bluuebunny/crossref_metadata_2025 huggingface dataset:
Diminished Pulmonary Lecithin Synthesis in Acidosis: Experimental Findings as Related to the Respiratory Distress Syndrome
Authors: Merritt T. Allen , Farrell Philip M.
Published: December 2021

Lung slices from term fetal rats were incubated in vitro at various pH values and the rates of the two de novo pathways for lecithin biosynthesis were determined by measuring the conversion of either 14C-choline (pathway 1) or 14C-methionine (pathway 2) to the phospholipid. It was observed that the choline pathway, but not phosphatidyle-thanolamine methylation, is pH-sensitive with maximum rates occurring at pH levels between 7.3 and 7.5; significantly less activity was found at pH levels between 7.0 and 7.2 and at pH levels between 7.6 and 8.0. Adjustment of the pH from 7.0 to 7.4 in vitro, simulating the clinical correction of acidosis by alkali infusion, was found to increase the conversion of choline to lecithin to a rate approximating that observed at pH 7.4. Since lecithins are the principal phospholipid components of pulmonary surfactant, and since pathway 1 is predominantly responsible for lung lecithin synthesis, the demonstration of impaired production with reduced pH offers a biochemical explanation for the pathophysiological effects of acidosis in the respiratory distress syndrome. A comparison of pH effects on choline pathway rate with the pH profiles of pathway enzymes suggests that these effects are mediated by the catalysts of lecithin synthesis.
Trends in Fatness and the Origins of Obesity
Authors: Garn Stanley M. , Clark Diane C. , Lowe Charles U. , Forbes Gilbert , Garn Stanley , Owen George M. , Smith Nathan J. , Weil William B. , Nichaman Milton Z. , Johansen Erling , Rowe Nathaniel
Published: December 2021

BY intent and by design, the Ten-State Nutrition Survey (TSNS) of 1968-1970 was concerned with both undernutrition and overnutrition. One concern was caloric and nutrient insufficiency and the effects of inadequate nutrition on growth and development. A second concern was caloric excess, as reflected by the level of fatness, and especially the prevalence of obesity, in different socioeconomic groupings and in different population segments.

In the design of the TSNS, it was obvious that weight alone—or even weight relative to height—was an inadequate measure of fatness. A child might be "overweight," yet of less than average fatness; another child or adult might be underweight, yet actually obese. Accordingly, two fatfold measurements (commonly but improperly called "skinfolds") were incorporated into the anthropometric program.

One benefit of the TSNS may be seen in the fact that we now have nine-decade triceps or subscapular fatfold data on more than 40,000 individuals; nearly one half of them are American Negro (i.e., black), for whom scant data were previously available. A second benefit is that these new data are sufficient in scope to describe lifelong changes in fatness, including some phases not previously known in detail. A third benefit is the socioeconomic partitioning of fatness, showing both an economic-related fatness increase in the male at all ages and an economic "reversal" of fatness in the female at adolescence and beyond.

The TSNS was conducted on a household and family-line basis, including both parents and their children.1 So we have the opportunity to compare true family-lines, parents and their children, brothers and sisters, and husbands with wives.
Carcinogens in Drinking Water
Authors: Miller Robert W.
Published: December 2021

There has recently been concern about carcinogens in drinking water.

ASBESTOS

In Duluth, Minnesota, asbestos in substantial amounts has been found in the water supply, which has apparently been contaminated since 1955 with industrial waste from taconite ore discharged into Lake Superior.1 Asbestos, when inhaled, is known to be carcinogenic in man. It causes pleural and peritoneal mesothelioma, lung cancer, and gastrointestinal neoplasia in factory workers exposed to the fibers,2-5 and mesothelioma of the pleura or peritoneum among persons living in the neighborhoods of these factories and perhaps in the households of workers.3,6-9 An increase in the frequency of bronchogenic carcinoma has also been reported among persons with low-level (nonoccupational) exposures to asbestos.10

Asbestos is believed to be carcinogenic because of its physical rather than its chemical properties—specifically, the length and diameter of the fibers are related to their carcinogenicity in rats.11,12 Long thin fibers seem to be more harmful than short thick ones, but short fibers cannot yet be regarded as harmless.13

Millions of asbestos fibers are found per liter of water drawn from the taps in Duluth.1 Most are of short length, less than 5µ. Studies of cancer mortality through 197114,15 showed no increase that was attributable to contamination of the water supply, but the latent period for asbestos-induced cancer is known to be two or more decades, well beyond the interval for which data were available.

