventilation for the treatment of respiratory failure and phototherapy for the treatment of hyperbilirubinemia. An observation was made that within a few seconds of removal of the phototherapy unit from the bedside the skin surface Pco2 would increase dramatically. If the phototherapy was then reintroduced, the Pco2 would decrease as dramatically.
Pediatric Resident Training in Telephone Management: A Survey of Training Programs in the United States
Authors: Wood Pamela Runge
Published: December 2021

Although practicing pediatricians spend a major portion of each day in the management of acute illness via telephone, information concerning instructional programs in telephone management is scanty. A 34-item questionnaire was mailed to the 242 program directors of US training programs to obtain information on how telephone calls are handled in pediatric training programs and how pediatric house officers are trained in telephone management. Fifty-five percent of programs have a formalized system for handling telephone calls. One half of programs have a policy on who can answer telephone calls; 11% stated that only physicians are permitted to handle calls. Residents handle an average of 19 calls per day (39% of the total calls received). Only 51% of programs document any telephone calls and only 19% document all calls. Despite the volume of calls handled by pediatric residents, only 45% of training programs offer specific training in telephone management. The most common instructional method is lecturing. Less than one third of programs have a review system or periodically audit telephone calls. Programs that offer resident training in telephone management are significantly more likely to have a system for handling calls, to document calls, and to have a review system.
Effect of Dose Formulation on Isoniazid Absorption in Two Young Children
Authors: Notterman Daniel A. , Nardi Michael , Saslow Judy G.
Published: December 2021

In an 8-month-old infant with tuberculous meningitis treatment with isoniazid was unsuccessful and was associated with lower than expected plasma concentrations of isoniazid (measured concentration 0.1 µg/mL). The infant had received isoniazid as a crushed tablet admixed with apple sauce. Oral administration of the parenteral solution of isoniazid (Nydrazid, Squibb) mixed in apple juice produced a higher isoniazid concentration (2.9 µg/mL) and the child improved clinically. Pharmacokinetic studies in two subjects were performed following intramuscular injection of isoniazid and oral administration of (1) an isoniazid tablet crushed and mixed with apple sauce, (2) parenteral isoniazid solution mixed with apple juice, and (3) a commercially available syrup containing isoniazid and pyridoxine (P-I-N Forte, Lannett). Of the three oral preparations, the syrup produced the highest peak concentrations (8.3 and 6.9 µg/mL). The crushed tablet in apple sauce produced the lowest peak concentrations (1.4 and 2.4 µg/mL). Administration of crushed isoniazid tablets with food may be associated with impaired gastrointestinal absorption, lower than expected isoniazid concentrations, and treatment failure.
Auditory Testing and Bilirubin
Authors: SHAPIRO STEVEN M. , HECOX KURT B.
Published: December 2021

To the Editor.—

Nakamura et al (Pediatrics 1985;75:703-708) provide a useful correlation of the auditory brainstem response (ABR) with unbound bilirubin levels. However, their findings of normal I-V interwave intervals despite increased wave I latencies are surprising in light of other reports of increased interwave intervals in neonates with hyperbilirubinemia. Their suggestion that with bilirubin toxicity alone "brainstem function probably is not involved" contradicts other studies of hyperbilirubinemic neonates that have found central (brainstem), in addition to peripheral, auditory brainstem response abnormalities.
Aplastic Anemia Following Chloramphenicol Therapy Still Happens!
Authors: LEPOW MARTHA L.
Published: December 2021

To the Editor.—

Chloramphenicol is still the drug of choice for treatment of ampicillin-resistant Haemophilus influenzae b meningitis, brain abscess,1 Rocky Mountain spotted fever in severely ill patients and young children, and typhoid fever. Intravenous oral and intraocular routes of administration have been widely used.

Smith and Webber2 have recently reviewed the pharmacology of chloramphenicol. Reversible erythroid suppression is dose related and more common in children. Genetic predisposition of the stem cell to inhibition of nucleic acid synthesis is thought to be the explanation for the "idiosyncratic" chloramphenicol-induced bone marrow aplasia, although Daum et al3 reported a probable dose-related case.
Pathogenesis of Biliary Atresia
Authors: MOORE THOMAS C.
Published: December 2021

In Reply.—

The letter of Esterly is an important one with some significant observations regarding a potential acquired inflammatory and viral etiology of biliary atresia. A marked and progressive inflammatory component of biliary atresia with extensive early round cell infiltration and progressive fibrosis was reported by one of the authors in 1953.1 This observation led to strong recommendations for early operation in biliary atresia.2,3

