bluuebunny/crossref_metadata_2025 huggingface dataset:
SERUM IONIZED CALCIUM IN NEWBORN INFANTS
Authors: Brown David M. , Boen James , Bernstein Audrey
Published: December 2021

Relationships of serum ionized calcium with several biochemical parameters have been examined in newborn infants under 72 hours of age. Hypocalcemia was defined as plasma total calcium below 7.5 mg/100 ml. There was a linear correlation between plasma total calcium and ionized calcium in the entire group. Other positive correlations included: (1) plasma total calcium and serum total protein, albumin, and globulins and (2) absolute concentrations of ionic calcium and albumin. No statistically significant correlations were observed between either total or ionized calcium and serum phosphorus, percent ionized calcium, capillary pH, or Pco2. The derived values for serum ionic calcium from the McLean-Hastings nomogram did not correlate with the plasma ionic calcium as determined by the ion-specific electrode and may not be used in newborn infants to predict accurately the level of plasma ionic calcium.
A PHYSIOLOGIC RATIONALE FOR THE MANAGEMENT OF NEUROLOGIC RECTAL INCONTINENCE IN CHILDREN
Authors: White John J. , Suzuki Hiroshi , Shafle M. El , Mahesh Kumar A. P. , Haller J. Alex , Schnaufer Louise
Published: December 2021

Anorectal manometry was used to physiologically assess the anorectal sphincteric reflexes in 38 children with neurologic fecal incontinence.

There was a normal relaxation of the smooth muscle internal sphincter, and absent or impaired contraction of the striated muscle external sphincter, supporting the concept that the external sphincter is responsible for continence. Daily evacuation regimens were instituted to utilize the resting tone of the internal sphincter and avoid overfilling of the rectum and inadvertant accidents. From a status of constant soiling and staining, socially acceptable continence has been attained. Half of the children are always clean, and the rest have minor staining; one-third have learned regular bowel habits, and no longer require assistance. Colostomy was not needed. The difference in age between those children no longer requiring assistance (3.3 years), and those who still need daily assisted evacuation (6.5 years) suggests that bowel training regimens should be started early in children with neurologic incontinence.
II. REMARKS ON RECEIVING THE C. ANDERSON ALDRICH AWARD
Authors: Erikson Erik H.
Published: December 2021

The C. Anderson Aldrich Award, when given to a man so late in life for what he has contributed so much earlier, unavoidably awakes reminiscences. Let me, therefore, first devote a few words to the most important pediatrician in my life. He looked after my health when I was 3 years old and then entered my life more decisively by marrying my widowed mother. We moved into his house. In those days, of course, a pediatrician's office was attached to his home, and for years when I came home from school in the afternoon, I had to make my way through groups of worried mothers and sick children who sat in the entrance hall as well as in the waiting room. I did not become a pediatrician proper, so to speak, but I eventually was trained in child analysis. Beyond this, in all my thinking, the world for me has always been full of mothers and children which seemed to appeal for responsible help in saving not only lives, but also the vitality and integrity of living. If your award attests to the fact that we share this responsibility, it is also, in my case, a tribute to the power of early professional imprinting.

Now it so happens that to my surprise and joy the second most important pediatrician in my life is right here today and is, in fact, last year's recipient of the Aldrich Award. Our acquaintance goes way back, to what now seem prehistoric days. But I felt closest to Ben Spock during some years in Pittsburgh when he permitted me, a regular visitor to the staff, to share on occasion his well baby clinic at the Arsenal Health Center.
Observations on the Compensatory Response to Hypoxemia in a Case of Reversed Differential Cyanosis
Authors: Rosenthal Amnon , Nathan David G. , Nadas Alexander S.
Published: December 2021

Studies in a patient with congenital heart disease and "reversed differential cyanosis" suggest that physiologic adaptive mechanisms to hypoxemia in this condition are related to the arterial blood oxygen saturation or tension perfusing the lower half of the body.
Letter to the Editor
Authors: Hoekelman Robert A.
Published: December 2021

I am surprised we have not seen more letters expressing the viewpoint of Dr. Walter Pick concerning the utilization of nurse practitioners in pediatric practice. I am convinced his opinion reflects that of the majority of practicing pediatricians and in part explains the lethargy in the growth and development of pediatric nurse practitioner training programs.

His view implies that it is reasonable to utilize pediatric nurse practitioners in areas where child health services are sparse, but unethical to do so in private practice.
Aminophylline in Status Asthmaticus: Route of Administration
Authors: Weiss Charles F.
Published: December 2021

I wish to comment on the paper by W. E. Pierson and associates in which the aminophylline was given intravenously. I am sure the authors are aware that this drug frequently is administered in a rectal suppository in pediatric practice. Would the conclusions in their paper also be applicable to rectal administration?
Letter to the Editor
Authors: Pierson William E. , Bierman C. Warren , Stamm Stanley J. , VanArsdel Paul P.
Published: December 2021

In answer to Dr. Weiss' inquiry, aminophylline was specifically delivered intravenously to maintain control of the rate and dosage administered. Since rectal absorption is irregular, varies from preparation to preparation, and may often be associated with over-dosage, especially in the poorly hydrated child who is vomiting, we neither advocate nor condone rectal aminophylline. The last two fatal cases of aminophylline toxicity in our community occurred in young patients who were given injudicious doses of aminophylline rectally as outpatients.
Erwinia Conjunctivitis in Children
Authors: London Robert , Bottone Edward
Published: December 2021

The recovery of the gram-negative rod Erwinia from human sources is being reported with increasing frequency. It has been demonstrated as the pathogenic organism contaminating infusion sets and associated with bacteremia. The organism has been recovered from skin infections, ear infections, blood cultures, bone marrow, and a brain abscess.

