bluuebunny/crossref_metadata_2025 huggingface dataset:
The Health Profile of Incarcerated Male Youths
Authors: Forrest Christopher B. , Tambor Ellen , Riley Anne W. , Ensminger Margaret E. , Starfield Barbara
Published: December 2021

Objective.

To identify the health needs of adolescent males incarcerated in a juvenile justice facility and to compare their health profiles with those of male adolescents in the community.

Methods.

Cross-sectional surveys were conducted of incarcerated (N = 202) and school (N = 379) samples of male youths. Questionnaires were self-administered and completed before admission health screens (incarcerated youth) or in classrooms (school sample). Health status was assessed by the Child Health and Illness Profile, Adolescent Edition, using scale and item means and by categorizing each youth's pattern of health into 1 of 13 mutually exclusive health profile types.

Results.

Compared with school counterparts, incarcerated male youths had significantly worse health status as demonstrated by poorer health and functioning scores in perceived well being, self-esteem, physical discomfort, acute, chronic, and psychosocial disorders, family involvement, physical activity, interpersonal problem-solving, risk behaviors, and academic performance. Three profile types—High Risks, High Risks/Low Resilience, and Worst Health—accounted for patterns of health for 69.8% of incarcerated youth versus 37.3% of an age-matched school sample. Just 6.4% of incarcerated males were in the Excellent/Good Health profile types, which contrasted with 34.2% of the age-matched school sample.

Conclusions.

The health profiles of incarcerated male youths were worse than those of male youths in school. Our results indicate that rehabilitation programs will need to address incarcerated youth's basic health needs as well as modifying their risk and antisocial behaviors.
Exploring Barriers to Utilization of Poison Centers: A Qualitative Study of Mothers Attending an Urban Women, Infants, and Children (WIC) Clinic
Authors: Kelly Nancy R. , Groff Janet Y.
Published: December 2021

Objective.

Prior research regarding poison center utilization identified risk factors for underutilization including race/ethnicity and acculturation. The purpose of this study was to understand factors contributing to underutilization of poison centers by low-income and minority mothers.

Methods.

Focus groups were conducted with women attending an urban Women, Infants and Children clinic. Transcripts were analyzed for themes and key points.

Results.

Twenty-two English-speaking mothers and 21 Spanish-speaking mothers participated in 7 groups. Participants viewed poisoning as a serious problem to which all children are susceptible. English-speaking mothers had heard of the poison center but were unaware of services provided. They preferred to use the 911 system, which was viewed as immediate medical assistance and was an easy number to remember. Women questioned the credentials of the poison center staff. Spanish-speaking mothers had limited knowledge of poison centers and were concerned about language barriers.

Conclusions.

To increase utilization of poison centers, educational interventions must address these specific needs and misconceptions and should be produced in Spanish and English versions.
Variation in Hospital Discharges for Ambulatory Care-Sensitive Conditions Among Children
Authors: Parker Jennifer D. , Schoendorf Kenneth C.
Published: December 2021

Objective.

Ambulatory Care-Sensitive Conditions (ACSCs), conditions for which ambulatory care may reduce, though not eliminate, the need for hospital admission, have been used as an index of adequate primary care. However, few studies of ACSC have focused on children. We estimated national hospitalization rates for ACSC among children and examined the behavior of the index between subgroups of children.

Methods.

We used data from the 1990–1995 National Hospital Discharge Surveys (NHDS), the US census, and the National Health Interview Survey (NHIS) to calculate hospital discharge rates. Rates were estimated as the number of condition-specific hospital discharges from the NHDS divided by the population at risk, as estimated from the US census and NHIS.

Results.

Predictably, ACSC hospitalization rates were significantly higher among children who were younger, black, had Medicaid insurance, and lived in poorer areas compared with their counterparts. However, the relationship between ACSCs and income and the distributions of conditions within the index varied significantly between children.

Conclusions.

ACSCs may indicate disparities in access and utilization of health care, however, the differing behavior of the index between subgroups suggests that inferences from examining rates of ACSCs may not be comparable for all children.ambulatory care-sensitive conditions, hospitalization rates.
IDIOPATHIC CELIAC DISEASE
Authors: DI SANT'AGNESE PAUL A.
Published: December 2021

The mortality and course of the illness of 58 patients with celiac disease, previously reported, are described. Three patients died; the remaining 55 went on to clinical recovery. The greatest clinical gains were made by these cases in the 6 to 24 months following initiation of treatment, but the abnormal character of the stools persisted for months or years. Relapses were not uncommon during the early years of improvement following upper respiratory infections or dietary indiscretions.

The results of the follow-up study of 23 patients, 3 to 11 years after the original admission to Babies Hospital, are reported. It was found that despite remission of clinical symptoms, many abnormal laboratory and roentgenographic findings persisted (termed "latent phase of celiac disease"). It is reasonable to expect that some patients who have had severe celiac disease during infancy or early childhood may experience a recurrence of gastrointestinal symptoms in adult life.
Interpretation of Traumatic Lumbar Punctures: Who Can Go Home?
Authors: Mazor Suzan S. , McNulty Jennifer E. , Roosevelt Genie E.
Published: December 2021

Objective. To determine whether a ratio of observed to predicted (O:P) cerebrospinal fluid (CSF) white blood cells (WBCs) after a traumatic lumbar puncture (LP) can be used to predict which patients do not have meningitis and can safely be discharged from the hospital.