It has been suggested that biliary atresia, neonatal spontaneous perforation of the extrahepatic bile ducts, and choledochal cysts may be variants of an acquired infalmmatory process, possibly viral, such as cytomegalovirus, and possibly oncogenic.4
The American Occupational Therapy Association, lnc, Viewpoint
Authors: BING ROBERT K.
Published: December 2021

To the Editor.—

The American Occupational Therapy Association would like to provide the profession's perspective to your recently published statement entitled "School-Aged Children With Motor Disabilities" which appeared in Pediatrics (1985;76:648-649). We commend the Committee on Children With Disabilities on their efforts to establish guidelines regarding the treatment of children with dyspraxia and other motor disabilities, and we strongly encourage pediatricians to become knowledgeable of education-related services available to these children. However, it is important that their statement reflect current practice and research relevant to the services discussed.
Physical Maturity and Outcome of Pregnancy in Primiparas Younger Than 16 Years of Age
Authors: Sukanich Aurapin C. , Rogers Kenneth D. , McDonald Hugh M.
Published: December 2021

The association of complications and adverse outcomes of early teenage pregnancy with physical growth maturation of mothers was studied in subjects identified from review of medical records in a Pittsburgh obstetrical hospital from 1970 through 1977. Five groups were used to categorize the subjects: (1) 449 primiparas younger than 16 years of age, (2) 347 primiparas 20 to 24 years of age, pair-matched with subjects in group 1 by race, hospital service status, sex of infant, trimester of first prenatal visit, and year of delivery within 5 years, (3) 139 group 1 mothers at the time of their second delivery, (4) 104 group 1 primiparas whose postmenarcheal age was ≤2.6 years at delivery, and (5) 108 group 1 primiparas whose postmenarcheal age was ≥4.1 years at delivery. Subjects in groups 1 and 2, first and second pregnancies of subjects in group 3, and subjects in groups 4 and 5 were compared for prepregnancy weight and height, weight gain during pregnancy, complications of pregnancy, birth weight and gestational age of infant, and perinatal morbidity and mortality. Although primiparas younger than 16 years of age had not achieved mature height and weight, no relationship between mother's physical growth maturation and adverse pregnancy course or outcome was demonstrated.
Screening for Anemia and Erythrocyte Disorders in Children
Authors: GLADER BERTIL E.
Published: December 2021

The American Academy of Pediatrics currently recommends that children should be screened for anemia during infancy, in early childhood, in late childhood, and again some time during adolescence. In this issue of Pediatrics, Young and co-workers1 report their comparison of two different commonly used tests to screen for anemia. Specifically, they compared the sensitivity of the microhematocrit using capillary blood v electronically determined cell counts (ie, Coulter count) using venous blood. The authors conclude that the capillary blood microhematocrit test is an acceptable office screening test for anemia and very few children with low venous hemoglobin concentrations escape detection using this procedure.
Missing Children
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

Changes within our society are contributing to the apparent increase in the number of missing children. The risks associated with child care in single-parent households and the hurried, inappropriate expectations of children's social maturity are two areas in which pediatricians can legitimately become involved. Pediatricians must be sensitive to the family and social circumstances that place children at high risk. Pediatricians should address the issue of missing children by concentrating on (1) enhancing public awareness of the problem and (2) integrating specific preventive strategies such as screening and parental education education into their practices.
Home Phototherapy Recommendations Questioned
Authors: GRABERT BRIAN E.
Published: December 2021

To the Editor.—

The report and recommendations for home phototherapy, as reported by the Committee on the Fetus and Newborn (Pediatrics 1985;76:136-137), was well intentioned but in my opinion hastily conceived and fell far short of expectations. Just when the pediatric community was convinced that the bilirubin/kernicterus issue was "a real mess,"1 this committee seemingly attempts to provide order where chaos has reigned.

I am concerned about the lack of referencing of available data2,3 on home phototherapy, albeit limited, in the committee's report.
Life Insurance for Disabled Children
Authors: VINCE DENNIS J.
Published: December 2021

To the Editor.—

Most parents consider the achievement of financial and psychologic independence as a desirable goal for their children. In our increasingly complex society, these goals are becoming difficult to achieve. To finance self-employment opportunities or to purchase a home, disabled adults usually require life insurance. Because of this, many parents of disabled children apply for life insurance for their child so that these options will be available to them as adults. The life insurance company usually will then request that the child's physician comment on the medical condition and prognosis.
Constipation and Meconium Ileus Equivalent in Patients With Cystic Fibrosis
Authors: Rubinstein Steven , Moss Richard , Lewiston Norman
Published: December 2021

