bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Emergencies and Administration of Medication in School
Authors:   Committee on School Health
Published: December 2021

Although the occurrence of medical emergencies that are life-and-death matters is quite rare in the school population, certain medical illnesses and injuries do occur while children are in school and require immediate assessment. Since it is unrealistic to expect a school nurse or physician to be immediately available for this assessment, school administrations should develop a set of written policies and procedures to handle these emergencies until such time as a nurse or physician can be contacted or be physically present. Two or more regular members of the school staff, depending on school size, should be designated as the responsible persons to handle the assessment, and one member should be available at all times to give whatever first aid is needed. These persons should be trained in a standard Red Cross course, including cardiopulmonary resuscitation, or have training as an emergency medical technician. This training should be updated as often as necessary to keep them competent in this area.

An emergency medical kit should be available in each school and checked regularly by the responsible staff persons who are trained in this area.

A detailed account of medical emergencies in school, including a list of equipment necessary for an emergency medical kit and how to classify medical emergencies and their treatment, is contained in chapter 18 of the school health manual of the American Academy of Pediatrics.1

The emergencies related to participation in athletics should be handled by a member of the athletic staff. Chapter 15 of the school health manual details procedures for management of athletic injuries.1
This Might Work
Authors: Denicola Lucian K.
Published: December 2021

We have adopted a policy of writing to any druggist or firm that dispenses medication meant for children that is not in a safety container. The use of safety containers and small quantities in containers is a major reason why we now rarely see serious instances of aspirin ingestion. If each hospital pharmacy and poison committee informed the druggists and drug companies that their product had resulted in serious ingestion by a child, I am sure we could encourage more careful packaging of drugs.
Use Auto Dealers?
Authors: Thompson Hugh C.
Published: December 2021

Three articles and a commentary in the September 1976 issue of Pediatrics dealt with car safety for infants and children.1-4 Not one mentioned the cooperation of automobile dealers in promulgating the sale and use of proper devices. Local pediatricians and pediatric societies might well enlist the cooperation of automobile dealers in this effort, and obtain statistics over several years on the value of such a cooperative campaign.
In Reply: Questions About Dipstick Screening
Authors: Kunin Calvin M.
Published: December 2021

I was quite stimulated by the comments in Dr. Wolman's letter concerning our study of the nitrite test as a simple method to detect urinary tract infections among preschool children. As with all field studies, there are limitations which I would readily grant. We tried to present all of our data as carefully and honestly as possible. What more can one ask?

I have been actively studying the epidemiology of urinary tract infections in childhood for 17 years.
Breast Feeding
Authors: Keith Ronald Mac
Published: December 2021

Iain Chalmers asks in his commentary (Pediatrics 58:311, September 1976) "What kind of support does a mother need to establish lactation successfully?"

One sort of support clearly shown by Blaikley et al. (1952) to be successful is to have a lactation nurse giving guidance prenatally and especially during the first ten days of the infant's life.

Better knowledge on the part of nurses, family physicians, and pediatricians of the physiology and psychology of lactation and of the management of breast feeding would probably improve the quality of support available to mothers.
Are We Being Too Cautious?
Authors: San James M.
Published: December 2021

I personally find the implications for the eventual eradication of varicella most exciting, as presented by Asano et al. (Pediatrics 59:3, January 1977). To safely prepare such a vaccine for mass use would surely require most stringent safeguards (more stringent than those used in the measles vaccine trials).

Now, addressing myself to the comments of Dr. Brunell in the same issue (p. 1), I have a few observations from the standpoint of a solo practitioner of pediatrics for 27 years.
Diagnosis of Neonatal Subarachnoid Hemorrhage: Other Laboratory Methods
Authors: Y. Docteur Brossard
Published: December 2021

We have taken much interest in the article by Chaplin et al. (Pediatrics 58:751, November 1976). The technique described by the authors to differentiate subarachnoid hemorrhage from a traumatic lumbar puncture in infants who are transfused with adult blood after subarachnoid bleeding has occurred is very interesting, although it is only one of at least three possible techniques.

