bluuebunny/crossref_metadata_2025 huggingface dataset:
Teenaged and Pre-teenaged Pregnancies: Consequences of the Fetal-Maternal Competition for Nutrients
Authors: Naeye Richard L.
Published: December 2021

The study attempted to determine whether the growth needs of young mothers compete with the growth needs of their fetuses for available nutrients. In a large prospective study, 10- to 16-year-old mothers had significantly smaller newborns at term than older mothers when the various maternal age groups were matched for prepregnancy body size and pregnancy weight gain. Five percent of the urines of 10- to 14-year-old mothers had 2+ or greater acetone vs only 2% of the urines of 17- to 32-year-old mothers (P < .001). Acetonuria has been shown to be a marker for high perinatal mortality in undernourished gestations, and it correlated with a high perinatal mortality in the present study. The growth retardation found in the newborns of very young mothers disappeared during childhood.
A NEW METHOD OF RESUSCITATING STILLBORN CHILDREN AS DESCRIBED BY A NEW YORK PHYSICIAN IN 1814
Authors: C. T. E.
Published: December 2021

The treatment of asphyxia neonatorum was rarely mentioned in American medical literature until the second half of the last century. A few anecdotal papers were published in the early 1800's, including one by Dr. Gilbert Smith, Physician and Surgeon to the New York Almshouse. His "new method" was described as follows1:

About three years since I was called upon to attend a lady with her first child; it being a breech presentation, the labor was of course tedious and the head was retained such an unusual length of time after the body was delivered, that, apprehending the most serious consequences, I directed a warm bath to be in readiness, into which the child was placed immediately after delivery. At this time there was no pulsation in the chord [sic], or the smallest sign of life. Its legs and spine were frequently rubbed with stimulating applications, which I was assiduously employed in endeavoring to excite action in the lungs by breathing into them, and pressing out the air alternately. This process was carried out for the unprecedented period of two hours, when my strength failing, I was upon the point of discontinuing any farther effort as useless; when one of the attendants, by whose importunity I was, perhaps, induced to persevere for such a length of time, proposed by taking some brandy and water; after having drank, I resumed my labors, when the idea forcibly struck me that the alcohol might be volatilized by the heat of the mouth and breathed into the lungs.
Minibikes
Authors: Van Rooy C. W.
Published: December 2021

Minibikes—which are basically miniature motorcycles—are being bought for and ridden by children who are too young to be permitted to obtain a driver's license. Because the increasing use of minibikes by young children is accompanied by an increase in minibike-related accidents, pediatricians should become aware of the accident potential of these vehicles and precautions to be taken by the parents or other care-givers of young riders.

Rivara and Berger1 found that minibike riders received 20,000 injuries from 1975 to 1976. Children 5 to 9 years old accounted for 83% of these injuries, and children 10 to 14 years old accounted for 17%.
Who Will Buy?
Authors: Hoekelman Robert A.
Published: December 2021

In the late 1960s Henry Silver1 and his colleagues in Colorado, recognizing a then current shortage of physicians available to provide health care to children, developed educational programs to prepare two new types of child health professionals—the pediatric nurse practitioner and the child health associate.

The pediatric nurse practitioner model has been replicated throughout the United States. By mid- 1980 there were in operation 53 graduate and continuing education programs to prepare nurses to assume an expanded role in the provision of health care to children, and an estimated 4,000 to 5,000 nurses have been so prepared (M. K. Willian, personal communication, July 1980).
O2, Retrolental Fibroplasia Dogma Questioned
Authors: Sweet Avron Y.
Published: December 2021

In their recent article Clarke et al (Pediatrics 65:884, 1980) advocate the use of transcutaneous oxygen monitors during the transport of certain newborn infants. In support of their position, the authors state, ". . . hyperoxia is a serious cause of morbidity to the small preterm infant. Exposure to hyperoxia for a period as short as 30 minutes has, on occasion, been associated with the occurrence of retrolental fibroplasia (RLF). Hyperoxia has also been postulated as an important cause of bronchopulmonary dysplasia . . . ." Their clear message is that a brief occurrence of above usual arterial oxygen tension may result in RLF.
‘Negligible Results of Early Intervention’
Authors: Holm Vanja A. , Robinson Nancy M. , Sells Clifford J.
Published: December 2021

We are writing to express our concern about the lead article in the March issue of Pediatrics (65:463, 1980), which reported the negligible results of a program of early intervention with Down syndrome infants.1 The topic of infant programs is a controversial one on which valid scientific information is scarce. This report might be used as proof that early intervention with handicapped children is ineffective.

The authors discuss some of the weaknesses of their study.
Possible Relationship Between Amniotic Fluid Microviscosity and Middle Ear Effusion
Authors: Gebhardt D. O.E.
Published: December 2021

I was amazed to read the commentary of Jaffe on amniotic fluid microviscosity and middle ear effusion (Pediatrics 65:362, 1980). It is apparent that the author is unaware of the fact that the viscosity (resistance offered by a fluid to flow) of amniotic fluid is independent of the microviscosity of a fluorescent probe added to amniotic fluid and determined by measurement of its fluorescence polarization. For instance, a fivefold dilution of amniotic fluid—which must have a profound influence on its viscosity—has no influence on its fluorescence polarization and therefore microviscosity.1
Early Beikost
Authors: Sullivan Cary E.
Published: December 2021

Before the report of the Committee on Nutrition (Pediatrics 65:1178, 1980) settles into unquestioned orthodoxy, I wish to comment for myself and, perhaps, other die-hard empiricists on the matter of "early" beikost.

