bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertension With Virilizing Adrenal Tumor
Authors: Siegler Richard L. , Rallison Marvin L.
Published: December 2021

It is not generally recognized that virilizing adrenal tumors can cause severe hypertension, and these tumors are not mentioned in recent review articles of childhood hypertension. This report emphasizes that severe but reversible hypertension can result from these neoplasms.

CASE REPORT

A boy was well until age 5 years, when deepening of his voice, acne, increasing body hair, progressive muscularity, and enlarging genitalia were noted.

When examined by his local physician several months later, virilization was obvious, hypertension (150/100 mm Hg) was present, and initial laboratory studies suggested a 21-hydroxylase deficiency. The presence of hypertension prompted a renal evaluation, which revealed normal urine, serum creatinine concentration, intravenous pyelogram, and renal arteriogram.
SOME PEDIATRIC PRESCRIPTIONS FROM THE FIRST MEDICAL BOOK PUBLISHED IN NORTH AMERICA (1708)
Authors: C. T. E.
Published: December 2021

Nicholas Culpeper (1616-1654) is the author of the first medical book published in the British North American colonies.1 The book, published in Boston in 1708, more than 50 years after the author's death, and titled The English Physician, is a small (approximately 3 x 5 inches) publication of only 94 pages, meant for the lay reader, and contains some of the author's "Choicest Secrets in the Art of Physick."2

Some of Culpeper's prescriptions under Children's Infirmities are these:

To prevent the Falling Sickness, and Convulsions

Take of red Coral in powder 10 Grains, give it in Breast milk to a new Born Child, for the first Food it takes after its Birth. It mightly strengthens the Brain.

To make them Teeth easily

Take pure Capons Grease well clarified, as much as a Nutmeg, twice as much Honey, then mix them together three or four times in a day anoint the Gums when they are teething.

Against Agues and Fevers, coming by pain in breeding of Teeth, or otherwise.

Take one spoonful of Ungent Populeon, two spoonfuls of Oyl of Roses, mix them, then before the Fire anoint the Childs bowing places of his Arms, Legs, soles of its Feet, Fore-head and Temples, twice a Day, Chasing it well with a warm Hand.

Against the Worms

Take Myrrh and Aloes of each alike, finely powdered; and with a few drops of Chymical Oyl of Wormwood, or Savin, with a little Turpentine, mix them, and make them up for a Plaister for the Childs Navel.
Drs. Nadas and Levy Reply
Authors: Nadas Alexander S. , Levy Robert J.
Published: December 2021

We share Dr. White's concern about the premature use of new drugs in humans without previous animal experiments and controlled double-blind trials in humans. Our general attitude in regard to these principles might be documented by an editorial about the use of prostaglandin inhibition in the treatment of patent ductus arteriosus in respiratory distress syndrome; a national coordinated double-blind study had been proposed as a sequel to the editorial. In the area of dopamine, a drug we are using extensively to treat low urine output in patients in the cardiac intensive care unit, an abstract summarizing our work, according to a strict protocol, was presented at the February meeting of the American College of Cardiology.
Drs. Twarog and Colten Reply
Authors: Twarog Frank J. , Colten Harvey H.
Published: December 2021

We thank Dr. Mueller for his comments on a controversial area of immunotherapy. We do maintain, however, that the weight of evidence speaks against the use of bacterial vaccine in the therapy of infectious asthma.
Private Practice View of Otitis Media
Authors: Schwartz Richard , Barsanti Ronald G. , Rodriguez William J.
Published: December 2021

In the June 1977 issue of Pediatrics (59:827), Dr. Tetzlaff et al. reported their important study of 59 young infants less than 11 weeks of age who were seen in a hospital setting. The infants had a diagnosis of otitis media confirmed by tympanocentesis. We have recently compiled our data on otitis media in suburban, middle-class infants seen in a private-practice setting during a similar period (28 months). With respect to the above article, we have found a number of similarities as well as some differences in our patient population.
Education for the Post?
Authors: Gluckman Richard J.
Published: December 2021

Having read the commentary "Primary Care: We Need All the Help We Can Get!" (Pediatrics 59:315, March 1977), I agree with Dr. Haggerty and oppose Dr. White's view-point. I agree with Dr. Hoekelman that we need to "develop partnerships with family practitioners and others if we are to succeed" in providing "optimal primary care."

The current trend in many pediatric training centers is not directed toward this goal. As has been stated many times, we are training more primary care pediatricians using sick patients in a hospital setting.
Dr. Wolf Replies
Authors: Wolf Sheldon M.
Published: December 2021

In reply to Dr. Hamburger, children receiving phenobarbital daily were initially given a dosage of 3 to 4 mg/kg/day, but the dosage was subsequently adjusted to maintain a level of 10 to 20 µg/ml in the early years of our study and 15 to 20 µg/ml in the later years.