We have been faced with this diagnostic problem about a half-dozen times, and during the past five years, we have devised two different methods for this purpose.1
Receptive Language Development in Preterm Children as Related to Caregiver-Child Interaction
Authors: Cohen Sarale E. , Beckwith Leila , Parmelee Arthur H.
Published: December 2021

Fifty preterm children who had experienced a range of biological hazards were divided into two competence groups on the basis of their receptive language development at 24 months. The groups were then compared in terms of the kinds of caregiver-child interactions the children and their primary caregivers engaged in three months earlier in a laboratory assessment. The two language skill groups did not differ on perinatal factors such as birth weight and gestational age, or on length of hospitalization, but did differ in social transactions. The more competent group as compared to the less competent group had caregivers who were more stimulating, the children themselves emitted more vocalization, and the caregivers and children engaged in more reciprocal social transactions.
Were Infants in the Control Group Sicker?
Authors: Vollman John H.
Published: December 2021

The article by Belenky et al. in the December 1976 issue (Pediatrics 58:800, 1976) is a very important and thought provoking one which will undoubtedly stimulate a plethora of letters in addition to this one.

Upon reviewing the article I noticed that, in each weight group studied, nearly twice as many infants in the treatment group were receiving intermittent positive pressure ventilation (IPPV) at entry into the study compared to the control group (50% vs. 25% at 1,001 to 1,500 gm, 33% vs. 17% at 1,501 to 2,000 gm, and 27% vs. 17% at 2,001 + gm), although as stated by the authors, these differences were not statistically significant.
THE REVEREND FRANCIS HIGGINSON DESCRIBES HIS YOUNG DAUGHTER'S DEATH FROM SMALLPOX ON BOARD A SHIP BOUND FOR MASSACHUSETTS IN 1629
Authors: C. T. E.
Published: December 2021

The Reverend Francis Higginson, his wife, and his eight children left England on the Talbot on April 25, 1629, bound for Massachusetts to prepare the way for Governor Winthrop and his party of 400 colonists who were to establish the Massachusetts Bay Colony the following year (1630).

His letter of July 24, 1629, addressed to friends in England, contains one of the earliest pediatric reports in the history of American pediatrics.

And this day towards night my daughter grew sicker, and many blue spots were seen upon her breast, which affrighted us. At the first we thought they had been the plague tokens, but we found afterwards that it was only an high measure of the infection of the pox, which were struck again into the child, and so it was God's will the child die about six of the clock at night, being the first in our ship that was buried in the bowels of the great Atlanticke Sea, which as it was a grief to us her parents and a terror to all the rest as being the beginning of a contagious disease and mortality. So in the same judgment it pleased God to remember mercy in that child, in freeing it from a world of misery wherein otherwise she had lived all her days. For being about four years old a year since, we know not by what means [she] swayed in the back, so that it was broken and grew crooked, and the joints of her hips were loosed and her knees went crooked, pitiful to see, since which time she hath had a most lamentable pain in her belly and would ofttimes cry out in the day and in her sleep also, "My belly!" which declared some extraordinary distemper, so that in respect of her we had cause to take her death as a blessing from the Lord to shorten her misery.
Group C Streptococcal Surgical Wound Infections Transmitted by an Anorectal and Nasal Carrier
Authors: Goldmann Donald A. , Breton Sylvia J.
Published: December 2021

Streptococcus equisimilis (Lancefield group C), an unusual cause of nosocomial surgical infection, was isolated from two orthopedic postoperative wound infections. Both operations had been performed by the same surgeon within a three-day period. Examination of the surgeon revealed perianal dermatitis from which S. equisimilis was isolated. The organism was also recovered from the surgeon's nose and rectum. The wound infections responded to treatment with penicillin derivatives. The surgeon was successfully treated with topical bacitracin and oral penicillin and vancomycin. This report documents the pathogenicity of the C Streptococcus in postoperative infection and suggests a possible nosocomial source of the organism.
Normal Blood Pressures and the Evaluation of Sustained Blood Pressure Elevation in Childhood: The Muscatine Study
Authors: Rames Linda K. , Clarke William R. , Connor William E. , Reiter Mary Ann , Lauer Ronald M.
Published: December 2021

