bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypothalamic Adipsia Without Demonstrable Structural Lesion
Authors: Hayek Alberto , Peake Glenn T.
Published: December 2021

The clinical and laboratory data of a 5-year-old boy with the syndrome of essential hypernatremia are presented. In a four-year follow-up, no demonstrable hypothalamic structural lesion has been identified. Review of the literature has uncovered four similar cases, suggesting a distinct syndrome of altered hypothalamic function. The syndrome is characterized by: adipsia-hypodipsia (5/5 patients), recurrent hypernatremia (5/5), obesity (4/5), inability to excrete a water load (5/5), lack of growth hormone release in response to provocative stimuli (4/4), blunted thyrotropin releasing hormone responses (3/4), hypothyroidism (2/4), and hyperlipemia associated with hypernatremic crisis (1/1). In one of the patients the syndrome has been attributed to a disturbance of the opioid-peptide system.
Prostacyclin and Platelet Aggregation in Sickle Cell Disease
Authors: Mehta Paulette , Albiol Loreto
Published: December 2021

Patients with sickle cell disease have been described to have decreased platelet aggregation. The cause of this decrease is believed to be the refractory state of platelets from continual in vivo activation. In this study, plasma 6-keto PGF1α (stable metabolite of vessel wall-derived prostaglandin, prostacyclin) levels were measured to study the mechanism of decreased platelet aggregation. Plasma 6-keto PGF1α levels were measured by radioimmunoassay in ten patients with sickle cell disease and in ten control subjects. Plasma 6-keto PGF1α levels in normal subjects ranged from 0 to 100 pg/ml (mean 40 ± 14 pg/ml), but were significantly higher in patients with sickle cell disease (range 170 to 880 pg/ml, mean 446 ± 89 pg/ml, P < .002). Platelet aggregation in response to an endoperoxide analog in these patients was lower compared with that of the control subjects. This study suggests that prostacyclin activity is increased in subjects with sickle cell disease. This increased activity is probably due to persistent stress to the endothelium from hemolysis and continual platelet activation. Decreased platelet aggregation seen in these patients may be due to elevated prostacyclin activity.
Nonnutritive Sucking During Tube Feedings: Effects on Preterm Neonates in an Intensive Care Unit
Authors: Field Tiffany , Ignatoff Edward , Stringer Sharon , Brennan Jayne , Greenberg Reena , Widmayer Susan , Anderson Gene C.
Published: December 2021

Preterm neonates (mean 32 weeks' gestation, 1,300 gm birth weight) were provided a pacifier for nonnutritive sucking during tube feedings in the intensive care nursery. Their clinical course, subsequent bottle feeding behavior, and performance on the Brazelton Neonatal Behavior Assessment Scale were compared with those of control group infants. The infants provided with pacifiers averaged 27 fewer tube feedings, started bottle feeding three days earlier, averaged a greater weight gain per day, and were discharged eight days earlier for an average hospital cost savings of approximately $3,500. Formula intake was similar for the two groups, although nurses appeared to provide more feeding stimulation for the control infants. On the Brazelton scale, the infants provided with pacifiers showed weak reflexes more frequently. Increased restfulness and diminished activity level in these infants may have contributed to the appearance of weak reflexes. The consistency between these fmdings and those of previous investigators suggests that the provision of a pacifier for nonnutritive sucking during tube feedings may be a cost-effective form of intervention.
Aspergillus Osteomyelitis in an Immunocompetent Adolescent: A Case Report and Review of the Literature
Authors: Corrall C. James , Merz William G. , Rekedal Kirby , Hughes Walter T.
Published: December 2021

A black male adolescent with intact cellular and humoral immunity developed Aspergillus flavus-caused osteomyelitis involving the right tibial epiphysis following penetrating injury to that area. There was an apparent cure following amphotericin B therapy for six weeks. The clinical, pathologic, and therapeutic features of this case are described and compared with those in previously published cases. This case report represents the first well documented case of Aspergillus osteomyelitis in an immunocompetent host. The increasing incidence of invasive disease due to Aspergillus species and the increased awareness of the incidence of mycotic bone infections, particularly in pediatric patients, may allow further definition of pathogenesis and appropriate therapy.
Fab Fragments of Digoxin-Specific Antibodies Used to Reverse Ventricular Fibrillation Induced by Digoxin Ingestion in a Child
Authors: Zucker Aaron R. , Lacina Samuel J. , DasGupta D. S. , Fozzard H. A. , Mehlman David , Butler Vincent P. , Haber Edgar , Smith Thomas W.
Published: December 2021

Digitalis poisoning is a rare problem in children, but it may be life threatening. A case of massive overdose of digoxin in a 2½-year-old boy that produced prolonged ventricular fibrillation refractory to conventional therapy is reported. After two hours the boy was given digoxin-specific Fab fragments of antibody in sufficient quantity to bind his estimated dose of 10 mg. By completion of the treatment minutes later, normal rhythm and circulation were restored. The serum free digoxin level before antibody administration was > 100 ng/ml, and it rapidly fell to undetectable levels after antibody was given. Digoxin bound to the antibody had a clearance half-life of approximately 48 hours. The child had no apparent neurologic damage and his intellectual function was normal on discharge. He had a transient hematuria and a residual incomplete right bundle branch block. Administration of purified Fab fragments of digoxin-specific antibodies can be life saving in children with digitalis poisoning, and prolonged cardiopulmonary resuscitation in children is justified when the cause of cardiac arrest is potentially reversible.
Canalization of Early Psychological Development
Authors: Kagan Jerome
Published: December 2021

