bluuebunny/crossref_metadata_2025 huggingface dataset:
Furosemide in Hyaline Membrane Disease
Authors: Marks Keith H. , Berman William , Friedman Zvi , Whitman Victor , Lee Cheryl , Maisels M. Jeffrey
Published: December 2021

In a randomized clinical trial designed to evaluate the effect of diuresis on infants with hyaline membrane disease, seven infants were treated with furosemide (2 mg/kg intravenously) and five received 5% dextrose water in 0.225% sodium chloride (control group). Arterial blood gas analyses performed before and during the six hours after treatment showed no significant difference between control and treated infants. Urine output and urine sodium and calcium loss were significantly increased (P < .05) in the infants receiving furosemide. The diuresis seemed to have no effect on left atrial size determined echocardiographically, whereas measurements of dynamic skinfold thickness suggested mobilization of subcutaneous water. One infant became seriously dehydrated and hypotensive secondary to a massive diuresis. We concluded that furosemide had a potent diuretic effect in infants with hyaline membrane disease but does not improve cardiorespiratory function acutely. This may be because of failure to mobilize pulmonary interstitial fluid in the time period tested. It may also be possible that the presence of pulmonary interstitial fluid does not play an important role in the impairment of gas exchange in the acute stage of hyaline membrane disease.
Aminophylline Therapy for Idiopathic Apnea in Premature Infants: Effects on Lung Function
Authors: Gerhardt Tilo , McCarthy Jeane , Bancalari Eduardo
Published: December 2021

The effect of aminophylline on lung function was studied in 14 premature infants with apnea (gestational age, 30.2 weeks; birth weight, 1,052 gm). The infants showed compromised pulmonary function with a large difference in alveolar-arterial PO2 gradient (83.9 mm Hg), a low normal lung compliance of 1.1 ml/cm H2O • kg, and a normal inspiratory resistance of 45.3 cm H2O/liter/sec. Aminophylline therapy did not change these functions significantly, but it decreased the incidence of apneic episodes from 29.7 to 4.4 per day. The effectiveness of aminophylline in treating apnea in premature infants must be related to its central stimulating effect and not to an improvement in lung function and oxygenation.
On the Terminology of Adolescent/Adolescence
Authors:   Committee on Adolescence
Published: December 2021

In 1972 the American Academy of Pediatrics stated that the purview of pediatrics begins in the period prior to birth when conception is apparent and continues to age 21 years. The Committee on Adolescence believes that the terminology used in all Academy materials should be changed to reflect the pediatrician's expanded role.

The words "infant," "child," "adolescent," and "young adult" connote different images which, in turn, provoke the age-specific response. The Committee on Adolescence recommends that all references to pediatric patients give proper semantic recognition to infants, children, and adolescents, and that the Academy adopt the policy that the term "child" should no longer be used for all age groups. The words "youth," "adolescent," or "adolescence" should be used when referring to those between puberty and maturity.
Intramuscular Penicillin Administration at Birth: Prevention of Early-Onset Group B Streptococcal Disease
Authors: Steigman Alex J. , Bottone Edward J. , Hanna Bruce A.
Published: December 2021

The large number of deaths in newborns resulting from invasive early-onset group B streptococcal (GBS) disease constitutes a grave challenge. The apparent absence of this affliction in our institution appears to be a dividend of the routine use of penicillin for the prophylaxis of ophthalmia neonatorum in all newborns since 1952. Significant confirmation of the efficacy of parenteral penicillin therapy for this purpose derives from a recent report from Halifax in Canada. It is concerned with 983 newborns weighing less than 2,500 gm at birth in whom no deaths occurred during the study period. This contrasted with ten deaths due to GBS disease in 1,208 similar infants in the preceding year when penicillin was not administered.
Health promotion program of the Academy
Authors: Robinson Saul J.
Published: December 2021

This year the American Academy of Pediatrics has embarked on a health promotion program which will lead to a schedule of events for its participation in the Year of the Child—1979, as proclaimed by the United Nations. It will reach a climax in 1980 with the celebration of the 50th anniversary of the founding of the American Academy of Pediatrics. The motto the Academy has adopted for this is "The Academy of Pediatrics Speaks Up for Children."

A Committee under the chairmanship of Dr. Sprague Hazard, a member of the Executive Board, has organized a program which emphasizes four aspects of child health: accident prevention, nutrition, immunization, and health education.
Letter To The Editor
Authors: Valaes Timos , Hyte Marilyn
Published: December 2021

We are grateful to Dr. Poland for the care with which he read our article. He is correct in pointing out that the anticoagulant used in the blood for the exchange transfusion (ET) made a difference in the bilirubin binding at the end of the procedure. As is shown in the Table, there was a significant difference between the means of the two groups when either the pre-ET values minus the post-ET values or the expected values minus the actual values at the end of the ET were examined.
Primaquine Phosphate Is the Drug of Choice
Authors: Brown Thomas
Published: December 2021

The article by Thompson et al. on congenital malaria (Pediatrics 60:209, August 1977) needs to be clarified. If the patient was given only chloroquine phosphate, as stated in the article, a clinical and not a radical cure was effected. This patient will sooner or later have a resurgence of symptoms unless he was also treated with primaquine phosphate. The hepatomegaly and splenomegaly were undoubtedly due to exo-erythrocytic Plasmodium vivax parasites, conditions that are well known in tropical areas where malaria is endemic.
Dose-Response Effect of Maternal Smoking
Authors: Garn S. M. , Shaw H. A. , McCabe K. D.
Published: December 2021

