bluuebunny/crossref_metadata_2025 huggingface dataset:
PIETAS AND THE ALIMENTA ITALIAE
Authors: McNamara John J.
Published: December 2021

Pietas is the Roman virtue which describes the concern and respect of the father for his children, or the state for its citizens. The Roman state was informed by religious values and traditional virtues. The Alimenta Italiae is the first known nutrition program for children initiated by the emperor Nerva (96-98 A.D.) and expanded by the emperor Trajan (98-117 A.D.). The scheme worked in this fashion: The state, in order to support agriculture made available to farmers low interest loans, however, the interest on the loans was repaid directly to municipalities which were obliged to use the money to provide food and necessities for poor children. The scheme ultimately came to cover thousands of children in Italy and was widely acclaimed. "Alim. Italiae" appears frequently on the coins of Trajan proclaiming the program to the known world.

Despite much blather about traditional virtues, there is no positive family policy in this country. However, we do have a new agricultural policy which is to liquidate dairy herds lest the land be flowing with milk if not honey. Here, in one of the wealthier provinces failure to thrive is endemic. At the Brockton Hospital it is rare that a child is not hospitalized with the diagnosis of nonorganic failure to thrive.

"Quo usque tandem abutere patientia nostra?"; loosely translated with apologies "Gimme a break."
In Reply: Vitamin Dosages in Premature Infants
Authors: GREENE HARRY L. , PHILLIPS BARRY L.
Published: December 2021

As indicated on p 533 of our article, the original recommendations given by the AMA Nutrition Advisory Group in 1975 indicated that, for premature infants, 10% of a vial should be given for each kilogram of body weight. By the time a pediatric formulation was manufactured according to the Nutrition Advisory Group guidelines, several investigators believed that 10% of a vial would not supply the needs of very low birth weight infants for vitamins A, D, and E. For this reason, an ad hoc committee was organized in 1983 by the FDA to make new recommendations for premature infants.
THE PRESIDENT'S PAGE
Authors: BEAVEN PAUL W.
Published: December 2021

I AM sure that the greater part of our membership is not aware of the immense amount of productive work accomplished by our scientific committees.

Unfortunately I cannot comment on all of them because there is not space. I shall outline the composition and objectives of three of these committees which shall serve as examples. I was going to include the Committee on Education, but I will refer to that committee in a later letter.

The Committee on Immunization and Therapeutic Procedures has as its chairman John Miller of San Francisco. This committee is composed of nine pediatricians whose chief interest lies in the field of immunology. There are those interested in bacterial, viral, rickettsial, and other childhood diseases for which active or passive immunization has significance. Others are specialists in immune sera, vaccines, or other antigens, and still others in the public health aspect of contagious diseases. Together they have just finished the revision of the Red Book. It will soon be in your hands and you will realize when you see it the labor expended. It is not intended to be a text book but a concise and contemporaneous reference on what the committee regards as good standard practice.

Peter Danis of St. Louis is the chairman of the Committee on Hospitals and Dispensaries. This committee is also composed of nine child specialists, and each was chosen because he or she was particularly qualified to contribute a special knowledge in the differing areas of the care of the child in the hospital.
INHIBITION OF GROWTH AND OTHER EFFECTS OF ACTH IN PREMATURE INFANTS
Authors: SILVERMAN WILLIAM A. , DAY RICHARD L. , BLODI FREDERICK C.
Published: December 2021

Premature infants who received more than ACTH 5 mg./kg./day became hyperirritable and ravenous. Many became pallid immediately after injection of the hormone. During the course of treatment infections which appeared could be controlled with antibacterial therapy.

Untreated premature infants excreted increasing amounts of chemically assayed urinary "corticosteroids" with increased body weight. Under the influence of doses of ACTH in excess of 5 mg./kg./day the urinary excretion of "corticosteroids" increased significantly.

Retardation of growth occurred during the administration of more than 5 mg. ACTH/ kg./day. "Rebound" increase in growth took place upon cessation of hormonal administration.
THE PRESIDENT'S PAGE
Authors: BEAVEN PAUL W.
Published: December 2021

I AM SURE that the majority of our members are not aware of the influence of the Academy in public health and child welfare. For this reason I will recount some of the incidents that have occurred in the past few months which illustrate this.

In May, Dr. Edward Davens, representing our Committee on School Health, went to a meeting in Washington arranged by the National Educational Association to examine the real meaning of citizenship in our country. Excerpts from his report will be published in the News Letter.

Last January, Dr. Reginald Higgons attended a conference on school health in Cleveland, which he reported in full to the Executive Board and which will appear in the agenda of committees published in Pediatrics. I would commend this to anyone interested in school health work.

In April, Dr. Stewart Clifford used the report of this same School Health Committee, of which Dr. Thomas Shaffer is Chairman, to modify the school health laws in Massachusetts to conform to its recommendations. If members in states are attempting to introduce modern practices in school health, they are referred to the central office. Dr. Christopherson will be glad to send them a copy of Dr. Shaffer's report.