Recent research on the infant and young child suggests that the maturation of cognitive abilities and biologically based temperamental dispositions plays an important role in early psychological development. The enhancement of the cognitive competence of retrieval memory displayed during the end of the first year is a prerequisite for the universal fears of infancy, and the capacities for empathy and inference appear to be necessary for the development of standards on aggression. The temperamental disposition to display inhibition and distress to the unfamiliar appears to be a stable and significant characteristic of children in the second year of life.
Covert Administration of Benzyl Alcohol to Neonates
Authors: Humma K. Gregory
Published: December 2021

On May 28, 1982, the Food and Drug Administration issued a letter to physicians and hospital pharmacists concerning the apparent toxicity of benzyl alcohol in premature infants (H. M. Meyer, Jr, Director, Bureau of Drugs and Biologics, Public Health Service, Food and Drug Administration, Rockville, MD). Cases were described in which neonates weighing less than 2,500 gm had died from a syndrome consisting of metabolic acidosis, CNS depression, respiratory distress, hypotension, renal failure, and sometimes seizures and intracranial hemorrhages.
Isolation of Human Surfactant from Amniotic Fluid and a Pilot Study of Its Efficacy in Respiratory Distress Syndrome
Authors: Hailman Mikko , Merritt T. Allen , Schneider Howard , Epstein Benita L. , Mannino Frank , Edwards David K. , Gluck Louis
Published: December 2021

Isolation of a sterile, surface-active human surfactant complex from amniotic fluid is described. Its effects on respiratory failure of five very low-birth-weight infants (974 ± 61 g) with severe RDS were studied before and after surfactant administration and were compared with those of a similar group of untreated infants with severe respiratory distress syndrome (RDS). Human surfactant (60 mg/kg) in 3.5 mL of saline was given as a single bolus intratracheally 6 ± 1 hours after birth with the following effects: Pao2 increased from 69 ± 11 mm Hg to 239 ± 19 mm Hg within five minutes, and within 1 hour fraction of inspired oxygen (FiO2) decreased from 0.94 ± 0.03 to 0.49 ± 0.03, mechanical ventilator pressure requirements decreased significantly, PaCo2 dropped, and the pH increased. Air bronchograms on chest roentgenograms lessened within five hours. In four infants the beneficial effects lasted eight to 15 hours, and although thereafter their respiratory conditions deteriorated somewhat, the RDS was less severe than before surfactant administration, and there were no associated pulmonary complications. However, a fifth infant had severe respiratory failure after striking improvement that lasted fewer than three hours, and subsequent interstitial emphysema, bronchopulmonary dysplasia, and intraventricular hemorrhage occurred. There were no detectable side effects with surfactant administration, although a search for immunologic complications continues. Protease activity in lung effluent from the treated infants was lower during the first week of life than among the comparison group, suggesting a lessening of lung injury by surfactant treatment. RDS among patients treated with one dose of human surfactant tended to be milder overall than RDS among control subjects.
Parental Behavior of Adolescent Mothers
Authors: Elster Arthur B. , McAnarney Elizabeth R. , Lamb Michael E.
Published: December 2021

The results of the studies reviewed lead to the conclusion that some adolescent parents are faced with excessive stress, have an inadequate social support network, lack adequate knowledge of child development, are developmentally immature, and possess inappropriate child-rearing attitudes. The lack of rigorous, well-controlled studies, however, makes these conclusions tentative at best. Each of the socioeconomic and psychological factors listed above, in addition to innate infant characteristics, affects parental behavior. Too few studies have been done to state conclusively which of these factors have major effects on adolescent parenting. Preliminary results would suggest, however, that adolescent and adult mothers interact differently with their children. The reasons why this occurs and the significance of this difference are not presently known. Although there are conflicting results, it appears as though children of adolescent parents are at a slightly increased risk for child abuse, but not suboptimal intellectual development, when compared to children of adult mothers.
Gonorrhea in Prepubertal Children
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

Physicians should assume that children with gonorrhea have acquired it by sexual contact and that most such contacts are abusive. Children old enough to talk will often reveal the nature of the sexual contact if interviewed skillfully and sensitively in privacy. Such interviews are an essential part of the evaluation of children with gonorrhea and should be conducted as soon as possible after the diagnosis is made, and when it is suspected on clinical grounds prior to bacteriologic confirmation. Sexual abuse of children is common and is usually perpetrated by a relative or a caretaker of the child. It is usually accomplished secretly and without force, and it commonly continues for months or years with very serious psychological consequences for the victim. Often the child has complained to a parent and has not been believed. The occurrence of symptomatic gonorrhea and the resulting contact may provide a rare opportunity for intervention. The diagnosis of gonorrhea in a prepubertal child will dictate reports to both protective agencies and the public health department. It should not be assumed that the agencies will communicate with each other. In areas where sexual abuse treatment programs exist, consultants associated with them may be very helpful.
The Clinical Significance of Placental Villous Edema
Authors: Naeye Richard L. , Maisels M. Jeffrey , Lorenz Robert P. , Botti John J.
Published: December 2021