In reply to Drs. Canfield, we agree that a placebo control would have been valuable. Our experience has been that not many are willing to participate in a placebo group.
Emergency Treatment of the Choking Child
Authors: Greensher Joseph , Mofenson Howard C.
Published: December 2021

The Committee on Accident and Poison Prevention of the American Academy of Pediatrics concurs with the American Heart Association and the National Academy of Sciences-National Research Council recommendation that the relief of foreign body airway obstruction in infants and children should be achieved through a combination of back blows and chest thrusts. The four back blows are intended to produce an artificial cough resulting in increased pressure in the blocked respiratory passages. The four chest thrusts are added to give an additional sustained pressure increase to facilitate expulsion of a foreign body. The use of the abdominal thrust is not recommended and blind finger sweeps should be avoided. Infants should be held face down with the head lower than the trunk; older children can be placed across the thighs. The back blows are delivered with the heel of the hand. The chest thrusts are delivered as for external cardiac compression. Physicians and the general public should be familiar with recommended resuscitation techniques.
SAMUEL JOHNSON WAITS FIFTY YEARS TO THE DAY TO EXPIATE A BREACH OF FILIAL PIETY COMMITTED AS A BOY
Authors: C. T. E.
Published: December 2021

Samuel Johnson (1709-1784), an eccentric, of ungainly appearance and sometimes savage manner, was the foremost conversationalist of his day and chief dictator of its literary taste.

A touching aspect of his life is revealed in this little known confession of an episode that took place when he was a boy.

During the last visit which the Doctor made to Lichfield, the friends with whom he was staying missed him one morning at the breakfast-table. On inquiring after him of the servants, they understood he had set off from Lichfield at a very early hour, without mentioning to any of the family whither he was going. The day passed without the return of the illustrious guest, and the party began to be very uneasy on his account, when, just before the supper-hour, the door opened, and the Doctor stalked into the room. A solemn silence of a few minutes ensued, nobody daring to inquire the cause of his absence, which was at length relieved by Johnson addressing the lady of the house in the following manner: ‘Madam, I beg your pardon for the abruptness of the departure from your house this morning, but I was constrained to it by my conscience. Fifty years ago, Madam, on this day, I committed a breach of filial piety, which has ever since lain heavy on my mind, and has not till this day been expiated. My father, you recollect, was a bookseller, and had long been in the habit of attending Uttoxeter market, and opening a stall for the sale of his books during that day.
Pediatrics and the Psychosocial Aspects of Child and Family Health
Authors:   Committee on Psychosocial Aspects of Child and Family Health, Green Morris , Brazelton T. Berry , Friedman David B. , Reinhart John B. , Schwartz Irwin L. , Wallace Peter D.
Published: December 2021

Pediatricians through their participation in primary, secondary, and tertiary health care services have the opportunity and the responsibility for guiding parents in the health care of their children as well as protecting the health of children and adolescents. More than any other health care provider, pediatricians have the requisite longitudinal and cross-sectional perspective, and a background in biologic and psychological development. In providing optimal child and family health care, the American Academy of Pediatrics seeks to enhance the important contributions of pediatricians in relation to basic health needs as reflected in the psychosocial aspects of child and family life. The purpose of this statement is to define that role.

Over the past four decades, pediatric education, research, and practice have been enriched by inclusion of relevant knowledge, skills and attitudes from the behavioral and social sciences, child development, education, and child psychiatry. The extensive scientific and experiential knowledge base applicable to pediatric practice includes normal growth and development; adaptive and pathologic psychosocial development; the nature of parentchild and family relationships; child care and parenting practices and their relation to different family styles and ethnic and cultural back-grounds; reactions of children of various ages to illness and death; nature and significance of psychometric tests to assess status, aptitude, and achievements; opportunities for preventive intervention in primary care and counseling at-risk families; and principles of the psychotherapeutic role of the pediatrician.

As a primary care physician and consultant, the pediatrician is increasingly expected to be concerned with the prevention, early detection, and management of psychosocial problems pertinent to optimal child and family health and development.
Congenital Lobar Emphysema in a Mother and Daughter
Authors: Wall Michael A. , Eisenberg Jay D. , Campbell John R.
Published: December 2021

Congenital lobar emphysema (CLE) is a well-described cause of respiratory distress in infancy and is characterized by hyperinflation of the affected lobe with compression ofsurrounding normal lung tissue. On occasion a specific cause for the lobar hyperinflation, such as torsion of the bronchus, extrabronchial vascular compression, or bronchial atresia, may be demonstrated.1 More common, however, is the association of CLE with presumed hypoplastic bronchial cartilage1-3 and dynamic bronchial collapse.

CLE is not usually described as an inherited disease. To our knowledge, there have been no previously reported cases of a parent and child with CLE. We report here a mother and daughter, both of whom had congenital right middle lobar emphysema.
Fragile Chromosomes
Authors: Murray Jeff
Published: December 2021

The recent article by Hecht et al1 provided a comprehensive summary of this area of genetics that is of particular importance to pediatricians. I would like to add two recent findings of interest.

First, Webb et a12 have reported a family with a male of normal intelligence and the fragile X marker chromosome. He was ascertained through his daughter who had a mentally retarded son with the associated fragile site and in addition the daughter showed the fragile X confirming her obligate carrier status.
Letter to the Editor
Authors: Hecht Frederick , Glover Thomas W. , Kaiser-Hecht Barbara
Published: December 2021

The commentary on "Fragile Sites on Chromosomes" consisted of two pages of text.1 It was not a "comprehensive survey." Rather it was meant simply to provide a passing perspective on this rapidly progressing area: fragile sites.