In February, Dr. Danis' Committee on Hospitals and Dispensaries sent representatives to a meeting in New York, called to discuss the care of contagious diseases in a general hospital. This group represented many organizations, including the American Public Health Association, the American Medical Association, the American Hospital Association, the American Nursing Association, and others. It was financed by the National Foundation for Infantile Paralysis.
ELECTROCARDIOGRAPHIC PATTERNS OF NORMAL CHILDREN FROM BIRTH TO FIVE YEARS OF AGE
Authors: GROS GERARD , GORDON ARMOND , MILLER ROBERT
Published: December 2021

The ECGs of 104 normal children from a few hours old to 5 years of age were studied. These ECGs consisted of the standard limb leads, the aV limb leads and six precordial leads: V4R, V1, V2, V4, V5 and V6.

While the number of cases in each group are small, the following conclusions are suggested by this study:

1. ECGs of the newborn infant present important variations from those seen in later life. This is especially true during the first week of life. Thereafter the contour evolves [SEE FIG. 2 IN SOURCE PDF] in a definite manner until the adult-like pattern is reached.

2. The vertical and semivertical "electric" positions were the most frequently encountered in this age group.

3. P-waves present a rather permanent pattern in this age range:

a. is usually upright in lead 1 and 2, aVF, V4, V5 and V6.

b. is usually inverted in lead 2 and aVR.

c. is either upright, inverted or diphasic in lead 3, aVL, V4R, V1 and V2.

4. The P-R interval varies from 0.10 sec. minimum to 0.16 sec. maximum with the average being 0.12 sec. in this age range. It tends to become greater in the older age groups.

5. QRS duration is shorter in the younger age groups and increases slowly with age.

6. Polyphasic, M-shaped or slurred QRS complexes are not uncommon in the ECGs of normal children in this age range.

7. A Q wave is frequently absent in lead 1 and in all chest leads during the first week of life. Thereafter up to 5 years of age the pattern of the Q wave is as follows:

a. Q is generally absent in lead 1, V4R, V1, V2 and V4.

b. Q is generally present in lead 3, V4R, aVF, V5 and V6.

8. There is a distinct pattern of right ventricular dominance in leads from the sternum and to its right at birth. This pattern gradually undergoes involution, probably related to normal physiologic development, until the left ventricle becomes dominant. Thus the evolution of the S-wave parallels a gradual involution of the R-wave in right precordial leads and probably also in aVR. This dominance of the left ventricle over the entire precordium is usual by about 3 years, but may be delayed normally until 5 years of age.

9. The T-wave is upright or diphasic in V4R, V1, and V2 and inverted in V5 and V6 for the first 24 hours of life; it gradually alters so that by the fourth day it is inverted in V4R, V1 and V2 and upright in V5 and V6 and thereafter.

10. The transition zone of QRS varies from one age group to another and tends in some ages to be broad. In some instances no real transition zone can be determined.
EARLY INTEREST IN PEDIATRICS IN SOUTH CAROLINA
Authors: WARING JOSEPH IOOR
Published: December 2021

FROM the few existing accounts of the development of pediatrics in America one gets the impression that there was little or no recorded concern for the subject before the early part of the nineteenth century. Garrison mentions Thomas Thacher's "Brief Rule" (1677-78), Samuel Bard's paper on "Angina Suffocative" (1771), Benjamin Rush's writings on the Cholera Infantum (1773) and Hezekiah Beardsley's paper on Pyloric Stenosis (1788) as the only writings of pediatric interest which were published before 1800. Adams previously had considered Rush as one of the first in this country to write on pediatric subjects, counting Rush's "Account of the Influenza, as it appeared in Philadelphia in the Autumn of 1789, the Spring of 1790, and the Winter 1791" as a contribution to the clinical description of the disease in children, and crediting Charles Caldwell's thesis written in 1796 at the University of Pennsylvania on "An Attempt to Establish the Original Sameness of Three Phenomena of Fever (principally confined to infants and children) described by medical writers under the several names of Hydrocephalus Internus, Cynanche Trachealis and Diarrhea Infantum" with being the first truly pediatric publication in this country. With such scanty background for our enormous pediatric literature of the present, it might not be amiss to note some few writings which came out of Charleston in the 18th and early part of the 19th centuries, and, without trying to squeeze too much blood out of a turnip, to show that there was some written evidence of interest in pediatrics which was perhaps somewhat more localized in South Carolina than in any other parts of the country.
Round Table Discussion
Authors: DIETRICH HARRY F. , WHEATLEY GEORGE M. , BROOKS GLIDDEN L. , KOTTE ROBERT H. , WYVELL DOROTHY
Published: December 2021

Chairman Dietrich: We wish to direct attention to the much neglected problem of accidents in children. It is a unique one. The ultimate solution rests on child-parent relationship, and we as pediatricians are responsible for guiding that relationship. So far, the medical profession's attack on the problem has been piecemeal, perfunctory and without potency. For this round table discussion, our plan is as follows: Dr. George Wheatley of the Metropolitan Life Insurance Company will present the size and shape of the accident problem, Dr. Glidden Brooks will indicate the hospital's role in the problem of accidents and outline the research needs in this field, I will briefly outline what I think is a practical theory of accident prevention, and Dr. Wheatley will sketch some areas of thought on community organization for accident prevention.