Several questions have been raised about the effects of maternal smoking during pregnancy on the fetus, as measured by the dimensions of the newborn and the length of gestation. One question is the dose-response relationship, taking the extent of smoking into account. A second question relates to the "constitutional" explanation, i.e., that women who smoke have an intrinsic constitutional tendency to have small and premature neonates.1

Using data on more than 19,000 normal singlings from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Diseases and Stroke (NINCDS),2 a fairly linear relationship exists between the level of cigarette usage and various measures of size and prematurity.3
Preferential Distribution of Lobar Emphysema and Atelectasis in Bronchopulmonary Dysplasia
Authors: Moylan Fergus M.B. , Shannon Daniel C.
Published: December 2021

The chest roentgenograms of 142 neonates who survived mechanical ventilation for respiratory distress syndrome (N = 99) and prolonged apnea (N = 43) were reviewed. Thirty-seven infants had bronchopulmonary dysplasia (BPD) and 17 of these developed lobar hyperinflation of the right lower lobe and collapse of the right upper lobe. Regional lung function was measured with a xenon 133 technique in three of these infants and in five other patients who either died or were lost to follow-up. All had BPD with right lower lobe overinflation. Ventilation was less in the lower regions than the upper regions bilaterally ( P <.001), indicating that the hyperinfiation of the lower lobes was not compensatory for upper lobe collapse but was due to emphysema. Mean regional perfusion was equal in the upper and lower regions of the chest. This preferential distribution of lobar emphysema and ipsilateral atelectasis in BPD tended to present and regress simultaneously, but in many infants it lasted as long as eight weeks. Only one infant with persistent atelectasis developed pneumonia. The best mode of therapy appears to be supportive.
Juvenile Chronic Granulocytic Leukemia and the Rationale and Indications for Bone Marrow Transplantation in Leukemia
Authors: McCallister John A. , Baehner Robert L.
Published: December 2021

Effective treatment of the chronic granulocytic leukemias (CGL) remains a frustrating problem for the hematologist. Although the quality of life has been improved in Philadelphia (Ph1)-chromosome-positive CGL, little improvement in survival has been achieved with the currently available therapeutic modalities.1 Only 2% to 4% of childhood leukemia is CGL, and the Ph1-chromosome-negative form is even rarer.2 In several series of adults with CGL, the Ph1-chromosome-negative forms comprise 10% to 20% of the group; these forms first appear at a median age of 60, and the patients have a survival time of 18 months.3 When this form occurs in the young child, it invariably means a refractory response to chemotherapy and death within months.
Hypertension Screening in Schools: Results of the Dallas Study
Authors: Fixler David E. , Laird W. Pennock , Fitzgerald Victoria , Stead Sarah , Adams Richard
Published: December 2021

The purpose of this study was to determine the prevalence of persistent blood pressure elevations in an eighth-grade population composed of three ethnic groups, and to determine the feasibility of using school health facilities for hypertension screening. Blood pressure was recorded in 10,641 subjects (90% of the total eighth-grade population) in the Dallas Independent School District. Blacks made tip 46% of the population; non-Latin whites, 40.1%; and Latin-Americans, 13.9%. On the first blood pressure screening, 8.9% had systolic or diastolic pressures or both at or above the 95th percentile. Of those whose blood pressures were elevated on the first examination, 98.3% were reexamined. After the third examination, 1.2% continued to have systolic hypertension, and 0.37% diastolic hypertension. No student had diastolic pressure above 90 mm Hg on all three examinations. The prevalence of persistent hypertension was similar for the three ethnic groups. Analysis of variation in blood pressure measurements revealed that the school nurses introduced a relatively small increase in variability. These data indicate that although school screening initially identifies large numbers of students as having inconstant presstire elevations, subsequent follow-up examinations show that less than 2% have persistent hypertension.
Clinical Characteristics of the Afebrile Pneumonia Associated With Chlamydia trachomatis Infection in Infants Less Than 6 Months of Age
Authors: Tipple Margaret A. , Beem Marc O. , Saxon Evelyn M.
Published: December 2021

Respiratory tract colonization with Chlamydia trachomatis commonly occurs in natally acquired chlamydial infection and is sometimes associated with a chronic, afebrile pneumonia that has relatively distinctive clinical characteristics. To further define the frequency and clinical characteristics of lower respiratory tract disease associated with C trachomatis, we grouped 56 infants aged less than 6 months with afebrile pneumonia according to nasopharyngeal shedding of Chlamydia and viruses and compared their illnesses. Forty-one (73%) were positive for C trachomatis (23 had C trachomatis only, while 18 had C trachomatis plus a virus [cytomegalovirus, respiratory synctial virus, adenovirus, rhinovirus, or enterovirus]), and 15 were C trachomatis negative (nine had a virus only, and six had neither C trachomatis nor virus). The 41 infants with C trachomatis alone or C trachomatis plus a virus were similar clinically and differed significantly from other infants in several ways: (1) onset of symptoms before 8 weeks of age; (2) gradually worsening symptoms; (3) presentation for care at 4 to 11 weeks of age; (4) presence of conjunctivitis and ear abnormalities; (5) chest roentgenograms showing bilateral, symmetrical, interstitial infiltrates and hyperexpansion; (6) peripheral blood eosinophils ≥300/cu mm; and (7) elevated values for serum immunoglobulins M, G, and A.
Annual Summary of Vital Statistics-1977
Authors: Wegman Myron E.
Published: December 2021