Normal Males with Fragile X. In the commentary we cited the initial report2 of the "fragile X in a normal male." The second report3 of a normal male with the fragile X appeared subsequently. Both reports are brief. It is entirely possible that both reports are wrong. These males may prove retarded when carefully tested and compared with their normal relatives. More detailed cytogenetic studies may show that these males do not really have the fragile X chromosome.
Home Apnea Monitoring in ‘Near-Miss’ Sudden Infant Death Syndrome (SIDS) and in Siblings of SIDS Victims
Authors: Duffty Paul , Bryan M. Heather
Published: December 2021

Electronic monitors were used at home to detect apnea in 134 infants who were considered to be at risk for sudden infant death syndrome (SIDS). Seventy-two infants had idiopathic apnea at a mean age of 2.2 ± 1.4 (± 1 SD) months. Of these, 31 subsequently had prolonged apnea (> 20 seconds) with the last spell occurring at 6.2 ± 3.2 months of age. Fourteen infants required vigorous stimulation on at least one occasion and 14 had more than ten separate episodes. Eighteen infants with awake apnea had a significantly smaller chance of subsequent spells (P < .05). Ten additional term infants had apnea during the first week of life but none had subsequent episodes. Of 52 siblings of SIDS victims, only seven had had apnea before monitoring started. Sixteen had prolonged apnea while on a monitor; seven required vigorous stimulation on at least one occasion and one infant died despite cardiopulmonary resuscitation. The first documented spell in these 16 infants was at 2.6 ± 2.1 months and the last at 7.2 ± 2.7 months of age. Ten infants had more than ten subsequent spells. A tendency to clustering of spells was noted. Preceding events, especially a mild upper respiratory tract infection, were noted in 36 of the 47 infants who had apnea on the home monitor.
Cow's Milk Formula as a Cause of Infantile Colic: A Double-Blind Study
Authors: Lothe Lasse , Lindberg Tor , Jakobsson Irene
Published: December 2021

The role of cow's milk in infantile colic in formula-fed infants was estimated in a double-blind study. Sixty colicky infants were given a cow's milk-containing formula (Enfamil) and a cow's milk-free formula based on soy (ProSobee). Eleven infants (18%) were free of symptoms while receiving soy formula. Symptoms of 32 infants (53%) were unchanged or worse when they were fed cow's milk formula and soy formula, but symptoms disappeared when they were fed a formula containing hydrolyzed casein (Nutramigen). Symptoms of 17 infants (29%) could not be related to the diet; these infants were permitted to continue on a cow's milk-based formula. A challenge with cow's milk-based formula after one month (at approximately age 3 months) produced symptoms of infantile colic in 22 infants (36%). At age 6 months, a challenge with cow's milk was positive in 11 infants (18%) with epidermal and gastrointestinal symptoms. Eight infants (13%) at 12 months of age and five infants (8%) at 16 months of age were still intolerant to cow's milk. Cow's milk seems to be a major cause of infantile colic in formula-fed infants. A dietary treatment is suggested for moderate or severe forms of the colic. Cow's milk protein intolerance is common later in infancy in these infants.
Seizures with Apnea in Children
Authors: Watanabe Kazuyoshi , Hara Kimiko , Hakamada Susumu , Negoro Tamiko , Sugiura Midori , Matsumoto Akiko , Maehara Mitsuo
Published: December 2021

Five children who had apneic attacks as a manifestation of epileptic seizures are reported. In three children, the apneic attacks were the sole symptom of epileptic fits. The other two children had additional types of seizures. The apneic seizures usually lasted one to two minutes and were characterized by respiratory embarrassment rather than complete arrest. These seizures are usually accompanied by cyanosis which appears early during the course of the attack. Although consciousness seemed to be impaired, this was difficult to assess accurately in infants. The ictal EEGs disclosed paroxysmal discharges of focal onset in all cases, consisting of high amplitude θ-waves, gradually mixed with or replaced by sharp waves or spikes in some and fast waves followed by slower waves in others. These occurred in temporal areas in three patients and in frontal and central areas in one patient each. Interictal EEGs, however, revealed paroxysmal discharges in only one patient. Apneic attacks in these infants are considered to be an integral part of the manifestations of complex partial seizures originating mostly in the limbic system.
Clostridium difficile in Normal Infants and Sudden Infant Death Syndrome: An Association with Infant Formula Feeding
Authors: Cooperstock Michael S. , Steffen Earl , Yolken Robert , Onderdonk Andrew
Published: December 2021

Large numbers Clostridium difficile were found in the stools of two victims of sudden infant death syndrome (SIDS). This prompted a study of normal infants in the SIDS age group. Thirty-two infants were studied, using two selective culture techniques and two assays for bacterial products. Thirteen of the normal infants (39%) were found to carry C difficile, and fecal toxins were detected in eight of these, four with cytotoxin detectable at 10-4 or higher dilution. Colonization was observed in one of 13 (7%) breast-fed babies and 12 of 17 (71%) of those whose primary milk source was infant formula (P < .01). Fecal C difficile toxin was detected only in the latter group. The isolation of C difficile or its toxins in the stools of infants with SIDS, diarrhea, or other conditions must thus be interpreted with caution, even if large quantities of fecal cytotoxin are present.
Current Status of the Etiology and Management of Dysmenorrhea in Adolescence
Authors: Alvin Patrick E. , Litt Iris F.
Published: December 2021