In the past 22 months we have isolated this organism from the conjunctiva of 11 children. They range in age from a few days to 15 years.
Opportunities for Pediatric Training in the Indian Health Service
Authors: Posner Michael Kagan
Published: December 2021

As a partially trained pediatrician in the Indian Health Service, interested in the Report of the Committee on Indian Health, I would like to add some personal observations:

1. The number of training deferments through CORD is determined by needs of the Department of Defense, to which pediatric services are not essential although a convenience. Because pediatric services are critical in Indian Health where the population is markedly skewed to younger ages, could not the Committee propose that, while the draft continues, pediatricians might choose their branch of service?
Creative Opportunities for the Retarded Child (Six illustrated booklets containing advice and practical information about arts and handicrafts for the parents, nurse, social volunteer or vocational worker who has daily contact with a handicapped child), by H. Cornelia Hollander, New York: Doubleday & Company, Inc., 1971, $10.00
Authors: MacCubrey Jean K.
Published: December 2021

In six illustrated booklets Cornelia Hollander has set forth a rationale and directions for an arts and crafts program for handicapped children. The first booklet describes how a group of parents and teachers of mentally retarded children organized a workshop to teach "uncreative adults" skills that they in turn could teach their handicapped children." The succeeding booklets deal, respectively, with finger painting and simple print making, drawing and painting, clay and other dimensional media, stitchery, and woodworking and odds and ends.
EXPERIMENTAL USE OF METHYL TESTOSTERONE IN PREMATURE INFANTS
Authors: SEITCHIK JOSEPH N. , AGERTY HORST A.
Published: December 2021

Fifty-seven premature infants weighing between 1.3 and 2.3 kg. were studied in respect to time to regain birth weight, time to attain an arbitrarily chosen weight and rate of weight gain. Twenty-seven infants received methyl testosterone. These infants demonstrated no evidence of growth stimulation.

In view of the meager metabolic effects of methyl testosterone in premature infants, there appears to be little justification for its use in premature infants.
COMPARISON OF NUTRITIVE VALUE OF MINERALENRICHED MEAT AND MILK
Authors: MCQUARRIE IRVINE , ZIEGLER M. R.
Published: December 2021

The nutritive value of cooked lean meat enriched with Ca, P and other minerals, as well as with fat, carbohydrate and vitamins, was compared with that of whole cow's milk in feeding experiments on young growing rats and on two adolescent boys. As judged by changes in body weight, whole carcass analyses, bone composition, blood serum analyses, character of the furry coat and spontaneous motor activity, growing rats thrived at least as well on the meat as on the milk regimen, when the two diets contained the same amounts of Ca, P, Mg and K, as well as protein, fat, carbohydrate and vitamins.

The meat formula without any mineral enrichment or with either Ca or P omitted from the salt mixture failed to support normal growth and normal bone composition in the rat.

Preliminary N, P and Ca balance studies on two adolescent human subjects showed the Ca- and P-enriched meat to be as good as or slightly better than milk as a source for these elements.
ETIOLOGIC FACTORS IN TETANY OF NEWLY BORN INFANTS
Authors: GARDNER LYTT I. , MACLACHLAN ELSIE A. , PICK WALTER , TERRY MARY L. , BUTLER ALLAN M.
Published: December 2021

Sixteen cases of neonatal tetany are reported, all of whom were fed cow's milk formulas.

Relative to human milk, cow's milk has a low Ca:P ratio and increased total P concentration. These differences are accentuated in some commercial milks prepared for infant feeding.

Cow's milk, even if diluted 2:1 with water, is an unphysiologic food for the human infant in the neonatal period, producing elevated serum P and decreased serum Ca and Mg levels.

Increasing the Ca:P ratio of cow's milk to that of human milk or dilution 1:2 with water limits the abnormal changes in serum P, Ca and Mg concentrations referred to.

A high P diet of an inadequately diluted cow's milk formula causes hypertrophy of the parathyroid glands of the newborn infant.

The maximum renal P clearance of the human newborn infant in the first week of life appears to approximate 3500 ml./sq. m./24 hrs.

Our observations indicate that when newborn infants are fed cow's milk formulas commonly used in this country limitation in parathyroid and renal function predisposes to tetany.