The problem, if indeed there is one, may not be limited to Duluth, since other water supplies contain asbestos fibers leached from serpentineor amphibole-rock or from asbestos-containing cement pipes.16,17
A New Approach to Teen-age Smoking
Authors: Garell Dale C. , Guthrie Andrew , Hammar S. L. , Heald Felix P. , Hofmann Adele D. , James W. Scott , Olson Ardis Lee , Shen Jerome T.Y. , Tanner Natalia M. , Thornton Melvin L. , Wasserman Martin P. , Wolfish Martin G.
Published: December 2021

In January 1964, the Surgeon General's office released its report demonstrating the strong potential relationship between cigarette smoking and lung cancer as well as the pulmonary and cardiovascular diseases which afflict thousands each year.1

Since that time, an estimated 30 million Americans have quit smoking; but, during the last two years, there has been a noticeable increase in per capita cigarette consumption among women and teen-age girls.2 Every day 3,200 adolescents between the ages of 12 and 18 take up smoking (exclusive of those who are just experimenting with smoking, the 10- to 12-year-olds).3 The Bureau of Census estimates that the number of teen-agers smoking rose from 3 million to approximately 4 million between 1968 and 1972. The proportion of smokers in the 12 to 18 age group increased from 14.7% to 15.7% among boys and 8.4% to 13.3% among girls.4

Analysis of research by the Department of Health, Education, and Welfare on teen-age populations indicates there are many environmental factors that affect the initiation of the smoking habit; however, by far the strongest influence is the smoking behavior of parents and siblings.5 If both parents smoke, the teen-ager has about twice the likelihood of being a smoker than if neither parent smokes (the rates are 18.4% to 9.8% respectively). If an older brother or sister smokes, the teen-ager is twice as likely to become a smoker himself.5

When the combined effect of smoking of parents and older siblings is considered, the concept of family patterns is reinforced. The lowest level of smoking is found among teen-agers who live in nonsmoking households.
Academy Policy in Relation to the Pediatric Nurse Associate
Authors:   Executive Board, American Academy of Pediatrics
Published: December 2021

The Academy has been involved with the concept of the pediatric nurse associate (PNA) since its evolution in the early 1960's. At that time it was recognized that there were children in this country who were receiving inadequate or no health care. In addition, predictions were being made of an impending physician shortage. It was also becoming increasingly apparent that there was a reservoir of health professionals who were not being utilized to their fullest potential within the health care system. This reservoir was nursing; thus, the concept of the PNA was conceived, developed, and has continued to grow over the past ten years.

The education of the PNA has many unique aspects, for in this endeavor medicine and nursing assume joint responsibility in the development and administration of the educational programs. The PNA is a professional nurse with additional education in the field of child health care. In addition to his/her nursing role, she/he assumes certain functions and responsibilities which traditionally have been the domain of medicine. In the provision of these medical services the PNA functions under the supervision, direction, and review of the physician. Thus, it is imperative that medicine be actively involved, not only in the educational process, but also in the development of the role of the PNA within the health care system.

There have been many changes not only within the specialty of pediatrics, but also within the health care system in general in recent years. To mention a few: a decline in the birth rate; the development of national health programs; rapid expansion of medical schools and classes; an increased emphasis on primary care and avoidance of fragmentation of care; the emergence of the family physician; and a crisis in the medical profession regarding professional liability coverage.
Computer-Assisted Newborn Intensive Care
Authors: Perlstein Paul H. , Edwards Neil K. , Atherton Harry D. , Sutherland James M.
Published: December 2021

A minicomputer has been programmed to aid in the intensive care of high-risk newborn babies. The computer provides 24-hour on-line access to physiologic and environmental data and controls the heating of infant incubators. The control algorithm limits fluctuations in the incubator chamber and protects the infant against escape from neutral thermal conditions. The mortality rate for 105 infants cared for using the computerized system was significantly reduced when compared to that of 105 matched high-risk infants cared for using standard non-computer-assisted techniques in the same nursery setting.
Antinuclear Antibodies and Lupus-like Syndromes in Children Receiving Anticonvulsants
Authors: Singsen Bernhard H. , Fishman Lawrence , Hanson Virgil
Published: December 2021

Drug-induced systemic lupus erythematosus (SLE)-like syndromes in children are most commonly associated with the administration of ethosuximide, diphenylhydantoin, and trimethadione. Five children receiving ethosuximide who presented with syndromes suggestive of SLE were studied. Each had fever, malar rash, arthritis, and lymphadenopathy. Two children had pleural effusions and another developed myocarditis and pericarditis. Three patients had anti-DNA antibodies associated with low serum C3. In four of five children symptoms disappeared with the discontinuation of ethosuximide; two of these continue to have antinuclear antibodies (ANA). One child continues to have active SLE with nephritis. A group of 101 children from a seizure clinic were tested for the presence of ANA. ANA were found in 14 of 70 children receiving ethosuximide and/or diphenylhydantoin; 2 of 14 had anti-DNA antibodies. Serum ANA titers in the drug-induced SLE group did not differ significantly from those of the asymptomatic seizure patients. ANA were also present in 5 of 23 children receiving phenobarbital only. The induction of ANA by phenobarbital is a possible hypothesis. Quantitative immunoglobulins and C3 were not significantly altered in the asymptomatic children with ANA. Follow-up studies at ten months showed no asymptomatic child with ANA to have developed clinical evidence of SLE. This study suggests that asymptomatic children who develop ANA should have careful observation, but need not have their anticonvulsants discontinued.
When Should a Child Be in the Hospital?
Authors: North A. Frederick
Published: December 2021

With the advent of more active and widespread utilization review activities, spurred federally by Professional Standards Review Organization1 (PSRO) legislation and locally by various types of quality assurance programs, physicians who care for children are increasingly concerned with setting norms, criteria, and standards for judging the necessity for admission to hospital and the duration of hospital care.2 Most of the current approaches to devising utilization standards attempt to identify for each common diagnostic category a standard for length of stay based either on statistical analyses of current hospitalization practices3,4 or upon normative values based on a consensus of expert opinion.3 Criteria for admission may also be derived for each diagnosis.2,5-7 Committees of the American Academy of Pediatrics and of state and local medical and pediatric societies are currently devoting a great deal of effort to formulating admission and length of stay standards for a variety of diagnoses which are associated with hospitalization of children.