Constipation and its complications, particularly meconium ileus equivalent, may become management problems in patients with cystic fibrosis. The medical records of 168 patients with cystic fibrosis were reviewed for the prevalence of constipation and meconium ileus equivalent. Of 168 patients, 54 (32%) had experienced at least one episode of constipation which responded to oral or rectal laxative therapy. In 16 of the study group (9%) meconium ileus equivalent developed. Patients younger than 5 years of age had a lower prevalence and those older than 30 years of age had a much higher prevalence of both conditions. Those with prolonged histories of inadequately controlled steatorrhea appeared to be at higher risk for the eventual development of meconium ileus equivalent. Recurrences and complications of constipation may be avoided by instituting early and aggressive therapy.
Prudent Life-style for Children: Dietary Fat and Cholesterol
Authors:   Committee on Nutrition
Published: December 2021

In the 1983 AAP Committee on Nutrition statement, "Toward a Prudent Diet for Children," the evidence linking dietary factors with the risk of atherosclerosis was reviewed.1 Based on the analysis of the available information, the Committee made seven recommendations concerning steps to be taken during childhood that would reduce the risk of atherosclerotic cardiovascular disease in adults. With respect to childhood eating habits, it was noted that, after 1 year of age, a varied diet that includes items from each of the major food groups is the best assurance of nutritional adequacy. The dietary trends in the United States during the last few decades, with emphasis on decreased consumption of saturated fats, cholesterol, and salt and increased intake of polyunsaturated fats, were recommended as sensible when followed with moderation.1

OTHER FINDINGS

Since publication of that Committee statement, recommendations for alteration of childhood diets have also been made by the American Heart Association, 2 by the American Health Foundation, 3 and by a Consensus Development panel sponsored by the National Institutes of Health (NIH).4 All three of these groups have recommended more restrictive childhood diets than had been recommended by the Committee on Nutrition.

The American Heart Association2 recommends a total fat intake that would be approximately 30% of total calories; this 30% would include 10% or less from saturated fat, 10% from monounsaturated fat, and less than 10% from polyunsaturated fat. The recommendation for daily cholesterol intake was 100 mg/1,000 calories and not to exceed 300 mg/d, total.

Similar recommendations have been made by the American Health Foundation3 to achieve a target goal of serum total cholesterol values averaging 140 mg/dL for children and young adults.
Sexuality, Contraception, and the Media
Authors:   Committee on Adolescence
Published: December 2021

Approximately half of all American adolescents have experienced coitus by 17 years of age.1 The majority say their first experience was not anticipated. More than 85% have first coitus before seeking professional advice about prevention of pregnancy or infection. The earlier the first coitus, the longer the interval until such advice is sought. The consequences of unprotected coitus include pregnancy, often unwanted, and exposure to sexually transmitted infections, which increase the risk of adverse pregnancy outcome, as well as damage to the reproductive system, which could result in sterility.2 Female adolescents who have sexual intercourse, are sexually promiscuous, and have repeated genital infections have an increased risk for cervical cancer.3 Teenagers are most likely to risk these consequences of sexual intercourse when they lack knowledge about methods of preventing pregnancy and infection, have received limited encouragement for responsible sexual behavior, and/or hold Unwarranted fears about the risks of specific contraceptive methods.4

THE MEDIA AND SEXUAL LEARNING

The average American family watches six to seven hours of television and 70 to 90 commercials daily.5 Teenagers average 24 hours of television viewing and 21 hours of radio listening a week.5 Annually, American youths spend more time watching television than they spend in school. Although the specific impact of television on psychosexual development and sexual behavior has not been documented, there is strong evidence that television influences attitudes, values, behaviors, and socialization.6

The American television audience is exposed to more than 9,000 sexual references, innuendoes, and behaviors each year.5 In many households, access to cable television and home videos has increased the exposure to more explicit sexual messages.
Leukemia and Hemophilia
Authors: OZSOYLU SINASI
Published: December 2021

To the Editor.—

I enjoyed reading the paper by Aronis et al,1 and would like to bring to your attention that we have also recently observed leukemia in two patients with hemophilia A and B, 10 and 1½ years of age, respectively.2 Because commercial factor VIII and IX were not used and only blood, fresh frozen plasma, and plasma were given on a few occasions, it was less likely that AIDS-like immune changes were responsible for the leukemia in our patients.
Leukemia and Hemophilia
Authors: ARONIS-BOURNAS S.
Published: December 2021

In Reply.—

As far as we know, previous data on the incidence of malignancies in hemophiliacs are lacking; nevertheless, we quite agree with the iemark of Altay et al1 that malignancies in hemophiliacs should be reported for future evaluation of their frequency.