A study was undertaken to determine why there is such variability in morbidity and mortality in neonates exposed to antenatal chorioamnionitis. Villous edema provides a clue. It was present in 72/83 placentas with chorioamnionitis. The extent and severity of the edema had a strong, positive correlation with cord arterial blood pH values, low Apgar scores, the need to resuscitate vigorously at birth, the subsequent need for assisted ventilation, the frequency of hyaline membrane disease, and neonatal mortality. Most of the difference in morbidity and mortality between preterm and full-term infants was related to the greater severity and extent of villous edema in those born prematurely.
Infants Weighing 1,000 Grams or Less at Birth: Developmental Outcome for Ventilated and Nonventilated Infants
Authors: Rothberg Alan D. , Maisels M. Jeffrey , Bagnato Stephen , Murphy James , Gifford Kathleen , Mckinley Karen
Published: December 2021

The neurodevelopmental outcome at a mean age of 40 months was investigated in 23/25 surviving infants of birth weights ≤1,000 gm. Eight infants required intubation and assisted ventilation and 17 were not ventilated. One ventilated infant was lost to follow-up and one nonventilated infant was a victim of sudden infant death syndrome at age 6 months. Fifteen (65%) had a good outcome but the differences between ventilated and nonventilated infants were striking. Thirteen (81%) of the nonventilated group were normal, but only two ventilated survivors (28%) were normal (P < 0.05). Cicatricial retrolental fibroplasia occurred in three (43%) of the ventilated survivors and in none of the nonventilated infants (P < .02). The requirement for assisted ventilation in these very low-birth-weight infants is associated with significant morbidity. Improvement in outcome may depend as much upon better understanding and management of prenatal events as upon improvements in neonatal care.
Prenatal Screening for Neural Tube Defects
Authors: HOLTZMAN NEIL A.
Published: December 2021

Despite improvements in management,1 open spina bifida (OSB) remains severely handicapping, associated in almost all patients with paraplegia, impaired bladder, and bowel control, and, in 25%, with IQs of less than 80 (calculated from McLone et al2). Social isolation and diminished self-esteem are observed more frequently in adolescents with OSB than in healthy control subjects.3 The divorce rate among parents of affected children can be high.4 On the order of $70,000 is spent in the lifetime care of a person with OSB, and another $12,000 is lost through diminished productivity.5 With an incidence of approximately one in 2,000 live births in the United States in 1980,6 OSB is one of the most common of all serious congenital malformations.
Probable Graft-Versus-Graft Reaction
Authors: BUCKNER C. DEAN
Published: December 2021

To the Editor.—

The report by Lauer et al "Probable Graft-vs-Graft Reaction in an Infant after Exchange Transfusion and Marrow Transplantation" deserves comment. Proof of initial engraftment from the random blood donor depends on the HLA type of the donor. The HLA typing of the patient's lymphocytes rules out engraftment unless the donor was fortuitously HLA matched and this is conceivable as the HLA phenotype is a relatively common one. It is also suggested from other reports that some degree of donor-recipient compatibility is necessary for engraftment via blood transfusions.
Likelihood Ratio, Skull Roentgenograms, and Clinical Decision-Making
Authors: LEVENTHAL JOHN M. , LEMBO ROBERT M.
Published: December 2021

To the Editor.—

In the February 1982 issue of Pediatrics, Leonidas et al1 examined the relationship between clinical findings and skull fractures in children evaluated with skull roentgenograms to develop reliable criteria for the ordering of roentgenograms in patients with head trauma. In their analysis, the authors used the liklihood ratio (LR) to characterize quantitatively the relationship between a clinical finding and the presence of a skull fracture. As defined by the authors, the LR is that ratio between the probability of a certain clinical finding occurring in the presence of a fracture and the probability of the same clinical finding occurring in the absence of a fracture.
Hypertension Screening in the Follow-up of Premature Infants
Authors: Sheftel David N. , Hustead Virginia , Friedman Aaron
Published: December 2021

Results of hypertension screening using the Doppler technique in a group of premature infants following discharge from an intensive care nursery are reported. Systolic blood pressure (BP) was measured at follow-up in 79/99 premature infants who were cared for in the special care nursery over a 9-month period. The mean BP was 99.3 ± 2.0 (SEM) mm Hg at a mean age of 14.7 ± 1.3 weeks; mean age corrected for 40 weeks of gestation was 7.4 ± 1.3 weeks. Seven infants (8.9%) with BP greater than 113 on three separate occasions were identified as hypertensive. Three of these hypertensive infants were found to have a specific etiology requiring treatment: neuroblastoma, coarctation of the aorta, and unilateral ureteropelvic junction obstruction. No difference was found between the hypertensive and normotensive infants for a variety of perinatal and neonatal factors, including the presence or duration of an umbilical arterial catheter. These data suggest that the premature infant may be at risk for the development of hypertension. In the future, neonatal follow-up programs may find hypertension screening a useful part of their evaluation.
Idiopathic Disorders of Fecal Continence in Children
Authors: Arhan Pierre , Devroede Ghislain , Jehannin Bertrand , Faverdin Claude , Révillon Yann , Lefevre Daniel , Pellerin Denys
Published: December 2021