The approach to formulating utilization standards using separate diagnostic categories may prove not to be well suited to children. As is shown in Tables I and II, a large number of diagnostic categories must be dealt with, and many of the diagnostic categories are so broad that admission and length of stay standards would be impossible to derive except for much smaller subsets. Table I shows the 25 most common diagnoses of children admitted to approximately 1,200 hospitals which reported data to the Professional Activities Survey (PAS) in 1970.2 The diagnostic categories used in this analysis group several separate ICDA diagnostic codes together.
Complications of Peritonsillar Abscess Due to Fusobacterium necrophorum
Authors: Oleske James M. , Starr Stuart E. , Nahmias André J.
Published: December 2021

Even though anaerobic bacteria have been causally related to peritonsillar abscesses and secondary complications,1-3 such infections have been diagnosed infrequently. Reported here is a patient with a peritonsillar abscess, complicated by cellulitis and lung abscesses. An anaerobic organism, Fusobacterium necrophorum,, was identified as the etiological agent.

CASE REPORT

A 14-year-old black boy was in good health until three weeks prior to admission when he developed a sore throat, dysphasia, fever, and chills. His physician diagnosed viral pharyngitis; a throat culture was not obtained and no antimicrobial therapy was prescribed. During the following 12 days, because the patient had developed a nonproductive cough and experienced a 4.52-kg weight loss, he was brought to the Pediatric Emergency Clinic, Grady Memorial Hospital.
THE CARDIAC ARRHYTHMIAS, ed. 2. By Brendan Phibbs, M.D. St. Louis, C.V. Mosby Co., 1973. $7.50; 205 pp
Authors: Talner Norman S.
Published: December 2021

The major aim of this book is to provide the interested clinician with a simple, direct approach to the diagnosis and management of the common cardiac arrhythmias. The author prides himself in going out of his way to describe the phenomena in the book in a simple, clear fashion and he achieves his aims fairly well. Since the author considers this a basic book for the noncardiologist, it might be of value for the practicing pediatrician who wants to know more about cardiac arrhythmias.
Milk Protein Quantity and Quality in Low-Birthweight Infants: I. Metabolic Responses and Effects on Growth
Authors: Räihä Niels C. R. , Heinonen Kirsti , Rassin David K. , Gaull Gerald E.
Published: December 2021

The optimal quantity and quality of protein for low-birthweight infants is undefined. In this study, 106 well, appropriate-for-gestational age, low-birthweight infants weighing 2,100 gm or less were grouped in three gestational age categories: T1 = 28 to 30 weeks; T2 = 31 to 33 weeks; T3 = 34 to 36 weeks. Each group was assigned randomly to either banked human milk (BM) or to one of four isocaloric formulas varying in quantity and quality of protein but not in mineral content or in fat content: formula 1 = 1.5 gm of protein per 100 ml, 60 parts bovine whey proteins to 40 parts bovine caseins: formula 2 = 3.0 gm of protein per 100 ml, 60:40; formula 3 = 1.5 gm of protein per 100 ml, 18:82; formula 4 = 3.0 gm of protein per 100 ml, 18:82. Caloric intake was 117 kcal/150 ml/kg/day for the formulas. Human milk was fed at 170 ml/kg/day in order to attain a caloric intake approximately equal to that of the formulas. No significant differences were found in the rate of growth in crown-rump length, in femoral length, in head circumference, or in rate of gain in weight from time of regaining birthweight to time of discharge at 2,400 gm. Blood urea nitrogen, urine osmolarity, total serum protein, serum albumin, aiud serum globulin varied directly with the quantity of protein in the diet: F2, F4 > F1, F3 > BM. Blood ammonia concentration varied with both quantity and qualtiy of protein in the diet: F2, F3, F4 > F1, BM. Metabolic acidosis was more frequent, more severe, and more prolonged in the infants fed the casein-predominant formulas (F3, F4) than in those fed the whey protein-predominant formulas (Fl, F2).
Intellectual Deficits After Transient Tyrosinemia in the Term Neonate
Authors: Mamunes Peter , Prince Paul E. , Thornton Nancy H. , Hunt Patricia A. , Hitchcock Elizabeth S.
Published: December 2021

In order to determine if prolonged, significant transient neonatal tyrosinemia (TNT) is injurious to the developing central nervous system, 15 term infants who had suffered from this disorder for a mean duration of 50 days underwent comprehensive psychometric evaluations at a mean (± 1 SD) age of 56.5 ± 7.8 months. Their mean maximum detected tyrosine level had been 25.8 mg/dl (range, 13.6 to 42.0) and their defect was considered secondary to a combination of a high protein formula intake and a lack of supplemental vitamin C.