Methods. A retrospective medical record review was performed on 2 cohorts of previously healthy children who had received an LP at Children’s Memorial Hospital in Chicago, IL. All children were older than 1 month and had a red blood cell (RBC) count in the CSF >500/mm3. Cohort 1 consisted of children who were examined in 1990 through 1999 and had CSF cultures positive for a bacterial pathogen. Cohort 2 consisted of children who were tested during January through December 1999 and had a CSF culture negative for any bacterial pathogen. Exclusion criteria included patients who received antibiotics within 72 hours before evaluation, patients with a previous neurosurgical procedure or CNS bleed, and patients whose complete blood count was not done within 6 hours of LP. The predicted CSF WBC count was calculated using the formula CSF WBC (predicted) = CSF RBC × (blood WBC/blood RBC). The O:P ratio was obtained by dividing the observed CSF WBC by the predicted CSF WBC. The simple ratio of WBCs to RBCs was also calculated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to predict the absence of disease. Receiver operator characteristic curves were generated for the O:P ratio and the WBC:RBC ratio. Continuous variables were analyzed with Mann-Whitney U test.

Results. Among the 57 patients who fit all of the study criteria, 12 (21%) had positive CSF cultures for bacterial pathogens. The patients with meningitis were significantly older (median: 7.8 months; range: 1–106 months) than the patients without meningitis (median: 1.3 months; range: 1–139 months). The O:P ratio was significantly lower in the patients without meningitis (median: 0.064; range: 0.000054–1.09) as compared with patients with meningitis (median: 1.26; range: 0.045–4.72). The WBC:RBC ratio was significantly lower in the patients without meningitis (median: 0.001; range: 0–4.46) as compared with patients with meningitis (median: 1.98; range: 0.04–24.45). The specificity and positive predictive value of an O:P ratio ≤0.01 and a WBC:RBC ratio ≤1:100 were 100% predicting the absence of disease. The area under the curve for the O:P ratio (0.981) did not differ significantly from the area under the curve for the WBC:RBC ratio (0.970).

Conclusion. A WBC:RBC ratio of ≤1:100 (0.01) and an O:P ratio of ≤0.01 identified a large group of patients without meningitis. Using these methods in children younger than 1 month, the majority of patients without meningitis can be differentiated from those with meningitis despite the CSF abnormalities associated with a traumatic LP. However, the clinician should examine all clinical and laboratory information before opting not to treat a child after a traumatic LP.
Using Organizational Assessment Surveys for Improvement in Neonatal Intensive Care
Authors: Baker G. Ross , King Hannah , MacDonald Jeanne L. , Horbar Jeffrey D.
Published: December 2021

Background. Problems with organizational culture, lack of or poor team communications, and conflict are often seen as barriers to improvement efforts.

Methods. A survey measuring aspects of organizational culture was administered twice to staff in neonatal intensive care units participating in the Neonatal Intensive Care Unit Quality Improvement Collaborative Year 2000 collaborative. The surveys provided comparative data on coordination, teamwork and leadership, conflict management, unit leadership and unit culture. These data were summarized and fed back to NICU teams with guidance on their use. Interviews on the use of the survey were held with 12 medical directors and patient care leaders in 9 different NICUs.

Results. The findings indicated that all the units contacted saw themselves as committed to undertaking the organizational survey and using the results. Some units shared the data widely and initiated changes. Other units limited the distribution of data to the unit leadership. There was no apparent relationship between scores on the survey and activities undertaken. Several respondents credited the survey with helping to promote discussions about organizational and team issues.

Conclusions. Future use of the survey should include additional materials to assist in disseminating the results to staff.
Evaluation and Development of Potentially Better Practices to Prevent Chronic Lung Disease and Reduce Lung Injury in Neonates
Authors: Sharek Paul J. , Baker Robin , Litman Fern , Kaempf Joseph , Burch Kelly , Schwarz Edward , Sun Shyan , Payne Nathaniel R.
Published: December 2021

Objective. Despite increased knowledge and improving technology, chronic lung disease (CLD) rates in extremely low birth weight infants have remained constant for 20 years. One reason for this is an ineffective translation of research-proven improvements into practice. The Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was created to provide participating nurseries the tools necessary to effect change. The objective of this study was to develop and implement a process that uses quality improvement techniques to collaboratively improve CLD rates.

Methods. Nine member hospitals of the NIC/Q 2000 collaborative formed a focus group aiming to decrease CLD rates. The focus group established goals and outcome measures, created a list of potentially better practices (PBPs) based on available literature, benchmarked and performed site visits, encouraged individual site implementation of PBPs, developed a database, and measured outcomes.

Results. The goal “decrease CLD rates in extremely low birth weight infants” was established. Nine PBPs were identified, and 57 PBPs were implemented by the 9 participating sites. Twelve site visits were conducted, and a 435-patient database of infants with a mean birth weight of 789 g was established.