Regarding our patient,2 we believe that his lymphoma occurred in the setting of AIDS. This is supported by our retrospective finding of his being seropositive for HTLV-III antibodies, by Western blot technique, on several occasions since 1982.
Statement on Infant Mortality
Authors:   Task Force on Infant Mortality
Published: December 2021

Why Is Infant Mortality Important?

Rates of infant mortality are sensitive indicators of a broad range of factors affecting children's health. As such, infant mortality is the "tip of the iceberg" of child health problems, and changes in infant mortality are a signal of factors affecting child health more broadly. In addition to its role as a general gauge of child health, infant mortality itself represents an important health problem. It is well to remember that infant death rates are the highest of any age group less than 65 years.

The message conveyed by infant mortality rates if better understood in terms of the causes of mortality at different times during the first year of life.

Neonatal Mortality

Neonatal mortality rate is defined as the number of infants dying between 0 and 27 days of life per 1,000 live births. These deaths in the first month of life reflect primarily factors associated with health of the mother before and during pregnancy and the special problems of the newborn. Deaths in this age range result chiefly from inadequate intruterine growth (prematurity, intrauterine growth retardation) and congenital anomalies. As a result, neonatal mortality rates provide an indicator of the factors affecting pregnancy, delivery, and the neonate and the adequacy of services in the prenatal, intrapartum, and neonatal periods.

Postneonatal Mortality

Postneonatal mortality rate is defined as the number of infants dying between 28 days and 11 months of life per 1,000 live births, ie, deaths occurring during the remainder of the first year of life.
Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia
Authors: HARRIS HOWARD , STINE MARY JO
Published: December 2021

To the Editor.—

The recent report by Perlman et al1 suggesting that chloride deficiency may be a significant contributing factor in the poor outcome of infants with bronchopulmonary dysplasia seems invalid because of the composition of the study and control groups. Although they found no difference between the two groups relative to the requirements for oxygen and mechanical ventilation, it would seem plausible that the study group, who all died in the neonatal intensive care unit, had more severe bronchopulmonary dysplasia than the control group, who were all able to be discharged home.
Annual Summary of Vital Statistics—1985
Authors: Wegman Myron E.
Published: December 2021

Data for this article, as in previous reports,1 are drawn principally from Monthly Vital Statistics Report, published by the National Center for Health Statistics (NCHS).2-6 The international data come from the Demographic Yearbook7 and the quarterly Population and Vital Statistics Reports,8 both published by the Statistical Office of the United Nations, which has also been kind enough to provide directly more recent data. Except for mortality data by cause and age, which are based on a 10% sample, all the US data for 1984 are estimates by place of occurrence, based upon a count of certificates received in state offices between two dates, 1 month apart, regardless of when the event occurred. Experience has shown that for the country as a whole the estimates, with few exceptions, are close to the subsequent final figures. There are, however, considerable variations in some states, particularly in comparing data by place of occurrence and place of residence. State information should be interpreted cautiously.
Periventricular Intraparenchymal Echodensities in the Premature Newborn: Critical Determinant of Neurologic Outcome
Authors: Guzzetta Franco , Shackelford Gary D. , Volpe Sara , Perlman Jeffrey M. , Volpe Joseph J.
Published: December 2021

Controversy exists concerning the degree of importance of periventricular intraparenchymal echodensities (IPE) observed on neonatal ultrasound scans in the determination of subsequent neurologic disability in premature infants. In this report, IPE was studied in 75 infants weighing less than 2,000 g at birth to determine the basic characteristics of the lesion, the likely pathogenesis, the outcome, and the aspects of the ultrasonographic appearance in the acute period of neonatal illness that are important for prediction of outcome. IPE was defined as any periventricular echodensity greater than 1 cm in at least one dimension. IPE was strikingly associated with large areas of intraventricular hemorrhage (IVH) (81% of cases). IPE was distinctly asymmetric. Thus, the lesion was either exclusively unilateral (67%) or bilateral with marked predominance on one side. The associated IVH was asymmetric in approximately 80% of cases, and in all 50 cases of large asymmetric IVH, IPE occurred on the same side as the larger amount of intraventricular blood. Moreover, more than 50% of such cases of IPE associated with large asymmetric IVH were progressive. Neuropathologic correlation showed that IPE represented hemorrhagic necrosis of periventricular tissue. Concerning pathogenesis, these data raise the possibility that large asymmetric IVH is related etiologically to IPE. Outcome varied with the severity of the IPE. Thus, the mortality rate among the 38 infants with extensive IPE was 79%. Of the survivors with extensive IPE, all had subsequent major motor deficits and all but one exhibited cognitive function less than 80% of normal. Among the 37 infants with localized IPE, the mortality rate was 38%. Of the survivors, although 79% had major motor deficits, 43% had cognitive function greater than 80% of normal. Thus, the findings demonstrate that with extensive IPE there is little or no chance for survival with normal neurologic and cognitive outcome, but with localized IPE, although major motor deficits are common, an appreciable proportion of infants have cognitive function in the normal range. Careful, quantitative assessment of the ultrasonographic features of IPE in the acute period of illness in the premature infant is of major value in estimating outcome.
Report of the Second Task Force on Blood Pressure Control in Children—1987
Authors:   Task Force on Blood Pressure Control in Children
Published: December 2021