The foregoing data emphasize the physiologic character of human milk for the newborn infant. If breast milk is unavailable, a suitable formula for the neonatal period appears to be cow's milk 1 part, water 2 parts, 10% carbohydrate and Ca-gluconate to produce a Ca:P ration approaching that of breast milk. The added water and Ca should then be gradually reduced.
Round Table Discussion
Authors: SHIRLEY HALE F. , LAYMAN MARY H. , CLANCY JAMES F. , LIMPER MARGARET A.
Published: December 2021

These, then, are two basic concepts which parents can well add to their viewpoint of the child and of childhood behavior: (1) that of emotional growth and (2) that of the emotional disturbances which children undergo when they cannot learn to satisfy their normal human needs in a reasonably socially acceptable way. It is worth emphasizing that you cannot understand a child's behavior until you know how he feels, and you cannot change his behavior until you know what can be done to change his feelings. Usually you cannot change his feelings until you understand what his needs are, and which needs, by his behavior, he is attempting to fulfill.
ELECTROCARDIOGRAM IN 679 HEALTHY INFANTS AND CHILDREN
Authors: MARONEY MARGARET , RANTZ LOWELL A.
Published: December 2021

An ECG was taken on each of 683 apparently healthy children. Flat, inverted or diphasic T or P waves never occurred in Lead I, rarely occurred in Lead II and frequently occurred in Lead III.

The QRS interval tends to be shorter in children than in adults and increases with age from 6 months to 9 years. Measurements less than 0.04 sec. or greater than 0.08 sec. are rare in healthy children under the age of 9 years.

The PR (PQ) interval tends to be shorter in children than in adults and increases with age from 6 months to 9 years. PR (PQ) intervals of 0.15 sec. or more are rare in healthy children under the age of 4 years. PR (PQ) intervals of 0.16 sec. or more are very rare in healthy children from 4 to 9 years of age.
CARDIO-ESOPHAGEAL RELAXATION (CHALASIA) AS A CAUSE OF VOMITING IN INFANTS
Authors: BERENBERG WILLIAM , NEUHAUSER EDWARD B. D.
Published: December 2021

Repeated vomiting in the newborn or young infant may be produced by persistent relaxation of the hiatus esophagus. Twenty-four patients with this condition have been observed during the past five years. Milder variants may occur more often than have been recognized.

The syndrome in the majority of patients is produced by a temporary neuro-muscular dysfunction. When some organic defect such as a congenitally short esophagus is the causative factor the condition is more apt to be persistent or to start later in life.

The diagnosis is suggested by persistent, otherwise unexplained vomiting which can be alleviated by keeping the patient in an erect position. An absolute diagnosis can be made only by fluoroscopic examination with a barium swallow. The diagnostic change is persistent relaxation of the hiatus esophagus with retrograde filling of the esophagus during inspiration or with increase in intra-abdominal pressure.

Therapy is empiric and consists of the use of thickened formulae and of keeping the patient in the erect position, particularly after feedings.
GEMONAL® (5,5-DIETHYL 1-METHYL BARBITURIC ACID)
Authors: PERLSTEIN M. A.
Published: December 2021

Gemonal® a relatively new, nontoxic, anticonvulsant barbiturate was employed in 50 cases of epilepsy. In this series it was of practically no benefit in idiopathic epilepsy, but improved 18 of 35 cases with seizures due to organic brain disease. Noteworthy was the rather consistent improvement in patients with myoclonic attacks.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: WILSON EUNICE W.
Published: December 2021

The term "handicapped child" tends to put emphasis upon the handicap rather than the child. There is still undue emphasis in many types of physical disability upon how a specific handicap can be overcome by special education or training methods, without sufficient attention to whether the child is having the normal relationships and social experiences necessary to equip him later to compete in adult society. If the ultimate goal for the child who is handicapped is participation with nonhandicapped children in normal life situations, the total needs of the child, as well as those for his specific handicap, must be considered.

This discussion portrays a method which individualizes a child and his needs in order to facilitate his social adjustment. Although the principles expressed have been drawn from experience with preschool children, they are applicable to some extent to all age groups. It is recognized, however, that problems arising in school age and adolescence may require different or additional types of service.

The reaction of parents to knowledge of a child's handicap is of great significance in the child's adjustment. The following reactions seem fairly general:

1. The basic parent-child relationship is somewhat threatened and feelings about the child may undergo change.
SERUM MUCOPROTEINS IN CHILDREN IN HEALTH AND DISEASE WITH SPECIAL REFERENCE TO RHEUMATIC FEVER
Authors: KELLEY VINCENT C. , GOOD ROBERT A. , MCQUARRIE IRVINE
Published: December 2021

Serum mucoprotein levels were determined in 125 normal subjects and in 207 patients suffering from a wide variety of diseases. Mucoprotein levels in normal children were found not to differ significantly from those of normal adults and no significant variation with age was found among children. Subnormal levels of mucoproteins were found invariably in the serum of patients with lipoid nephrosis. Marked elevations were found in generalized malignancy, in some cases of acute bacterial and viral infections, in rheumatoid arthritis and in active rheumatic fever in children. Normal or but slightly elevated serum mucoprotein levels were found in children with uncomplicated Sydenham's chorea, in those with rheumatic fever in the inactive phase, and in nonrheumatic children with uncomplicated acute streptococcal pharyngitis. In rheumatic fever elevations in the level of serum mucoproteins were found to parallel the degrees of activity of the disease process.
THE PRESIDENT'S COLUMN
Authors: SHAW EDWARD B.
Published: December 2021

THE returns of the vote on reorganization were overwhelmingly in favor of both propositions.