Conclusions. Collaborative use of quality improvement techniques resulted in creation of a logical, efficient, and effective process to improve CLD rates. Group creation of PBPs, based on literature review and reinforced with site visits, internal data analysis, and improved individual site outcomes, resulted in accelerated and effective change, unlikely to occur if attempted outside of the collaborative.
Implementing Potentially Better Practices for Multidisciplinary Team Building: Creating a Neonatal Intensive Care Unit Culture of Collaboration
Authors: Brown Mark S. , Ohlinger Judy , Rusk Connie , Delmore Paula , Ittmann Patricia ,   on Behalf of the CARE Group
Published: December 2021

Objective. Part of the process of deriving and refining the CARE (communication, accountability, respect, empowerment) focus group’s potentially better practices (PBPs) for multidisciplinary teamwork was to evaluate and experience the PBPs through implementation.

Methods. The 4 neonatal intensive care units (NICUs) in the CARE focus group each worked with implementation of the PBPs. The choice of initial PBP and method of implementation was left up to each NICU’s core team.

Results. The experience of each of the PBPs that is reported was selected from only 1 of the NICUs. These are summarized and described in a plan-do-study-act type of format.

Conclusions. There was no ideal PBP with which to start. The intertwined nature of all of the PBPs provided additional opportunities to implement other PBPs. A change seemed to be a matter first of vocabulary, then of tentative acceptance, followed by gradual integration into the culture. Change was facilitated when there was acknowledgment of a need to do things differently by the NICU leadership. Although the validity of the PBPs and their importance in cultural change have yet to be confirmed, once there was a persisting intent to change, the makeup of the NICU culture moved to embrace change as part of its culture.
Mercury Exposure and Child Development Outcomes
Authors: Davidson Philip W. , Myers Gary J. , Weiss Bernard
Published: December 2021

Mercury is ubiquitous in the global environment, ensuring universal exposure. Some forms of mercury are especially neurotoxic, including clinical signs at high doses. However, typical human exposures occur at low to moderate doses. Only limited data about neurotoxicity at low doses are available, and scientists differ in their interpretation. Dose–response data on neurodevelopment are particularly limited. Despite or perhaps because of the lack of sufficient or consistent scientific data, public concern about a link between mercury exposure and developmental disabilities has been rising. After reviewing the data, the US Environmental Protection Agency proposed a reference dose (an estimate of a daily dose that is likely to be without a risk of adverse effects over a lifetime) for methyl mercury that is substantially lower than previous guidelines from the World Health Organization, the US Agency for Toxic Substances and Disease Registry, and the US Food and Drug Administration. Some questions have been raised about the Environmental Protection Agency’s guidelines, but the issue remains unresolved. Meanwhile, consumer groups have raised questions about the potential link between mercury exposure and autism spectrum disorders as well as other adverse neurodevelopmental outcomes. This hypothesis has prompted some parents to seek regulatory, legal, or medical remedies in the absence of firm evidence. This article reviews what is known about mercury neurotoxicity and neurodevelopmental risk. Our intent is to focus the debate about mercury on 1) additional research that should be sought and 2) defining the principal issues that public policy makers face.
Skin
Authors: Mancini Anthony J.
Published: December 2021

Human skin provides a barrier between the host and the physical, chemical, and biological environment. It is also a potential portal of entry for hazardous or infectious agents and a potential target of environmental toxins. Cutaneous vulnerability may take on many forms in the embryo, infant, child, and adolescent. Teratogenic agents may occasionally target skin, as appreciated in the proposed association of the antithyroid medication methimazole, with the congenital malformation known as aplasia cutis congenita. Percutaneous absorption of topically applied substances and the potential for resultant drug toxicities are important considerations in the child. Many topical agents have been associated with systemic toxicity, including alcohol, hexachlorophene, iodine-containing compounds, eutectic mixture of local anesthetics, and lindane. Percutaneous toxicity is of greatest concern in the premature infant, in whom immaturity of the epidermal permeability barrier results in disproportionately increased absorption. Immature drug metabolism capabilities may further contribute to the increased risk in this population. Ultraviolet (UV) radiation exposure, which increases an individual’s risk of cutaneous carcinogenesis, may be a particularly significant risk factor when it occurs during childhood. The “critical period hypothesis” suggests that UV exposure early in life increases the risk of eventual development of malignant melanoma. Other risk factors for malignant melanoma may include severe sunburns during childhood, intense intermittent UV exposure, and increased susceptibility of pediatric melanocytes to UV-induced DNA damage. Last, percutaneous exposure to environmental toxins and chemicals, such as insecticides and polychlorinated biphenyls, may differ between children and adults for several reasons, including behavioral patterns, anatomic and physiologic variations, and developmental differences of vital organs.
How Environmental Hazards in Childhood Have Been Discovered: Carcinogens, Teratogens, Neurotoxicants, and Others
Authors: Miller Robert W.
Published: December 2021