Although the prevalence of clinical hypertension is of a far lesser magnitude in children than adults, there is ample evidence to support the concept that the roots of essential hypertension extend back into childhood. Prospective cohort data that could yield precise information about the relationship between childhood BP and cardiovascular risk are not yet available. Nonetheless, high BP in children represents a significant clinical problem which in 1977 was comprehensively addressed by the Task Force on Blood Pressure Control in Children. Contained herein, 10 years later, is the revised version of the original Task Force report including normative BP data derived from sampling more than 70,000 children, as well as advice on methodology and instrumentation for BP measurement, guidelines for detecting children with high BP, and strategies for appropriate diagnostic evaluation and pharmacologic and nonpharmacologic treatment.
Silver-Russell Syndrome With Unusual Findings
Authors: HANSEN KAREN KIRHOFER , LATSON LARRY A. , BUEHLER BRUCE A. , LATSON LARRY A.
Published: December 2021

In 1953, Silver et al1 described a syndrome of short stature and low birth weight with hemihypertrophy and abnormal sexual development. Independently, in 1954, Russell2 described a condition with similar findings, but his description emphasized disproportionately short arms, maternal difficulty during pregnancy, and craniofacial dysostosis. These two descriptions are now accepted as a continuum of the same entity, termed the Silver-Russell syndrome. A hallmark of the syndrome is its extreme clinical diversity. The findings most commonly seen in children with Silver-Russell syndrome are summarized in the Table.3

Recently, we encountered multiple cafe-au-lait spots, primary hypoparathyroidism, congenital glaucoma, congenital heart disease, and glucose-6-phosphate dehydrogenase deficiency in a newborn black girl with severe intrauterine growth retardation.
Efficacy Comparison of Oral Rehydration Solutions Containing Either 90 or 75 Millimoles of Sodium per Liter
Authors: Pizarro Daniel , Castillo Bernardita , Posada Gloria , Lizano Cecilia , Mata Leonardo
Published: December 2021

In a randomized trial, 62 infants 2 to 35 months of age with dehydration due to acute watery diarrhea were allocated to one of two groups: group A received solution A (World Health Organization-recommended oral rehydration solution), which contained (mmol/L): Na+ 90, K+ 20, Cl- 80, citrate3- 10, and glucose 110; group B received solution B (Pedialyte RS; Abbott Laboratories, North Chicago), which contained (in mmol/L): Na+ 75, K+ 20, Cl- 65, citrate3- 10, and glucose 139. Oral therapy was given until clinical signs of hydration status were normal. During the 48-hour trial, the following laboratory data were collected: blood gases, serum electrolytes, glucose, urea, and creatinine values and sodium and potassium concentrations in stool and urine; serial weights and clinical signs were also reported. Six of the 62 infants, three in each group, required intravenous fluids because of high stool output. Results of clinical outcome and normalization of altered serum electrolyte values were similar in both groups. During the 48-hour trial, eight patients in group A and four in group B had mild, asymptomatic hypernatremia. Pedialyte RS was found to be a safe glucose/electrolyte solution for oral rehydration therapy.
Cystic Fibrosis and Family Stress: Effects of Age and Severity of Illness
Authors: Walker Lynn S. , Ford Melissa B. , Donald William D.
Published: December 2021

Stress and adjustment in mothers of children with cystic fibrosis was compared with that in a control group of mothers of healthy children. Mothers of children in four age groups were included: preschool, middle childhood, early adolescence, and late adolescence. Mothers of children with cystic fibrosis did not report significantly higher levels of stress than did the control group mothers; nor did they report greater feelings of inadequacy as parents. However, mothers of children with cystic fibrosis in two age groups, preschool and early adolescence, scored higher on a measure of depression than did mothers of healthy children in the same age groups. The relationship of illness severity to maternal stress and adjustment was examined in the cystic fibrosis group. The mother's subjective rating of the child's illness severity was a better indicator of her reported stress than was the Shwachman clinical rating. It appears that many mothers are able to adapt to the presence of cystic fibrosis in the family, although certain periods in the child's life and perceived increases in illness severity are associated with increased maternal distress.
Development of Severely Malnourished Children Who Received Psychosocial Stimulation: Six-Year Follow-up
Authors: Grantham-McGregor Sally , Schofield William , Powell Christine
Published: December 2021