Given a caloric need of 115 calories per kilogram and a weight of 5 kg, a 2-month-old infant on 26 oz of proprietary formula is already incurring a caloric shortfall and registering his deprivation in no uncertain terms. My practice, at this point, is to introduce cereals and, sequentially over the next several months, fruits and vegetables.
THE SAD FATE OF DR MICHAEL UNDERWOOD'S WIDOWED DAUGHTER
Authors: C. T. E.
Published: December 2021

The most advanced writer on diseases of children in the 18th century, according to G. F. Still, was Michael Underwood.1 He was the first to describe sclerema neonatorum, apneic attacks in the newborn, "malignant familial jaundice" of the newborn, and the first to write about congenital heart disease of children. His Treatise on the Diseases of Children (1784) passed through at least 17 editions and remained in favor for more than 60 years; the last American edition appeared in 1842.

Unfortunately, Underwood apparently received no royalties from his textbook and died without being able to provide for his widowed daughter. Friends tried to help her by putting together a book entitled Extracts from the Diary of the Late Michael Underwood, M.D. (1823) that would then be sold to subscribers.

In the prospectus for this book Underwood's friends poignantly described their reasons for publishing this book as follows:

It is confidently hoped that the Friends of the late Dr Underwood, and more especially those in the Profession who are acquainted with the estimable works which he published on the "Diseases and Disorders of Children" &c. will feel an interest in the case of his widowed Daughter, who now stands in need of the benevolent exertions of her Friends. She is in her fiftieth year, and is borne down by an accumulation of troubles, arising partly from the loss of relatives and friends, and partly from serious mental debility, which frequently incapacitates her for the humble and precarious employment of needlework, in which she is at other times engaged.
The Private Worlds of Dying Children by Myra Bluebond-Langner. Princeton, Princeton University Press, 1978, $12.50, 282 pp
Authors: Wessel Morris A.
Published: December 2021

These quotations from Myra Bluebond-Langner's perceptive study of 40 leukemic patients between the ages of 3 and 9 reveal that even when adults hope to protect children from the tragic truth, they acquire accurate knowledge about their disease, its treatment process, and fatal prognosis.

The author, an anthropologist interested in how children acquire the knowledge and values of the adults in the world they live in, believes that all young patients learn in various ways of the seriousness and the anticipated outcome of their illness.
Hypersensitivity Vasculitis Presenting as Suspected Child Abuse: Case Report and Literature Review
Authors: Waskerwitz Steven , Christoffel Katherine K. , Hauger Sarmistha
Published: December 2021

As awareness of child abuse and neglect increases, children with medical causes for their presenting problems may, on occasion, be initially diagnosed as victims of suspected child abuse. Although a review of the Index Medicus from 1970 to 1978 revealed only two reports of this type of misdiagnosis,1,2 we suspect it occurs frequently. This report describes a child who initially was thought to be battered, but who, in fact, had a vasculitis unrelated to his social problems.

CASE REPORT

H.P., a 2½-year-old black boy, was seen at the Wyler Emergency Room with unexplained "swelling and bruising all over his body." He was accompanied by his father who appeared intoxicated and gave a changing and confusing history.
The 55 Miles per Hour Maximum Speed Limit
Authors: Holroyd H. James , Garrettson Lorne K. , Greensher Joseph , McIntire Matilda S. , Krassner Leonard S. , Chi Wing Ng Raymond , Overbach Avrin M. , Rumack Barry H. , Widome Mark D. , Armstrong George D. , l'Archeveque Andre , Otherson H. Biemann
Published: December 2021

When the 55 mph national speed limit became a law in 1973, the first significant reduction in the number of highway deaths in this country occurred. When this speed limit has been maintained, the number of automobile accident fatalities and injuries has continued to decrease. However, recent statistics1 indicate that the legal speed limit is again being exceeded, and the number of automobile accidents are again beginning to rise.2-4 The United States is in the midst of a worse energy crisis than the one which prompted the enactment of the 55 mph speed limit in 1973, and we should be more aware of attempts to save energy as well as save lives.

The Committee published comments on the incidence of mortality and morbidity in automobile accidents and the speed limit in its 1975 and 1976- 1977 newsletters.5,6 Because of recent statistics, the Committee wishes to reemphasize its previous statements.

The Committee strongly endorses the national, maximum speed limit of 55 mph as an effective method of lowering the incidence of automobile accidents, injuries, and fatalities. Pediatricians should make every effort to reinforce this form of accident prevention by personal example and by education of pediatric patients and their parents.
The Role of the Pediatrician in Adoption with Reference to ‘The Right to Know’: An Update
Authors: Sherry S. Norman , Baum Richard , Lattimer Agnes D. , Rieke William C. , Sokoloff Burton , Sterne George G. , Wagner Virginia , Davis Joseph , Lewis Donald , Seidel Henry , Felitto Helen , Schwartz Elaine
Published: December 2021

The adoption process in our country traditionally has been designed to safeguard the rights of the adoptive parents, ensure the solidarity of the adoptive family, and preserve the anonymity of the birth parents. When adoption is finalized, the original birth certificate is "sealed" and a new certificate is issued in the name of the adoptive parents. Once sealed, the laws of most states specify that the original record can be opened only by court order and for "just cause." A few states have provisions for opening of the records on demand of the adoptees when they become adults. This provision frequently is true in theory but not in practice, and the definition of "just cause" has varied considerably from court to court.