A group of 176 patients aged 2 to 15 years was investigated for idiopathic disorders of bowel function other than Hirschsprung's disease. Anorectal motility, as well as colorectal transit of radiopaque markers, were investigated. Before the end of the first month of life, 70 of the patients were constipated. Resting pressure was more unstable (P < 0.001) and higher than normal in the rectal ampulla and upper anal canal (P < 0.01). Retardation of markers occurred in the proximal and/or distal large bowel of 61% of the patients. The existence of functional abnormalities was demonstrated in the majority of children with idiopathic disorders of fecal continence.
Hemorrhagic Periventricular Leukomalacia in the Neonate: A Real-Time Ultrasound Study
Authors: Levene Malcolm I. , Wigglesworth Jonathan S. , Dubowitz Victor
Published: December 2021

Periventricular leukomalacia is an important complication of hypoperfusion of the brain in immature newborn infants. In a real-time ultrasound study with frequent scanning of 120 infants of birth weight <1,501 g, hemorrhagic periventricular leukomalacia was observed in nine (7.5%), and in five of these infants subsequent development of cystic degeneration was noted. The overall incidence of intraventricular hemorrhage in the same population was 48%.
Achalasia: Diagnosis, Management, and Clinical Course in 16 Children
Authors: Berquist William E. , Byrne William J. , Ament Marvin E. , Fonkalsrud Eric W. , Euler Arthur R.
Published: December 2021

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.
Relative Anemia and Iron Deficiency in Cystic Fibrosis
Authors: Ater Joann L. , Herbst John J. , Landaw Stephen A. , O'Brien Richard T.
Published: December 2021

Significant alterations in hemotologic function in cystic fibrosis are suggested by the observation that polycythemia is uncommon, even among cyanotic patients. To elucidate those factors that influence hematologic equilibrium, 39 stable patients with cystic fibrosis were evalulated with regard to hemoglobin, hematocrit, RBC indices, reticulocyte count, serum iron and total iron binding capacity, serum ferritin, vitamin E, and carboxyhemoglobin levels. Hemoglobin concentrations were below the 50th percentile for age in 90% of the patients, including the 23% who were cyanotic. Serum ferritin levels were below the mean for age in 85% and below 12 ng/mL in 33% of patients. Vitamin E levels were less than 5 µg/dL in 33%, indicating deficiency. Carboxyhemoglobin values were elevated in 64% of the patients. These data indicate that relative anemia is common in cystic fibrosis and suggest that iron and vitamin E deficiency may contribute to that anemia. Twenty-two patients with cystic fibrosis were then given 2 weeks of oral iron therapy followed by two to three additional weeks of iron and vitamin E. This therapeutic trial resulted in an increase in mean hemoglobin concentration from 13.87 to 14.50 g/dL (P < 0.01) associated with a significant increase in levels of serum ferritin (P < 0.001). The increase in hemoglobin occurred primarily during the second 2 weeks when patients were receiving both iron and vitamin E. However, we were unable to document evidence of increased hemolysis when patients were receiving iron therapy alone. This response to oral iron therapy is confirmation that iron deficiency contributes to the failure of some patients with cystic fibrosis to compensate hemotologically for hypoxia.
Preoperative Chest Radiographs
Authors:   Committee on Hospital Care
Published: December 2021

Review of the medical literature indicates that routine preoperative chest radiographs identify few children with unsuspected significant disease. Therefore, the Committee on Hospital Care of the American Academy of Pediatrics recommends that these examinations should not be considered mandatory and should be performed only at the discretion of the attending physician. Chest radiographs should not be a substitute for a complete medical history and physical examination, which remain the most effective methods for determining those patients who are at risk for complications associated with surgery.

Preoperative chest radiographs may be indicated when, for example, the history or physical findings suggest respiratory, cardiovascular, chronic renal, immune deficiency, or certain hematologic disease, or malignancy with possible pulmonary involvement. Similarly, these examinations may be helpful whenever it is anticipated that their results will be needed for comparison with postoperative radiographs. In any case, the attending physician should have the freedom to request preoperative chest radiographs under any circumstances in which his/her clinical judgment dictates the procedure to be appropriate.
Decreased Prostacyclin Levels in Sickle Cell Disease
Authors: MEHTA PAULETTE , ALBIOL LORETO
Published: December 2021

In Reply.—

We read with interest the letter by Longenecker and Mankad regarding measurements of prostacyclin metabolites in patients with sickle cell disease. The major difficulty in this area has been variability of measurements inasmuch as radioimmunoassay measurements of 6-keto-PGF1α of less than 100 pg/mL are considered unreliable.