There was some misunderstanding of proposition 2. The purpose of this proposal was to provide the Executive Committee with a directive to select, upon the retirement of Dr. Clifford G. Grulee, a successor to his office best suited to fulfill the requisites of this position who is, at the same time, available for appointment. The second proposal was perhaps unnecessary. Authority to select an Executive Secretary is vested in the Executive Board and it was suggested by Dr. Veeder in his letter of transmissal that changes might have to be undertaken slowly and involve a certain amount of pragmatism.

It is expected that Dr. Grulee will continue under the reorganization plan as Executive Director until his retirement in July of 1951. Meanwhile the Board is proceeding most thoughtfully with the consideration of possible appointees to this important position. It is necessary, of course, that this man should have the confidence and respect of the membership but he must, at the same time, have executive ability, business acumen and an unusual capacity to reconcile the divergent views of our powerful organization into a pattern of Academy activities. The nature of his office makes it almost inescapable that the popularity of the Executive Director will vary from time to time with one or another segment of the membership.

It is obviously to the advantage of the Academy and for the continuity of an over-all program to have the same individual remain in this position for many years.
TULAREMIA AS A PEDIATRIC PROBLEM
Authors: LEVY HAROLD B. , WEBB CLARENCE H. , WILKINSON JACQUES D.
Published: December 2021

The results obtained, it would appear that the lack of any pathognomonic clinical feature, tardy appearance of specific agglutinins, and variations from the typical adult course render imperative a high index of suspicion if an early diagnosis of tularemia is to be made in a child. Careful questioning concerning possible ingestion of infected meats, animal contact or tick bite must be stressed. Involvement of siblings may be a strong point in favor of ingestional tularemia.

Painstaking search for a local lesion should be made in every case with unexplained adenitis or appearance of sepsis; the frequency of pharyngo-tonsillar involvement must be appreciated. Usual laboratory aids may be of little value in early diagnosis in the average hospital or office at the present time. Early appearance of the heterophile cross-agglutination reaction may alert the observer to the possibility of tularemic infection.

A severely ill patient, for whom a definitive diagnosis cannot be reached, failing to respond to therapy for other suspected illnesses, and in whom any of the factors just mentioned prevail, should receive the benefit of a therapeutic test with streptomycin. Favorable response and survival, as is true of effective antibiotic therapy for other acute illnesses, may permit of later retrospective diagnosis in some whose illnesses or deaths would otherwise have remained unexplained.
HYPERCALCEMIA NEPHROPATHY AND ENCEPHALOPATHY FOLLOWING IMMOBILIZATION
Authors: DODD KATHARINE , GRAUBARTH HARRY , RAPOPORT S.
Published: December 2021

The case of an active 12 year old boy who was suddenly immobilized following fracture of a femur is presented. The prolonged immobilization led to hypercalcemia and renal damage with hypertensive encephalopathy and osteoporosis. Following withdrawal of Ca from the diet, administration of intravenous fluids and increase in the child's activity, the serum Ca gradually returned to a normal level and signs of hypertensive encephalopathy and of renal damage disappeared. The pathogenesis of acute osteoporosis following sudden immobilization is briefly discussed.
THE PEDIATRICIAN AND THE PUBLIC
Authors: LENNOX WILLIAM G.
Published: December 2021

I enclose a portion of an address, "Epilepsy Then, Now and A Century Hence," delivered at the Centenary of the Boston University School of Medicine. In the belief that the subject discussed will become increasingly timely, I request space for it in "The Pediatrician and the Public." Pediatricians occupy a strategic position with respect to genetics and childbearing and, because of their associations, pediatricians should be unusually youthful minded and forward looking.

From our little Mount Pisgah we have gazed hopefully toward the Promised Land of Epilepsy Control. Now we must descend to the common plain of economics. Fruitful research in any field depends primarily on inspired minds, but money, with its supporting stable politico-economy, seems increasingly important. What will be the state of the world a century hence? Who or what threatens its stability?

At the moment we fear the power of the fissured atom. We physicians envy atomic scientists with their billions to spend, and we feel superior because our labors do not engender fears of catastrophic destruction. And yet, what will people think of us a century hence? By then, we are told, the population of the earth, excessive with respect to its natural or man-made resources, will present a wider and more insoluble menace to peace and prosperity than the split atom. For this menace our profession will be chiefly to blame.

Medical science and public health forces have wonderfully reduced the scourge of sickness and death; but the doubled life span means a doubled population—and, for the added portion of that span, economic unproductivity. A passion for prolonging all lives, including the genetically unfit (coupled with war's destruction of the fit), has violated nature's plans for humanity's improvement. Flattered for past achievements in prolonging life, we physicians ignore the complementary problem of excessive births. We see no danger and cry no alarms. Knowing most about human genetics and the physiology, endocrinology and psychology of reproduction, we nevertheless have not grappled seriously with the vast problems involved in widespread efforts towards the limitation and the genetic improvement of the human breed.
POSTINFANTILE CORTICAL HYPEROSTOSIS WITH SUBDURAL HEMATOMA
Authors: BERREY BEDFORD H.
Published: December 2021

The coexistence of postinfantile hyperostosis and subdural hematoma, an association hitherto unreported, it described in a child 29 months old and a brief review of the 32 previously reported cases of infantile and postinfantile cortical hyperostosis is presented.

The cause of the syndrome is not known but hereditary, infectious, traumatic, allergic and hematologic factors have been considered. Hypervitaminosis A appears to be a definite etiologic possibility in the postinfantile form.