Primary dysmenorrhea is a major epidemiologic problem representing the leading cause of school absenteeism in female adolescents. An etiologic relationship between uterine contractility, uterine prostaglandin production, and dysmenorrhea has recently been proposed. Although further research is needed, this hypothesis has facilitated the development of an effective and noninvasive therapy with antiprostaglandin synthetase drugs. It is believed that these drugs will considerably enhance the pediatrician's ability to treat this prevalent problem of adolescence.
Shedding and Survival of Herpes Simplex Virus from ‘Fever Blisters’
Authors: Turner Ronald , Shehab Ziad , Osborne Karen , Hendley J. Owen
Published: December 2021

Shedding of herpesvirus by adults with herpes labialis and survival of the virus in the environment were examined. In nine adults with virus-positive herpes labialis, herpesvirus was detected in the anterior oral pool of seven (78%) and on the hands of six (67%). Herpesviruses isolated from patients with oral lesions were found to survive for as long as two hours on skin, three hours on cloth, and four hours on plastic. These findings support earlier recommendations for the protection of neonates from adults with "fever blisters." In addition, environmental surfaces may be a source of transmission of herpesvirus to the neonate.
An Outbreak of Airborne Nosocomial Varicella
Authors: Gustafson Tracy L. , Lavely Gail B. , Brawner Earl R. , Hutcheson Robert H. , Wright Peter F. , Schaffner William
Published: December 2021

An outbreak of nosocomial varicella was traced to airborne spread from an immunocompromised child hospitalized from Nov 11-19, 1980. Seventy potentially susceptible children were hospitalized on the ward during that period. Although the index patient remained in strict room isolation throughout his hospital stay, eight of these patients contracted varicella. The afternoon of November 12 was the period of highest risk for acquiring varicella. Eight of 36 patients (22%) present that afternoon, compared to none of 34 patients not present that afternoon, acquired the infection. A patient's risk of contracting varicella was significantly related to how near he/she came to the index patient's room that afternoon. Airflow studies, using the tracer gas, sulfur hexafluoride (SF6), demonstrated that patient rooms on this ward were at positive pressure with respect to the corridor. Despite isolation procedures, SF6 released in the index patient's room achieved concentrations in the corridor as high as 10% of those inside the room. Airborne spread of varicella has rarely been reported, but it may be a common mode of transmission in hospitals. We suggest that patients hospitalized with varicella be placed in strict isolation in negative-pressure rooms to reduce the risk of nosocomial transmission.
Perinatal Transmitted Acute Icteric Hepatitis B in Infants Born to Hepatitis B Surface Antigen-Positive and Anti-hepatitis Be-Positive Carrier Mothers
Authors: Sinatra Frank R. , Shah Praful , Weissman Joy Y. , Thomas Daniel W. , Merritt Russell J. , Tong Myron J.
Published: December 2021

Three infants born to mothers who were hepatitis B surface antigen (HBsAg) positive and had antibody to hepatitis Be antigen (anti-HBe), developed acute icteric hepatitis B within three months of birth. All three infants clinically recovered and developed circulating anti-HBs. Contrary to previous studies, these three cases indicate that mother-infant transmission of the hepatitis B virus (HBV) does occur in infants born to HBsAg-positive, HBeAg-negative carrier mothers, and these infants may develop severe acute icteric hepatitis. Therefore, immunoprophylaxis in such newborns may be indicated.
The Death of a Newborn Twin: An Analysis of Parental Bereavement
Authors: Wilson Ann L. , Fenton Lawrence J. , Stevens Dennis C. , Soule Douglas J.
Published: December 2021

The emotional responses of eight families who lost a singleton newborn were compared with those of eight families who lost a twin. The mean gestational age of the babies in both groups was 31 weeks. At a mean time of 15 months following their loss, parents were sent a questionnaire which requested that they report their responses during the first six weeks following their baby's death and their present response to this experience. Embedded in the questionnaire was a 20-item depression symptom inventory. Analysis of variance indicated that although mothers experienced significantly more depressive symptoms than fathers (F = 59.48, P = .001) and that all symptoms had diminished greatly over time (F = 6.02, P = .032), there was no significant difference between the parents who had lost a twin and those who had lost a singleton. However, family, friends, and hospital staff frequently ignored or downplayed the death of the twin assuming that the grief of the parents would be minimal because of the surviving twin. Results of this study indicate that the presence of a living twin in no way lessens the grieving process and that a conscious effort needs to be made to allow parents to express openly their feelings of loss when a twin dies.
The Role of Parental Information in the Incidence of Circumcision
Authors: Herrera Alfredo J. , Hsu Andrew S. , Salcedo Uma T. , Ruiz Maria P.
Published: December 2021

The decision of whether or not to circumcise an infant is usually left to the parents, as recommended by the American Academy of Pediatrics.1 However, recently, we showed2 that parents are not properly counseled to make such an important decision. In a study involving 100 parent pairs of circumcised male newborns, we found that 63% of them do not discuss the matter of risks and benefits of this procedure with any medical personnel until the time of birth. Twenty percent were confronted with the issue for the first time while the mother was being admitted to the hospital after the onset of labor; 23% did not know why the procedure should be performed or believed it was automatically required.2
Screening for Lethal Genetic Disease
Authors: Brusilow Saul W. , Valle David L. , Batshaw Mark L. , Waber Lewis J.
Published: December 2021

Neonatal genetic screening was originally devised for phenylketonuria (PKU) which, although clinically silent during the immediate neonatal period, nonetheless requires prompt diagnosis and therapy soon thereafter to minimize brain damage.