Review of the literature reveals that environmental hazards cause adverse health effects that include sterility, infertility, embryotoxicity, low birth weight, skin lesions, neurodevelopmental defects, immunologic disorders, cancer, and fear of late effects. They have been identified mostly by astute practitioners but also by a bacteriologist, an animal experimentalist, 5 factory workers in childless marriages, and a tipsy bystander in an economically impoverished area of Baltimore. Dust on a parent’s work clothes has transported a hazard at work to a hazard at home (lead, asbestos, and chlordecone). Causality is established by showing a dose-response effect and reproducing the effect in studies of other exposed groups or by using another epidemiologic method, eg, prospective instead of retrospective study. Also, the findings should be biologically plausible and not attributable to a concomitant variable such as cigarette smoking. Contrary to front-page newspaper headlines, incidence rates for childhood leukemia are not rising. Preserving specimens for future studies has been valuable: blood from people who were exposed to dioxin in Seveso, Italy; mummified umbilical cords containing methyl mercury at Minamata Bay, Japan; and Guthrie dried blood spots to screen retrospectively for 43 genetic disorders and a specific prenatal cytogenetic abnormality in some children with 1 form of leukemia. Recommendations are given for enhancing interest in environmental hazards and their discovery by clinicians.
SOME EFFECTS OF EXOGENOUS THYROID OR THYROXIN UPON PREMATURE INFANTS
Authors: STEVENSON STUART S. , WIRTH PATRICIA , BASTIANI RITA , DANOWSKI T. S.
Published: December 2021

Forty-eight premature infants, whose condition seemed satisfactory at one week of age and whose weights approximated 1500 gm., were selected for this study. Even-numbered infants in the series were given daily doses of desiccated thyroid or thyroxin for periods averaging 3½ weeks; odd-numbered infants were given placebos of lactose according to the same schedule. The clinical progress of the infants was noted and weekly red cell counts, hemoglobin and serum protein-bound iodine levels were determined.

1. Daily doses of 60 to 120 mg. thyroid produced no significant effects upon clinical condition and progress or upon the protein-bound iodine level.

2. Daily doses of thyroid 180 mg. or thyroxin 0.2 mg. did not affect the caloric and fluid intake, the gavage incidence, the amount of vomiting, the skin color or the body temperature. Such dosage, however, decreased the weight gain, increased the pulse rate and increased the incidence of diarrhea. A higher percentage of infants so treated required blood transfusions and did not fare so well clinically. The level of serum protein-bound iodine was elevated. The administration of thyroid or thyroxin to premature infants selected as noted above is therefore without observable benefit and is sometimes harmful. The effects of daily dosage with thyroxin 0.2 mg. were at least as great as those with thyroid 180 mg.

3. The mean protein-bound iodine level of 32 untreated infants was 5.7±.47 at an average age of 9 days, and mean values for the control infants did not differ significantly from this figure during a subsequent five week period. These levels do not suggest that the premature infant is deficient in circulating thyroxin.

4. Thyroid doses exceeding 120 mg./day are necessary to produce pharmacologic effects in premature infants and in euthyroid children and adults. This implies that the thyroid gland of the premature infant produces and releases thyroxin in amounts comparable to those of normal, older human beings and approximating 120 mg. thyroid/24 hours. Medication of the athyrotic cretin should be adjusted with this in mind.

5. When caloric intake is adjusted by the desires of the premature infant, he ingests an average of about 150 calories/kg. body weight/24 hours. On such a regimen, his weight gain approximates that of his fetal colleague of the same gestational age and averages more than 30 gm./day.
URINARY WATER EXCRETION AND NEUROHYPOPHYSIAL FUNCTION IN FULL TERM AND PREMATURE INFANTS SHORTLY AFTER BIRTH
Authors: AMES ROSE G.
Published: December 2021

In infants studied in the first month of life there was a gradual development of the ability to excrete excess water in a short period of time. When a water load was given according to body weight, orally or intravenously, no diuresis was observed in infants under 3 days of age. In comparison, all individuals tested over 3 days of age responded with a definite increase in water excretion. As early as 2 weeks of age and in all infants over one month of age the entire water load of 3 to 5% of their body weight was excreted in a three hour period following the administration of fluid. No difference in the diuretic response to a water load was apparent in full term and premature infants of comparable postpartum age.

Antidiuretic hormone whether produced endogenously following thirst, excitation or pain, or injected in the form of exogenous antidiuretic principle, caused a decrease in urine output only in infants who received a water load and who were responding to it with a diuresis.

When diuresis followed a water load, the degree of the renal response to antidiuretic hormone could not be compared in the various age groups studied, because of the inability to control a sudden release of endogenous hormone provoked by excitatory stimuli.

The hormone was detectable in the urines of infants under 3 days of age after fluid deprivation; this is assumed to be evidence of a functioning neurohypophysis.
ABNORMAL ELECTROLYTE COMPOSITION OF SWEAT IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: DI SANT'AGNESE PAUL A. , DARLING ROBERT C. , PERERA GEORGE A. , SHEA ETHEL
Published: December 2021

The electrolyte composition of sweat secreted in response to a standard mild thermal stimulus was found to be abnormal in 43 patients with cystic fibrosis of the pancreas. Sodium and chloride concentrations in sweat were 2 to 4 times as high as those found in 50 patients with a variety of other diseases. Sweat potassium levels were also increased in cystic fibrosis of the pancreas although not to the same extent. In contrast, the amount of sweat was not significantly different in patients with fibrocystic disease of the pancreas and control patients.