Compared to a control group, significantly lower mean scores were obtained by the TNT group on the McCarthy Scale of Children's Abilities (77.1 vs. 92, P = .008) and the Illinois Test of Psycholinguistic Ability (92.3 vs. 109.9, P = .002). Performance scores varied inversely with the duration of TNT. Although these children are not classifiable as "mentally retarded," TNT may cause specific learning disabilities. There is, therefore, a need to determine the frequency of TNT in infants fed evaporated milk and other high-protein milk formulas and to develop ways to prevent its occurrence.
Needle Biopsy of the Synovium of Children
Authors: Jacobs Jerry C. , Phillips Paul E. , Johnston Austin D.
Published: December 2021

While the diagnosis of juvenile rheumatoid arthritis is based on clinical criteria and does not require confirmation by synovial biopsy, biopsy is occasionally desired to exclude other diagnoses. Needle synovial biopsy of the knee may be performed on young children as an office procedure and generally provides adequate tissue for examination. In the author's clinic this procedure has replaced open biopsy of the knee of children.
Vitamin D: The Discovery of Its Metabolites and Their Therapeutic Applications
Authors: Beale Mary G. , Chan James C. M. , Oldham Susan B. , DeLuca Hector F.
Published: December 2021

Our understanding of the role of vitamin D in calcium-phosphorus metabolism has changed considerably in the last decade. Studies performed in tissue culture, animal, and man have firmly established that the natural compound requires hydroxylation in the liver at the C-25 position and in the kidney at the C-1 position to form the biologically active derivative 1,25-(OH)2D3. These hydroxylation reactions are finely regulated to maintain normal calcium-phosphorus homeostasis: We now regard 1,25-(OH)2D3 as a hormone which is released by the kidney during periods of hypocalcemia. This hormone acts on the intestinal mucosa to facilitate calcium absorption and on bone to increase calcium mobilization. Its function in other tissues is still being evaluated.

The active metabolites of vitamin D and several closely related analogs have been synthesized. It has been clearly demonstrated that 1,25-(OH)2D3 and 1α-OH-D3 promote healing in uremic bone disease. Administration of small amounts of these compounds has corrected the biochemical disturbances in vitamin D-dependency and hypoparathyroidism. Limited clinical experience with 25-OH-D3 and 1,25-(OH)2D3 in children with familial hypophosphatemia has failed to show convincing evidence of a therapeutic effect. Further clinical studies are needed to fully evaluate the therapeutic potential of this new family of compounds.
The Denver Prescreening Developmental Questionnaire (PDQ)
Authors: Frankenburg William K. , van Doorninck William J. , Liddell Theresa N. , Dick Nathan P.
Published: December 2021

To facilitate periodic developmental screening of all children, a Prescreening Developmental Questionnaire (PDQ) was created to identify those children who require a more thorough screening with the Denver Developmental Screening Test (DDST). Children positive on the DDST screen are then referred for a diagnostic assessment. To devise the PDQ, 97 of 105 standard DDST items were formulated into questions. Ten age-appropriate questions were answered by 1,155 parents with subsequent evaluation of their children with the DDST. Agreement between parental responses for individual items and the score for their children's corresponding DDST item varied from 68% to 100% (mean, 93.3%). When the PDQ was positive, 31.2% of the children were referred for a DDST screen. These referrals included 86.7% of abnormal and 53.8% of questionable DDSTs among the 1,155 children screened. The predictive value of a referral was 23.3%. The predictive value of a referral did not differ significantly whether the PDQ was answered by a parent or by day care center staff personnel. A subsequent field trial of 1,027 PDQs in private physicians' offices and public health clinics yielded a similar predictive value (24.7%) for a referral. The parents liked the PDQ which took them only about five minutes to answer and the physicians liked the PDQ since it decreased by almost 69% the number of DDSTs they felt obliged to administer.
The Use of Paraprofessionals To Teach Interviewing Skills
Authors: Stillman Paula L. , Sabers Darrell L. , Redfield Doris L.
Published: December 2021

Two nonphysician mothers were each trained to give a consistent and authentic history of a child's common medical problem. At the beginning of a Pediatric Clerkship, one half the students were randomly assigned to interview one of the trained mothers. The interviews were videotaped and then replayed in an evaluative feedback session with each student. At the end of the clerkship these students were rated significantly higher on the process of interviewing than those students who did not have the initial evaluative feedback session.
A reexamination of "the apnea monitor business"
Authors: Steinschneider Alfred
Published: December 2021

In the July 1975 issue of Pediatrics, the commentary "The Apnea Monitor Business," written by Bergman et al,1 seriously fails to achieve conceptual clarity and objectivity. The authors are noted for their scientific contributions as well as providing leadership in increasing our awareness of the sudden infant death syndrome (SIDS). However, in this commentary they appear to have allowed their personal involvements and commitments to obscure several important conceptual issues. In the sections to follow, I will reexamine some of the issues discussed by Bergman et al. in regard to (1) the abuse and use of monitoring, (2) the distinctiveness of SIDS as a diagnostic category, (3) the "theory of the month club," and (4) the "near-miss" SIDS concept.
The Automobile and Heat Stress
Authors: Roberts Kenneth B. , Roberts Ellen C.
Published: December 2021

This study suggests that the thermal burden of poorly ventilated parked automobiles can be considerable, particularly when the automobiles are exposed to direct sunlight. Leaving the windows open two inches does not appear to be protective.