Dr. Wheatley: Pediatricians are well aware of the child accident problem. But they are apt to look at it almost exclusively from the point of view of the day-to-day treatment of pediatric emergencies. Unquestionably proper management of accidents is important but it overlooks the basic approach in solving the problem. This major concern with accident-treatment contrasts with the modern pediatrician's orientation toward disease prevention.

What are the facts? The highest accident fatality rate is found in the preschool age group from 1 to 4 years, the period during which most of the children spend more of their time in the home environment under closer supervision than any other period in their lives. The remarkable conquest of the common childhood diseases has sharpened our focus on the child accident picture.
MIDDLEBROOK-DUBOS HEMAGGLUTINATION REACTION
Authors: ANDERSON H. W. , PLATOU R. V.
Published: December 2021

The Middlebrook-Dubos hemagglutination test, measuring a humoral antibody against a polysaccharide fraction of the tubercle bacillus, has been studied in 343 sera from 287 infants and children. The test appears to be practical and may be useful as an index to activity of tuberculous disease.

A transient rise in level of antibodies was observed in some sera after either negative or positive skin tests with old tuberculin; this occasional provocative effect is largely dissipated within a month or two. Little or no antibody may be demonstrated in most sera from patients with either far advanced or healing tuberculosis. An age factor makes "unexpectedly" negative serologic results in most infants and younger children apparently quite meaningless.
LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY
Authors: MCKINLEY HELEN I. , ANDREWS JEANNE , NEILL CATHERINE A.
Published: December 2021

Three cases of left coronary artery arising from the pulmonary artery in infants are reported, making a total of 35 cases now reported.

One of these was apparently complicated by cardiac rupture, a sequence, to the authors' knowledge, not previously reported.

The symptom complex is again reviewed in order to stimulate interest in earlier diagnosis.

Since eight cases of this anomaly have been reported in adults, one of whom lived to 64 years, it is suggested that the life of the infant might be saved if diagnosed before irreversible myocardial changes have occurred.

The ideal treatment, if vasodilatory drugs fail, would seem to be a direct anastomosis of the left coronary with the aorta; however, since technically this is impossible at the present time, other methods of increasing the flow to the left coronary should be attempted. Gasul suggests the Pott's-Smith operation, which, by raising the pulmonary pressure, might increase the left coronary flow.
Questions About Task Force on Meningitis—Recommendations
Authors: KLEIN JEROME O. , FEIGIN RALPH D. , MCCRACKEN GEORGE H.
Published: December 2021

To the Editor.—

We appreciate the many useful comments and suggestions about the Report of the Task Force on Diagnosis and Management of Meningitis (Pediatrics 1986;78 (suppl):959-982). We will respond to letters from Terry F. Cashmore (Bonita, CA), Alfred Florman (Albuquerque, NM), Robert J. Geller (Tuscaloosa, AL), Allen W. Mathies, Jr. (Pasadena, CA), Richard A. Moriarty and Gerald W. Fischer (Bethesda, MD), Kenneth B. Robbins (Honolulu, HI), Bradley Sullivan (Marshfield, WI), and M. C. Thirumoorthi.
Health Assessment and Screening During Adolescence
Authors: Marks Andrea , Fisher Martin
Published: December 2021

The "medical checkup," like hot dogs and apple pie, has become an American tradition. Adolescents have checkups requested by schools, summer camps, sports teams, employers, parents, and, less frequently, themselves. At such times, a cursory chat between the teenager and health professional, followed by a quick physical examination, is unlikely to detect the most prevalent and significant health problems of young people today. The very nature of such an interaction may even serve to alienate the teenager from the health care system or provider. Alternatively, if properly focused and thorough, a checkup may not only uncover important areas of disease or dysfunction, but also should initiate a meaningful dialogue and relationship between the adolescent patient and health professional. A checkup generally occurs when an individual feels well and visits a medical professional without complaint or a checkup may be had in conjunction with medical attention to a specific problem. In either case, the primary purpose of a checkup is health assessment and screening.

Health screening has been defined by the World Health Organization as ". . . the presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures which can be applied rapidly." The purpose of health screening is to detect a problem (or problems) before it would usually become apparent or before medical attention is sought, with the intent of initiating treatment at an earlier and more optimal time, so as to prevent or favorably alter its course and consequences. Screening is not in itself diagnostic.
Dose-Response Relationship of Doxapram in the Therapy for Refractory Idiopathic Apnea of Prematurity
Authors: Barrington Keith J. , Finer Neil N. , Torok-Both George , Jamali Fakhreddin , Coutts Ronald T.
Published: December 2021

Eighteen infants with idiopathic apnea of prematurity refractory to therapeutic levels of aminophylline were treated with incremental doses of doxapram beginning at 0.5 mg/kg/h. Continuous recording of heart rate, thoracic impedance, and transcutaneous Po2 demonstrated that 47% of the infants satisfied objective response criteria at the lowest dose, 53% responded at 1.0 mg/kg/h, 65% at 1.5 mg/kg/h, 82% at 2.0 mg/kg/h, and 89% at the highest allowed dose of 2.5 mg/kg/h. The mean serum doxapram concentration at the response dose was 2.9 ± 1.3 µg/mL, and all infants who responded had levels greater than 1.5 µg/mL. BP was significantly elevated at doses higher than 1.5 mg/kg/h (P < .05). Minute ventilation significantly increased and Pco2 significantly decreased as the doxapram dosage was increased (P = .02). Terminal elimination half-life was 9.9 ± 2.9 hours. When doxapram is used for treatment of refractory neonatal apnea the starting dosage should be no more than 0.5 mg/kg/h.
Cerebral Edema and Galactosemia
Authors: BELMAN ANITA L. , MOSHE SOLOMON L. , ZIMMERMAN ROBERT D.
Published: December 2021