Hyperirritability, fever and anemia with leukocytosis are the outstanding clinical manifestations; characteristic shadows of external thickenings of the corticallis of the bones are pathognomonic.

Since the course of the disease is self-limited, treatment is directed toward symptomatic relief and reduction of intake of vitamin A when it has been excessive.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: HUSE BETTY , H. AUFRANC W. , GOODWIN MARY S.
Published: December 2021

Congenital syphilis still occurs too frequently. The transmission of the disease to infants can be eliminated through adequate case-finding and treatment of pregnant women. For those children who, in spite of past and present efforts to control syphilis among pregnant women, have congenital syphilis, the goal is detection and treatment at the youngest age possible.
EFFECT OF INFUSIONS OF CITRATED PLASMA ON THE PLASMA CITRATE LEVEL OF INFANTS
Authors: AMES R. , SYLLM I. , RAPOPORT S.
Published: December 2021

The effect of infusions of citrated plasma given at varying rates on the plasma citrate level of infants has been studied. The plasma citrate as a rule rose from 0.17 to 2.0 mM/1. after single infusions to fall rapidly at first and more slowly later. In two instances levels of 2.6 and 2.8 mM/1. were observed. Considerable decreases in the calcium ion concentration, assuming unchanged total calcium values, were calculated. ECGs indicated some lengthening of the duration of the Q-T interval, compatible with a decrease in the calcium ion concentration, but to a degree less than expected.

One infant suffered a nearly fatal reaction, considered to be tetanic in nature. The examination of the citrate in the plasma of an infant dead after infusion of plasma showed a high citrate level of 2.8 mM/1. It is assumed that normally physiologic forces are operative to counteract the calcium-ion-lowering effect of citrate.
HYDRANENCEPHALY: CLINICAL DIAGNOSIS
Authors: HAMBY WALLACE B. , KRAUSS RUTH F. , BESWICK WILLIAM F.
Published: December 2021

DURING the past two years the authors have identified in living infants seven examples of a cerebral anomaly which presents some of the clinical characteristics of hydrocephalus but which consists essentially of serious maldevelopment, or even complete absence, of the cerebral hemispheres, with intact meninges and cranium.

The Anomaly

The anomaly consists primarily of absence of the cerebral hemispheres within intact meninges and skull, the resulting cavity being filled with cerebrospinal fluid. The fluid circulation may be normal or the outlets of the ventricles may be closed; "hydrocephalus" results in either case. At operation or autopsy the most striking feature noted is absence of the cerebrum, although a few islands or bands of it may persist. The pia-arachnoid usually is intact, although in some cases it also may have broken down. In the authors' surgical cases the transparent membrane was intact and the attenuated major branches of the middle cerebral artery were pulsating vigorously. As the fluid is aspirated, two egg-shaped, white, glistening bodies representing the basal ganglia are seen on the floor of the skull. Different specimens reveal variable amounts of residual cerebral tissue in the periphery of the tremendously expanded and freely communicating lateral ventricles. The anatomic description of these residual masses of nervous tissue as investigated in autopsy specimens (Cases 1, 3, 6 and 7) will be presented elsewhere.

Etiology and Terminology: The cause of the condition remains controversial, but since the meninges and cranium are intact, it must be assumed that the anlage of the neopallium was present during the period of formation of these layers. Cruveilhier described the anomaly as hydrocephalic anencephaly ("l'anencéphalie hydrocéphalique") and contrasted it with anencephaly associated with absence of the cranial vault.
CONGENITAL TUBERCULOSIS
Authors: AMICK FREDERICK EUGENE , ALDEN MANNING W. , SWEET LEWIS K.
Published: December 2021

Four patients with congenital tuberculosis, all prematurely born infants, are described. Three infants born of mothers with acute miliary tuberculosis apparently contracted the disease by aspiration of infected amniotic fluid in utero. The fourth infant, who was born to a mother with acute pelvic tuberculosis and tuberculous peritonitis, seems to have been infected during passage through the birth canal. Two of the infants were treated by intramuscular injections of streptomycin. In both instances the tuberculous infection appears to have been arrested; the infants are in good condition at the ages of 18 and 24 months, respectively. It is recommended that all infants born to mothers with acute miliary or pelvic tuberculosis be followed with frequently repeated tuberculin tests to insure an early diagnosis and adequate treatment.
KERNICTERUS
Authors: ZUELZER WOLF W. , MUDGETT ROXIE T.
Published: December 2021

A study of etiologic factors in 55 consecutive cases of kernicterus seen at autopsy disclosed the existence of a large, seemingly heterogeneous group in which erythroblastosis fetalis was not a causative factor.

In 21 cases which had shown the characteristic features of erythroblastosis fetalis as regards family history, order number of pregnancy, racial distribution, clinical symptoms, hematologic findings and autopsy observations, the distribution of Rh types of mothers and infants was typical of erythroblastosis fetalis and maternal isoimmunization against Rh was readily demonstrated in 20 instances, the 21st having been studied before adequate technics were available.