This study describes the seated blood pressure distributions of 6,622 predominantly white schoolchildren in Muscatine, Iowa. Subjects with seated pressures equal to or greater than the 95th percentile for age and sex or 140 mm Hg systolic or 90 mm Hg diastolic were examined on repeated occasions. Approximately 13% of subjects were found to have blood pressures at these levels when first examined, but less than 1% were found to have persistent blood pressure elevations. Of 41 subjects found to have persistent blood pressure elevations, 23 were obese with relative weights in excess of 120%. Of the 18 lean subjects, 5 had secondary hypertension and 13 were considered to have essential hypertension. Mass screening of school-age children identifies many children with transient elevation of blood pressure and few with fixed high blood pressures. Children's blood pressures should be assessed during their continuing care where pressures can be measured over a period of time to identify those with fixed blood pressure elevations.
The Effect of Open- vs. Closed-Book Testing on Performance on a Multiple-Choice Examination in Pediatrics
Authors: Schumacher Charles F. , Butzin Diane W. , Finberg Laurence , Burg Fredric D.
Published: December 2021

A study was undertaken to test the effect of open- vs. closed-book testing conditions on performance on a graduate-level, multiple-choice examination in pediatrics. A group of practicing pediatricians and a group of medical students took the examination. For the practice group, no significant difference between mean scores was observed, and the correlation between scores under the two testing conditions was high. In the student group, however, the mean score was significantly higher under open-book conditions and the correlation between scores under the two testing conditions was positive but low. The mean score obtained by practitioners was significantly higher than the mean score obtained by students under both testing conditions. The effects of time limit and level of motivation were not explored in the present study.
Chorea Associated With Systemic Lupus Erythematosus: Report of Two Cases and Review of the Literature
Authors: Herd J. Kenneth , Medhi Muzaffar , Uzendoski Donald M. , Saldivar Victor A.
Published: December 2021

It is well recognized that systemic lupus erythematosus (SLE) masquerades as various other illnesses including neurologic disorders.1 Neurologic manifestations of SLE include seizures, organic brain syndromes (psychoses), aseptic meningitis, and a variety of focal neurologic syndromes, of which chorea is one example. Although chorea is reportedly a rare sign of CNS involvement in lupus, recent experience, such as the two cases reported here, suggests that it is more common than previously suspected, particularly in children. In 1975 Lusins and Szilagyi reviewed the cases of 28 patients with chorea associated with SLE.2 The majority of these patients were female, none were related to each other, and the youngest was 9 years old at the onset of lupus.
AN AMERICAN CASE REPORT OF PRECOCIOUS PUBERTY PUBLISHED IN 1832
Authors: Le Beau J. , C. T. E.
Published: December 2021

I believe this is one of the earliest case reports of precocious puberty in American medical literature.

I take the liberty to acquaint you with an extraordinary case of prematurity in a child, which fell under my observation in this city. Matilda H. was born of a white family in low circumstances, the 31st of September, 1827. She came into this world with her mammae perfectly formed, and the mons veneris covered with hair, as much as a girl between thirteen and fourteen years old; when precisely three years of age the menses made their appearance, and have continued to reappear regularly every month until the present time, and as copious as any woman might have them-each period lasting four days. She is now four years and five months old; she measures forty-two inches and a half in height, French measure; her features are regular; she has a rosy complexion; her hair chestnut colour; her eyes bluish-gray; she is what may be called handsome; and conformation of her body is very strong; her mammae are now of the size of a full-grown orange, and the dimensions of the pelvis are, in my opinion, such as to enable her to bear children when eight years old, and very likely sooner. She constantly enjoys good health.
Interaction Between Erythromycin and Theophylline
Authors: Weinberger Miles
Published: December 2021

The report of Cummins et al. (Pediatrics 59:144, January 1977) is of potential clinical importance. Additional information, however, would make their data easier to interpret.

Erythromycin is marketed as the free base and as various salts. Only erythromycin estolate has been demonstrated to have hepatotoxic potential. Since troleandomycin, another macrolide antibiotic with even greater hepatotoxic potential, has a profound effect on theophylline clearance, probably by decreasing hepatic metabolism,1 the highest index of suspicion for a similar interaction with an erythromycin would be directed at the potentially hepatotoxic estolate salt (Ilosone).
Drs. Goyette and Conners Reply
Authors: Goyette Charles H. , Conners C. Keith
Published: December 2021

Miller's emotion-laden comments concerning our article clearly misrepresent and/or ignore the reported data, the specifics of the K-P diet, and the comparable difficulties and nutritional aspects of the two diets tested. Careful reading of the article will answer most questions posed and contradict Miller's anecdotal clinical observations.