Screening procedures have now been introduced for a number of other diseases: one group shares the asymptomatic qualities of phenylketonuria in the newborn period (eg, hypothyroidism) and a second group (maple syrup urine disease, organic acidurias, galactosemia) exhibits life-threatening symptoms in the immediate neonatal period that demand immediate diagnosis and therapy.

In this issue Talbot et al (Pediatrics 70:526, 1982)1 propose new screening procedures for two diseases that fall into the former group (argininemia and the hyperornithemias) and two diseases, argininosuccinate synthetase and lyase deficiencies, that fail into the latter group.
Neural Tube Defects: A Two-Pronged Approach to Primary Prevention
Authors: Laurence K. M.
Published: December 2021

It is generally agreed that neural tube defects (NTD) have a multifactorial etiology when genetic factors render the developing fetus susceptible to intrauterine environmental factors acting during the fourth week of gestation to interfere with the orderly closure of the neural tube.1 As there is little likelihood that anything can be done about the genetic background, primary prevention would therefore be dependent on eliminating these factors from the environment or avoiding them. My intention here is to enlarge on some aspects of primary prevention of NTD as outlined by Smithells in an earlier issue (Pediatrics 69:498, 1982).2 One environmental factor, poor maternal nutrition and, more particularly, folic acid deficiency seems now to have been identified, but there are almost certainly a number of others.
Why Not Use Acetaminophen for Fever?
Authors: Eden Alvin N.
Published: December 2021

The recent "Special Report" of the Committee on Infectious Diseases of the American Academy of Pediatrics, titled "Aspirin and Reye Syndrome"1 left me confused and disappointed. The Committee based their recommendations on a supposedly careful analysis of all the available data and concluded that, based on our current state of knowledge, aspirin should not be given to any child with varicella or with possible influenza. Although the evidence of a definite association between salicylates and Reye syndrome is tenuous at best, I probably would agree with this conclusion.
Breast-Feeding During Pediatric Residency: Is ‘Breast-Fed Is Best Fed’ Only for Others?
Authors: Balk Sophie J. , Yellin Tova G.
Published: December 2021

Breast-feeding is recommended by the American Academy of Pediatrics as the optimal method of infant feeding in the first 4 to 6 months of life.1 Because more mothers are (re)entering the work force due to economic need or career demands, pediatricians have begun to acquire new counseling skills so as to be able to assist mothers who choose to nurse when returning to work.2

It has been our observation that there are increasing numbers of female house officers in our pediatric residency training program who become pregnant, work right through their pregnancies, and initiate nursing after delivery.
Pulmonary Artery Sling: A Follow-up
Authors: Rheuban Karen S. , Alford Bennett , Sturgill Benjamin C.
Published: December 2021

This letter provides the unfortunate follow-up to the case presented in our paper "Pulmonary Artery Sling: A New Diagnostic Tool and Clinical Review."1

Thirteen months following pulmonary artery reimplantation the infant was seen again with increasing stridor and respiratory distress. The chest radiograph showed narrowing of the intrathoracic portion of the trachea and the main bronchi. The position of the carina was inferior to that normally seen. The child underwent bronchoscopy which demonstrated marked tracheal stenosis secondary to complete tracheal rings.
Hyponatremia in Kawasaki Disease
Authors: Laxer Ronald M. , Petty Ross E.
Published: December 2021

Since its initial description in 1967,1 Kawasaki disease has been further defined and the clinical syndrome continues to expand.2,3 As part of a retrospective review of our patients with Kawasaki disease, we have noted a high frequency of hyponatremia (serum sodium <135 mEq/liter) in patients whose serum sodium was measured on admission to hospital (6/11). Serum sodium values in the six patients were 126 mEq/liter in one, 128 mEq/liter in one, 130 mEq/liter in two, 133 mEq/liter in one, and 134 mEq/liter in one.
Free Bilirubin Is of Importance
Authors: Wennberg Richard P. , Ahlfors Charles E.
Published: December 2021

The March issue of Pediatrics contains three important and provocative articles,1-3 which further our understanding of bilirubin neurotoxicity. However, the conclusion that unbound bilirubin is of minor1 or no importance2 in the pathogenesis of encephalopathy is not justified by the data presented.

On the contrary, the data of Ritter et al1 strongly support the clinical application of free bilirubin determinations. In sick babies, both pH and free bilirubin must be considered when interpreting binding tests.
Letter to the Editor
Authors: Levine Rodney L. , Turkel Susan Beckwitt
Published: December 2021

Plus que ça change, plus que c'est la même chose.