The practice of exposing infants and toddlers to such thermal risk appears to be common and the need for adequate ventilation unrecognized. Education measures stressing the use of carseats and other safety devices should include the potential hazards of high temperature in parked automobiles.
Clostridia Infection in the Newborn
Authors: Bogdan Joseph C. , Rapkin Richard H.
Published: December 2021

With the exception of neonatal tetanus, infections due to clostridia in the newborn are rare. Although these organisms are normally found in the female genital tract,1 exposure to such anerobes during delivery does not commonly appear to lead to neonatal colonization.2 Occasionally, however, the newborn is colonized and may become infected. Usually there are additional underlying factors which may be contributory, such as exchange transfusion3 or abdominal surgery,4 but infants have been reported with primary omphalitis or sepsis due to clostridia.3,5 We recently cared for an infant with omphalitis due to clostridia. This entity may need more emphasis, since it is potentially treatable and, therefore, is reported.
Mycoplasma pneumoniae Meningoencephalitis and Transverse Myelitis in Association with Low Cerebrospinal Fluid Glucose
Authors: Klimek Joseph J. , Russman Barry S. , Quintiliani Richard
Published: December 2021

Awareness of the neurologic complications of Mycoplasma pneumoniae is increasing as is indicated by two recent review articles on this subject1,2 and by the appearance of more frequent isolated case reports on the same subject.3-6

The association of M. pneumoniae with central nervous system dysfunction has been based mainly on clinical observations and serological data from serial serum samples. Direct evidence of an etiologic relationship is still lacking, for attempts at isolation of this organism from the cerebrospinal fluid (CSF) of brain tissue have been uniformly unsuccessful. In fact, most of the serological support for this association has been established from serum samples rather than from studies of the CSF.
Dr. Jacobs Replies
Authors: Jacobs Jerry C.
Published: December 2021

I am grateful to Dr. Athreya for his comments regarding the diagnosis of arthritis in small infants. The eight pediatric rheumatologists who served on the American Rheumatism Association subcommittee which suggested diagnostic criteria for juvenile rheumatoid arthritis discussed this subject at length and agreed that pain and tenderness and limitation of motion together were equally good as swelling as evidence of arthritis.1 The subject is further discussed in Brewer's textbook under the title, "Patterns of Pain and Tenderness."2
Dr. Cox Replies
Authors: Cox Frederick
Published: December 2021

Patient 2 had been treated with pentamidine isethionate for nine days at the time of diagnosis of nocardia lung infection. Trimethoprim and sulfonamides were not used to treat the pneumocystis infection.

Patient 4 did not have Pneumocystis carinii pneumonitis. The last sentence of the last paragraph on page 136, "In patient 4 the nocardial lung abscess developed during Pneumocystis carinii pneumonitis" is an error and should be deleted.
Hypoglycemia in Small-for-Dates Newborn Infants
Authors: de Leeuw Richard , de Vries Ivan J.
Published: December 2021

In 24% (18 out of 76) small-for-dates a "significant" though asymptomatic hypoglycemia was demonstrated during the first six hours of life. The cord blood glucose concentration was lower in the hypoglycemic compared to that of the small-for-date normoglycemic group.

In the hypoglycemic infants, the disappearance rate of glucose was significantly elevated and the lipid mobilization disturbed.

It is suggested that a lack of lipids for energy metabolism increases the glucose expenditure and hence increases the risk for hypoglycemia.
On doubting and certainty
Authors: Pless I. Barry
Published: December 2021

Since they were first introduced in 1971, three terms have become established in the lexicon of health services research. The concepts of efficacy, effectiveness, and efficiency are now widely accepted as essential measures for assessing health care programs and practices.

Efficacy is concerned with "establishing objectively that a new form of preventive, diagnostic, curative or restorative intervention is more useful and beneficial than it is harmful or useless for the purposes for which it is advocated." Effectiveness describes "the extent to which an efficacious form of intervention can be shown to have been made available or applied to all those in a defined population who could benefit from it." Efficiency, in turn, is concerned with "measuring the extent to which a stated level of effectiveness can be achieved with the least expenditures of personel, resources and money."1
Central Nervous System Pathology Associated With Mask Ventilation in the Very Low Birthweight Infant: A New Etiology for Intracerebellar Hemorrhages
Authors: Pape Karen E. , Armstrong Dawna L. , Fitzhardinge Pamela M.
Published: December 2021

Mask-applied ventilatory support was noted to cause severe head molding in infants with birthweights under 1,501 gm. To determine if this molding was detrimental to the infant, the neonatal course and autopsy findings were reviewed for 106 infants. Twenty significant intracerebellar hemorrhages were found. An association between these hemorrhages and mask-applied positive pressure ventilation was demonstrated (P = .05). This relationship was maintained when all cases of generalized bleeding dyscrasia were removed (P = .021). It is proposed that the distortional forces produced by the mask attachment, together with the buffeting effect of intermittent positive-pressure ventilation, are causally related to the production of intracerebellar hemorrhages by direct contusion, by ischemic stasis, or by altered venous drainage. The authors urge strong caution when dealing with the small premature infant in using any attachment device that causes molding of the cranial vault, particularly in the occipital area.
Cardiorespiratory Status of Erythroblastotic Newborn Infants: III. Intravascular Pressures During the First Hours of Life
Authors: Phibbs Roderic H. , Johnson Paul , Kitterman Joseph A. , Gregory George A. , Tooley William H. , Schlueter Mureen
Published: December 2021