The fundamental point, as presented by Miller, revolves around the use of a comparison treatment condition when a naive subject pool is unavailable. Empirical testing of a highly publicized and easily recognizable treatment program does raise methodological difficulties in developing an adequate comparison condition.
Can We Screen Febrile Children for Pneumonia and/or Bacteremia Without Chest X-ray Films and Blood Cultures?
Authors: Feder Henry M.
Published: December 2021

McCarthy et al. in their article "Temperature Greater Than or Equal to 40 C in Children Less Than 24 Months of Age: A Prospective Study" (Pediatrics 59:663, May 1977) recommend using both WBC count (≥ 15,000/cu mm) and ESR (≥ 30 mm/hr) for screening febrile young children for pneumonia or bacteremia. If either is elevated they suggest doing blood cultures and taking a chest roentgenogram. However, in 25% of their patients with bacteremia and 42% of their patients with pneumonia neither WBC count nor ESR was elevated, leaving a sizable false-negative group.
Functional Immaturity of Pulmonary Irritant Receptors and Apnea in Newborn Preterm Infants
Authors: Fleming Peter J. , Bryan A. C. , Bryan M. H.
Published: December 2021

Absence of cough and gag reflexes has been noted in premature infants, but pulmonary irritant reflexes have not been studied. Irritant receptors respond to deflation, direct stimulation, or inhalation of irritant gases, resulting in an increased inspiratory effort. We have studied the responses of 28 intubated infants to direct bronchial mucosal stimulation with a fine catheter. Six of ten infants whose gestation was 35 weeks or more consistently showed a "mature" response, with an increase in inspiratory effort, while only one of 18 infants less than 35 weeks consistently showed this response. The premature infants showed variable able responses. Fifty-eight of 93 stimulations produced an increased inspiratory effort, followed by marked slowing or apnea, while 20 stimulations resulted in slowing or apnea alone. These paradoxical responses to irritant stimulation may be related to immaturity of vagal myelination, and may be an important factor in the frequency of silent aspiration and apnea in premature infants.
Hereditary Late-Onset Lymphedema
Authors: Holmes Lewis B. , Fields James P. , Zabriskie John B.
Published: December 2021

Two different types of hereditary late-onset lymphedema are presented. In one family the father and one son had recurrent streptococcal lymphangitis beginning in childhood. In the son there was lymphatic hypoplasia in both legs with the infection having only occurred in one. Prophylaxis with penicillin prevented the recurrent lymphangitis. Because of 30 years of untreated lymphangitis, the father has chronic severe lymphedema. The second type, lymphedema associated with extra eyelashes (distichiasis) and a wide spinal canal, occurred in a woman whose lymphedema began at age 12 but in whom the hereditary nature of the disorder was not recognized until she was 29. Both of these types of late-onset lymphedema, lymphedema with lymphangitis and lymphedema with distichiasis, are due to autosomal dominant genes. Both families would have benefited from early diagnosis of the cause of the lymphedema.
SCIENTIFIC TRADITION
Authors: Popper Karl R.
Published: December 2021

My thesis is that what we call "science" is differentiated from the older myths not by being something distinct from a myth, but by being accompanied by a second-order tradition—that of critically discussing the myth.

This second-order tradition was the critical or argumentative attitude. It was, I believe, a new thing, and it is still the fundamentally important thing about scientific tradition....

Scientific theories are not just the results of observation. They are, in the main, the products of myth-making and of tests. Tests proceed partly by way of observation, and observation is thus very important; but its function is not that of producing theories. It plays its role in rejecting new myths, new theories which may stand up to these observational tests. Only if we understand this can we understand the importance of tradition for science.
Transcutaneous PO2 Monitoring in the Home Management of Bronchopulmonary Dysplasia
Authors: Philip Alistair G. S. , Peabody Joyce L. , Lucey Jerold F.
Published: December 2021

Despite recent advances in the treatment of respiratory distress syndrome and other pulmonary disorders, many infants in the United States develop a chronic lung disorder usually designated bronchopulmonary dysplasia. Management of this disorder frequently requires prolonged hospitalization. However, home management has recently been proposed.1