In 1897 in the first edition of his textbook of pediatrics,1 Holt wrote of neonatal jaundice:

As a rule icteric children appear in other respects healthy, but in [prematures] the icterus is apt to be more intense. Few subjects have given rise to wider speculation than this form of icterus. Its exact pathology is at present unknown. . . . Other conditions, such as atelectasis, may coexist, which may make the case grave.
Babies at Double Hazard: Early Development of Infants at Biologic and Social Risk
Authors: Escalona Sibylle K.
Published: December 2021

From the population of a neonatal intensive care unit, 114 infants and their families were followed from birth to age 3½ years. Infants showing massive brain damage at birth and/or severe mental retardation at 7 months of age were excluded from this analysis. The remainder were predominantly poor and nonwhite. The group showed normal cognitive development through age 15 months. By 28 months of age and thereafter, a severe decline in cognitive status proved to be associated with social class. In addition, serious behavioral maladjustment led to improverished cognitive development. The incidence of maladjustment was unrelated to social class. The impact of maladjustment on test scores was significant in all classes, but greater for the higher rather than the lower socioeconomic social groups. Neither neurologic pathology (excepting severe brain damage) nor gestational age (small for gestational age [SGA] vs appropriate for gestational age [AGA]) had a significant effect on IQ scores at 3½ years of age. It is suggested that environmental deficits and stresses impair early cognitive and psychosocial development for both full-term and premature infants, but that the latter group is more vulnerable to environmental insufficiencies than are full-term babies.
Congenital Central Alveolar Hypoventilation Syndrome in Six Infants
Authors: Guilleminault Christian , McQuitty John , Ariagno Ronald L. , Challamel Marie Joseph , Korobkin Rowena , McClead Richard E.
Published: December 2021

Six infants with congenital central alveolar hypoventilation syndrome (CCHS) were seen and observed over several years. Two had an association of CCHS with Hirchsprung's disease. All infants were treated by tracheostomy and mechanical ventilation. Three infants have survived (including one with CCHS and Hirchsprung's disease). However, all survivors have required frequent rehospitalization. The infant with the longest survival (now 4 years of age) has developed significant daytime problems involving the "behavioral control" of ventilation. One infant was considered as a "near miss for sudden infant death syndrome" and became significantly symptomatic after establishment of delta (stage 3-4 non-rapid eye movement) sleep, which normally develops between 2 and 4 months of age. CCHS involves autonomic nervous system dysfunction, and the question of a defect involving the integration of chemoreceptor information more than a direct defect of the central chemoreceptor is discussed.
Membranous Laryngotracheobronchitis
Authors: Denneny James C. , Handler Steven D.
Published: December 2021

The etiology, clinical presentation, and therapeutic strategies associated with membranous laryngotracheobronchitis are discussed. A case is presented in which a lateral neck radiograph gave the preliminary impression of a tracheal foreign body. Endoscopic examination of the upper airway revealed the correct diagnosis of acute membranous laryngotracheobronchitis. Comparison with the more commonly occurring viral laryngotracheobronchitis is made.
RESPONSE BY NESTLE TO THE WHO CODE ON BREAST-MILK SUBSTITUTES
Authors:   Student
Published: December 2021

The Nestle Group has prepared written instructions (dated February, 1982) for its employees on the implementation of the W.H.O. International Code of Marketing of Breast-milk Substitutes. . . . The instructions appear in parallel with the relevant sections of the code, and the comparisons thus offered raise some doubts about the purity of Nestle's intentions. Article 2 of the international code, for instance, states that it covers all breast-milk substitutes, including complementary foods. Nestle has limited its applicability to infant formula alone, exempting its weaning cereals and canned milks, which are often marketed as early supplements to breast milk. Concerning the circulation of informational and educational material to pregnant women and mothers of young children, Nestle says: "Information intended for mothers. . . may bear corporate and product brand (packshot permitted)." Is this really within the terms of the code? Another requirement of the code disregarded by Nestle, is the inclusion in any such material of a warning of the health hazards of the improper use of infant formula. Article 5 of the W.H.O. code states that "There should be no advertising or other forms of promotion to the general public of products within the scope of this Code." Nestle has written: "Information relating to specific brands of infant formula must not be communicated directly to mothers or to the general public." Conceivably, such a statement could permit generic infant formula advertising in the mass media. Analysis of Nestle's guidelines discloses ways in which they might be used to circumvent various parts of the international code, such as the code's stipulations on free samples to health workers and free supplies to institutions.
The Cardiovascular System in Cystic Fibrosis
Authors: Moss Arthur J.
Published: December 2021

Available evidence indicates that cystic fibrosis causes widespread involvement of the cardiovascular system. Aside from the heart, unusual aberrations have been observed in the bronchial arteries, the aorta, and the systemic capillaries. Of all cardiovascular complications, cor pulmonale is the most serious. Recognition of a significant degree of cor pulmonale is generally possible on the basis of the severity of the underlying disease. Although echocardiography and radionucide angiography are valuable research tools in the study of cor pulmonale in cystic fibrosis, they add little, from a practical standpoint, to the management of the patient. The basis of cor pulmonale is hypoxemia and unless this is relieved, no enduring effect can be expected from therapy directed toward the heart. Inasmuch as cystic fibrosis is a progressive disease, cor pulmonale is also progressive. At best, cardiac treatment represents a delaying action that may provide more time to combat an intercurrent infection.
THE AUTHOR'S EYE VIEW
Authors: Johnson Charles F.
Published: December 2021