We measured aortic and central venous pressures beginning soon after birth in 40 prematurely born infants with moderate or severe erythroblastosis fetalis, including 13 with severe and 10 with mild hydrops fetalis. All but four were asphyxiated at birth and this affected intravascular pressures. Before resuscitation, aortic or central venous pressure or both were elevated in more than one third. All but two of the remaining infants had normal initial pressures. Following resuscitation which relieved acidosis, hypoxia, and anemia, but did not reduce blood volume, the high pressures usually fell to normal and occasionally to subnormal levels, normal pressures fell to subnormal in almost one half, and those with initial subnormal pressures remained hypotensive. In all, 40% were hypotensive after resuscitation; treatment with blood volume expanders consistently returned these pressures to normal. Only two of the 13 severely hydropic infants and none of the mildly hydropic had findings indicative of hypervolemia and myocardial failure which persisted after treatment of asphyxia.
Urogenital Tract Abnormalities in Sons of Women Treated With Diethylstilbestrol
Authors: Henderson Brian E. , Benton Barbara , Cosgrove Malcolm , Baptista Joyce , Aldrich James , Townsend Duane , Hart William , Mack Thomas M.
Published: December 2021

Since in utero exposure to diethylstilbestrol (DES) is known to cause abnormalities of the female genital tract later in life, exposed male offspring were located, surveyed by mail, and compared with unexposed male offspring from the same period and medical practices. The exposed and unexposed respondents appeared comparable and did not differ in their response to most medical questions. However, a larger proportion of exposed than of unexposed boys had experienced problems in passing urine (12.9% vs. 1.8%; P = .0003) and abnormalities of the penile urethra (4.4% vs. 0%; P = .017).
Gasoline and Flammable and Nonflammable Clothing Studies
Authors: Crikelair George F. , Agate Frederic , Bowe Andrew
Published: December 2021

Studies were conducted on mannequins using gasoline and flammable and nonflammable children's clothing. The results indicate that the flame-resistant standards currently required by law for children's sleepwear lead to much less severe burns.
Dr. McMahon Replies
Authors: McMahon Jean L.
Published: December 2021

Dr. Stein's points are well taken. Making the diagnosis takes as much, if not more, knowledge and acumen than the administration of the medication. The term "organicity" as used in the statement is meant to differentiate the condition from that due to environmental causes or emotional disturbance. As in most forms of treatment, it is difficult, if not impossible, to rule out all psychogenic factors.

The description of "the hyperactive child" was intended to rule out failure due to retardation or cultural disadvantage rather than to imply the necessity for academic achievement.
Development of Attention in Preterm Infants
Authors: Hack Maureen , Mostow Ann , Miranda Simon B.
Published: December 2021

The quality of the awake state and attention in preterm infants has been evaluated by rating indices of attention such as widening of the eye, type of fixation, brightening, scanning, and cessation of sucking measured during visual fixation of patterns. Twenty-six infants ranging from 28 to 32 weeks' gestation at birth (mean, 31 weeks) were tested from one to four weeks postnatally until 36 weeks' gestation. Indices of attention were rated on a scale of 4 with an optimal mean index of 4.

A progressive increase in behaviors associated with fixation of visual stimuli has been shown from 32 to 36 weeks of conceptual age. Mean scores ranged from 0.7 at 31 weeks' gestation to 1.8 at 34 weeks' and 2.7 at 36 weeks' gestation. The possibility therefore exists that by as early as 31 to 32 weeks from conception the human brain may be capable of waking states and thus able to process some sensory stimulation.
Differential Effects of Maternal Heroin and Methadone Use on Birthweight
Authors: Kandall Stephen R. , Albin Susan , Lowinson Joyce , Berle Beatrice , Eidelman Arthur I. , Gartner Lawrence M.
Published: December 2021

An analysis of birthweights of 337 neonates in relation to history of maternal narcotic usage was undertaken Mean birthweight of infants born to mothers abusing heroin during the pregnancy was 2,490 gm, an effect primarily of intrauterine growth retardation. Low mean birthweight (2,615 gm) was also seen in infants born to mothers who had abused heroin only prior to this pregnancy, and mothers who had used both heroin and methadone during the pregnancy (2,535 gm). Infants born to mothers on methadone maintenance during the pregnancy had significantly higher mean birthweights (2,961 gm), but lower than the control group (3,176 gm). A highly significant relationship was observed between maternal methadone dosage in the first trimester and birthweight, i.e., the higher the dosage, the larger the infant. Heroin causes fetal growth retardation, an effect which may persist beyond the period of addiction. Methadone may promote fetal growth in a dose-related fashion after maternal use of heroin.
Iron Sufficiency in Breast-Fed Infants and the Availability of Iron From Human Milk
Authors: Mcmillan Julia A. , Landaw Stephen A. , Oski Frank A.
Published: December 2021

Four infants were studied who had been exclusively breast-fed for periods varying from 8 to 18 months. All had grown sufficiently to have exhausted their prenatally acquired iron endowment with respect to meeting current needs for maintaining normal hemoglobin levels. All infants had normal hemoglobin values and normal serum iron values. Studies of iron absorption from breast milk and cow's milk were performed in ten normal adults. The absorption of iron from the human milk was significantly higher. These findings suggest that the iron present in human milk is sufficient to meet the iron requirements of the exclusively breast-fed infant until he approximately triples his birthweight.
Breast milk leukocytes
Authors: Pitt Jane
Published: December 2021

The apparent increase in frequency of neonatal necrotizing enterocolitis1 and the recognition that the gastrointestinal tract is often the portal of entry in neonatal sepsis2 has renewed interest in breast milk as a source of newborn immunity. Attention has recently focussed on milk leukocytes. The purpose of this commentary is to summarize the available information on this subject and to examine the implications that this knowledge may have on the possible use of human milk-feeding to protect the newborn from infection.