The development of 16 children who were hospitalized for severe malnutrition and participated in a home-visiting program of psychosocial stimulation was compared with that of two other groups who were also hospitalized but received standard medical care only: severely malnourished group (n = 18) and an adequately nourished one (n = 20). All groups were assessed regularly on the Griffiths Mental Development Scales and the Stanford-Binet test. Both groups of malnourished children were markedly behind the adequately nourished group on admission to the hospital and the group that received no intervention showed little sign of catching up. The intervention group caught up to the adequately nourished group in 2 years. This report covers the third year of home-visiting and the 3 years following its cessation. The intervention group showed a decline in three of the five Griffiths subscales. However, they retained a marked advantage over the nonintervention group of malnourished children on the Stanford-Binet test until the end of follow-up, showing no further decline in the last year. For height, both malnourished groups failed to catch up to the adequately nourished group. It was concluded that a relatively simple intervention can benefit the development of severely malnourished children.
Smoke and Ear Effusions
Authors: ETZEL RUTH A.
Published: December 2021

To the Editor.—

The Committee on Environmental Hazards of the American Academy of Pediatrics has reviewed the acute and long-term health effects of involuntary smoking and offered recommendations to reduce the exposure of children to tobacco smoke.1

Chronic middle ear effusions requiring tympanostomy tube placement occur more often in the children of parents who smoke than in the children of parents who do not smoke.2,3 Although not mentioned in the Committee's statement, this is another important adverse health effect associated with involuntary smoking about which both parents and pediatricians should be informed.
Intensive Care Unit Resources and Costs
Authors: POLLACK MURRAY M. , GETSON PAMELA R. , RUTTIMANN URS E.
Published: December 2021

To the Editor.—

Dr Bushore's perceptive and progressive commentary on the need to reduce health care expenditures while assuring appropriate care for appropriate patients should be applauded.1 Too little emphasis on this important, national issue has been given in the pediatric literature. Dr Bushore's commentary referred to only one paper, our recent analysis of inappropriate intensive care unit (ICU) admissions2 and emphasized the importance of an objective method for evaluations of potential resource reduction. The use of objective methods for these evaluations should be expanded upon.
Neonatal Intracranial Hemorrhage and Phenobarbital
Authors: BATTISTI O. G. , BERTRAND J. M. , LANGHENDRIES J. P.
Published: December 2021

To the Editor.—

We appreciate the recent study by Kuban et al1 about neonatal intracranial hemorrhage and phenobarbital use, but we would like to mention several points.

The number of neonates not having been enrolled represents a high proportion of the eligible population (263/554 or 47.5%) from which 48 (8.7%) had hemorrhage before enrollment, suggesting that the inclusion criteria were not sufficient according to the pathophysiology of cerebral blood flow variability in the neonates. In fact, the authors were missing 48/140 (34.3%) of infants with any hemorrhage (the number of infants with any hemorrhage they studied was 92).
Too Many Warnings on Missing Children
Authors: STERNE GEORGE G.
Published: December 2021

In Reply.—

Dr Green's point is well taken. The Committee's statement on missing children began by noting that concerns about missing children are a serious source of parental anxiety. Although we were also aware of anecdotal data concerning fears in children, we did not know of any available data documenting or quantifying this.

The Committee's intent was to provide pediatricians with information so that they could counsel the parents of their patients. By giving relative risk estimates, we hope to relieve parental, and indirectly children's, anxiety.
Hand-Powered Apparatus for Aspiration of Meconium From the Airway
Authors: PRETLOW ROBERT A.
Published: December 2021

In delivery room resuscitation of infants with meconium aspiration, it is common clinical practice to insert an endotracheal tube below the infant's vocal cords and apply suction to the tube directly with the resuscitator's mouth as the tube is withdrawn. Although a surgical mask or sterile gauze is often interspersed between the physician's mouth and the connector of the endotracheal tube, Ballard et al in a recent study found that many physicians bypass such "filters" and as many as 74% reported having ingested secretions during oral meconium suctioning. In several cases, moreover, such secretions were infected with herpes type II, hepatitis B, or Neisseria gonorrhoeae. Although proper application of a mask or gauze over the tube connector may prevent ingestion of secretions, the authors point out that, "some bacteria and most viruses pass through a mask or are readily aerosolized ... and ... a mask moistened by secretions represents an opportunity for exchange of potentially harmful organisms."
PITUITARY ADRENOCORTICOTROPIC HORMONE (ACTH) AND 11-DEHYDRO-17 HYDROXY CORTICOSTERONE (CORTISONE) THERAPY IN THE LEUKEMIAS AND LYMPHOMAS OF CHILDREN
Authors: SNELLING C. E. , DONOHUE W. L. , LASKI BERNARD , JACKSON S. H.
Published: December 2021