Most adoptive parents have warm and loving relationships with their adoptive children. Most try to pass on to them, at appropriate times, as much of the birth information as they know and are able to provide. Most adoptees have a warm and loving and truly bonded relationship with their adoptive parents. In spite of this, and regardless of their attachment to the adoptive parents, some adoptees have a compelling desire and/or need to learn of their birth parent or parents.

Many adult adoptees and adoption specialists see this search as essential to the establishment of a sense of identity. Most reports of reunions indicate that adoptees have been pleased with the meeting and that their ties to their adoptive parents have been strengthened thereby. In addition, there is the growing body of law that has spoken to the right of people to know the content of various personal records.
Letters to the Editor
Authors: Ostrea Enrique M. , Naqvi Mubariz
Published: December 2021

We, as well as others, have observed that meconium staining of the amniotic fluid is a phenomenon more commonly seen in infants with a gestational age ≥38 wk.1,2 We have also noted (E. M. Ostrea, Jr, M. Naqvi, unpublished observations) that even under stressful conditions, such as acute asphyxia, the premature fetus will usually not pass meconium as compared to infants of higher gestational age. Consequently, meconium staining of the amniotic fluid should not be expected to be a common feature of fetal distress if the fetus is premature.
Henoch-Schönlein Purpura and (γ)-Benzene Hexachloride
Authors: Fagan Joel E.
Published: December 2021

Many drugs have been cited as possible etiologic agents in Henoch-Schönlein (anaphylactoid) purpura. I have recently seen a case of Henoch-Schönlein purpura occurring shortly after an exposure to (γ)-benzene hexachloride, an occurrence not previously documented.

A 9-year-old boy was admitted to Foothills Hospital on March 12, 1979 for investigation of a skin rash of four days' duration and severe vomiting of 40 hours' duration. Six days before admission, several classmates were found to have head lice and an inspection of the patient's scalp was thought to show two nits.
Questions Cerebral Blood Flow Method
Authors: Rahilly P. M.
Published: December 2021

I read with interest the article "Quantitative Noninvasive Method to Measure Cerebral Blood Flow in Newborn Infants" by F.A.N. Leahy et al (Pediatrics 64:277, 1979). Their method is severely limited by the fact that vertebral flow has been ignored. Using an electrical model we have been able to calculate this flow,1,2 and I have shown3 that any increase in cranial blood flow is accompanied by a rise in the proportion of blood drained by the vertebral system.
Mercury in Incubators: Detecting ‘Safe’ Levels
Authors: Greene R Joel
Published: December 2021

The article, entitled "Mercury Vapor Contamination of Infant Incubators: A Potential Hazard" (Pediatrics 64:640, 1979) provided some information that is critical for clinicians, administrators, and others concerned with patient safety and medical liability issues in the health-care environment. Considering the lack of information on acute infant exposure to mercury vapor, it is clear that, " . . . the prudent course would be to avoid all contact with this toxic substance."1

Instrumentation commonly available today, such as that used in the survey, has an accuracy of 0.01 mg/cu m.
Mortality of Chronic Hemodialysis and Renal Transplantation in Pediatric End-Stage Renal Disease
Authors: Avner Ellis D. , Harmon William E. , Grupe Warren E. , Ingelfinger Julie R. , Eraklis Angelo J. , Levey Raphael H.
Published: December 2021

The long-term mortality of chronic hemodialysis and renal transplantation was analyzed in all children treated for end-stage renal disease at Children's Hospital Medical Center over the past 8½ years. A total of 216 transplantation or dialysis courses in 120 patients were studied. No patients were excluded from treatment or analysis. Overall actuarial survival was 92% at six months, 90% at 12 months, and 89% at five years. When actuarial survival for each form of treatment was examined, patient survival was 100% at six months and 95% at five years for chronic hemodialysis; 92% at six months and five years for living related transplantation; and 88% at six months and 85% at five years for cadaveric transplantation. We conclude that most children with endstage renal disease can be kept alive with current treatment programs, and that the mortality of chronic hemodialysis in children is comparable to that of renal transplantation.
Is Exercise Testing Worth It?
Authors: Boiko Patricia
Published: December 2021

On the basis of the conclusions of the article "Exercise Performance of Hypertensive Adolescents" by Dov B. Nudel et al (Pediatrics 65:1073, 1980), I would not feel comfortable exercise testing any of my adolescent patients with hypertension. In addition, their study failed to show me any reason to exercise test a hypertensive adolescent.

The conclusion that "... maximal exercise performance in hypertensive adolescents is safe," is based on a study of only ten essential hypertensive adolescents.
Letters to the Editor
Authors: Nudel Dov B.
Published: December 2021

Our study included 18 patients: ten with sustained and eight with labile hypertension and our conclusions are based on this sample. Whether larger studies will confirm our results remains to be seen.