The data given by Longenecker and Mankad raise some important questions. The normal levels of 6-keto-PGF1α, which they found, are similar to those detected by us. In contrast to our findings, patients with sickle cell disease had even lower concentrations which are in undetectable range for this assay and are therefore not reliable.
Adolescent Chest Pain: A Prospective Study
Authors: Pantell Robert H. , Goodman Benjamin W.
Published: December 2021

One hundred adolescents with chest pain were prospectively analyzed to determine the etiology, functional consequences, and illness attributions of patients seen in a general pediatric clinic. The typical patient had frequent pain (63% had two or more episodes weekly) of moderate duration (51% of the pain lasted longer than six minutes) that had been occurring for many months (36% had pain occurring longer than 6 months). Stressful events, such as a death in the family, major illness, an accident, family separations, and school changes occurred in 31% of patients. The most frequently diagnosed condition was musculoskeletal problems (31%) including costochondritis (14%), chest wall syndrome (13%), skeletal trauma (2%), and ribcage anomalies (2%). Hyperventilation accounted for 20% of diagnoses and 5% had breast-related problems. Thirty-nine percent of patients had pain not readily classifiable. Serious underlying illness was a rare cause of chest pain, although several patients had associated organic disease not responsible for their chest pain. More than two thirds of patients restricted physical activities; more than 40% were absent from school. When patients were questioned about their understanding of their illness, 44% were afraid that they were experiencing a heart attack, 12% worried about heart disease, and 12% feared cancer. Chest pain is a prevalent problem that is usually benign but is commonly misunderstood and causes considerable dysfunction and anxiety in adolescents.
Hyaline Membrane Disease Treated with Bovine Surfactant
Authors: Smyth J. A. , Metcalfe I. L. , Duffty P. , Possmayer F. , Bryan M. H. , Enhorning G.
Published: December 2021

Six preterm infants with severe hyaline membrane disease requiring ventilation were treated, at a median age of 15.5 hours, with a single intratracheal bolus of a bovine surfactant suspension. Arterial oxygenation increased dramatically, and chest radiograms showed improvement after two to four hours. However, a variable degree of deterioration occurred within 24 hours. All of the infants required oxygen therapy for several weeks, and one developed severe bronchopulmonary dysplasia.
Cardiovascular Manifestations in the Larsen Syndrome
Authors: Kiel Ernest A. , Frias Jaime L. , Victorica Benjamin E.
Published: December 2021

The Larsen syndrome consists of a skeletal dysplasia with multiple joint dislocations and a characteristic facies. The basis of the abnormalities is felt to be a generalized mesenchymal disorder involving connective tissues. More than 80 cases have been reported in the literature with isolated reports of congenital cardiac septal defects and acquired abnormalities of the aorta and mitral valve. A case with marked aortic dilation and insufficiency as well as an aneurysm of the ductus arteriosus is presented. The aortic lesions are similar to those described in other connective tissue disorders, particularly the Marfan syndrome. Previous reports of ductal aneurysms have not revealed an association with connective tissue disorders, but have described a significant morbidity. In summary, patients with the Larsen syndrome are likely to have cardiac lesions similar to those classically associated with the Marfan syndrome; these patients deserve a careful investigation for cardiac anomalies. These aortic lesions may be as prognostically significant as cardiac lesions in the Marfan syndrome.
Transient Immunodeficiency During Asymptomatic Epstein-Barr Virus Infection
Authors: BOWEN THOMAS J. , WEDGWOOD RALPH J. , OCHS HANS D. , HENLE WERNER
Published: December 2021

In vivo and in vitro humoral and cellular immune responses were studied in a 2½-year-old girl immediately before, during, and after an asymptomatic infection with Epstein-Barr virus. During the acute EBV infection, the patient's peripheral blood mononuclear cells were deficient in immunoglobulin synthesis and suppressed the in vitro immunoglobulin synthesis of normal allogeneic cells. In vitro mitogen transformation of lymphocytes was reduced. In vivo antibody responses to the T cell-dependent antigens bacteriophage φX 174 and Keyhole limpet hemocyanin were markedly depressed. These studies suggest that suppressor cells induced during acute EBV infection not only suppress immunoglobulin synthesis in vitro, but also interfere with in vivo antibody synthesis.
Cholelithiasis in a 3-Week-Old Small Premature Infant
Authors: BOYLE ROBERT J. , SUMNER THOMAS E. , VOLBERG FRANK M.
Published: December 2021

Cholelithiasis is an extremely unusual finding in infancy. Hemolytic disease, infection, ileal disease, and anatomic deformity of bile ducts have been implicated.1 Recently, an association of prematurity, bronchopulmonary dysplasia, total parenteral nutrition, and furosemide has been reported.2

We have observed a small premature infant who developed cholelithiasis early in his hospital stay after a very short course of parenteral nutrition.