It was shown that pancreatic deficiency, chronic pulmonary disease and the administration of certain drugs do not per se affect the electrolyte composition of sweat. It was also demonstrated by metabolic studies that disturbances in renal and adrenal function are not responsible for the high sweat chloride and sodium in fibrocystic disease. The dissociation between increased electrolytes in the sweat and their very low levels in the urine during salt restriction are unique to this condition.

The fact that the sweat glands do not retain salt effectively in hot weather, during salt restriction or when DCA is administered, points to a disturbance in the sweat glands themselves. This abnormality may not be pathognomonic of cystic fibrosis of the pancreas, but it is an expected finding.

These disturbances in sweat composition together with preliminary observations of abnormal salivary gland secretion suggest that the secretory activity of many and perhaps all exocrine glands is affected in cystic fibrosis of the pancreas. The term "mucoviscidosis" does not seem justified in view of the fact that at least two nonmucus-secreting structures are affected in this condition.

Massive salt loss through sweating in hot weather accounts satisfactorily for the "heat casualties" in cystic fibrosis of the pancreas. The mechanisms are discussed and it is emphasized that the symptoms are initiated by pure salt loss and the consequent reduction in extracellular fluid volume. Since the condition may, if not treated, lead to fatal cardiovascular collapse, it should be regarded as an acute medical emergency.

Under the usual circumstances, serum electrolyte concentrations are normal in fibrocystic disease of the pancreas. In the presence of marked pulmonary dysfunction in this disease, the bicarbonate of the plasma is elevated and the chloride reduced in compensation. It is therefore necessary to demonstrate a lowered serum sodium as well as chloride to detect the massive salt loss which may occur in hot weather.
STUDIES OF TERRAMYCIN IN PREMATURE INFANTS
Authors: COODIN FISCHEL J.
Published: December 2021

In a study of 57 treated premature infants and 56 control prematures, the daily administration of terramycin 25 mg. in the formula failed to alter the rate of weight gain. Changes in the bacterial flora of throat and stool as a result of the terramycin administration were studied and their possible implications discussed.
PRESIDENT'S ADDRESS
Authors: BARBA PHILIP S.
Published: December 2021

OF ALL the men who have given hours and days of time and thought to the Academy and its affairs the President is the only one prescribed, by custom, an opportunity publicly to express his thoughts on these affairs. Others may write to the Executive Board or struggle for space in letters to the Editor or may explode with frustration. Only one or two have approached this last extremity. Usually, after attempting the first two methods they subside to the rumbling level of low pressure borborygmi.

In taking advantage of this opportunity I first want to express my most sincere admiration, respect and gratitude to the men and women serving on the various Academy Committees. Even those of us who have served on a committee, anytime, anywhere, are apt to forget, when reading the report of another committee, the many hours of debate, of research, of correspondence, of correlation, of drafting and redrafting and the hours spent in committee meetings when they might have been having fun. We read the final report, we agree with most of it and we complain bitterly about the one or two points with which we do not agree. Isn't it odd how quick we are to criticize adversely and how seldom we take the trouble to offer thanks or praise? In the same way we are glad to accept a negative Wassermann or tuberculin test but always demand a repeat of a positive.

I will not record here the various committees and their achievements. They and their membership are printed in the Fellowship list. Their achievements speak for them.
HEMANGIOMA OF THE LIVER WITH HEART FAILURE: A CASE REPORT
Authors: WINTERS ROBERT W. , ROBINSON SAUL J. , BATES GEORGE
Published: December 2021

A case of multiple hemangiomata of the liver is reported in an infant who presented signs and symptoms strongly suggesting congenital heart disease. The post mortem examination revealed no gross anomalies of the heart or great vessels, but did show a heart with cardiac hypertrophy. A mechanism to explain the cardiac failure in this case is discussed.
CEREBROSPINAL FLUID STUDIES IN INFANT CHILDREN WITH CEREBRAL PALSY AND OTHER NEUROLOGIC DISORDERS
Authors: SPIEGEL-ADOLF M. , BAIRD H. W. , SZEKELY E. G. , WYCIS H. T.
Published: December 2021

(1) In 100 children with cerebral palsies and various types of developmental cerebral disorders and 32 neurologically normal controls, the extinction co-efficient of the CSFs (ECSF) was studied by spectrography in ultraviolet light, and their ascorbic acid and protein contents were determined. From these determinations, the extinction co-efficients corresponding to the ascorbic acid (EASC.) and protein values (EProt.) and the difference, D = ECSF - EASC. - EProt., were computed.

(2) Normal newborn infants presented much higher values of ECSF, ascorbic acid and proteins than older children.

(3) A marked increase of the average D values was noticeable in the neuropathologic group, which included cases of birth trauma, cerebral palsy, mental retardation, hydrocephalus, and convulsions.

The increase of D values when statistically evaluated and compared with the analogous values of children without neurological conditions was significant in all pathologic groups (bith trauma, mental retardation, cerebral palsy, hydrocephalus) with the exception of convulsions.

(4) Mental deficiency, especially in its severe forms, is associated with changes in the CSF indicative of damage to cells of the CNS. A correlation is noted between the developmental quotient and the D values; higher D values were found in the group with DQs below 50%, than in that with DQs above 50%.