Dr Boiko states that the patients with essential hypertension "were not sex, weight, race, or activity matched to the normal control subjects." In each of the two groups there are nine boys and one girl. The patients with sustained hypertension included eight whites and two blacks, and the mean weight was 72.3 (± 3.6 SE) kg.
Water Intoxication
Authors: Silber David L.
Published: December 2021

The recent communication by Schulman,1 which reminds us that water intoxication is not always iatrogenic and may occur out of the hospital, appeared just as we were combing the literature for a better understanding of a similar problem; namely, heat illness. The similarities between Schulman's patients and some patients with heat exhaustion are noteworthy.

In an exhaustive review of the subject of heat illness, Knochel2 describes two forms of heat exhaustion: one resulting from predominant water depletion; the other, from predominant salt depletion.
Unnecessary Biopsy?
Authors: Berliner Benjamin C.
Published: December 2021

The clinical description of the little girl's disease which is provided in the article by Manzella et al1 is certainly sufficient for a diagnosis, and biopsy rather than being "essential" is an unnecessary and unwarranted intervention.

I am puzzled by the diagnostic term "toxic epidermal necrolysis" as used here. What is described is a typical instance of erythema multiforme bullosa (Stevens-Johnson syndrome), a disorder which involves the mucous membranes as well as the skin. This entity is readily distinguishable from the staphylococcal scalded skin syndrome (toxic epidermal necrolysis, staphylococcal scarlet fever, Ritter's disease of the newborn) by the fact that the latter patients exhibit neither bullae nor mucous membrane involvement.
Letters to the Editor
Authors: Manzella John P.
Published: December 2021

Dr Berliner raises two points. He questions both the need for the biopsy in the evaluation of patients with desquamating skin disorders and the use of the term "toxic epidermal necrolysis."

While it is true that severe mucosal involvement does not occur in the staphylococcal scalded skin syndrome (SSSS), the initial desquamating process may involve the lips. In turn, during the early stages of toxic epidermal necrolysis (TEN) mucous membrane involvement may be minimal. Contrary to Dr Berliner's statement that bullae do not occur in the SSSS, a prominent part of this syndrome is the appearance of flaccid bullae within 24 to 48 hours of the beginning of the disease process.1
The Known Hazards of Ureterosigmoidostomy
Authors: Grünberg José
Published: December 2021

Macfarlane et al1 have pointed out the unheralded hazard of patients with ureterosigmoidostomy: leakage of foul-smelling urine and feces into their beds or underpants and frequent interruption of their sleep due to their inability to remain continent at night. The authors stated: "Why this aspect of ureterosigmoidostomy has gone unnoticed for so long may be due to the fact that this was a treatment for conditions of enormous magnitude ... and the patients may feel that any result that keeps them alive is acceptable...." The "unheralded" hazards decribed by Macfarlane et al have not been disregarded.
Value of the Chest X-Ray as a Screening Test for Elective Surgery in Children
Authors: Wood Robert A. , Hoekelman Robert A.
Published: December 2021

A retrospective study was conducted to assess the value of the chest x-ray as a preoperative screening procedure in pediatric patients. Admissions for elective surgery were compared at two hospitals, one that required routine preoperative chest x-rays and one that did not. Our purpose was to determine the yield of the screening chest x-ray in detecting unknown abnormalities and to determine whether patients who had a preoperative chest x-ray taken experienced fewer anesthetic or postoperative complications than did those who did not. In all, 1,924 cases were studied; in 749 a preoperative chest film was taken. Of those 749 cases, a previously unsuspected abnormality was discovered in 35 (4.7%) patients. Nine (1.2%) of these abnormalities were considered to be clinically significant and three (0.4%) resulted in cancellation of surgery. No differences in anesthetic or postoperative complications were noted between the two groups of patients. It is recommended that the performance of routine preoperative chest x-rays on apparently healthy children be discontinued.
Understanding the Pleurevac
Authors: Rothberg Alan D. , Marks Keith H. , Maisels M. Jeffrey
Published: December 2021

The infant nonmetered Pleurevac was studied under laboratory conditions. Evacuation of a spirometer was measured at various negative pressures through the infant thoracostomy tubes routinely used in the clinical setting. In addition, a tension pneumothorax model was designed, and factors affecting its evacuation rate were studied. In accordance with Poiseuille's law, the evacuation rate was proportional to the negative pressure applied to the thoracostomy tube, and the radius of the tube. The airflow rate (bubble rate) through the Pleurevac was found to be of minor importance in affecting evacuation.
Perceived First Contact Care for Disabled Children
Authors: Okamoto Gary A. , Shurtleff David A.
Published: December 2021