By contrast the clinical features were not characteristic of erythroblastosis in a second group of 32 patients which also differed from the first by its incidence of first born infants and by a high percentage of Negroes. In 20 of these 32 case studies of the Rh types of mothers and infants had been made, showing only one instance in which the combination of Rh-negative mother and Rh-positive infant was present. In no instance was it possible to demonstrate maternal Rh antibodies or sensitization of fetal erythrocytes. In the majority of the cases tested mother and infant were compatible in regard to blood group A-B-O. The incidence of incompatibility between mother and child in the A-B-O system was higher than expected in this group and appeared statistically significant. In no instance, however, was it possible to demonstrate unusually high agglutinin titers or immune antibodies against A or B in the maternal serum. The over-all clinical picture of the A-B-O incompatibility group did not differ from that of the patients with compatible blood groups. A-B-O incompatibility may be a predisposing factor in kernicterus but no conclusive evidence for this hypothesis was uncovered by these studies.

The conclusion was reached that kernicterus does not represent a specific entity. Prematurity, severe infections, diarrheal disease, pulmonary and cerebral hemorrhage and maternal diabetes were the chief conditions encountered in those cases of kernicterus in which erythroblastosis fetalis was excluded.
EFFECT OF THE PATENT DUCTUS ARTERIOSUS ON THE PULMONARY BLOOD FLOW, BLOOD VOLUME, HEART RATE, BLOOD PRESSURE, ARTERIAL BLOOD GASES AND pH
Authors: CASSELS DONALD E. , MORSE MINERVA , ADAMS W. E.
Published: December 2021

The effect of the patent ductus arteriosus on the circulation and on the arterial blood gases and pHs has been studied. The pulmonary blood flow diminished 19.6 to 61.8% following ligation in 12 cases examined. The blood volume diminished following closure of the ductus in most cases. Likewise, the heart rate lessened and the pulse pressure was lower after surgery. Arterial oxygen saturation was low preoperatively in some cases and in most instances postoperatively, and this low value sometimes persisted. Some aspects of the data presented have been discussed in detail.
ABSORPTION OF FAT AND VITAMIN A IN PREMATURE INFANTS
Authors: MORALES SOLEDAD , CHUNG ARTHUR W. , LEWIS J. M. , MESSINA ANGELINA , HOLT L. EMMETT
Published: December 2021

Six premature infants were fed butter fat and a vitamin A preparation in an emulsified and in an unemulsified form in order to ascertain whether a reduction in particle size facilitates the absorption of these substances. The results of this investigation indicate that by reducing the particle size of fat and of an oily preparation containing vitamin A to 1 to 2 microns by an homogenizing apparatus the absorption of fat and vitamin A was greatly enhanced. Thus, the particle size of fat and of vitamin A preparations plays an important role in the absorption of these substances in premature infants.
POSSIBILITIES OF SPECIFIC PREVENTION AND TREATMENT OF POLIOMYELITIS
Authors: HAMMON WILLIAM MCD.
Published: December 2021

Particular emphasis is placed on possibilities of passive immunization, because it is felt that this offers practical and theoretic advantages over active immunization. A vaccine is not available at present and may never be available in adequate quantities for all immunologic types or at reasonable cost. Furthermore, if an inactivated vaccine is used, annual revaccination for duration of life might logically ensue. Experimental work has demonstrated the effectiveness of serum prophylaxis in animals and has been given field trials in man, the results of which are suggestive but inconclusive. Gamma globulin from adults should contain antibody to all prevalent types and has been shown to be active in monkeys against three types. It has been used on a small scale as a human prophylactic agent but not on an experimental basis. Gamma globulin, on the basis of inadequate experiment and epidemiologic reasoning, might not prevent infection, though it would be expected to prevent clinical disease. If this proves to be a fact, it would not prevent the development of permanent immunity through inapparent infection, a decided practical advantage. Its use would be recommended only during epidemic years and for only the more susceptible age groups. Dosage and interval would have to be determined. Since gamma globulin is now available, it is felt that a carefully controlled field experiment to determine its effectiveness is in order. There is still no evidence that a serum, gamma globulin or other immunologic agent, has any therapeutic effect, or abortive effect, once illness has begun.

So far, no report of a reliable nature has appeared for a practical therapeutic or prophylactic antibiotic or chemotherapeutic agent against poliomyelitis. However, developments in this field as applied to rickettsial diseases and a few other virus diseases lead to considerable optimism. It is believed that the most likely final control methods will be developed along these lines.
TREATMENT OF MIXED TUMORS OF THE KIDNEY IN CHILDHOOD
Authors: GROSS ROBERT E. , NEUHAUSER EDWARD B. D.
Published: December 2021

Mixed tumors of the kidney in infancy and childhood can be easily recognized in most instances by simple procedures of physical examination and pyelography. In general, it is not difficult to differentiate them from other masses which can appear in the upper quadrants of the abdomen. Therapy in all instances should include transabdominal nephrectomy and postoperative roentgen irradiation to the area. Whether preoperation irradiation has any advantage other than reducing the size of the mass and facilitating its operative removal is still unproved in the authors' experience or in any literature which has appeared to date. By immediate nephrectomy, combined with routine postoperative irradiation to the operative site, survivals (from 1940 through 1947) have been 47% in children of all ages; in babies under 12 months of age the survivals have been 80%.
Should we stop using the P value in descriptive studies?
Authors: Jekel James F.
Published: December 2021

Statistical tests of significance are often (and incorrectly) used in analyzing data from descriptive studies to determine what variables are associated with each other. The standard tests of significance are usually invalid for this purpose and their use leads to unimportant findings being reported and important findings being omitted.