Human colostrum and early milk contain 1 to 2 x 106 leukocytes; 80% to 90% of these are monocytic phagocytes and the remainder are lymphocytes.3,4
NATIONAL HEALTH INSURANCE: CAN WE LEARN FROM CANADA? Edited by Spyros Andreopoulos. New York, John Wiley & Sons, Inc., 1975, $10.95; 273 pp
Authors: Wheatley George M.
Published: December 2021

The assumption is widely prevalent that the United States will have in the not too distant future some form of national health insurance. The questions being debated now are what kind of national program and how it will be legislated.

Now that we may be on the threshold of another multibillion dollar social program, it is prudent to examine carefully the successes and errors of other countries in order to guide our planners to wise decisions and to avoid costly mistakes.
Feeding the Low-Birthweight Infant: Orally or Parenterally?: II. Corrected Bromide Space in Parenterally Supplemented Infants
Authors: Brans Yves W. , Sumners James E. , Dweck Harry S. , Bailey Penrhyn E. , Cassady George
Published: December 2021

Previously published data suggested that the faster rate of weight gain observed in parenterally supplemented neonates compared to their orally fed peers might be attributable to water retention rather than to more rapid tissue accretion. The present study was designed to test that hypothesis by observing changes in extracellular water, estimated as corrected bromide space (CBS).

Ten neonates with a mean birthweight of 1,250 gm (range, 800 to 1,980 gm) and a mean gestational age of 31 weeks (range, 24 to 38 weeks) were randomly assigned to a 67 cal/dl formula feeding or an oral 100 cal/dl formula feeding supplemented parenterally with dextrose and amino acids. CBS was estimated within 19 hours of birth and between the 7th and 28th postnatal days. Mean total daily water and protein intakes during the intervening period were similar for orally fed and supplemented neonates, but the latter took significantly less orally and received more parenterally. CBS increased in all but one of the supplemented neonates whereas two of four orally fed babies had decreasing values and one had stable values. Shorter times before regaining birthweight, faster rates of weight gain, and lower arterial pH were associated with larger CBS as well as with parenteral supplementation. These data suggest that parenteral supplementation may result in water retention and/or shifts from the intracellular to the extracellular space. Previously reported earlier and greater mean daily weight gains in supplemented babies may be related to water accumulation rather than tissue accretion, but definitive conclusions must await further studies, including concomitant estimates of total and extracellular body water.
Endotracheal Intubation and Its Relationship to Bacterial Colonization and Systemic Infection of Newborn Infants
Authors: Harris Howard , Wirtschafter David , Cassady George
Published: December 2021

The role of antibiotics in preventing respiratory tract bacterial colonization and systemic infection after orotracheal intubation was prospectively studied in 54 newborn infants. Respiratory tract colonization was assessed from nasopharyngeal and tracheal aspirate cultures obtained at intubation and daily thereafter, while systemic infection was monitored by blood, cerebrospinal fluid, and suprapubic urine cultures performed initially and every three days thereafter while intubated. Colonization and systemic cultures were also obtained at extubation or death. The study group, provided with antibiotics at intubation, and the control group were similar in birthweight and gestational age, as well as race, sex, hospital or origin, and indication for intubation. Colonization at intubation was five times more common in infants intubated 12 or more hours after birth than in infants intubated earlier. Subsequent colonization was twice as frequent in infants intubated longer than 72 hours as well as in those requiring two or more reintubations. Systemic infection occurred only in those infants who were initially or subsequently colonized and was three times more frequent in the control group than in the study group.
Neonatal Circumcision: A Ten-Year Overview: With Comparison of the Gomco Clamp and the Plastibell Device
Authors: Gee William F. , Ansell Julian S.
Published: December 2021

The records of 5,882 live male births were reviewed to ascertain the incidence and nature of complications following neonatal circumcision. Approximately one half of the patients were circumcised with the Gomco and half with the Plastibell. The incidence of complications was 0.2%; most frequent were hemorrhage, infection, and trauma; there were no deaths; and no transfusions were given.
Skin Lesions in Association With β-Hemolytic Streptococcus Group B
Authors: Lopez Juan B. , Gross Paul , Boggs Thomas R.
Published: December 2021

A full-term male infant delivered by caesarean section following a prolonged rupture of the amniotic membranes of 30 hours' duration manifested peculiar skin lesions at the time of birth consistent with the healing phase of bullous impetigo. He was colonized with β-hemolytic Streptococcus group B that was also cultured from the mother's cervix. It is possible this infant became infected in utero since the healing stage of the lesions suggest that they were present sometime before birth.
Ampicillin-Associated Diarrhea: Effect of Dosage and Route of Administration
Authors: Phillips John A. , Lovejoy Frederick H. , Matsumiya Yoichi
Published: December 2021