In a mail-back questionnaire survey, 169 mothers of myelodysplastic children were asked whom they would contact first for each of 24 health-related problems. These problems ranged from earaches to shunt obstruction to sexual counseling. All children were being followed in a comprehensive care clinic at a regional center; however, nearly half of these families lived in rural areas distant from the clinic. Eighty percent of children were said to have local physicians. Mothers tended to perceive clinic staff and specialists for first contact care according to severity of the child's motor paralysis, the greater the child's hospitalization experience, and the shorter the travel time from home to clinic. However, when travel time was controlled, there was no difference in overall perceptions for those mothers living more than 90 miles away from the clinic. In a second survey to 91 physicians designated as the "child's local doctor" and a third survey to the 27 clinic staff members, respondents were asked whom should mother contact first for each of the 24 health-related problems. The clinic staff tended to prefer itself, despite the general policy of the clinic to encourage families to utilize comunity resources, including their local physicians. Local physicians tended to prefer themselves over clinic staff, a position consistent with the philosophy of primary care to the chronically disabled child.
Tap Water Burns in Handicapped Children
Authors: Feldman Kenneth W. , Clarren Sterling K. , Mclaughlin John F.
Published: December 2021

The original tap water burn series included three handicapped children, but the extent of their special risk of injury was not appreciated or emphasized.1 When I (K.W.F.) presented that burn series to the medical staff at Children's Orthopedic Hospital and Medical Center, my colleagues in the handicapped children's clinic suggested the possible increased risk to their patients because of their anesthesia and motor dysfunction. In September 1978, we sent letters to the 730 families of those clinic patients informing them that tap water can cause severe burns and that their children might be at a greater risk of injury. We suggested that they set back their water heater thermostats to 49 to 54 C (120 to 130 F).
Serum 25-Hydroxyvitamin D Concentrations in Sudden Infant Death Syndrome
Authors: Hillman Laura S. , Erickson Marilyn , Haddad John G.
Published: December 2021

In the article "Serum-25-hydroxyvitamin D Concentrations in Sudden Infant Death Syndrome" by Hillman et al (Pediatrics 65:1137-1139, 1980) authors and affiliations should read: Laura S. Human, M.D., Marilyn Erickson, and John G. Haddad, Jr., MD. From the Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital; St Louis County Medical Examiner's Office and Department of Pathology, St Louis University; and Division of Metabolism, The Jewish Hospital of St Louis, St. Louis.
School Health Examinations
Authors: Cook Donald E. , Andringa Conrad L. , Hess Karl L. , Kishner Leonard L. , Leavitt Samuel R. , Novak Stanley F. , Rogers Kenneth D. , Stackpole J. Ward , Wiggins Casper E. , Carlyon William , De Angelis Catherine , Kolb Weldon G. , Mcginnis Betty , Newton Jerome , Weiss Charles
Published: December 2021

School health examinations were begun years ago because parents, educators, and physicians all realized that healthy children learned more effectively than children with health problems. Earlier in this century, many children in the United States entered school without having had a health evaluation. Most children in this country today receive health care during their preschool years. Therefore, reevaluation of the concept of routine health exammations is now indicated because of changing health patterns in the United States and children's different health needs.

PHYSICAL EXAMINATION

Ideally, every school child should have a complete physical examination and health evaluation every one to two years from his or her personal physician or source of ongoing medical care. Several things should be accomplished during this examination:

(1) interval health history; (2) head-to-toe health appraisal; (3) assessment of growth, development, and school progress; (4) mental health evaluation of the child and family; (5) assessment of immunization status; (6) health education and counseling for both parent and child; (7) evaluation for participation in athletics; (8) recommendations about the child's health needs.

Physicians may not be available for comprehensive health supervision in some rural and urban areas. Therefore, the Committee makes the following recommendations for health examinations required by schools.

1. Schools should require a complete physical examination for all children at least every three years.

2. Ideally, this physical examination should be done by the child's pediatrician or primary care physician. A school nurse, with physician backup, if trained in physical assessment skills, can do an assessment if no physician is available to conduct the examinations.
Hyperammonemia and Perinatal Asphyxia
Authors: Procianoy Renato S.
Published: December 2021

In a recent article Goldberg et al1 presented data on 12 asphyxiated newborn infants with high ammonia levels concomitant with abnormal liver function tests. They pointed out that the liver dysfunction, probably secondary to the ischemic-hypoxic injury, might have contributed to ammonia elevation by decreasing urea biosynthesis.

I have recently seen two asphyxiated newborn infants who had elevated ammonia levels without any liver dysfunction. Both were meconium-stained postterm neonates with Apgar scores of 1 and 4 at one and five minutes, respectively, who developed seizures, coma, and apnea on the first day of life and required mechanical ventilation for apnea and phenobarbital for seizures.
Letters to the Editor
Authors: Goldberg Ronald N. , Cabal Luis A.
Published: December 2021

We agree with Dr Procianoy's suggestion that high caloric solutions may ameliorate the hyperammonemia accompanying asphyxia. However, we would like to stress that hyperammonemia secondary to perinatal asphyxia most likely begins in utero and results from an increase in protein breakdown,1 and hepatic damage secondary to ischemia. It is unlikely that early high caloric intake will suppress this elevation although it might attenuate it. We have recently noted hyperammonemia in asphyxiated neonates within 15 minutes of birth.
Observations on Maternal Preference for Rooming-in Facilities
Authors: Dharamraj Claude , Sia Concepcion G. , Kierney Catherine M. P. , Parekh Aruna , Harper Rita G. , Weissman Barry
Published: December 2021