There is no substitute for the mind of the investigator considering each relationship to determine its importance; in this search, a statistical test of the strength of association will be more useful than a statistical test of significance.

Such a change in approach to the analysis of descriptive data would result in greater clarity and reproducibility of studies. I don't know what the "probability" of such a change occurring is, but I do believe such a change would be "important."
Dr. Collu Replies
Authors: Collu Robert
Published: December 2021

The question raised by Dr. Rowe et al. concerning the occurrence of hypoglycemic episodes during the levodopapropranolol test is a valid one since we have observed one such episode in a 5-year-old boy with short stature and ketogenic hypoglycemia whose baseline glucose levels were already low.

I must emphasize, however, that this is the only complication we have experienced in more than 50 tests performed over a two-year period. In all such cases, including 12 cases of hypopituitarism, blood glucose levels tended to increase slightly as already shown in the article.
The Causes of Interstitial Pneumonitis in Immunocompromised Children: An Aggressive Systematic Approach to Diagnosis
Authors: Wolff Lawrence J. , Bartlett Marilyn S. , Baehner Robert L. , Grosfeld Jay L. , Smith James W.
Published: December 2021

A systematic, aggressive approach to the immunocompromised child with interstitial pneumonitis has been used in 24 consecutive patients. Parent and physician awareness of early symptoms and signs has been emphasized. When laboratory data confirmed clinical suspicion, open lung biopsy was done and lung tissue was studied by impression smears, sections, and culture techniques. The etiologic agent was established by stained impression smears within three hours of receipt of tissue in 21 of 24 patients. Eighteen of 24 patients survived. Patients had a poor prognosis if they required ventilatory assistance (five of seven died) or had respiratory symptoms for three days or more prior to biopsy (four of 13 died). Children with solid tumors who had absolute lymphocyte counts < 500/cu mm, had received chemotherapy and radiotherapy to the chest, and had developed Pneumocystis carinii pneumonitis had a poor outcome (all three died).
Sudden Infant Death Syndrome: Normal QT Interval on ECGs of Relatives
Authors: Kukolich Mary K. , Telsey Aimee , Ott Jurg , Motulsky Arno G.
Published: December 2021

Genetically determined prolongation of the QT interval on ECGs has been proposed as one basic pathogenetic mechanism for the sudden infant death syndrome (SIDS). ECG studies in a total of 108 first-degree relatives of 26 patients with this syndrome in comparison with 99 such subjects from 22 control families failed to show any significant differences in the QT interval in these two groups. Hereditary prolongation of the QT interval is therefore unlikely to be a significant factor in the etiology of the vast majority of cases of SIDS.
Detection of Gastroesophageal Reflux in the Pediatric-Age Patient by Esophageal Intraluminal pH Probe Measurement (Tuttle Test)
Authors: Euler Arthur R. , Ament Marvin E.
Published: December 2021

The esophageal intraluminal pH probe test (Tuttle test) was used in 24 pediatric-age patients who had symptoms of gastroesophageal (GE) reflux to determine its sensitivity in detecting gastric acid reflux and to document its usefulness as a prognostic indicator. Eight children had a positive Tuttle test. Six of these patients failed a trial of medical management and required surgery to control their symptoms. None of these patients had GE reflux on esophagrams. Only one of 16 children with a negative test required surgery. This patient also did not have GE reflux on esophagram. The Tuttle test should be included in the diagnostic evaluation of pediatric patients with the clinical presentation of GE reflux.
Children's Behavior During Automobile Rides: Do Car Seats Make a Difference?
Authors: Christophersen Edward R.
Published: December 2021

The behavior of children riding in automobiles with their mothers was assessed by having an observer accompany them on repeated 15-minute automobile rides. Children riding in car seats exhibited very high levels of appropriate or safe behavior, whereas children not riding in car seats exhibited very low levels of appropriate behavior. When car seats were introduced to those children who previously had not used them, the level of appropriate behavior improved dramatically. These results were maintained at three-month follow-up observations.

Prevention or reduction of disruptive child behavior on car rides is an obviously important, but previously unreported, benefit of the use of child restraint seats. This fact might very well be used by the pediatrician to further encourage or persuade parents to purchase and use child restraint seats. The use of a child restraint seat to reduce disruptive behavior during automobile rides is an advantage, beyond the safety aspects, of introducing car seats to young children.
Sudden Infant Death Trends in Six Metropolitan Communities, 1965-1974
Authors: Peterson Donald R. , Chinn Nina M.
Published: December 2021

Data from six geographically dispersed metropolitan areas in the United States in which special sudden infant death syndrome (SIDS) surveillance programs for detection and autopsy diagnosis existed during the period 1965 through 1974 reveal considerable diversity in overall ten-year incidence rates as well as in annual rate distribution patterns. A downward trend in SIDS incidence occurred in some areas but not in others. Non-SIDS postneonatal death rates, which were used for comparison, also decreased in some areas. Rate trends for whites and nonwhites were not consistent. During the same period, the fertility rate in the United States decreased by about a third for both whites and nonwhites. To explain the observed trends we postulate that concomitants of the fertility rate decline may have reduced the number of "high mortality risk babies" to a variable degree in different places and at different times.
Gasoline Sniffing and Tetraethyl Lead Poisoning in Children
Authors: Boeckx R. L. , Postl B. , Coodin F. J.
Published: December 2021

Two cases of acute organic lead poisoning following gasoline sniffing, with one death, are reported. Signs of lead encephalopathy with elevated blood lead levels and markedly decreased levels of erythrocytic δ-amino levulnic dehydratase (ALAD) were demonstrated.