The date of publication of the National Center for Health Statistics' "Annual Summary for 1977" was incorrect in reference 2 of the article "Annual Summary of Vital Statistics-1977" by M. E. Wegman (Pediatrics 62:947, December 1978). The reference should have read: Monthly Vital Statistics Report, National Center for Health Statistics, vol 26, No. 13, December 7, 1978.
Spontaneous Closure of Small Ventricular Septal Defects: Ten-Year Follow-up
Authors: Alpert Bruce S. , Cook David H. , Varghese P. Jacob , Rowe Richard D.
Published: December 2021

The natural history of small ventricular septal defect (VSD) was studied in 50 infants for up to 10.5 years. The VSD closed spontaneously in 34 patients. Life-table analysis of the data showed that by 10 years of age, 75% of small VSD will close spontaneously; the figure is higher for defects in the muscular septum (83%).
Gastroesophageal Reflux in Steroid-Dependent Asthmatic Youths
Authors: Shapiro Gail G. , Christie Dennis L.
Published: December 2021

The aims of this study were to evaluate the incidence of gastroesophageal reflux (GER) in chronic allergic steroid-dependent asthmatic children and to assess whether a medical antireflux regimen might improve pulmonary status of asthmatics found to have reflux. Nineteen patients had a determination of lower esophageal sphincter (LES) pressure, pH assessment after acid instillation into the stomach (acid reflux test), and esophagram. After the reflux evaluation, an antireflux regimen was instituted for three weeks; patients were followed with asthma symptom diaries and weekly pulmonary function tests for this period and for another three weeks after finishing the regimen. Gastroesophageal reflux, diagnosed by positive acid reflux test, occurred in nine patients. Five patients had low LES pressure (≤12 mm Hg), and two patients had an abnormal esophagram. There were no significant changes in asthma syniptoms or pulmonary function tests with the medical antireflux regimen. Although GER does exist in a high percentage of this patient sample (47%), a short-term antacid and positional antireflux regimen does not improve the pulmonary status of these patients.
Fungus Cultures in a Pediatric Outpatient Clinic
Authors: Rockoff Alan S.
Published: December 2021

Comparison of culture results with clinical impressions showed that pediatric house officers made frequent errors in diagnosing superficial fungus infections. Results of cultures on dermatophyte test medium (DTM), read by nonmycologists in the clinic, were comparably accurate with those on standard media processed in a laboratory. DTM is a useful aid in diagnosing dermatophytoses and teaching clinical mycology to pediatric residents.
BAD RESULTS OF DRUNKEN COPULATION—REDISCOVERED?
Authors: Berkely Henry J.
Published: December 2021

The lession taught by the study is of much practical interest in demonstrating that drugs, particularly of the ethereal alcohol series, may exert an undoubtedly deleterious influence upon the embryo during the period of gestation—an influence that in the human being should be carefully shunned if the future of the race is to be regarded.

The influences of alcohol upon the normal development of the foetus has been recognised and commented upon in various classic works (Plutarch et al). "A drunkard is unprofitable for any kind of good service," says Plato—and least of all in the begetting of children. Intemperance in pronounced degree on one side of the family usually results in mental feebleness of the children. When both parents are equally at fault, the progeny usually show well-defined brand-marks. It is a well-recognized fact that drunkenness at the moment of copulation is frequently responsible for the lowest forms of congenital idiocy.
A Comparative Study of the Behavior of Greek Neonates
Authors: Brazelton T. Berry , Tryphonopoulou Yolanda , Lester Barry M.
Published: December 2021

Three groups of 30 Greek neonates each (an adoptive group from the Metera orphanage, a lower-class group, and a middle-class group) were evaluated at days 1, 5, and 10 after birth using a behavioral scale of 21 items and a neurologic evaluation of 16 items. Behaviors were examined for group differences and group-by-age recovery curves were determined during the first ten days. Significant differences were found in the separate items and items grouped to reflect interactive, motor, and state behavioral dimensions. The adoptive babies at the Metera orphanage generally performed the most poorly. This difference seems not only to reflect intrauterine differences, especially in regard to nutrition but to point to the likelihood of eliciting less than optimal responses from future environments. The middleclass group had the worst scores on physiologic items and were similar to the Metera babies in having initially depressed interactive, motor, and state behavior. Improvement in these areas over ten days suggested that temporary effects of maternal medication caused the poor scores. The recovery curves of the infants pointed to the important effects of such perinatal variables as maternal medication on early neonatal behavior.
Valine-Toxic Intermittent Maple Syrup Urine Disease: A Previously Unrecognized Variant
Authors: Zipf William B. , Hieber Virginia C. , Allen Richard J.
Published: December 2021