Ampicillin is one of the most frequently used antibiotics in pediatric practice.1 Its clinical efficacy has been widely studied, but its gastrointestinal side effects are poorly documented. In adults with urinary tract infections, 11% taking 1 gm/day of ampicillin orally had bowel movements which were at least twice as frequent as normal.2 Another series in adults receiving ampicillin reported an increase in stools with 16% having ≤5 and 5% having ≥5 stools per day. The change in stools increased with total dosage and was equal after oral or intravenous administration.3 In children, ampicillin ranging from 50 to the unusually high dose of 200 mg/kg/day resulted in mild diarrhea (≤5 stools per day) in 18% to 30%, moderate diarrhea (5 to 10 stools per day) in 2% to 11%, and severe diarrhea (≥10 stools per day) in 1% or less of cases.
Lymphangiomas of the Alveolar Ridges in Neonates
Authors: Levin L. Stefan , Jorgenson Ronald J. , Jarvey Bradley A.
Published: December 2021

Blue-domed, fluid-filled lesions on the alveolar ridges of neonates were noted in 3.7% of all normal black newborns examined. None were found in whites. On microscopic examination of eight such lesions, the diagnosis of lymphangioma was made. These lymphangiomas should not be confused with Epstein's pearls, Bohn's nodules, eruption cysts, or mucous retention phenomena. The natural history of such lymphangiomas is unknown. However, spontaneous regression was noted in several cases.
Language Screening Test
Authors: Nader Philip R.
Published: December 2021

The article by Schwartz and Murphy1 in the May 1975 issue emphasizes the key position of the pediatrician in recognition of speech and language disorders, as well as the lack of training of health professionals in this important area of development.

We would like to call attention to a five-minute screening test appropriate for children 6 months to 6 years of age. The Physician's Developmental Quick Screen for Speech Disorders (PDQ)2 is designed for use by non-speech pathologists.
A Cannabis Registry?
Authors: Milman Doris H.
Published: December 2021

The report of the Committee on Drugs on the effects of marihuana on man1 is commendable for its thorough survey of the current literature and its succinct presentation of a complex subject.

I would like to add some comments in regard to adverse psychological effects, an aspect of the marihuana problem that is of special interest to pediatricians.

The Committee discounts many reports of adverse effects on several grounds: uncontrolled observations, data from the Far East and Caribbean of doubtful clinical verity on men with nutritional and other disease problems, and the confusion of interpreting multiple drug effects.
Pulmonary Hypertension in the Perinatal Aspiration Syndromes
Authors: Fox William W , Gewitz Michael H. , Dinwiddie Robert , Drummond Willa H. , Peckham George J.
Published: December 2021

Ten patients clinically diagnosed as having perinatal aspiration syndromes were found to have pulmonary hypertension. These infants were either term or postmature babies and had the following characteristics: (1) systemic or suprasystemic levels of pulmonary artery pressure (range, 50 to 117 mm Hg); (2) a degree of pulmonary hypertension not related to the degree of aspiration evident on chest roentgenograms; (3) evidence of right-to-left shunting at the ductal or foramen ovale level; and (4) sustained severe hypoxemia despite 100% inspired oxygen concentration. The overall mortality for the group was 50%. Since these patients had marked clinical and physiologic similarities to patients previously reported as having the persistent fetal circulation syndrome (PFC), they were classified as having "PFC with aspiration." The existence of pulmonary hypertension should be suspected despite roentgenographic evidence of aspiration in any patient who also manifests the clinical characteristics of PFC because its treatment may alter the prognosis of such patients.
Simultaneous Iothalamate, Creatinine, and Urea Clearances in Children With Renal Disease
Authors: Brouhard Ben H. , Travis Luther B. , Cunningham Robert J. , Berger Michael , Carvajal Hugo F.
Published: December 2021

Glomerular filtration rate (GFR) is often used to evaluate and manage patients with renal disease. Few studies in children have compared accurate estimations of GFR (clearance of inulin and/or iothalamate) with the clearance of creatinine which, because of simplicity, has been used as an approximation of GFR. At reduced levels of GFR, studies in adults suggest that the mean of the creatinine and urea clearances closely approximate the GFR. The present investigation shows that the clearance of creatinine approximates the GFR at normal levels; however, at reduced levels the creatinine clearance and the mean of the creatinine and urea clearances both overestimate the GFR as measured by iothalamate. The clearance of creatinine remains a useful clinical tool if its limitations at low levels of GFR are realized.
Helping Parents Cope With the Diagnosis of Congenital Heart Defect: An Experimental Study
Authors: Kupst Mary Jo , Blatterbauer Sandra , Westman James , Schulman Jerome L. , Paul Milton H.
Published: December 2021

An experimental study was designed to help parents cope with the implications of the diagnosis of congenital heart disease. Intervention strategies involving clarification of medical information, discussion of psychological issues, and a combination of the two, were more effective than no intervention in helping parents to gain an accurate understanding of the diagnosis and other medical information. Regardless of the intervention strategy used, satisfaction was generally high, and parent anxiety did not appear to fluctuate during the course of the visit. The team approach was recommended for use in pediatric specialty clinics where time is often short, and a more personal interaction may he needed.