See image in the PDF file
Renal Osteodystrophy in Children with Chronic Renal Failure: An Unexpectedly Common and Incapacitating Complication
Authors: Hsu Anthony C. , Kooh Sang Whay , Fraser Donald , Cumming William A. , Fornasier Victor L.
Published: December 2021

The incidence, age at onset, and progression of the biochemical, radiographic, and histologic characteristics of renal osteodystrophy were studied in 50 children in whom chronic renal failure had been recently diagnosed. During a ten-year observation period, 19 patients progressed to end-stage renal failure and radiographic signs of renal osteodystrophy developed in 15 of these (79%). Renal osteodystrophy developed in all nine patients whose chronic renal failure was diagnosed before 3 years of age and in six of the ten children with later onset of failure. The mean interval from diagnosis of renal failure to development of osteodystrophy was 1.4 years. Radiographically, growth zone lesions predominated in the younger children, whereas cortical erosions were more prevalent in the older children. Histologic examination, performed in 38 patients, showed both defective mineralization and excessive resorption and was a more sensitive diagnostic index than radiography. Noticeable deformities developed in one third of the patients with osteodystrophy, despite medical treatment including vitamin D2 therapy. Deformities were particularly frequent and Severe in patients whose renal failure developed in infancy. In all 13 patients whose growth patterns were studied before and after osteodystrophy developed, the onset of bone lesions was associated with a deterioration of growth, indicating that osteodystrophy plays a major role in causing the growth retardation commonly observed in children with chronic renal failure.
Examination of Genitalia in Children: ‘The Remaining Taboo’
Authors: Balk Sophie J. , Dreyfus Norma G. , Harris Paul
Published: December 2021

Trained student observers rated 123 physical examinations by pediatric house staff during health care maintenance visits to assess the frequency of examinations done on male and female genitalia compared with examination of ears, heart, and abdomen. Sixty-five observations were made of 21 male house staff and 58 observations of 18 female house staff. One to five examinations per physician were observed. Whereas physicians examined the ears, heart, and abdomen of pediatric patients ≥97% of the time regardless of the sex or age of the child, female genitalia were examined 39% of the time and male genitalia 84% of the time. Female genitalia were examined approximately half as frequently as male genitalia at all ages with a trend to less frequent genital examinations on older children. Both male and female physicians examined female genitalia less frequently than male genitalia. It is concluded that increased emphasis is needed in house staff training programs on the examination of genitalia.
Early Contact and Maternal-Infant Bonding: One Decade Later
Authors: Lamb Michael E.
Published: December 2021

In the last decade, there has been considerable speculation concerning the importance of early skin-to-skin contact between parturient mothers and neonates. This contact is viewed as crucial to the occurrence of maternal bonding, which is seen as a precursor of optimal maternal behavior and thus as a necessary antecedent of optimal child development. In the present review, these conclusions are shown to have been based on equivocal findings obtained in methodologically impoverished studies. Although early contact may have modest but beneficial short-term effects in some circumstances, no positive long-term effects have been demonstrated.
Increased Child Abuse in Families with Twins
Authors: Groothuis Jessie R. , Altemeier William A. , Robarge Joyce P. , O'Connor Susan , Sandler Howard , Vietze Peter , Lustig James V.
Published: December 2021

Large families and inadequate spacing of children increase the risk for abuse. Twin births incorporate both of these factors, yet the association of twinning with subsequent abuse has not been explored. Forty-eight families with twins from St Vincent Hospital and Medical Center and Nashville General Hospital were compared with 124 single-birth families, matched for hospital of delivery, birth date, maternal age, race, and socioeconomic status. Three control (2.4%) and nine twin (18.7%) families were reported for maltreatment (P < .001). Mothers of twins experienced greater previous parity than did control subjects (P < .001). Twins also had significantly longer nursery stays (P < .001), lower birth weights (P < .001), and lower Apgar scores at one (P < .01) and five (P < .05) minutes. A regression analysis incorporating all of these variables, however, showed that twin status was most predictive of subsequent abuse.
Family Life Events and Behavioral Problems in Preschool-Aged Children
Authors: Beautrais A. L. , Fergusson D. M. , Shannon F. T.
Published: December 2021

The relationship between family life events and rates of maternal reports of child behavior and child rearing problems was studied in a birth cohort of 1,265 New Zealand preschool-aged children. Mothers experiencing a large number of life events reported higher rates of child rearing problems. The correlation between family life events and child rearing problems persisted when a number of statistical measures of family and social background were taken into account. Possible explanations for the relationship between family life events and maternal reports of child rearing problems are discussed.
IS STATISTICS A SCIENCE?
Authors:   Student
Published: December 2021

What. . .distinguishes technology from science? Let me put my own view as forcibly as I can. I hold that, in contrast to the scientist, the technologist is not concerned with truth at all. . . .