An 18-month-old boy with repeated episodes of vomiting, lethargy, irritability, acidosis, and hypoglycemia from the age of 2 months was proved to have a variant form of maple syrup urine disease (MSUD). Amino acid load tests for leucine, isoleucine, valine, and phenylalanine were performed and compared to similar tests in a child with classic MSUD; maximum serum concentrations during tolerance studies in our patient were 24, 16, 26, and 18 mg/dl, respectively. All amino acid challenges were tolerated well except for valine. Within one hour after valine administration the child developed symptoms of lethargy, vomiting, ataxia, irritability, and hypoglycemia. Cortisol, growth hormone, insulin, and glucagon response to hypoglycemia were normal. Filbroblasts studies on cultured cells from our patient demonstrated abnormally low rates of 14CO2 production from both 14C-labeled leucine and 14C-labeled valine. Decarboxylation with valine as substrate was significantly less than the decarboxylation with leucine. A proteinrestricted diet was started but he continued to have occasional symptomatic episodes of hyperaminoacidemia and at the age of 4 years died during one of these episodes. Results of neuropathologic studies differed from those reported in the literature for classic MSUD disease.
Committee on Drugs Anticonvulsants and Pregnancy
Authors:   Committee on Drugs
Published: December 2021

There is an increased risk of congenital heart disease and cleft palate among the offspring of women with epilepsy, most of whom are on anticonvulsants. Part of this increase may be caused by phenytoin. The risk of all abnormalities in these infants appears to be about 4% to 5%, which is approximately double the rate of malformations in the general population. There appears to be an ill-defined "syndrome" associated with fetal exposure to hydantoin, although it has not been proven to be caused by the drug. The risk of this "syndrome" is of unknown magnitude, but it is probably less than 10%. The significance to a given child of the abnormalities in this "syndrome" is not predictable at this time.
Interpretation of Statistical Nonsignificance and Retrolental Fibroplasia
Authors: Day Richard L. , Dell Ralph B. , Darlington Richard B. , Fleiss Joseph L.
Published: December 2021

An important and well-documented Supplement to Pediatrics was published in April 1976 entitled "History of Oxygen Therapy and Retrolental Fibroplasia."1 It was prepared by the Committee on the Fetus and the Newborn, with the aid of several consultants, and was edited by L. Stanley James, M.D., and Jonathan T. Lanman, M.D.

Unfortunately, there is a misprint on page 612 that has caused serious confusion and misunderstanding. A key study by Lanman et al2 is misquoted as follows: "Mortality in the low oxygen group was somewhat higher than in the high oxygen group, but the difference was not statistically (p .03)."
Transfusion, Surgery, and Sickle Cell Disease
Authors: McIntosh Sue , Pearson Howard A.
Published: December 2021

In a report of fatal myocardial infarction following general anesthesia in a child with hemoglobin SC disease (Pediatrics 61:73, January 1978), the authors cite recommendations from the literature that preoperative exchange transfusion should be reserved for situations in which the patient's anemia is severe. We disagree with the concept that elective preoperative tive transfusins ( or exchange transfusion for emergency surgery) be used only for anemic patients with the sickling diseases, and we take issue with the statement that preoperative tive " transfusion was unnecessary because the hemoglobin level was nearly normal."
SKEWED PEDIATRIC PRIORITIES
Authors: Morley D.
Published: December 2021

Although three quarters of the population in most developing countries live in rural areas, three quarters of the spending on medical care is in urban areas, where three quarters of the doctors live. Three quarters of the deaths are caused by conditions that can be prevented at low cost, but three quarters of the medical budget is spent on curative services, many of them provided for the elite at high cost.
A TEN-YEAR-OLD VIEWS LIFE—AND DEATH
Authors: Hudson Virginia Cary
Published: December 2021

Most of the things you get somebody dies so you can get it, but you have to die your own self to get Everlasting Life.

When you are as dead as a doornail, God gives it to you, and you can't get rid of it. You can't buy it, or sell it, or trade it. You have to keep it whether it suits you or not. When you take it to Heaven with you, that's good, but when you have to take it along with you to Hell, that's different. Bishop Jordan told me Everlasting Life was God's precious gift, and I told him if it was just the same with God, I could think of things I would like better.
Treatment of Haemophilus influenzae Type B Epiglottitis
Authors: Faden Howard S.
Published: December 2021

During 1969-1977, 48 children with blood cultures proved positive for Haemophilus influenzae type B epiglottitis were evaluated and treated. The fatality rate was 2%; one child died and another developed irreversible hypoxic brain damage. Ninety-five percent of the children were intubated and none required tracheostomy. The endotracheal tubes remained in place for 3.3 ± 1.5 days. Shortterm parenteral antimicrobial therapy, 4.0 ± 1.4 days, was sufficient to eradicate bacteremia and prevent metastatic infectious foci. This report demonstrates the excellent results achieved in the treatment of epiglottitis with brief intubation and parenteral antimicrobial therapy.
Latrogenic Second-Degree Burn Caused by a Transilluminator
Authors: Mcartor Robert D. , Saunders Brian S.
Published: December 2021

The use of transillumination in medicine has increased dramatically since it was first recorded in 1831 by Richard Bright.1 Among the suggested uses of this technique have been transillumination of the skull (1960s),2.3 of the abdomen (1968),4 for pulmonary air leaks (1975),5 and for venipuncture6 and arterial puncture7 (1977). Complications with permanent sequelae have not been documented previously.