CASE REPORT

The patient was an 810-g male infant of 28 weeks' gestation (by Dubowitz examination) born to a 25-year-old gravida 2, para 1, abortus 1. The pregnancy was complicated only by premature rupture of membranes followed by labor. The mother had no fever or other signs or symptoms of infection prior to delivery.
Serum Immunoglobulins in Preterm Infants: Comparison of Human Milk and Formula Feeding
Authors: Savilahti Erkki , Järvenpää Anna-Liisa , Räihä Niels C. R.
Published: December 2021

Serum concentrations of immunoglobulins (IgA, IgG, and IgM) were studied in 64 preterm infants with gestational age of 31 to 36 weeks (mean 33.2 weeks), between 1 week and 4 months after birth. Infants were fed solely human milk or formula based on cow's milk. Infants fed formula exhibited significantly higher IgA levels at the age of 9 to 13 weeks than infants fed human milk. Infants given human milk who received more than 60% of their feeding in the hospital from their own mother had significantly higher IgA levels at the age of 3 weeks than did those receiving less than 30% of their feeding from their own mother. At 1 week of age, formula-fed infants with gestational age of 31 to 33 weeks had a significantly lower mean IgG concentration than those with gestational age of 34 to 36 weeks. However, the two term subgroups of infants receiving human milk, had similar mean concentrations of IgG and the value for infants of 31 to 33 weeks of gestation was significantly higher than that for formula-fed infants at the same gestational age. Serum IgM concentrations were similar whether infants were receiving human milk or formula. The formula feeding caused a more rapid maturation of IgA than did human milk. Results suggest that preterm infants may absorb IgA from the milk of their own mothers and that preterm infants with gestational age of 31 to 33 weeks may absorb IgG from human milk.
Hyperosmolality in Small Infants Due to Propylene Glycol
Authors: GLASGOW ALLEN M. , BOECKX ROGER L. , MILLER MARILEA K. , MACDONALD MHAIRI G. , AUGUST GILBERT P. , GOODMAN STEPHEN I.
Published: December 2021

Propylene glycol (1,2-propanediol) is used in many drug preparations. Although propylene glycol is regarded as having low toxicity in adults, in humans and animals there have been reports of CNS, renal, hematologic, and cardiac toxicity.1-5 The absorption of propylene glycol through large burn wounds has recently been documented as a cause of serum hyperosmolality.6,7

Investigation of the cause of unexplained hyperosmolality in a premature infant led to the finding that several infants in our nursery were hyperosmolar due to administration of propylene glycol in a multivitamin preparation used in parenteral nutrition. This finding raises concern about the relatively large dose of propylene glycol that may be received by very small infants, especially those receiving multiple medications.
Soy-Protein Formulas: Recommendations for Use in Infant Feeding
Authors:   Committee on Nutrition
Published: December 2021

Many infant formulas are available as alternatives to breast-feeding. These formulas are necessary and valuable resources in the nutriture of infants, but it is important to evaluate their use and efficacy periodically. Soybean preparations were suggested as a milk substitute by Hill and Stuart1 in 1929.

Since then, the use of these products has expanded appreciably, and they are used for an estimated 10% to 15% of all formula-fed infants. This increase in use has prompted examination of the following critical issues about the indications for use of soy-protein formulas in infants. (1) Are soy-protein formulas an adequate nutritional substitute for cow's milk-based formulas in full-term infants? (2) Is it appropriate to recommend soy-protein formulas to provide a lactose-free formula, or are there better alternatives? (3) Are soy-protein formulas ever indicated for use in premature infants? (4) What is the evidence for and against the use of soy-protein formulas in the management of cow's milkprotein allergy? (5) What is the role of soy-protein formulas in prophylaxis of allergic disease? (6) What is the evidence for and against the use of soy-protein formulas in the management of "colic"?

Examination of these issues will hopefully, provide a more clear-cut basis for decisions regarding the use of soy-protein formulas and updated recommendations for the role of soy-protein formulas in feeding human infants.

COMPOSITION OF SOY-PROTEIN FORMULAS

Soy-protein formulas, although different in carbohydrate and protein source, are similar in composition to cow's milk-protein formulas following the American Academy of Pediatrics, Committee on Nutrition, 1976 recommendations for nutrient levels in infant formulas.2
Newborn Screening for Phenylketonuria: Predictive Validity as a Function of Age
Authors: McCabe Edward R. B. , McCabe Linda , Mosher Gayle A. , Allen Richard J. , Berman Julian L.
Published: December 2021

Data from questionnaires were assembled for 109 infants with phenylketonuria (PKU) and 114 control infants to assess the predictive validity of newborn screening for PKU as a function of age. Patients with PKU had values of <4 mg/dL in cord blood and in samples from days 1, 2, and 4 through 7. The proportion of patients with PKU expected to fall below screening cutoffs of 2, 4, and 6 mg/dL was predicted for each age range. Using a cutoff of 4 mg/dL, approximately one third of patients with PKU would be missed by a sample taken from the neonate in the first 12 hours of life, and nearly 10% would be missed with a sample from the second 12 hours of life. This study shows that not all patients with PKU will be detected by newborn screening, and that the phenomenon of early nursery discharges must be considered in developing appropriate screening strategies.
Is There an Acquired Immune Deficiency Syndrome in Infants and Children?
Authors: AMMANN ARTHUR J.
Published: December 2021

An acquired immune deficiency syndrome (AIDS) has recently been described in young homosexual males.1,2 As defined by the Centers for Disease Control (CDC), AIDS is a disorder characterized by T-cell immunodeficiency, recurrent and chronic infection with a variety of opportunistic infections and/or Kaposi's sarcoma. Following initial reports in 1981, an intensive surveillance program was instituted. In 1983, more than 1,000 cases were recorded. However, in addition to AIDS as defined by the CDC, it is clear that there are several related syndromes which include individuals with chronic lymphadenopathy, fever, and weight loss (lymphadenopathy syndrome); other malignancies; and healthy homosexuals with laboratory evidence of immunologic dysregulation.3,4
Hazards of Battery Ingestions
Authors: MOFENSON HOWARD C. , GREENSHER JOSEPH , CARACCIO THOMAS R.
Published: December 2021

To the Editor.—

We found the report from Temple and McNeese1 on the hazards of small flat disc batteries very timely. The management of these ingestions has been controversial and in recent months, the pendulum of recommendations for therapy has swung from nonintervention to very early endoscopic or surgical intervention.