In Reply.—

We thank Drs Welch and Milligan for calling our attention to their interesting case. They describe a neonate who at four days of age had hyperbilirubinemia and neurologic dysfunction. At six days, cerebral edema was demonstrated by ultrasonographic examination. Galactosemia (transferance deficiency) was subsequently diagnosed. Neuroimaging procedures such as CT and ultrasound are invaluable diagnostic aids for the early identification of cerebral edema and may, as the authors suggest, provide evidence that cerebral edema occurs commonly in the acute phase of galactosemia.
Septic Arthritis
Authors: RAO SREEDHAR P. , MILLER SCOTT T.
Published: December 2021

To the Editor.—

We read with interest the report by Syrogiannopoulos et al.1 The authors have reported six cases of isolated septic arthritis and eight cases of osteomyelitis, two with septic arthritis, in children with sickle cell disease. Whereas Salmonella was the commonest cause of osteomyelitis, Streptococcus pneumoniae was the commonest cause of septic arthritis. This appears to be the first report describing several cases of isolated septic arthritis in children with sickle cell disease.
Nipple Units for Newborn Infants: A Functional Comparison
Authors: Mathew Oommen P. , Cowen C.
Published: December 2021

Milk flow characteristics of nipple units commonly used in the neonatal period were compared in the laboratory using a mechanical system. The number of simulated sucks required to empty 120 mL of formula was determined for each nipple unit. In general, the number of simulated sucks required to empty the bottle decreased when the applied negative pressure was increased from -60 to -120 cm of H2O except for SMA nipple units for premature infants. The Nuk type required less sucks (ie, higher flow) than standard nipple units. Among the Nuk-type nipple units, the SMA nipple had the highest mean flow and Enfamil Natural the lowest mean flow; among the standard nipple units, SMA single-hole had the highest flow and Ross Twist-on had the lowest flow. However, wide variability in performance was observed not only between different types of nipple units but also within the same type. Flow characteristics of nipple units for preterm infants overlapped markedly, with that for term neonates with Enfamil nipples exhibiting the highest flow. Clinical relevance of these differences in flow characteristics among the nipple units is discussed.
Nephrolithiasis Following in Utero Diuretic Exposure: An Unusual Case
Authors: FISCHER ALLEN F. , PARKER BRUCE R. , STEVENSON DAVID K.
Published: December 2021

Reports have appeared in the literature describing the relationship between diuretic therapy and nephrocalcinosis or nephrolithiasis in groups of preterm infants. Most of the affected infants were receiving furosemide for the treatment of bronchopulmonary dysplasia. Here, we report an unusual case of nephrolithiasis related to in utero diuretic exposure.

CASE REPORT

The patient was born prematurely at 33 weeks' gestation. The baby's mother was 33 years old, gravada 1, para 0, and had blood type O. She was a class FR diabetic (retinopathy, nephropathy, systemic hypertension), with a medication regimen that included captopril, 25 mg, twice daily; hydralazine, 25 mg, twice daily; and ethacrynic acid, 50 mg, twice daily.
Role of Pediatrician in Pediatric Emergency Medical Services
Authors: NARKEWICZ RICHARD M.
Published: December 2021

The statement by the American Academy of Pediatrics' (AAP) Provisional Committee on Pediatric Emergency Medicine in this issue highlights the importance of pediatricians' involvement in emergency medical care for children. Pediatricians have responsibilities in advocating for children's unique needs in the emergency medical system at the state and regional levels and in individual practices as well. The AAP brings together many pediatric specialists in carrying out its role in this effort.

In the primary care setting, the pediatrician's role is to promote safety and injury prevention when counseling parents. This is a crucial part of health supervision, and the AAP has developed The Injury Prevention Program (TIPP) to assist pediatricians.
Salary or Fee-for-Service
Authors: HICKSON GERALD B.
Published: December 2021

In Reply.—

Our study was directed at the big picture or more global concept of improving our basic understanding of physician reimbursement and how it impacts practice behavior. We hope that our controlled, prospective study will be the first of many such studies and literature reviews that will help to focus the pediatric community on finding ways of providing economically efficient high quality care to more people under circumstances of rapidly increasing medical inflation and community/governmental cost cutting. Asking patients who were chronically behind on their bills to obtain care at Metropolitan Nashville General Hospital (which was staffed by Vanderbilt residents and attending physicians) did not impact the health of such patients and was necessary for the study to serve as a model of the way the great majority of pediatrics is practiced in this country.
Primary Lymphoma of the Central Nervous System in Children With Acquired Immunodeficiency Syndrome
Authors: Esptein Leon G. , DiCarlo Frederick J. , Joshi Vijay V. , Connor Edward M. , Oleske James M. , Kay Deborah , Koenigsberger M. Richard , Sharer Leroy R.
Published: December 2021