CASE REPORT

A 900-gm female infant was the product of a twin gestation; delivery was premature at 32 weeks. The infant's left wrist was transilluminated to facilitate puncture of the radial artery. The transilluminator was placed against the dorsum of the left wrist for approximately one minute.
Alterations in Gastrointestinal Microflora During Antimicrobial Therapy for Necrotizing Enterocolitis
Authors: Bell Martin J. , Shackelford Penelope G. , Feigin Ralph D. , Ternberg Jessie L. , Brotherton Thomas
Published: December 2021

Changes in the gastrointestinal microflora were noted in 22 infants during comlbined topical and parenteral antimicrobial therapy for necrotizing enterocolitis (NEC). Gastric and fecal cultures obtained during therapy showed significantly decreased Gram-negative aerobic organisms, most of which were Enterobacteriaceae, when compared with pretreatment cultures. Members of this bacterial family have been implicated in the pathogenesis of NEC in many reports. The data presented here show that the number of organisms retrieved can be reduced with this method of antimicrobial therapy.
Can We Design a Better Immunization Mousetrap?
Authors: Marcuse Edgar K.
Published: December 2021

Our nation's failure to adequately immunize children remains a vexing and embarrassing problem. An article in this issue (p 416) verifies the virtual impossibility of fully immunizing 90% of children by age 2 years. Repeated national immunization surveys have shown that most children receive some immunization by age 2 years.1 The failure results principally from children who enter the health care system and are then lost to follow-up. A 1977 immunization survey in Washington state showed that a single additional visit to a health care provider could have increased the number of two-yean-olds fully immunized from 60% to 82%.2 Part of the solution may lie in simplifying the recommended immunization schedule.
Lactobezoar in the Low-Birth-Weight Infant
Authors: Erenberg Allen , Shaw Robert D. , Yousefzadeh David
Published: December 2021

Lactobezoar is an unusual complication associated with infant feeding. Seven low-birth-weight infants developed lactobezoars, including one whose case was complicated gastric perforation. Six of these infants were fed formulas specifically designed for the low-birth-weight infant. Abdominal Distention regurgitation were the most frequent symptoms. The diagnosis was confirmed or made prospectively on supine or cross table lateral chest roentgenograms that included the upper abdomen. Treatment consisted of withholding feeding for 24 hours. There was no recurrence of symptoms following resumption of feedings.
Further Experience With Intragastric Oxygen Measurement to Diagnose H-Type Tracheoesophageal Fistula
Authors: Powers William F.
Published: December 2021

In their report on the measurement of elevated intragastric oxygen concentration to detect H-type tracheoesophageal fistula (TEF), Korones and Evans1 mention that they waited two years before reporting their experience in hopes of finding additional cases. We have recently encountered two cases of H-type TEF in which the intragastric oxygen test proved helpful in confirming the diagnosis.

CASE REPORTS

Case 1

A 1,925-gm girl was born by repeat cesarean section on December 10, 1977, to a 27-year-old gravida 4, para 4 black woman after 34 weeks' gestation. The mother had had a bloody discharge in the second trimester. Membranes ruptured 17 hours before delivery.
Gastrointestinal Bleeding Due to Oral Dicloxacillin Therapy for Osteomyelitis
Authors: Fox Vardith L.
Published: December 2021

Adverse gastrointestinal reactions to oral dicloxacillin are enumerated as hepatotoxicity, nausea, vomiting, epigastric discomfort, flatulence and loose stools.1 The latter has seldom necessitated discontinuing treatment.2 Gastrointestinal bleeding has not been previously described in the literature as an effect of this drug. A case is presented of gastrointestinal bleeding associated with oral dicloxacillin therapy of acute osteomyelitis.

CASE REPORT

A 16-year-old Mexican-American boy awoke with pain in the left forearm on February 27, 1978. There was no history of trauma, illness, allergy, or drug intolerance. Physical examination was entirely negative except for temperature of 38.3 C and exquisite point tenderness of the left distal ulna, without overlying skin changes.
The Pediatrician and the School
Authors: Vanderpool Nathalie A. , Wright Gregg F. , Nader Philip R.
Published: December 2021

In this issue of Pediatrics (p 565), the tiresome theme is again sounded: We really should get around to training pediatricians to meet new child health needs and to have influence beyond the office setting in order to promote the health of children. In 1965, we speculated that one of the major reasons preventive health and child advocacy activities were not carried out by more pediatricians is because they have not received adequate training or developed skills to work with community organizations.1

Perhaps one reason such training programs have not mushroomed (how many are there, anyway?) is that no one is really sure what the specific objectives of such a training program should be.
The Heart in Acute Glomerulonephritis: An Echocardiographic Study
Authors: Vardi Pnina , Markiewicz Walter , Levy Joseph , Adler Olga , Riss Egon , Benderley Abraham
Published: December 2021