The data concerning 16 cases of leukemia and one case of lymphosarcoma in children treated with pituitary adrenocorticotropic hormone (ACTH) and 11-dehydro-17-hydroxy corticosterone (cortisone) are presented.

Treatment of this group of diseases in children with these hormones resulted in complete but temporary remissions in a large proportion of the cases. Most patients in which remissions were produced were almost completely refractory to retreatment with the hormones. Chemical studies indicated that in those patients in which a remission was produced, coincident with the remission there was a mass destruction of leukemic tissue.

Great variations were noted from patient to patient and also in the same patient in regard to the cytologic, physiologic and biochemical effects of the hormones.

Although ACTH and cortisone are unsatisfactory for permanent treatment of the leukemias and lymphomas, they offer invaluable tools for the investigator in the study of these diseases.
INCONCLUSIONS OF STUDIES, MOSTLY OF PREMATURE INFANTS
Authors: GORDON HARRY H.
Published: December 2021

We do not know whether or how the rate of oxygen consumption by the cells of premature infants differs from that of full term infants. We do not know the clinical significance of subnormal body temperatures in premature infants. We do not know how much immature renal function and how much handicaps in intracellular defenses contribute to [See CHART 4, CHART 5 in Source PDF] the tendency of premature infants to develop disorders of water and acid-base balance. We do not know the nature of the deviation in ability of premature infants to absorb fat. We do not know how ascorbic acid and other dietary factors promote breaking open of the phenol ring of tyrosine or phenylalanine. We do not know what constitutes "immunity" to malaria.

This is a doleful summary; it is a consolation to note the epigram of Rabbi Tarfon, written almost 1,900 years ago: "It is not for thee to complete the work, but neither art thou free to desist from it."
COR PULMONALE IN INFANCY AND EARLY CHILDHOOD
Authors: ROYCE STEPHEN W.
Published: December 2021

A higher incidence of cor pulmonale exists in the pediatric age group, especially among infants, than was previously suspected. The majority of cases come from the patients whose lung disease is associated with fibrocystic disease of the pancreas; and because these children now tend to live longer, with improved antibiotic therapy, the chances of seeing this complication are increased. A large proportion (over 70% in this series) of infants and children with this type of lung disease show cor pulmonale at autopsy. This means, statistically speaking, that fibrocystic disease has a high rank among the precursors of pulmonary heart disease in the general population. Other severe lung diseases of childhood, tuberculosis and bronchiectasis, for example, rarely produce cor pulmonale, and the asthmatic patients usually escape entirely.

Approximately half the patients with cor pulmonale have terminal decompensation and die in severe right-sided cardiac failure. This may occur suddenly, only a few days after the first signs of chest disease, or may come on gradually after many years. The duration of disease bears an inverse ratio to the severity of the initial insult. Massive overloading of the pulmonary circulation by blood-borne foreign bodies may cause immediate death, and fibrocystic lung disease may produce such abrupt pulmonary hypertension that the patient survives only a few days. But most infants and children are able to compensate after the initial strain and show a gradual progression to the decompensated state over a period of years.

The diagnosis of cor pulmonale assumes greatest interest at the infant level. It is now clear that otherwise mysterious episodes of infant cardiac failure have been on the basis of pulmonary disease. In an older child with extensive pulmonary disease and clinical evidence of a failing heart, the presence of proved fibrocystic disease makes cor pulmonale a likely postmortem finding. An infant with the same combination of signs presents a more difficult problem in differential diagnosis since his critical condition often makes direct analysis of pancreatic enzymes hazardous, and stool analysis for trypsin activity may be unreliable under these circumstances. Once the diagnosis is established, however, all effort should be directed toward clearing the chest of infection, since therapy of the secondary cardiac involvement is generally unsuccessful.
LABORATORY ASPECTS OF ANTIBIOTIC THERAPY
Authors: SPAULDING EARLE H.
Published: December 2021