Erythrocytic ALAD activity was used as a screening test for the detection of tetraethyl lead (TEL) poisoning in a group of 43 children who were presumed gasoline sniffers. Their mean ALAD activity was 190 units compared to a mean of 538 units for a control group.

A survey of schoolchildren in another isolated community revealed that 59% had decreased ALAD activity, which correlated well with a history of gasoline sniffing. Only 5% of the children had blood lead levels over 40 µg/dl.

The two surveys herein reported suggest that there may be large numbers of children living in isolated communities who are suffering from TEL poisoning as a result of gasoline sniffing. This constitutes a major medical, public health, and social problem heretofore virtually unrecognized.
Use of Trained Mothers to Teach Interviewing Skills to First-Year Medical Students: A Follow-up Study
Authors: Stillman Paula L. , Sabers Darrell L. , Redfield Doris L.
Published: December 2021

This report describes an attempt to evaluate the effectiveness of "trained mother" interviews early in the medical school curriculum. As an adjunct to a first-year course that teaches interviewing techniques, half of the students were exposed to an interview with one of three trained mothers early in the course. This treatment interview was immediately followed by a feedback session which concentrated on the content and process of interviewing. At the end of the course, all students had an evaluative interview. Those students who had an initial interview and feedback session with a trained mother scored significantly higher on both the content and process of their interviews than the control group. This technique is an effective and efficient way to teach interviewing skills to medical students prior to entering any of their clinical clerkships. A follow-up assessment conducted one year later indicated that one interview with a trained mother is sufficient for optimal learning and that the skills learned are retained over at least that period of time.
A GIANT BIRTH-A MALE INFANT WEIGHING 23 3/4 POUNDS-REPORTED IN 1879
Authors: C. T. E.
Published: December 2021

I believe the infant reported below is the heaviest ever recorded.

The mother . . . stands 7 feet 9 inches . . . [her husband] is 7 feet 7 inches in height. . . . At 12 M., January 15, 1879, I was called upon to attend this lady in confinement. . . . I found her surrounded with competent attendants, and everything in order. . . . After a convenient time . . . I proceeded to make an examination, but was unable to reach the os uteri, it being so far up. . . . At the end of 36 hours the pains became more frequent, and on examination I found the os dilating and labor progressing favorably. The head engaged . . . notwithstanding the long interval between pains, the head made good speed through the great depth of [the] pelvis. At 4 P.M., on the 18th . . . the membranes gave way spontaneously and the amniotic fluid came pouring out so profusely as to startle every one. . . .The bed was well protected with rubber blankets, which carried the waters over the side of the bed, where they were caught in vessels to the amount of five gallons. That lost by absorption and evacuated with succeeding pains, would make the total of water not less than six gallons. Soon after the rupture of membranes the foetal head . . . disengaged. . . . The mother was in good condition, the foetus seemed strong and healthy, and everything mdicated a speedy and successful termination.
Congenital Malaria: A Rare Cause of Splenomegaly and Anemia in an American Infant
Authors: Thompson D. , Pegelow C. , Underman A. , Powars D.
Published: December 2021

A 38-day-old infant had fever, jaundice, hepatosplenomegaly, and a hemolytic anemia. A peripheral blood smear demonstrated intraerythrocytic malarial parasites identified as Plasmodium vivax. Maternal and infant sera contained antibodies to this species. A directed history revealed the mother had suffered several febrile illnesses in Mexico during her pregnancy. Malaria had not been diagnosed nor was it considered at the time of her delivery at this hospital. Review of this and six other cases of congenital malaria reported in this country since 1950 indicates clinical manifestations seldom appear before 3 weeks of age. Although these signs are more frequently associated with other transplacental infections, their occurrence in an infant whose mother is from or who has traveled in an endemic area should prompt consideration of the diagnosis of congenital malaria.
Lipoblastomatosis: A Tumor of Children
Authors: Gibbs Marvin K. , Soule Edward H. , Hayles Alvin B. , Telander Robert L.
Published: December 2021

A 10-month-old boy with circumscribed lobular lipoblastomatosis of the trunk was examined and treated at the Mayo Clinic. This is only the third case of lipoblastomatosis at our institution. The diagnosis depends on the pathologist, and the lesion must be differentiated from low-grade liposarcoma. Effective treatment involves adequate local excision and local reexcision for recurrence.
Dr. McDaniel Replies
Authors: McDaniel David B.
Published: December 2021

We are very pleased that our article stimulated Dr. Overend and his associates to review their immunization activities. Their vaccine-specific levels appear to be higher than those we reported. However, the differences in study design make a direct comparison impossible. Our study was designed to evaluate preschool immunization levels exclusively. The selection of 2-year-old children allows for little delay in the performance of the required vaccinations. Consequently, lower overall and vaccine-specific levels were obtained than would be the case had older children been used.

See table in the PDF file