Patients with acute glomerulonephritis often are seen with signs suggesting heart failure. Whether these signs are due to fluid overload secondary to kidney damage only, or whether there is associated myocardial damage has not been elucidated. Fourteen children with acute glomerulonephritis were studied by echocardiography during the edematous phase of the disease and five months later to evaluate cardiac function in this disease. Left ventricular size and function remained normal in all children throughout the study. The most consistent finding was enlargement of the left atrium during the edematous phase with a return toward normal values five months later. There was no correlation between blood pressure and the echocardiographic findings. This study suggests that signs of heart failure in acute glomerulonephritis are not due to myocardial damage but probably reflect fluid overload.
The Right Not To Read
Authors: Snyder Russell D.
Published: December 2021

Skill in reading is desirable. However, the importance of reading may be overemphasized in schools. Reading skills are determined relatively and not absolutely. Thus, relatively poor readers will persist. Schools cannot eradicate individual differences. Biological Makeup and societal pressures are the important factors in determining reading skill. Present methods of reading remediation are of questionable efficacy and are traumatic to some children. Time with its associated normal development succeeds in remediating the majority of children with dyslexia. Most poor readers eventually attain reading levels that enable them to comprehend the types of printed materials commonly encountered. If a child finds reading difficult or distasteful, that child should be encouraged to read but should have the right not to be forced to read.
Statement on Teenage Pregnancy
Authors: Cohen Michael I. , Dudenhoeffer Frank E. , Guthrie Andrew , Hammar Sherrell L. , Heald Felix P. , Hofmann Adele D. , Jenkins Renee R. , Long William A. , Millar Hilary E. C. , Shen Jerome T. Y. , Wasserman Martin P. , Wolfish Martin G.
Published: December 2021

In recent years, a nationwide concern over the "epidemic" of teenage pregnancy has developed. Explanations for this phenomenon have ranged from poor sex education to promiscuity. This statement will review current data and information so that pediatricians responsible for the health care of adolescents can appreciate the implications and consequences of early childbearing.

SEXUAL ACTIVITY AMONG ADOLESCENT GIRLS

The term adolescence must be used with caution in describing the rapid biological, psychologic, and cognitive changes that take place during the teen years. Teenage girls are considerably different from each other in pubertal and emotional development. In making observations and interpretations about the attitudes, behaviors, and sexual activity of teenage girls, we must use developmental age rather than chronologic age as the standard for comparison. Sexual activity in 12-year-old girls living in intact households1,2 is unusual; therefore, the number of live infants born to mothers in this age group is small. However, more than 50% of 19-year-old girls have engaged in sexual activity, and their fertility rate is comparable to women in their 20s.

The current problems with teenage pregnancies cannot be appreciated fully without understanding adolescent sexual behavior and the secular changes that have taken place. From 1900 to the early 1960s, sexual behavior in the unmarried, teenage population changed. A review of the earlier literature indicates that a significant increase (tenfold) in the incidence of sexual intercourse among single, teenage girls occurred in the early part of this century.3 Measureable changes in the attitude of adolescents toward sexuality became strikingly apparent in the 1960s.
Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome
Authors: Wiswell Thomas E. , Rawlings James S. , Wilson James L. , Pettett Gary
Published: December 2021

The syndrome of megacystis-microcolon-intestinal hypoperistalsis has been reported in a total of seven female infants. Massive abdominal distention secondary to a distended urinary Fig 1. Plain film of markedly distended abdomen with no air beyond stomach. Stomach is displaced upward toward left. der was the major presenting characteristic. Iutestinal hypoperistalsis, apparent in the early neonatal period, persists without improvement. Exploratory laparotomy reveals malrotation and malfixation of a small microcolon. No anatomic cause of intestinal or bladder obstruction can be found. Intestinal and/or rectal biopsy specimens contain abundant ganglion cells and nerve fibers. The outcome has been uniformly fatal, with survival in the reported cases ranging from two days to 34 months.
Neonatal Seizures, Intracerebral Hematoma, and Subarachnoid Hemorrhage in Full-Term Infants
Authors: Chaplin Edward R. , Goldstein Gary W. , Norman David
Published: December 2021

During the first days of life intracranial hemorrhage is a frequent cause of convulsions in the full-term infant.1,2 If spinal fluid is bloody and there is no evidence of asphyxia, infection, or acute metabolic disease, then a presumptive diagnosis of primary subarachnoid hemorrhage is often made.1-3 These infants appear remarkably well in the interictal period, and their outcome is usually good.1,2 Since pathologic confirmation is not available, it has been assumed that bleeding occurs directly into the subarachnoid space and not as an extension of a subdural, intraventricular, or intracerebellar hemorrhage.1,3-5 During a 13-month period at our institution, only four full-term infants had seizures and bloody spinal fluid.
Pediatricians and Pediatric Nurse Practitioners/Associates: Growth of Collegial Relationships
Authors: Dunn Barbara H.
Published: December 2021

From my vantage point as president of the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) during the years 1975-1978, I have had an opportunity to observe and participate in the "growth and development" of professional and interpersonal relationships between pediatricians and pediatric nurse practitioners/associates (PNP/As).