That the technologist is not concerned with truth may sound a bit shocking but it should come as no surprise. . . . The mark of the technologist is that he must act; everything that he does has some sort of a deadline. He has to manage, therefore, with as much truth as is available to him, with the scientific theories current in his time, and if these are subsequently proved to be untrue (the fate of all scientific theories), or are even known already to be so, he must still do the best he can. One of his tactics is embodied in the splendid institution of factors of safety, where structural members are carefully designed to take the known stresses according to the best available theories, and are then made 100 percent or so stronger again just in case the theories are not quite right.
Observation Scales to Identify Serious Illness in Febrile Children
Authors: McCarthy Paul L. , Sharpe Michael R. , Spiesel Sydney Z. , Dolan Thomas F. , Forsyth Brian W. , DeWitt Thomas G. , Fink Howard D. , Baron Michael A. , Cicchetti Domenic V.
Published: December 2021

The pediatrician makes a judgment of the degree of illness (toxicity) of a febrile child based on observation prior to history and physical examination. In order to define valid and reliable observation data for that judgment, data from two previous studies were used to construct three-point scales of 14 observation items correlated with serious illness in those reports. Between Nov 1, 1980 and March 1, 1981, these 14 scaled items were scored simultaneously by attending physicians, residents, and nurses prior to history and physical examination on 312 febrile children aged ≤24 months seen consecutively in our Primary Care Center-Emergency Room and in one private practice. Of these 312 children, 37 had serious illness. Multiple regression analysis based on patients seen by at least one attending physician in the Primary Care Center revealed six items (quality of cry, reaction to parents, state variation, color, state of hydration, and response to social overtures) that were significant and independent predictors of serious illness (multiple R = 0.63). The observed agreement for scoring these six items between two attending physicians who saw one third of the patients ranged from 88% to 97%. The chance corrected agreement levels (κw) for these six items were, with one exception, clinically significant (κw = .47 to .73). A discriminant function analysis revealed that these six items when used together had a specificity of 88% and a sensitivity of 77% for serious illness. Individual scores for each of the six key items were added to yield a total score for each patient. Only 2.7% of patients with a score ≤10 had a serious illness; 92.3% with a score ≥l6 had a serious illness. The sensitivity of the six-item model for serious illness when combined with history and physical examination was 92%. In the population studied, this predictive model, when used prior to history and physical examination, was reliable, predictive, specific, and sensitive for serious illness in febnile children. It was most sensitive when combined with history and physical examination. The model wifi need to be validated on a new population of patients.
First Announcement of the Fanconi Anemia International Registry
Authors: Auerbach Arleen D. , Schroeder Traute M.
Published: December 2021

We, Arleen D. Auerbach, USA, and Traute M. Schroeder, West Germany, call upon our colleagues to cooperate with us in order to establish and maintain an International Registry of all known Fanconi anemia (FA) patients. Clinical diagnosis of FA is often difficult to establish due to phenotypic diversity of patients and the occurrence of other disorders that manifest some of the features of FA. Diagnosis may be confirmed by the use of a cytogenetic method based on the sensitivity of FA lymphocytes, fibroblasts, and amniotic fluid cells to chemically induced chromosome breakage (Auerbach, Adler, and Chaganti: Pediatrics 67:128, 1981).
Letter to the Editor
Authors: Bartoshesky Louis E.
Published: December 2021

The note from Pagon and associates is appreciated. Since their publication,1 we have observed at least two children in our clinic with the CHARGE association and agree that our reported case might represent a third. Neither of the two others had cleft lip.
Optimum Therapy of Digoxin for Low-Birth-Weight Infants
Authors: WETTRELL GÖRAN
Published: December 2021

Johnson et al suggested that digoxin, even in relatively low dosages, can cause deleterious complications in ill low-birth-weight infants. They asked for further controlled pharmacologic studies of digoxin effects as a guide for rational use of digoxin therapy in low-birth-weight infants.

Today, there is accumulating evidence that adequate contractility of young myocardium can be produced with lower digoxin doses than those previously used. There are also reports showing that young patients can be intoxicated at serum concentrations of digoxin previously considered to be safe.
In Reply: Optimum Therapy of Digoxin for Low-Birth-Weight Infants
Authors: JOHNSON GREGORY L.
Published: December 2021

We thank Wettrell for bringing to our attention his excellent work concerning digoxin pharmacokinetics in premature infants. The work was, unfortunately, published after our report had been submitted, preventing appropriate reference. The work, however, as Wettrell points out, provides a sound pharmacologic basis for our report, as well as others.

Two points concerning our report merit reiteration. First, the majority of infants experiencing clinical digoxin toxicity in our report were not given a loading dosage but simply begun on maintenance dosages of digoxin.
In Reply: Cerebral Blood Flow
Authors: BEJAR RAUL
Published: December 2021

Baylen and Emmanouilides give the impression that their abstract was misquoted in our commentary. We would like to explain our interpretation of their data.

In the abstract, Baylen et al indicate that they measured regional blood flows (RBF) in premature fetal lambs, expressing them as a percentage of the left ventricular output (LVO) before and after patent ductus arteriosus (PDA) closure. Their results (percent of LVO) before and after PDA closure were: lung, 42.7% vs 8.4% (P < .01); carcass, 35% vs 55% (P < .01); heart, 5.5% vs 10.2% (P < .05); gastrointestinal tract, 5.1% vs 9.3% (P < .05); brain, 2.7% vs 3.4% (P = NS); kidney, 2.2% vs 3.3% (P = NS); liver, 3.2% vs 5.7% (P = NS).