Three children with acquired immunodeficiency syndrome and primary lymphoma of the CNS are described. All three children had clinical signs of focal mass lesions and progressive neurologic deficits. In one child the deterioration was extremely rapid. New lesions appeared on serial CT scans every few days, simulating an infectious process and leading to death within 3 weeks. Results of neuroradiologic studies in these patients demonstrated multicentric lesions that were often periventricular. On CT scans, the lesions were hyperdense before contrast and were enhanced with contrast medium. Double-dose delayed contrast CT scans and magnetic resonance imaging studies were more sensitive in indicating additional lesions. Histologically, all three tumors were B cell neoplasms; two lymphomas were large cell type, whereas one was small cell, noncleaved (Burkitt-like). Primary CNS lymphoma occurred with an incidence of 1/26 (4%) in our autopsy series and 3/100 (3%) of all pediatric cases of human immunodeficiency virus-type 1 infection, living and dead, that have been seen at the Children's Hospital of New Jersey. By comparison, opportunistic and reactivated latent CNS infections were less common in this same population and never appeared clinically as mass lesions. Therefore, in our experience, primary lymphoma is the most common cause of focal or multifocal mass lesions in the brains of children with acquired immunodeficiency syndrome. This tumor may be radiosensitive. In most cases, early biopsy is probably necessary to establish the diagnosis.
EXCEPTIONS TO SI UNITS IN A PEDIATRIC JOURNAL
Authors: L. J. F.
Published: December 2021

January 1989 results and measurements in the Archives of Disease in Childhood will be given in SI units only. Would contributors please ensure that all results in manuscripts, tables, and figures submitted from now on are in SI units; otherwise, publication may be delayed. Exceptions to this are: (a) Blood pressure in mm Hg; (b) Ventilation pressure in cm H2O; (c) Concentration of drugs; (d) Concentration of any substance where the molecular weight is not known accurately. No old units or conversion factors should be submitted in manuscripts: conversion is the responsibility solely of the author.
The Hastings Center Project on Imperiled Newborns: Supreme Court, Jury, or Greek Chorus?
Authors: LANTOS JOHN D.
Published: December 2021

Ethics committees are many-splendored things and fulfill a variety of different functions. They can be educational resources, policy-making bodies, or consultants for particularly troubling cases. They can be legal watchdogs or instruments of institutional risk management. They can empower nurses or parents in conflicts with physicians or provide solace to physicians who face disturbing decisions. When ethics committees do so many things at once, there is a danger that they will do nothing well or will sabotage their central mission by getting embroiled in tangential or peripheral issues.

But how should ethics committees work? Should they merely reflect widely held opinions, or can they show us new and better ways to analyze and solve controversial problems?
Lipid Composition of Milk From Mothers With Cystic Fibrosis
Authors: GOLEMBESKI DAVID J. , EMERY MAURICE G.
Published: December 2021

In response to the article by Bitman et al concerning the lipid composition in the breast milk of women with cystic fibrosis, we would like to share information about a recent case from our clinic and present information that counters the statement, "abnormalities in the fatty acid composition of cystic fibrosis milk may contraindicate its use for the nursing infant."
In Reply: Statistical Power
Authors: LOVERING JOHN S.
Published: December 2021

Dr. Mauro is obviously knowledgeable in the area of statistical analysis and raises a valid point regarding the importance of evaluating the likelihood of a type II error in studies with negative results. Although one does not wish to detract from the main point of a study with extensive details of the statistical analysis (two pages in this case), some readers may desire more mathematical information than values of mean, variance, t, and P, and do not wish to make their own calculations, to reassure themselves that a reasonable conclusion has been drawn by the authors and their statisticians.
AGAIN, THE PERFIDY OF SMALL CLINICAL TRIALS
Authors: Student
Published: December 2021

The analysis [of British trials of phenobarbitone and valproate for the prophylactic treatment of febrile convulsions] shows well how small study groups serve to exaggerate benefits of drawbacks of treatment. All the trials have been too small for paediatricians to use their findings with confidence.
Sample Sexual Assault Data Sheet
Authors: EMANS S. JEAN , PARADISE JAN E.
Published: December 2021

We are concerned that the protocol for evaluation of adolescent rape victims recommended by the American Academy of Pediatrics, Committee on Adolescence, contains several instances of misplaced emphasis, in light of current information about sexual assault in adolescents. The sheet puts strong emphasis on the examiner's discovery of injuries, although recent reports indicate that only about one third of adolescent and adult rape victims sustain any physical injury at all and that 7% to 26% sustain genital injuries.
FOR WHAT?
Authors: Student
Published: December 2021

Her head looked shrivelled, somehow dessicated. She had electrodes fitted to her scalp, tubes and drips from every orifice, her eyes were bandaged against the light.