Historically, the specialty of pediatrics has taken a leadership role in areas related to consumer advocacy and the implementation of change: as primary care providers, emphasizing health education and maintenance, prevention, guidance and counseling; as citizens of the larger community, supporting screening and preventive health programs, encouraging development of needed health and educational services for children and their families, and influencing political/social systems to affect change.
Diet Discontinuation in Phenylketonuria
Authors: Wulliamson Malclom , Koch Richard , Berlow Stanley
Published: December 2021

The Collaborative Study of Children Treated for phenylketonuria (PKU) is being conducted in 15 medical centers throughout the United States.1 In this study, initiated in 1967, 140 PKU children were treated from near birth to 6 years of age. At age 6, with the consent of the parents, each child was randomly assigned to one of two groups, either to continue on a phenylalanine-restricted diet, or to discontinue dietary restrictions and eat a normal diet.
Malignant Paraganglioma (Pheochromocytoma) of the Urinary Bladder: Report of a Case and Review of the Literature
Authors: Meyer James J. , Sane Shashikant M. , Drake Robert M.
Published: December 2021

A rare case of malignant paraganglioma of the urinary bladder with metastasis to a lymph node in a 12-year-old girl is reported, and eight other previously recorded cases are reviewed. Headache, fainting, and hypertention initiated by voiding were the most prominent clinical symptoms. Hematuria was Present in three cases and aided cystoscopy were most diagnostic. Cystography, pelvic angiogtaphy, and cystoscopy were most diagnostic. Segmental cystectomy, when feasible. was the preferred surgical treatment. The prognosis was slightly better than for other forms of extraadrenal pheochromocytomas.
The Task Force Report
Authors: Haggerty Robert J.
Published: December 2021

The Future of Pediatric Education,1 a report by a special Task Force under Dr. C. Henry Kempe, has been widely circulated to practitioners and academicians since its publication in the spring of 1978. Dr. Kempe summarized its recommendations in his presidential address to the American Pediatric Society.2 The Task Force consisted of 17 members representing most of the constituent societies responsible for pediatric education, research, and service in the United States. They worked for two years, commissioned two surveys—one of parents and one of 7,000 recent (since 1964) graduates of pediatric residencies— and met with numerous consultants.

Of the 11 recommendations, most have resulted in little disagreement, perhaps in part because no single group was forced to change its behavior as a result of the study.
The Fetal Monitoring Debate
Authors: Hobbins John C. , Freeman Roger , Queenan John T.
Published: December 2021

Medical technology has improved at a staggering pace, and perhaps obstetrics is the field most affected by this progress. obstetrician now depends on information from electronic equipment to follow growth and development of the fetus, to diagnose fetal anomalies, and to assess the fetus's condition before and during birth. Since the equipment used for fetal surveillance is expensive to develop, acquire, and maintain, the technology has contributed somewhat to the rising cost of managing pregnancy. Since its intrOduction in 1960, electronic fetal monitoring (EFM) has become a Widely utilized modalitv. and it is estimated that the technique is used in Over half the labors in the United States.
TWO AMERICAN CASE REPORTS OF THE SUDDEN DEATH SYNDROME: THE FIRST IN 1686 AND THE SECOND IN 1863
Authors: C. T. E.
Published: December 2021

I believe the first recorded American case of the sudden infant death syndrome will be found in Samuel Sewall's diary for February 13, 1686.1 He wrote:

Feb. 13, 1686. Mr. Eyre's little son dyed, well to bed: dyed by them [the parents] in the Bed. It seems there is no Symptom of Over-laying.

In 1863 Dr. David W. Cheever of Boston wrote:2

March 9th; "Sudden Death of an Infant without Known Cause":—

An infant, 10 weeks old, apparently in perfect health, suddenly died while sleeping, and after having been asleep one and a half hours.
Parent Education
Authors: Turtle William J.
Published: December 2021

So much time and money, research and expertise, sophisticated equipment and team effort go into seeing to it that the newborn leaves the hospital normal and healthy! In the midst of this remarkable scientific and technological progress, however, I wonder if something of far-reaching importance isn't being overlooked?

Every baby, whether it's—full term normal—high risk—the product of artificial insemination, in vitro fertilization, or some future-day product of in vitro procreation —every baby has to go home, and I find myself asking! to what? As far as I can see, no comparable effort, study, or even interest is going into making sure that something remotely approaching this highly intensive level of care will be maintained in the home.
Is It Worthwhile and What Are the Risks?
Authors: Cohen Daniel L.
Published: December 2021

Dr. Breslow's recent paper1 concerning hyperlipidemia and the role the pediatrician may play in prevention of coronary artery disease provoked considerable controversy at my recent journal club.

It seems clear to most physicians concerned with the problem of preventing arteriosclerosis that a high correlation exists between coronary artery disease, hypercholesterolemia (LDL), and diets rich in cholesterol and saturated fatty acids. It is assumed on the basis of primary prevention trials in adults (in one study the mean age was 66) that early dietary intervention in childhood may prevent coronary artery disease.2
Useless Tests on Febrile Children?
Authors: Woodward Celeste L.
Published: December 2021

McCarthy and colleagues1 have recently reported pro-spectively accumulated data on the use of various acute phase reactants in the evaluation of febrile children. It is not stated whether the 400 study children represented all febrile patients evaluated during the five-month study period or only a fraction. In any case, the conclusion ... " that evaluation of a febrile child with acute-phase reactants should include at least a determination of the ESR" seems to be of little differential diagnostic or practical importance.
Letters to the Editor
Authors: Grossman Lindsey K. , Nair Prasanna , Papiez Joseph , Wald Ellen R.
Published: December 2021