To determine the length of time mothers prefer their infants with them, 1,000 mothers at North Shore University Hospital (NSUH) and 435 mothers at Kings County Hospital (KCH) were asked postpartum whether they would prefer their infants with them every four hours for ½ hour for feeding or rooming-in with their infants during the daytime only or 24 hours a day. Approximately one third of the mothers at NSUH preferred rooming-in whereas approximately three quarters of the mothers at KCH preferred rooming-in. Significantly more mothers at KCH preferred 24-hour rooming-in than at NSUH. Factors such as primiparity, attendance at Lamaze classes, and breast-feeding were significantly associated with the mother's preference to room-in at NSUH, but there was no such association at KCH. This study suggests that: (1) the desire to room-in is not universal; (2) each institution must individualize rooming-in facilities according to the needs of the population; (3) although the demand for rooming-in varies, more mothers prefer rooming-in than there are accommodations presently available; and (4) factors that may be associated with rooming-in are not the same in all populations. It appears that it is as inappropriate to impose rooming-in as it is to deprive mothers of rooming-in.
Cross-nursing: Wet-nursing in a Contemporary Context
Authors: Krantz Judith Z. , Kupper Nancy S.
Published: December 2021

Cross-nursing, or the breast-feeding of an infant not one's own, appears to be an increasingly popular, if not well reported, practice. The physical and psychologic effects are not well documented, but may be quite different from those of the institutionalized wetnursing of the past. Three mothers who cross-nurse were interviewed; the practice appears to have had no ill effect on them or their infants. Cross-nursing is a logical and practical extension of the resurgence of breast-feeding and may, in turn, increase the incidence of breast-feeding by making it more attractive to employed mothers. Before the practice can be properly evaluated, however, more data are needed, particularly with regard to possible physical reactions in the infants. In the meantime, pediatricians should be aware that their breast-fed patients may be participating in a cross-nursing situation, and suggest prudent considerations.
Fever and Convulsions— Indications for Laboratory Investigations
Authors: Jaffe M. , Bar-Joseph G. , Tirosh E.
Published: December 2021

The routine laboratory investigations performed on 562 children seen with their first episode of convulsions and fever were retrospectively analyzed. By dividing the cohort into SFC and nonSFC groups, it was found that the yield of abnormal laboratory results was significantly more prevalent in the latter group.

In almost all of the cohort cases, clinically significant laboratory abnormalities in blood chemistry could have been anticipated from the history and physical examination.

It is therefore concluded that the only routine investigation indicated, even in the absence of clinical suspicion, is a lumbar puncture. In ideal situations even this procedure may be omitted. Other investigations should be performed only if the clinical features of the case warrant them.
Acute Urinary Retention Secondary to Severe Gonococcal Balanoblennorrhea
Authors: Henretig Fred M.
Published: December 2021

Gonococcal genitourinary infection in males is usually manifested by urethritis with dysuria and purulent urethral discharge. Balanoblennorrhea (gonorrheal inflammation of the glans penis) may rarely accompany urethritis, and prostatitis and epididymitis are infrequent complications.1 However, as the current pandemic of gonorrhea involves increasingly larger numbers of young children (reference 2 and personal communication from J. H. Blount, 1980), it is probable that more unusual manifestations of both local and disseminated disease will be faced by the pediatrician. The child reported here developed severe genitourinary gonorrhea with such extreme local inflammation as to necessitate hospitalization and surgical relief of acute urinary retention.
Does Lumbar CSF Pressure Accurately Reflect Intracranial Pressure?
Authors: Rockoff Mark A.
Published: December 2021

In a recent article Horbar and colleagues1 claim that the Ladd fiberoptic sensor used to record intracranial pressure (ICP) is affected by the force with which the device is attached to the anterior fontanel. They have clearly shown that as this force increases, pressure recorded by the sensor also increases. The question is whether this increase occurs only at the sensing device, or truly reflects an increase in ICP.

The authors believe that, based upon simultaneous recording of lumbar CSF pressure and fontanel pressure in one infant, the former is the case.
Letters to the Editors
Authors: Horbar Jeffrey D. , Lucey Jerold F. , Philip Alistair G. S.
Published: December 2021

The Ladd sensor is an applanation device. When applied to a thin convex membrane enclosing a fluid-filled space the sensor will accurately reflect the fluid pressures over a wide range of application forces. The artificial monkey fontanel created by Myerberg may closely approximate this situation. The human infant fontanel, however, is not a thin convex membrane. It is often flat or concave and is separated from the subarachnoid space or sagittal sinus by compressible subcutaneous tissue.
Letter to the Editors
Authors: Stevenson David K.
Published: December 2021

The use of the phrase, "calorically deprived," in reference to infants breast-fed during the first several days of life was not intended to denote a pathologic condition. Instead, our comment was intended to characterize the breast-fed infant's transitional status of lower caloric intake relative to the situation in utero at term and that after the first several days of life when the volume of milk secreted daily from the breasts and its caloric content have increased substantially.
Another Aspect of the SIDS Problem
Authors: Young Paul C.
Published: December 2021

Dr Valdeś-Dapena's well-organized review article, "Sudden Infant Death Syndrome: A Review of the Medical Literature 1974-1979" in the October issue (Pediatrics 66:597, 1980) was an excellent analysis of the current literature of this confusing and complex entity. The extensive bibliography will be most helpful to any individual interested in the subject.