I wanted to drag everything away from her, every bit of machinery, to pick her up and hold her to my breast, even if it meant that she died in a few minutes. That would be better than having to suffer this—the pain, fear, noise, bewilderment, being surrounded and handled by strangers. At that moment, I did not see the medical staff as saviours, as people who were caring for my baby and trying to save her life; I saw them as aggressors, tormentors, people who had taken by baby away from me and were doing terrible things to her, who were keeping her from me. I was filled with anger and hurt on her behalf.

To a certain extent, I never got over that anger. It was an instinct, deep, irrational, passionate. She was being hurt, and for what? For the best? I wondered. I still do wonder.
VOX POPULI
Authors: Student
Published: December 2021

[A poll of public opinion about health care] confirms all of one's worst fears about the American system. We have the most expensive, the least well-liked, the least equitable and, in many ways, the most inefficient system.
ORDP: A NEW RUBRIC IN NEONATAL MEDICINE?
Authors: Student
Published: December 2021

Oxygen radical injury may be a common pathogenic mechanism in several neonatal diseases. The list includes but is not limited to retinopathy of prematurity, bronchopulmonary dysplasia, suabependymal and intraventricular hemorrhage, and necrotizing entercolitis. The greater incidence of these disorders in preterm infants suggests that some aspect of prematurity increases susceptibility to the effects of toxic oxygen species. Saugstad has proposed the term "oxygen radical disease in neonatology" to describe the apparent propensity of neonates to oxygen radical injury. Because of the greater incidence in preterm infants, perhaps a better name for this disorder would be "oxygen radical disease of prematurity."
HIDING BEHIND HORMONES IN MILK
Authors: L. J. F.
Published: December 2021

Bovine growth hormone, synthesized in bacteria by the new techniques of genetic engineering, may make cows produce some 15 percent more milk. Such a spectacular productivity gain should delight consumers with lower prices and dairy farmers with higher profits. Then why are farmers from New York to Minnesota organizing to oppose the new technology?

The harsh fact is that there are too many dairy farmers. Less efficient producers—some of them family farmers—are kept in business by Federal subsidies that in recent years have reached $1 billion annually. Farmers fear that more milk at lower prices may reduce their incomes, forcing many off their farms. The National Farmers Union hopes to ban the hormone or force milk from treated cows to be so labeled, igniting public concern about "unnatural" milk.

The milk hormone has not yet been approved by the Food and Drug Administration, but so far there seems no serious safety issue. Milk now contains minute amounts of natural bovine growth hormone; the hormone is destroyed in digestion and is in any case inactive in humans. The dairy industry risks enormous damage if it raises needless safety doubts by insisting on labeling provisions for milk from hormone-treated cows.
Cytomegalovirus Retinitis in an Infant With Acquired Immunodeficiency Syndrome
Authors: Levin Alex V. , Zeichner Steven , Duker Jay S. , Starr Stuart E. , Augsburger James J. , Kronwith Stephen
Published: December 2021

A case of cytomegalovirus retinitis in an infant with acquired immunodeficiency syndrome (AIDS) is described. Although well recognized as an ocular manifestation of AIDS in adults, only one case of the necrotic retinitis caused by cytomegalovirus has been described in a child with AIDS. Intravenous treatment with ganciclovir resulted in substantial ocular improvement, despite the advanced nature of the disease in one eye in which there was also secondary neovascular glaucoma. Home maintenance treatment was used via Broviac catheter. The patient later died following pulmonary infection with Pneumocystis carinii.
Who Cares for the Human Immunodeficiency Virus-Infected Child?
Authors: OLESKE JAMES M.
Published: December 2021

In the article by Levin and colleagues (Cytomegalovirus retinitis in an infant with acquired immunodeficiency syndrome. Pediatrics.1989;84:683-687), the treatment of cytomegalovirus retinitis in an infant infected with human immunodeficiency virus (HIV) with the investigational drug ganciclovir is described. The mother of this child was known to be HIV-antibody positive 9 months prior to conception of this child (presumably by sexual contact). Despite apparent successful treatment of his cytomegalovirus retinitis, this baby died 6 weeks after ganciclovir therapy from a fulminant Pneumocystis carinii pneumonia. He had normal immunoglobulin levels but reduced number of helper cells. A number of important questions are raised by this tragic case.
SOCIOLOGIC EFFECTS OF TECHNICAL INNOVATION
Authors: Student
Published: December 2021

The [inventions that led to] provision of light from central sources changed the nature of the home and the individual's relation to society. . .The erosion of domestic autonomy over light began with the introduction of the gaslight early in the 19th century. That replaced the domestic oil lamp. . .and bound each household to the "gas works." The introduction of gaslight virtually coincided with the beginning of impersonal mass transportation in the form of railroads. Instead of traveling as groups of individuals in horse-drawn carriages, rail passengers were carried like pneumatic parcels through a landscape they never touched.
ESCALATING COSTS OF CRACK
Authors: Student
Published: December 2021

It will probably cost more than $700 million for health care, social services and special education to get the 17,500 cocaine-exposed infants born in Florida in 1987 ready for kindergarten in 1992. Just think [of this cost] just one state will have to spend on one year's cocaine-exposed babies. Then multiply, multiply, multiply.
LEAP OF THE FLEA
Authors: Student
Published: December 2021