The Nassau County Medical Center's Long Island Regional Poison Control Center has reviewed its battery ingestion experience and statistics for the past 16 months.2 Only 1/30 cases of small flat disc battery ingestions required surgical intervention for removal of an intact battery.
Current Status of the Identification and Management of Tinea Capitis
Authors: Krowchuk Daniel P. , Lucky Anne W. , Primmer Susan I. , McGuire Joseph
Published: December 2021

Tinea capitis due to Trichophyton tonsurans has become a significant health problem affecting children and adolescents. This infection has several different distinctive clinical patterns which, if not recognized, may result in delayed diagnosis and therapy. This review is designed to emphasize the differences between tinea capitis caused by T tonsurans and that caused by other organisms. Current diagnostic and therapeutic measures are discussed.
Teenage Pregnancy: A Prospective Study of Self-Esteem and Other Sociodemographic Factors
Authors: Vernon Mary E. L. , Green James A. , Frothingham Thomas E.
Published: December 2021

A prospective study was undertaken to examine the relationship of self-esteem and other factors theorized to contribute to teenage pregnancy. The Coopersmith Self-Esteem Inventory and a questionnaire concerning demographic, attitudinal, and other factors, were administered to 874 of the 1,007 teenage women enrolled in two city high schools. During the following year, 95 of 858 teenage women followed up became pregnant, a pregnancy rate of 11.1%. The data show no significant association of self-esteem with subsequent pregnancy. Twelve of the 27 questionnaire items were associated significantly with pregnancy. However, further analysis revealed that either alone or in combination, there were no more than 57% sensitivity and 67% specificity for prediction of subsequent pregnancy from the questionnaires.
Unexpected Death of an Infant Sibling
Authors: Mandell Frederick , McAnulty Elizabeth H. , Carlson Andrew
Published: December 2021

When infants die suddenly and unexpectedly, family structures are abruptly altered. This loss and its subsequent changes affect remaining older siblings. New "big brother" and "big sister" roles are suddenly terminated, often in a catastrophic manner. Young surviving children are sometimes unable to understand the meaning of this event, its impact on the family, and their own role in what has occurred. In this study, 26 families that had sustained the sudden and unexpected death of an infant and that had surviving children were interviewed to obtain data about surviving siblings at least 10 months following the loss. Among the 26 families, there were 35 surviving siblings (ages 16 months to 6 years). The interview schedule sought information relevant to changes in patterns of sleep, toilet training, feeding habits, peer relationships, and parent-child interaction. Among these 35 surviving siblings, parents of 28 siblings (80%) perceived changes in their child's interaction with them, 24 siblings (69%) demonstrated changes in sleep patterns following the baby's death, and 13 siblings (37%) showed changes in social interaction. Regression in toilet training and changes in feeding patterns were infrequent and not areas of major concern for parents. These behavioral changes reflected both a continuum of adjustment by the child and a persistence of parental worries.
Auditory Nerve-Brainstem Evoked Responses in Hyperbilirubinemic Neonates
Authors: Perlman Max , Fainmesser Pinchas , Sohmer Haim , Tamari Hanna , Wax Yohanan , Pevsmer Bella
Published: December 2021

On the basis of the known predilection of the auditory brainstem pathway for bilirubin toxicity, we have examined auditory brainstem responses of neonates during the period of hyperbilirubinemia. The auditory brainstem responses of 24 infants with serum bilirubin values between 15 to 25 mg/dL were compared with the responses of 19 infants without hyperbilirubinemia, who had similar gestational and postnatal ages. Wave IV-V complex was absent in at least one recording of 10/24 jaundiced infants, whereas wave complex IV-V was consistently present in all of the 19 infants without hyperbilirubinemia (P <.001). Jaundiced infants also had prolonged brainstem transmission time (P <.01) which reflected increased latency at both lower and upper brainstem levels. The above changes were rapidly reversed in the majority of instances. Neonatal jaundice was associated with significant transient aberrations of auditory brainstem responses, suggestive of a transient brainstem encephalopathy. This evidence of bilirubin entry to the brain at conventionally acceptable serum concentrations raises questions about current concepts of the mechanism of transfer of bilirubin across the blood-brain barrier.
Lumbar Cisternography in Evaluation of Hydrocephalus in the Preterm Infant
Authors: Donn Steven M. , Roloff Dietrich W. , Keyes John W.
Published: December 2021