We appreciate Dr. Smith's comments regarding our recent paper.1 The major objective of our study was to define the likelihood of persistent pulmonary infiltrates in children initially presenting with acute pneumonia. We purposely excluded children with any history suggestive of prior immunologic, cardiac, or pulmonary disease including previous pneumonitis, and therefore our recommendations pertain only to first episodes of pneumonia. Although the number of children in this study is small and the time period covered only two respiratory seasons, our experience suggests that radiographically persistent infiltrates are less frequent than one occurrence in 70 in children with acute pneumonia.
Steroid Rosacea in Children
Authors: Franco Hector L. , Weston William L.
Published: December 2021

Steroid rosacea is a facial dermatitis clinically resembling acne rosacea. Fluorinated topical steroids have been implicated as the cause or precipitating factor in previous case reports mainly involving an adult population. Four cases of pediatric acne rosacea associated with the use of topical fluorinated glucocorticosteroids are described. The process worsened during the two weeks following steroid cessation. We recommend that fluorinated glucocorticosteroids should not be used on the face of infants and children.
Negative Effects of Oral Fatty Acid Supplementation on Sweat Chloride in Cystic Fibrosis
Authors: Lloyd-Still John D. , Simon Stuart H. , Wessel Hans U. , Gibson Lewis E.
Published: December 2021

Essential fatty acid supplementation with oral safflower oil (1 gm/kg/day) to 11 cystic fibrosis patients (aged 6 months to 14 years) for one year produced no significant change in sweat chloride concentration (mEq/liter) or sweat rate (gm/min/m2). Addition of vitamin E (10 mg/kg/day) to the safflower oil had no effect on sweat chloride concentration or rate compared to placebo. No clinical improvement could be detected compared to a control group. These results do not support previous reports of the effects of fatty acid supplementation on sweat electrolyte concentrations in cystic fibrosis.
A CASE OF HEREDITARY HEMORRHAGIC TENDENCY (HEMOPHILIA) REPORTED IN 1832 BY A PHYSICIAN PRACTICING IN SIMPSONVILLE, KENTUCKY
Authors: C. T. E.
Published: December 2021

Credit is usually given to Dr. J. C. Otto (1774-1844) of Philadelphia for offering, in 1803, the first clear description of a bleeding disease affecting males and sparing females.1 Twenty-nine years later, Dr. James N. Hughes of Simpsonville, Kentucky, apparently unaware of Otto's report, published this succinct clinical report of a case of hemophilia, including the hereditary aspects of this disease.2

On visiting the house of a respectable farmer of this neighbourhood, my attention was directed to the case of a youth ten or twelve years old, which appeared to be rheumatic, and which was so pronounced. The correctness of my opinion was called in question by an old lady present, who was herself a member of the family, and intimately acquainted with the history of the case. On further inquiry I ascertained it to be one of hereditary origin, the rheumatism being only the sequel of another affection to which the boy had been subjected from infancy, viz. haemorrhage. Learning that this disease was common in every branch of the N. family, of which that of my friend Mr. P. was one, I enquired particularly concerning it, when the following facts were communicated:

1st. That spitting, vomiting and purging of blood; bloody urine; bleeding at the nose; extravasations of blood among the muscles and integuments of the body generally, especially of the extremities, producing dark discolorations and swelling, attended frequently, after a few days, continuance, with obtuse pain and stiffness, and copious and obstinate haemorrhage from very inconsiderable incisions, on whatever part of the body they are made, have been exceedingly common among the male members of the connection.
The Current Status of Chloramphenicol
Authors: Meissner H. Cody , Smith A. L.
Published: December 2021

Streptomyces venezuela, a bacterium isolated from mulched soil near Caracas, Venezuela in 1947, was found to secrete an antibiotic active against Gram-positive and Gram-negative organisms, and rickettsiae.1,2 When it was determined that this antibiotic contained 2 molecules of chlorine, the name chloromycetin was proposed. A few months later, a separate report from the University of Illinois described a broad spectrum antibiotic (chloramphenicol) isolated from a different streptomyces; subsequently it proved to be identical to chloromycetin.3

Although chloramphenicol (the generic name) was developed for its antibacterial activity, its first clinical use was as an antirickettsial agent. In Mexico and Bolivia4,5 during the winter of 1947 to 1948, it was dramatically efficacious in patients with typhus. As an antibacterial drug, chloramphenicol was first used in two patients incorrectly thought to have scrub typhus. They were successfully treated with chloramphenicol; later they were proven to have typhoid fever.6 Since its introduction, chloramphenicol has continued to be widely used as an antibacterial and an antirickettsial agent.

CHEMISTRY

Chloramphenicol is a lipid soluble compound lacking acidic and basic groups that could form salts. As a consequence, the naturally occurring compound is most soluble in organic solvents, and has a maximum solubility in water of only 4 mg/ml.7 This relative insolubility requires large administration volumes which is a disadvantage in neonates and children. In the middle 195Os it was found that a succinate group attached to the drug by an ester linkage produced a marked increase in aqueous solubiity. In vivo, free chloramphenicol was generated by body esterases that hydrolyze the ester bond.