The flea's appearance under the microscope is so unusual as to appear diabolic, and diabolic is its ability to escape capture with a leap so swift that it abruptly eludes the eye and seems to disappear. It is precisely this leap that [is] rich in patience and ingenuity... [The flea's] elastically deformable musculature is analogous to a gun's spring and a crossbow's arch. [It] is constituted of a protein...almost unique in the animal kingdom, similar to rubber but with properties that have a much higher degree of performance. In this way the energy required for the instantaneous and prodigious leap is accumulated during a slower preparatory phase: between one leap and the next, the flea must "collect itself," again accumulate energy for its springs; but even for these pauses it needs only a tenth of a second. And this is the secret which allows the insect to leap even in cold environments, and leap so high and so far.
Fatal Nonpowder Firearm Wounds: Case Report and Review of the Literature
Authors: Lawrence H. Steven
Published: December 2021

A previously unreported fatality due to a head wound from a CO2-powered BB pistol is described. In a review of the English language medical literature (primarily forensic), ten previous reports of fatality due to nonpowder firearms were found. A common mechanism is identified in the head wounds leading to fatality. Modern day technology has elevated the BB gun from toy to weapon. Often appearing trivial, BB and pellet gun injuries must be considered in the same class as those from small-caliber low-velocity powder firearms. A patient with a nonpowder firearm injury must be evaluated with a high index of suspicion for injuries that are not apparent during a general physical examination.
Drug Screening
Authors: DUPONT ROBERT L.
Published: December 2021

To the Editor.—

The joint report of the committee on Adolescence, the Committee on Bioethics, and the Provisional Committee on Substance Abuse (Pediatrics 1989;84:396-398) appears to miss the mark by a wide margin. Drugs and kids are a bad combination. Those of us concerned about children and youth need to work to help them grow up drug free. Screening for drug use is no more a violation of privacy than is screening for diabetes or tuberculosis.
Drug Screening
Authors: TOLMAS HYMAN C.
Published: December 2021

To the Editor.—

I was dismayed and disappointed by the recommendations of the three committees responsible for the policy statement regarding drug screening, and I believe that they have failed to take into consideration the feelings of the general membership. The small print disclaimer on page 396 hardly equalizes the variations from stated policy for those who feel differently. Although I agree with many of the facts as stated, I believe the Committees have been remiss in not weighing some of the realistic aspects of this most important problem that plagues our youth and society in general.
Bone Marrow Transplants
Authors: FURMAN LYDIA
Published: December 2021

In Reply.—

The first issue is whether or not bone marrow transplantation is, indeed, the most effective therapy available for children with leukemia. Drs Ogden and Steuber refer to "more than a decade of literature in which good responses after bone marrow transplantation have been reported." Likewise, Drs Weinblatt et al state that "the majority of patients currently receiving transplantation therapy for. . .leukemia in first remission are cured. . . ." However, Pinkel (Leukemia. 1989;3:242-244), in a recent editorial, carefully and succinctly reviewed the relevant data and concluded the exact opposite.
Breast-Feeding Rates Among Black Urban Low-Income Women: Effect of Prenatal Education
Authors: Kistin Naomi , Benton Dessa , Rao Sita , Sullivan Myrtis
Published: December 2021

Many factors are associated with low breast-feeding rates among black low-income women. This study examines whether, despite such factors, health professionals' prenatal education of black poor women is assoicated with increased breast-feeding rates. Black women born in the United States who attended a midwives prenatal clinic (N = 159) were randomly assigned to two types of prenatal education or were followed up in a control group. All women were interviewed on entry into the study and after delivery of their infants. Women assigned to group classes attended at least one session discussing myths, problems, and benefits of breast-feeding. Women assigned to individual prenatal counseling spoke with a pediatrician or nurse practitioner, who discussed breast-feeding topics similar to those covered in the classes. Women in the control group received no additional prenatal education. The three study groups had significantly different percentages of women who breast-fed (controls 22%, classes 46%, individual sessions 53%). Higher percentages of women in the study groups carried out their prenatal plans to breast-feed (controls 50%, classes 86%, individual sessions 62%) or breast-fed despite prenatal plans to bottle-feed (controls 10%, classes 26%, individual sessions 48%). After multivariable analysis controlling for age, prenatal pians to breast-feed, prior breast-feeding experience, perceived support for breast-feeding, education, gravidity, and employment plans, women in intervention groups had a higher likelihood of breast-feeding than control subjects. These findings suggest that an increase in relatively simple, not-too-time-consuming educational efforts in institutions and offices serving black low-income women might yield significant narrowing of the gap in breast-feeding rates between white affluent women and black low-income women.
Fever and Petechiae in Children
Authors: KELLNER JAMES D.
Published: December 2021

To the Editor.—

I read the article on "Fever and Petechiae in Children" by Baker et al1 with great interest. The results of Baker et al support the teaching I have received and my clinical impression that children having fever and petechiae most often do not have meningococcemia. Further, it appears that consideration of initial clinical features, peripheral white cell count, and examination of cerebrospinal fluid should allow a definitive assessment of whether invasive bacterial disease is present.
Persistent Pulmonary Hypertension and ECMO
Authors: GROSS IAN
Published: December 2021

In Reply.—

Although it is difficult to compare the perinatal patient population in Israel directly with that in the US, the Jerusalem experience with persistent pulmonary hypertension (PPH) is encouraging and consistent with that of a number of centers here.