Bacterial strains within a single species exhibit highly specific susceptibility patterns when tested with the several antibiotics currently available. Because in vitro susceptibility tests constitute the only certain method for predicting clinical response, the bacteriology laboratory is playing an expanding part in the choice and control of antibiotic therapy. Although there is no need for bacteriologic studies in the vast majority of infections, they are sometimes essential to the successful management of severe acute, refractory and relapsing infections. The correlation between laboratory and clinical results is good providing allowances are made for certain factors discussed in this paper. Antibiotic susceptibility tests are entirely practical and should be used routinely in all laboratories which do bacterial cultures.
SPECIAL REVIEWS
Authors: CROCKER ALLEN C.
Published: December 2021

It is suggested that the term "xanthoma" be limited to lesions containing a high percentage of lipid as cholesterol and, since these are small yellow tumors, this seems appropriate.

The patient with these lesions deserves careful clinical study, and an estimation of serum lipids. If possible, total serum lipid determination with partition is desirable, especially in the obscure cases. At least an accurate estimation of serum cholesterol is needed before a logical prognosis and course of treatment can be provided. The Schoen-heimer-Sperry cholesterol method has the widest acceptance.

Patients with xanthomas can be divided into those with normal serum lipids and those with elevated lipids.

A. Xanthoma disseminatum lesions are the most frequent and the most benign, and are associated with normal serum cholesterol values.

B. Xanthomas without elevation of serum lipids are also found in patients with the "eosinophilic granuloma syndromes," and occasionally with other chronic diseases.

C. In xanthoma tuberosum the serum cholesterol is markedly elevated, and the frequent cardiac involvement gives the full-blown patient a poor prognosis.

D. Secondary or eruptive xanthomas can accompany most of the conditions with chronic hyperlipemia irrespective of the cause, but they are most common in diabetes mellitus and idiopathic familial hyperlipemia.

Another case of idiopathic familial hyperlipemia in an infant is reported, with a total serum lipid level of 6.2%, as well as two cases of the nephrotic syndrome in childhood with secondary xanthomas, a case of xanthomas complicating chronic obstructive liver disease, an example of eruptive xanthomata in von Gierke's disease, and a description of a diabetic girl with a serum total lipid level of 19.4%.

The basic cause for the accumulation of cholesterol in any of these conditions is unknown. Surgical removal of the lesions is rarely advisable, and dietary treatment is indicated only in certain of the hypercholesterolemic syndromes.
EPIPHYSEAL INJURIES IN BREECH DELIVERY
Authors: SHULMAN BERNARD H. , TERHUNE CHARLES B.
Published: December 2021

Four cases of epiphyseal birth injuries in direct or altered breech extractions are presented. Characteristic roentgenographic studies demonstrate the local findings. The role of parity in the occurrence of these injuries is discussed. The mechanism of the injury, pathology and therapy of epiphyseal birth injuries is reviewed.
CRYSTALLINE VITAMIN B12 AND SODIUM FOLVATE IN PREMATURITY
Authors: MITCHELL TOM , ETTELDORF JAMES N. , TUTTLE A. H. , CLAYTON GEORGE W.
Published: December 2021

The effects of vitamin B12, a combination of vitamin B12 and sodium folvate, and sodium folvate alone, on the weight, length, hemoglobin, hematocrit, etrythrocyte count, reticulocyte count, M.C.H., M.C.V. and M.C.H.C. has been studied in 52 premature infants. Twenty-four premature infants receiving neither sodium folvate nor vitamin B12 served as controls.

We were unable to demonstrate any influence of these vitamins singly or in combination during the first 50 days of life.
THE PEDIATRICIAN AND THE PUBLIC
Authors: GORDON HARRY H.
Published: December 2021

IT IS my purpose this morning to describe some facets of the program at the University of Colorado School of Medicine, the development of which has been conditioned by the needs of our community, i.e., of Denver and of Colorado.

A word is in order about some of the local stimuli to these developments. First, Dean Ward Darley and President Robert L. Stearns point out that as a state-supported institution we bear a special obligation to meet the varying needs of both rural and urban Colorado. Second, members of the faculty have participated actively in the reorganization of the Department of Health and Hospitals of Denver since 1947. Third, under the guidance of Dr. Alfred H. Washburn, the Child Research Council of Denver has for the past 20 years been making a multidisciplined study of the factors influencing human growth and adaptation. Fourth, from the Department of Philosophy on the Boulder campus comes Professor David Hawkins to tell us that the Hippocratic vision of medicine is of a "science extending far beyond the boundaries of the organism and including the investigation of whatever touches upon human health and welfare." Finally because our practice at the medical school is at present limited to the medically indigent, we have daily examples of our need to concern ourselves with social factors.