(5) Changes of D appearing on repeated punctures could be correlated to the clinical course of the disease; this special problem, however, requires further studies on a larger material.
CONGENITAL TRACHEO-ESOPHAGEAL FISTULA WITHOUT ATRESIA OF THE ESOPHAGUS
Authors: WARE GEORGE WILLIAM , CROSS LOUIS L.
Published: December 2021

Congenital tracheo-esophageal fistula without atresia of the esophagus is a rare anomaly. Twenty-six patients are reported in the literature. The authors report an additional case. The etiology is still obscure, but may be due to the development of aberrant blood vessels.

Patients present a triad of signs and symptoms, coughing and cyanosis with feedings, abnormal distention of gastro-intestinal tract and persistent pneumonitis.

Radiographic investigation is most important. Lipiodol study of the esophagus in the oblique or prone position is the most rewarding diagnostic test.

Surgery is the only method of cure.
BILIRUBIN ENCEPHALOPATHY
Authors: Waters William J. , Britton Howard A.
Published: December 2021

(1) Staining of the brain can be produced in normal newborn white rats by intraperitoneal injection of a solution of bilirubin.

(2) Under similar conditions it was not possible to produce staining of the brain in a comparable series of normal adult rats.

(3) This study further emphasizes the importance of the immaturity of the organism in the production of hyperbilirubinemia and its consequent passage through the "bloodbrain barrier" (Bilirubin Encephalopathy).

(4) This adds to the increasing evidence that immaturity of biochemical and physiological processes determines the pathological states which appear to be unique to the newly born organism.
EFFECT OF ADRENOCORTICOTROPIC HORMONE (ACTH) AND CORTISONE ON PROTEINURIA AND HEMATURIA IN THE NEPHROTIC SYNDROME
Authors: Heymann Walter , Gilkey Caroline , Salehar Milena
Published: December 2021

1. Fifteen children suffering from the nephrotic syndrome were treated with 22 courses of either ACTH or cortisone. Three children failed to have a diuresis during 4 courses of treatment. No decrease in proteinuria was noted. Eighteen courses of hormone treatment resulted in diuresis in 12 patients. A decrease in proteinuria preceded diuresis in each instance. [See Table II, Fig. 2 and Fig. 3 in Source Pdf]

2. A relationship between severity of hypoproteinemia and onset of diuresis, once proteinuria has started to decrease, has been established.

3. It is concluded that one of the important actions of ACTH or cortisone in inducing diuresis is concerned with the decrease in proteinuria, resulting in increasing plasma protein concentration and oncotic pressure.

4. The effect of these hormones on hematuria in nephrosis has been noted during 4 courses of treatment. In these proteinuria decreased appreciably. In 4 instances hematuria persisted and proteinuria decreased only slightly or not at all.
FACTOR V LEVELS IN THE NEONATAL PERIOD
Authors: Israels Lyonel G. , Zipursky Alvin , Sinclair Colin
Published: December 2021

Utilizing a modification of the 1-stage method of Wolff, the plasma activity of Factor V was estimated in 53 normal newborns during the first week of life. By this method many newborns were found to have low levels of Factor V during the first 2 days of life which rose towards normal by the sixth day. These findings are discussed with reference to previous findings and to the variations in the other clotting factors during the neonatal period.
ANTIBODY RESPONSES TO NATURALLY OCCURRING POLIOMYELITIS INFECTIONS IN CHILDREN
Authors: Miller C. Arden , Baumeister Jacqueline
Published: December 2021

Serums collected over an 18-month period from children with a clinical diagnosis of poliomyelitis were studied by means of the complement fixation test. Test antigens were prepared from the nutrient fluid of tissue cultures infected with each of the 3 known types of poliomyelitis viruses. Results were compared with those obtained from neutralization tests on the same serums. The complement fixation test was of little diagnostic help in these patients; a high titer, a rise in titer, and a fall in titer were all inconstant findings. A complement fixing antibody titer persisting beyond 100 days was more indicative of the immunologic type of the infecting virus than any other feature of the complement fixing antibody response.

The multitypic nature of the complement fixing antibody response was discussed in relation to the complex antigenic structure of poliomyelitis viruses.
SURGICAL ASPECTS OF LIVER DISEASE
Authors: Swenson Orvar , Fisher John Herbert
Published: December 2021

IN THE care of infants with prolonged jaundice, the surgeon is particularly concerned with those suspected of having obstruction of the extrahepatic ducts. In 1927, Ladd was the first to correct successfully congenital atresia of the bile duct system. At that time, and for some time afterwards, there was great enthusiasm and hope that a considerable number of infants with signs of obstructive jaundice could be helped. Unfortunately, events have not proved this to be so. According to various reports, only 2 to 3 per cent of infants with clinical obstructive jaundice prove to have an atresia of the extrahepatic duct system which is amenable to surgery. To select these few patients who have atresia of the extrahepatic duct out of the large number of jaundiced infants is a difficult task. Formerly, it was common practice to subject all these infants to extensive surgical exploration at 6 to 8 weeks of age to be sure that no correctable lesion was overlooked. Gellis was the first to call attention to the fact that these explorations, particularly in infants under 3 months, were not without hazard. Among the cases he reviewed there were some deaths directly attributable to the diagnostic explorations. Consequently, it has become common practice to delay exploration on these infants until they are 5 to 6 months of age. This practice seems reasonable to circumvent the problem of deaths after exploration, for this hazard is a great deal less after the infants are 6 months or more of age.
VARIABILITY OF MONGOLISM
Authors: Levinson Abraham , Friedman Abraham , Stamps Fredrick
Published: December 2021