Definitive data on this subject are not currently available, but there is considerable indirect evidence, such as that of Bruckheimer and Eidelman, to support the view that babies born at large centers with comprehensive perinatal services are less likely to require ECMO and, therefore, that some of the need for ECMO may be preventable.
SUMMATION AND COMMENTARY
Authors: MILLER C. ARDEN
Published: December 2021

The background papers and presentations document causes for concern about the health of children in the United States. Discussions at the conference affirm a zeal to improve supports and services on behalf of children. The international comparisons stimulate thinking on the approaches that are best suited for this country. Voices will be raised that the US must work out its own solutions and that we cannot learn from what other countries are doing. Understandings are firm that every nation's health care systems grow out of unique political, social, and economic traditions, but those systems are not immutable. A limited number of strategies are available to help children and young families. Insofar as the policies that enable those strategies can be clarified, the likelihood of developing the best approaches for this country is improved. We are grateful for the analysis of policies that prevail in other Western democracies.

One of the impressive aspects of health services for children in the five nations represented here is their differences. Health care financing and provider systems differ markedly; they are not cookie-cutter programs. Those differences present a responsibility to identify themes that are common to the nations with the best records of child health. Such themes deserve careful attention.

The first of the themes is the need for government action. The US has been through a decade of trying market systems featuring deregulation, individual responsibility, and volunteerism. The impression of most analysts is that these approaches have not worked. Important indicators of child health have worsened or previous favorable trends have slowed.
Epilogue
Authors: Harvey Birt
Published: December 2021

This conference has clarified a number of basic issues. If we expect to improve the health of our children, we must change our philosophy about social welfare and about looking after children. We have always considered individualism our ideal, and the concept is rooted firmly in our frontier spirit and our system of free enterprise. European thought is oriented more toward interdependence, with greater emphasis on the well-being of the group. How we treat our children is influenced heavily by our philosophy, as the responsibility rests with each individual family.

Except in the event of what we define as child abuse, representing a tiny fraction of ineffective and damaging parental behavior, we place very few legal or social limitations on parents. Children are a national resource, and responsibility for their welfare is shared by every member of society. As Dr Verbrugge has observed, what we need in the United States is more solidarity and less solitariness, less individuality. This is the direction we must now pursue.

The United States needs a children's policy; our guests have made this clear. Health care cannot be separated from all the other factors that influence the well-being of children. We have learned about grants that families get at birth, subsidized day care available to all, lengthy parental leave after childbirth, and paid leave when children are sick. We have a long way to go, but rational child health policy is a good start.

Some feel that we must do everything at once to avoid further fragmentation. Barring a revolution in this country, this is simply not possible.
Microphonic Versus End-Tidal Carbon Dioxide Nasal Airflow Detection in Neonates With Apnea
Authors: Toubas Paul L. , Duke James C. , Sekar K. C. , McCaffree Mary Anne
Published: December 2021

Impedance pneumography in combination with expired CO2 monitoring are commonly used techniques for detecting central and obstructive apnea in infants. In this investigation an American Telephone and Telegraph StarSet-1 3000-ohm self-actuating microphone connected to the end of an infant cannula was used to monitor neonatal nasal airflow to detect breaths and apnea. The microphone was placed in a soundproof container to eliminate environmental sound artifacts. Analyses of 100 breaths from five patient samples during active and quiet sleep showed that there was no significant difference between microphone and expire CO2 recording of respiration. The techniques were 98% and 96% sensitive, respectively. Microphonic detection of nasal airflow identified 27 of the 32 episodes of upper airway obstruction (84.2%) registered by end-tidal CO2 recording. Inspiratory and expiratory events could also be well documented. Microphonic recording of nasal airflow is a reliable and inexpensive technique to detect apnea.
Interpreting the Notion of "Nonbeneficial"
Authors: SAHLER OLLE JANE Z.
Published: December 2021

Resource allocation is of increasing concern as we seek to provide necessary services to our citizens within the confines of balanced budgets. Of particular interest to those allocating resources is the issue of efficiency or cost effectiveness (cost/those who benefit). Although budgetary constraints tend to focus attention on cost effectiveness, consideration of program effectiveness (the number of people who actually benefit/those who theoretically could benefit), itself, must be a primary concern of medical research and practice. Without this information, we cannot be assured that our patients are receiving the best care possible, let alone secure funding for programs that promise the best return for each dollar spent.
In Reply: `Ivory Tower' Fellowship Statement Challenged
Authors: STRAIN JAMES E.
Published: December 2021

I would like to respond to Dr Newhart's question about who authored the Statement on Pediatric Fellowship Training. It was written by the Federation of Pediatric Organizations and approved by the Executive Committees/ Boards of each of the organizations represented on the Federation. These include the Ambulatory Pediatric Association, the American Academy of Pediatrics, the American Board of Pediatrics, the American Pediatric Society, the Association of Medical School Pediatric Department Chairmen, the Association of Pediatric Program Directors, and the Society for Pediatric Research.