Radionuclide lumbar cisternography using indium 111-diethylenetriamine pentaacetic acid (111 In-DTPA) and a mobile γ-camera with a converging collimator was utilized as a bedside procedure to evaluate CSF dynamics and the patency of the cerebral ventricular system in 30 preterm infants with hydrocephalus. Serial images of the brain were obtained at 0, 1, 2, 6, 24, and 48 hours after instillation of the isotope in the lumbar subarachnoid space. Three distinct patterns were seen. Infants with posthemorrhagic hydrocephalus displayed prompt ventricular filling but markedly delayed emptying with minimal flow over the cerebral convexities. Infants with ventriculomegaly secondary to suspected brain atrophy or periventricular leukomalacia demonstrated a pattern of prompt ventricular filling, delayed emptying, but with flow present over the convexities. An infant with noncommunicating hydrocephalus secondary to an Arnold-Chiari malformation showed a pattern of complete obstruction with no ventricular filling. Radionuclide lumbar cisternography appears to be a safe, well-tolerated procedure which produces images of sufficient resolution to provide valuable information about CSF dynamics, delineating basal cisternae, ventricles, and subarachnoid flow paths.
Fetal Akinesia Deformation Sequence: An Animal Model
Authors: Moessinger Adrien C.
Published: December 2021

Rat fetuses were paralyzed by daily transuterine injections of curare from day 18 of gestation until term (day 21). The following anomalies were noted at the time of delivery: multiple joint contractures, pulmonary hypoplasia, micrognathia, fetal growth retardation, short umbilical cords, and polyhydramnios. Neither sham-operated nor untouched littermate control fetuses had any of these anomalies. The group of anomalies (or deformation sequence) obtained with this animal model is presumed to result from the paralytic effect of curare. This phenotype bears a striking resemblance to the syndrome of ankyloses, facial anomalies, and pulmonary hypoplasia (also known as Pena and Shokeir I), presumably inherited in an autosomal recessive manner. It is suggested that this phenotype is not specific but, rather, represents a deformation sequence which results from fetal immobilization or akinesia. Diagnostic evaluation of patients with this group of anomalies should include the identification of the underlying pathologic process (etiology of the akinesia) to allow for proper classification and genetic counseling.
Echocardiographic Characteristics of Premature Infants with Patent Ductus Arteriosus
Authors: Johnson Gregory L. , Breart Gerard L. , Gewitz Michael H. , Brenner Joel I. , Lang Peter , Dooley Kenneth J. , Ellison R. Curtis
Published: December 2021

As part of a multicenter collaborative study, M-mode echocardiograms were obtained shortly after birth on 3,559 premature infants with birth weight ≤1,750 g. Of these infants, 1,496 did not develop a cardiac murmur or other signs of a "hemodynamically significant" patent ductus arteriosus (PDA). Echocardiographic parameters from this "normal" group were compared with results obtained from 415 infants in whom PDA was diagnosed on the basis of clinical findings alone, irrespective of the echocardiogram (PDA group). The best discrimination between the two groups, when considering a single parameter, was provided by a left atrial to aortic root ratio (LA/AO) of 1.40, a left ventricular to aortic root ratio (LV/AO) of 2.10, or a left ventricular systolic time interval ratio (LPEP/LVET) of 0.27. Multivariate analysis demonstrated that better separation between the two groups occurred when the left atrial to aortic root ratio and the left ventricular systolic time interval ratio were considered jointly. Because of a large degree of overlap of all echocardiographic variables between the normal group and the group with PDA, the echocardiogram alone was not a good indicator of PDA. However, when used in conjunction with a priori estimates of the probability of PDA (based, for example, on birth weight and degree of respiratory disease), use of echocardiographic data was found to improve the detection of hemodynamically significant patent ductus arteriosus in premature infants.
Expanded Guidelines for Use of Varicella-Zoster Immune Globulin
Authors:   Committee on Infectious Diseases
Published: December 2021

I. BACKGROUND INFORMATION

1. Zoster Immune Globulin

Zoster immune globulin (ZIG) can prevent clinical chickenpox in exposed, susceptible, normal children.1 In a collaborative study2 in which 15 susceptible children at high risk received ZIG within three days following exposure, there were no deaths and only one child developed progressive varicella. At that time, a mortality of 7% and a rate of progressive varicella of 30% were reported in similar children who failed to receive prophylaxis.3 At the present time, varicella may be even more hazardous for children with leukemia, possibly because of the use of more intensive therapy.

2. Varicella-Zoster Immune Globulin

The use of plasma obtained from patients convalescing from zoster to prepare ZIG resulted in a limited supply of this material. The finding that plasma from normal donors with high varicella-zoster (V-Z) antibody could be used to prepare a globulin of similar potency, referred to as varicella-zoster immune globulin (VZIG),4 now assures ample supply. The availability of this material, through the American Red Cross, permits us to recommend it for additional indications. The major deterrent to the use of VZIG is its cost, which in August 1983 was approximately $75 per 125 units (approximately 1.25 mL), the dose for a 10-kg child. The recommended adult dose of 625 units costs about $375.

3. Morbidity from Varicella in Adults

Adults suffer greater morbidity from chickenpox than do children. Although less than 2% of reported cases occur in individuals after the second decade, nearly one quarter of all the reported mortality occurs in this group.5

Of particular concern are pregnant women who develop chickenpox.