A detailed study of 50 children with mongolism was conducted with the objective of evaluating the variability in their characteristics. The data presented demonstrate that none of the developmental characteristics or physical features are constant. Great variability exists in the frequency of occurrence as well as in the extent and degree of all the mongoloid characteristics. The electroencephalogram also shows considerable variability.
PRESACRAL TERATOMAS IN INFANCY AND CHILDHOOD
Authors: Gwinn John L. , Dockerty Malcolm B. , J. Kennedy Roger L.
Published: December 2021

Presacral teratomas are seen most frequently during infancy and childhood. Eighteen children with presacral teratomas were seen at the Mayo Clinic between 1907 and 1953, inclusive. Seventeen were girls. The clinical and pathologic findings are presented.

A mass in the presacral area usually is the only symptom as well as the only abnormal physical finding. Such a mass was seen at birth in 14 of the 18 patients. Occasionally symptoms or signs, or both, of obstruction of the urinary tract and/or the gastrointestinal tract constitute the presenting complain.

Roentgenograms aid in diagnosis; other laboratory findings contribute little.

Pathologically, the size of the tumor may vary greatly. It may contain almost any type of tissue. There was no orderly arrangement of the tissue in any case in our series.

In 4 of the 18 cases malignant changes were found microscopically. This is in close agreement with the recorded incidence of malignant changes in presacral teratomas. It is interesting that in one case 2 types of tissue were involved in malignant metamorphosis. Adenocarcinoma is the commonest type of malignancy found, and this is usually papillary. Metastasis frequently occurs via the blood stream to the lungs. The lymph nodes likewise may be the seat of metastatic lesions.

Surgical removal should be undertaken regardless of the size of the tumor on the age of the patient.
INFANTILE DIARRHEA IN THE DENVER AREA: SIGNIFICANCE OF PROTEUS-PROVIDENCIA ORGANISMS
Authors: Graber C. D. , Lincoln A. F.
Published: December 2021

A 4-month survey of 607 stools taken from 341 infants with diarrhea under 1 year in the Denver area resulted in the isolation of only 20 Proteus strains and 1 Providencia organism. Fifty colitypes of suspect pathogenicity along with 9 Shigella and 8 Salmonella were the principal diarrheal incitants recovered.

The small number of Proteus and Providencia recoveries suggest that these organisms are not frequent diarrheal incitants for the pediatric population in the Denver community.
SPECIAL ARTICLE
Authors: Tisza Veronica B. , Richardson Marianne
Published: December 2021

The evolution of the concept of comprehensive medical care as it is practiced at the Boston Floating Hospital has been described.

In the course of years, a mental health program has been developed and a Child Psychiatry Unit organized and integrated into the life of the hospital. The structure and the functions of this Unit have been influenced by the fact that from the beginning, it was a core part of the hospital and not a specialty service unit only.

The functions of the Child Psychiatry Unit have been elaborated and the play program described in some detail. A collaborative approach in the handling of individual cases has evolved and the importance of free and easy communication among the hospital workers has been demonstrated.
CONGENITAL ADRENAL HYPERPLASIA WITH ASSOCIATED EPISODES RESEMBLING HISTAMINE POISONING
Authors: Gonzales Romulo F. , Gardner Lytt I.
Published: December 2021

Developmental and metabolic observations are presented on a boy with congenital adrenal hyperplasia who also exhibited paroxysmal episodes resembling histamine poisoning. These attacks were characterized by hyperthermia, flushing of the head and ears, abdominal and/or head pain, chilly sensations, prostration and sometimes vomiting. Diastolic hypotension was observed twice during the episodes. The patient complained of marked dizziness if placed in the erect position. There was no evidence of excessive loss of sodium.

Two possible explanations for the above episodes are discussed: (1) that the episodes were due to paroxysmal, massive diencephalic discharge, and (2) that the episodes were due to the sudden liberation into plasma of an intracellular histamine-like substance. The interrelationships between histamine metabolism and adrenocortical function are reviewed. It is hypothesized that the patient's defect in corticosteroid synthesis may be causally related to the episodes resembling histamine shock.
CONTRADICTION OF THE CONGENITAL DYSPLASIA-PREDISLOCATION HYPOTHESIS OF CONGENITAL DISLOCATION OF THE HIP THROUGH A STUDY OF THE NORMAL VARIATION IN ACETABULAR ANGLES AT SUCCESSIVE PERIODS IN INFANCY
Authors: Caffey John , Ames Rose , Silverman William A. , Ryder Charles T. , Hough Gary
Published: December 2021

The acetabular angles were measured radiographically at birth in 627 unselected infants, of whom 551 were re-examined at 6 months, and 527 at 12 months of age. At birth there was a wide variation in the size of the angles. In the different categories, the mean values varied between 29 and 25 degrees; the two-standard-deviation ranges were 39 to 20 and 34 to 15 degrees, respectively. Clinical examination of the hips in a similar neonatal group of 666 infants. which was made up largely of the group examined radiologically, disclosed a high incidence of extra and asymmetrical skin folds in the thighs, and great uncertainty in the determination of limitation of abduction. Abduction was unequal on the 2 sides in 4 per cent of all newborns.