The clinician providing primary care for children is likely to be confronted with the sudden infant death syndrome (SIDS) phenomenon in one of three ways: First, there is the necessity of dealing with a family who has just lost a baby.
Letters to the Editor
Authors: Crespigny Lachlan Ch De , Robinson Hugh P.
Published: December 2021

We read with interest the report which suggested that the diagnosis of cerebroventricular hemorrhage ([CVH] including both subependymal [SEH] and intraventricular) with real time ultrasound was unreliable.1 Ultrasound, when compared with computed tomography scans, had a 35% false-positive rate and a 21% false-negative rate. In our institution over a 12-month period more than 200 premature babies have been examined (ADR real time linear array scanner with a 7-MHz transducer).
Etiology of Pertussis Syndrome
Authors: Garty Ben Zion , Drucker Moshe M. , Nitzan Menachem
Published: December 2021

Keller et al1 reported the interesting finding that 91 of 100 patients with pertussis syndrome were infected with Bordetella pertussis or had been exposed to this agent. Their article, however, did not mention the precise age distribution of the patients who "ranged from six weeks to adulthood." It is possible that the etiologic factors of pertussis syndrome in young infants is somewhat different from the etiology of pertussis syndrome in older children.

We believe that the laboratory investigation of pertussis syndrome during the first months of life should include examinations for Chlamydia trachomatis infection in addition to the search for Bordetella, Mycoplasma pneumoniae, and viruses, as demonstrated by the following case: A 4-week-old boy with previous history of conjunctivitis was admitted because of paroxysms of staccato cough followed by occasional vomiting or cyanosis.
Where Are the British?
Authors: Rockoff Alan S.
Published: December 2021

I want to take issue with a statement made by Weston et al in their article on "Diaper Dermatitis", (Pediatrics 66:532, 1980). They write, "Although commonly recovered from the rectum, British authorities have convincingly demonstrated that alimentary C albicans does not play a role in diaper candidiasis...." I must say that in my experience, British authorities are rarely recovered from the rectum. Even if Weston et al think otherwise, it really was not very nice of them to say so.
Coagulopathy Is Not an Important Factor in Intraventricular Bleeding
Authors: McDonald Marilyn M. , Hathaway William E.
Published: December 2021

Dr Dykes and colleagues in their prospective evaluation of intraventricular hemorrhage (Pediatrics 66:42-49, 1980) arrive upon the interesting conclusion that there is no correlation between intraventricular hemorrhage and coagulopathy. However, their study fails to describe any methodology with which the coagulation system was examined or specific results. Their important comment that "coagulopathy was not seen with any frequency in our population" does not appear to be adequately substantiated. Until detailed, systematic study of the coagulation system is made with attention to the timing of intracranial hemorrhage (ICH) in neonates, it is imposible to know whether coagulation abnormalities may precipitate or aggravate ICH.
Letters to the Editor
Authors: Dykes Francine D. , Lazzara Anthony , Ahmann Peter
Published: December 2021

We appreciate the comments of Drs McDonald and Hathaway. None of the infants studied demonstrated any clinical evidence of coagulopathy. Assessment of coagulation is not performed in infants in our nurseries unless there are signs of a bleeding diathesis.
Letters to the Editor
Authors: Rush David , Stein Zena , Susser Mervyn
Published: December 2021

Dr Strawbridge says that in our summary paper describing a randomized controlled trial of prenatal nutritional supplementation1 we draw conclusions not demonstrable by the conventions of statistics and logic. We can only reply that levels of significance must be understood to be no more than conventions: they cannot substitute for scientific coherence and judgment. Strawbridge fails to distinguish between the strength or magnitude of an association and its statistical significance. Significance is a function both of magnitude, and of the number of observations.
Diploid-Triploid Mixoploidy: Clinical and Cytogenetic Aspects
Authors: Graham John M. , Hoehn Holger , Lin Ming S. , Smith David W.
Published: December 2021

A patient with 46,XY/69,XXY mixoploidy (a mixture of cell populations whose component cells differ in their chromosome numbers, irrespective of whether these numbers are euploid or aneuploid) who had some clinical manifestations of the Russell-Silver syndrome is reported. Triploidy results in a clinically recognizable lethal syndrome with hydatidiform placental changes, severe intrauterine growth deficiency, dysplastic cranial bones, eye defects, cleft lip and/or palate, malformed ears, micrognathia, syndactyly, genital anomalies and, rarely, spina bifida. Less severe are instances of diploid-triploid mixoploidy and patients are more likely to survive; one of these patients was detected at birth because of asymmetric growth deficiency with syndactyly. Cytogenetic and flow cytometric studies demonstrated absence of triploid cells in peripheral lymphocytes while varying proportions of triploid cells were found in fibroblast cultures derived from each limb. The triploid cell population disappeared with prolonged cell culture. Replication studies with 5-bromodeoxyuridine-DAPI fluorescence revealed two active X chromosomes, and marker chromosomes suggested a paternal origin for the extra haploid set. The following points are emphasized: (1) diploid-triploid mixoploidy can be suspected clinically; (2) the triploid cell population may not be detectable on examination of peripheral blood; (3) the relative degree of asymmetry in the growth deficiency does not appear to relate to the proportion of triploid cells; and (4) both X chromosomes may remain active in the presence of an extra haploid set of chromosomes.
Frequency and Outcome of Disorders of Cardiac Rhythm and Conduction in a Population of Newborn Infants
Authors: Southall D. P. , Johnson A. M. , Shinebourne E. A. , Johnston P. G. B. , Vulliamy D. G.
Published: December 2021

Of 3,383 apparently healthy newborn infants studied in one region of England, 33 showed cardiac arrhythmias or preexcitation on a standard ECG. Twenty-six infants had multiple atrial or ventricular premature beats. One infant had atrial flutter, two had multifocal atrial tachycardia, and two had supraventricular tachycardia. Two infants showed the ECG pattern of the Wolff-Parkinson-White syndrome, but did not demonstrate cardiac arrhythmias. Performance of 24-hour ECG recordings on 15 of the 26 subjects with premature beats showed additional supraventricular or ventricular tachycardia in five cases. In one of two infants with multifocal atrial tachycardia, 24-hour recordings also demonstrated long episodes of rapid supraventricular tachycardia. Follow-up recordings (standard and 24-hour ECG) showed that in the majority of infants arrhythmias or preexcitation could not be demonstrated after 12 weeks of age. One infant with atrial premature beats, one infant with ventricular premature beats and ventricular tachycardia, and one infant with multifocal atrial tachycardia showed persisting arrhythmias. Four infants received antiarrhythmic therapy which probably influenced the natural history of their arrhythmias. Disorders of cardiac rhythm and conduction occur in apparently healthy infants. This study provides a basis for further prospective research into their natural history.
Oxygen Consumption and Temperature Control of Premature Infants in a Double-Wall Incubator
Authors: Marks Keith H. , Lee Cheryl A. , Bolan Charles D. , Maisels M. Jeffrey
Published: December 2021

The effects of a double wall in a forced convection-heated incubator were studied on ten naked, nondistressed, premature infants by measuring their mean skin temperature, esophageal temperature, and oxygen consumption when they were in thermal steady state with, and without, the double wall in place. The incubator air temperature was maintained within the recommended thermoneutral zone during the consecutive paired experiments. Ambient room temperature and relative humidity were constant and the infant's activity (quiet sleep) and postprandial state were the same in both conditions. Together with a significant rise in operative temperature (P < .05) induced by the double wall (accounted for by a 0.9 C mean increase in incubator wall temperature nearest the baby), their mean skin temperature and esophageal temperatures increased (P < .025), while a decrease in oxygen consumption occurred in nine of the ten infants (P < .05). These findings suggest that the double wall reduced radiant and total heat loss from the baby by diminishing the temperature gradient between the skin and incubator surfaces and that metabolic heat production (oxygen consumption) was reduced when the double wall was in place.
Pericarditis and Cardiac Tamponade in Juvenile Rheumatoid Arthritis
Authors: Yancey Carolyn L. , Doughty Robert A. , Cohlan Barbara A. , Athreya Balu H.
Published: December 2021

Cardiac tamponade is a rare complication of juvenile rheumatoid arthritis. Three cases seen in the last two years at the Children's Hospital of Philadelphia are reported and compared to four previously reported cases. All three children had systemic-type juvenile rheumatoid arthritis with tachypnea, shortness of breath, and chest pain. Cardiac signs in these children included decreased heart sounds, pericardial friction rub, jugular venous distention, and pulsus paradoxus greater than 12 mm Hg. Roentgenograms of the chest showed cardiomegaly with bilateral pleural effusions. Electrocardiograms showed sinus tachycardia and nonspecific ST-T wave changes. Echocardiograms demonstrated pericardial effusions in all subjects and poor ventricular movements in one child. All three children were treated with short-acting anti-inflammatory drugs and/or prednisone. Pericardiocentesis was performed in two cases. There was no significant morbidity after a mean follow-up of two years.
The Pediatric Family-Patient Health Education Library: The Issue of Access to Information
Authors: Sahler Olle Jane Z. , Satterwhite Betty B. , Reynolds Jeffrey D.
Published: December 2021

Access to medical information and full and complete disclosure of diagnostic and therapeutic data are becoming important themes in physician-family-patient relationships. A health education library that provides consumers with comprehensive reference materials, including texts originally designed for a professional readership, can be used to meet demands from the lay public for better communication between doctor and patient. Although realistic concerns about the impact on families of explicit or detailed medical information have been raised, the actual incidence of such problems has been very low among the users of such an "open access" library at our institution. However, support by physicians of the library as a useful resource and their willingness and availability to discuss materials read by patients and family members are key factors in the success of such a project.
Editor's Note
Authors: Lucey Jerold F.
Published: December 2021

This is obviously a muddled, complex, and very controversial subject. The American pediatric community, American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics were not brought into these deliberations until April 1981, months after the fourth and final draft of the Code had been made. It is unfortunate that the three United States representatives in the negotiations for the Code did not see fit to involve the pediatric scientific community. They not only didn't ask for pediatric input they also failed to consult the National Academy of Sciences Committee on International Nutrition Programs!

Dr Barbara Starfield, Past President of the Ambulatory Pediatric Association, and a member of our Editorial Board was asked to present the viewpoint of the Ambulatory Pediatric Association which has "endorsed in its entirety" the Code.