At 6 months of age the angles showed marked reduction in size compared with the neonatal values. At 12 months of age the angles were slightly reduced in comparison with those at 6 months.

The angles in white and Negro infants are approximately equal in size at birth, but in the same infants, the angles were slightly larger in Negroes at 6 and 12 months of age; notwithstanding the fact that congenital dislocation of the hips is virtually nonexistent in Negroes.
SYMMETRIC FORM OF BONNEVIE-ULLRICH SYNDROME
Authors: Silver Henry K.
Published: December 2021

Two cases of the syndrome of webbing of the neck, lymphangiectatic edema, shortness of stature, cubitus valgus and deformities of the toes (symmetric form of the Bonnevie-Ullrich syndrome) are presented.

One patient also had elevated urinary gonadotropins and ovarian agenesis.

The clinical findings of this syndrome and related conditions are described and the possible mechanisms of pathogenesis are reviewed.

The relationship of the Bonnevie-Ullrich syndrome to other clinical syndromes is discussed.
THE PATHOGENESIS OF INTRAUTERINE PNEUMONIA
Authors: Schaffer Alexander J.
Published: December 2021

PNEUMONIC changes can be found in the lungs of a substantial proportion of the fetuses which die in utero in the late stages of gestation. Similar alterations found in the lungs of percentage of liveborn infants who for only a few hours or day. In the first instance it is certain, in the second it is generally assumed that the process had its origin within the uterus. In an additional number of both stillborn and liveborn infants, it may be demonstrated by microscopic examination that there is an excessive quantity of amniotic sac contents within the lungs.

The pathogenetic factors responsible for both intrauterine pneumonia and for excessive aspiration of amniotic contents have never been definitely established. There still exit profound differences of opinion on every aspect of the process of intrauterine respiration. The following represent expert opinions on the question as to whether the fetus "breathes" or not.

Snyder and Rosenfeld state that "in the full-term fetus sponataneous rhythmic respiratory movements occur which may continue many hours. "Davis and Potter maintain that "amniotic fluid is normally aspirated into lungs as part of intrauterine respiratoy activity" and concluded that "an adquatic existence for the fetus is normal during intrauterine life."

Windle has arrived at the opposite conclusion. In 1939 he wrote,"One is tempted to entertain the false assumption that respiration at birth is a continuation of respiratory-like phenomena indulged in normally throughout fetal life. This is contrary to fact." Sir Joseph Barcroft came to the same conclusion. "There is during the second half of fetal life an inhibition of the nervous mechanism responsible for respiratory movements. If there were not the fetus would be drowned before it was born."
PREGNANEDIOL EXCRETION IN THE URINE OF NEWBORN MALE INFANTS
Authors: Roby Charles C. , Ober William B. , Drorbaugh James E.
Published: December 2021

Pregnanediol is found in small quantities in the urine of newborn male infants. It disappears from the urine progressively during the first week of life. The smallest amounts of pregnanediol were found in urines of premature infants born to normal mothers. Considerably higher amounts were found in term infants and in premature infants delivered by cesarean section to diabetic mothers treated with progesterone and stilbestrol throughout pregnancy. The difference between premature infants born to normal mothers and premature infants born to progesterone-treated diabetic mothers is interpreted as indicating that parenterally administered progesterone may, under certain circumstances, cross the placental membrane. Evidence that progesterone is elaborated by the fetus, possibly in the adrenal cortex, is discussed, and the hypothesis offered that the placenta may permit the passage of progesterone in either direction.
THROMBOTIC THROMBOCYTOPENIC PURPURA
Authors: Wile Simon A. , Sturgeon Phillip
Published: December 2021

Thrombotic thrombocytopenic purpura is a relatively new and distinct disease entity manifested clinically by purpura, thrombopenia, hemolytic anemia and bizarre transitory neurologic signs and symptoms. It is characterized histologically by widespread occlusion of the arterioles and capillaries with an amorphous or granular acidophilic material, endothelial proliferation within the vessels and the virtual absence of any inflammatory reaction in the walls of the blood vessel and adjacent tissues.

Three cases occurring in children are reported together with a discussion of our present concepts of the disease.

The clinical diagnosis of thrombotic thrombocytopenic purpura is not difficult provided the symptomatologic triad of thrombopenia, hemolytic anemia and neurologic disturbances are borne in mind. In some instances, diagnosis can be made prior to death by the finding of the characteristic histologic picture in paraffin sections of particles aspirated from the bone marrow or in biopsy specimens of the skin.

It is stressed that the possibility of thrombotic thrombocytopenic purpura should be considered whenever an unusually severe or fulminating purpura, associated with thrombopenia, is encountered.