Transcutaneous Po2 (tcPo2) has been shown to correlate closely with Pao2, in well newborns2 and in sick newborns3-4 in all but a few unusual clinical situations. Reports to date have been concerned with tcPo2 monitoring in acutely ill infants.
Brain Abscess Following Dental Extraction in a Child With Cyanotic Congenital Heart Disease
Authors: Lampe Richard M. , Cheldelin Lawrence V. , Brown Joseph
Published: December 2021

The American Heart Association advises that children with congenital heart disease and a history of penicillin sensitivity receive erythromycin before and after dental procedures to prevent bacterial endocarditis.1 A child managed in accordance with these guidelines subsequently developed a brain abscess caused by an organism resistant to erythromycin. His case and management form the basis of this report.

CASE REPORT

An 8-year-old Caucasian male with cyanotic congenital heart disease (type 4 truncus arteriosus and ventriculoseptal defect) was hospitalized following a two minute focal, left-sided seizure.
Games with children
Authors: Perlstein Paul H.
Published: December 2021

A child whispers into the ear of another child who tells the next who whispers to another who transmits to the fourth and so on until the chain of whispers ends with the last child who loudly announces the message received. Peals of laughter and delight occur when the anticipated distortion of fact happens! Of course, if the chain is short, a very careful player can transmit a message intact. But, make the chain long enough or the message sufficiently complicated and even the most fastidious child will have difficulty preventing a message from becoming distorted in its passage. Fooling around with facts is fun as long as everyone knows a game is being played.
Early Toilet Training
Authors: Gersh Marvin J.
Published: December 2021

In their superb study of toilet training (Pediatrics 60:170, August 1977), deVries and deVries reminded me that I had heard of early toilet training before. Accordingly, inquiries among our patient population here at Montefiore revealed that this process was not uncommon among Jamaicans when they resided in Jamaica. I found no instances of early toilet training among Jamaicans after they moved to the United States, even though they had previously done it in Jamaica. The methods used were essentially the same as those used by the Digos: the use of sounds, endearments, reward, and the absence of punishment.
On Toilet Training
Authors: Ravindranathan S.
Published: December 2021

I would like to endorse the observations and conclusions of deVries and deVries on early toilet training in East Africa (Pediatrics 60:170, August 1977). In southern India, especially in large extended families where the grandmother or other relatives actively participate in bringing up and training children, this has been the usual practice over centuries. Absorbent diapers or potties are hardly ever used. The mother considers it quite natural to toilet-train the babies in early infancy.
Pharyngeal Gonorrhea in Children
Authors: Silber Thomas J.
Published: December 2021

The article "Gonorrhea in Preadolescent Children" by Folland et al. (Pediatrics 60:153, August 1977) successfully brings to the attention of the pediatrician diverse clinical aspects of this infection and its important implications. I would like to call attention to another means of presentation of this condition—pharyngeal gonorrhea. This condition has been described increasingly in the medical literature in the last five years and I had the opportunity to diagnose it in five children (three of them in a screening procedure).
PROMOTION OF ORAL REHYDRATION THERAPY FOR DIARRHEA IN INDIA
Authors:   Student
Published: December 2021

Today, the great majority of cholera patients in the Infectious Diseases Hospital in Calcutta, India, are successfully being treated by oral rehydration. This switch over to oral fluid therapy, which in this hospital now saves about $50,000 every year in the cost of parenteral fluids alone, was the outcome of a study carried out by the Cholera Research Centre of the Indian Council of Medical Research, in collaboration with physicians in the Infectious Diseases Hospital, on the effectiveness of this treatment in cholera patients below the age of 5 years. The Cholera Research Centre, which is also in Calcutta, is a WHO Collaborating Centre for Reference and Research on Vibrios. The study showed that 92% of patients with moderate to severe dehydration responded well when given repeated small amounts (25-30 ml, every 10-15 minutes), rather than a single large volume (250 ml), of oral fluid. In this way, vomiting—which occurred invariably when the large volume was given—was found not to cause any problem.

The Centre in the meantime developed a cheap and simple system for dispensing the ingredients (glucose-salts mixture) for oral rehydration in sealed polythene packets to facilitate distribution. Under the name of Chorosol, the packets—which cost about $0.10 each—have been very well received by medical and paramedical staff. The use of Chorosol in the field, in the management of cholera epidemics, has also been very successful.
Effect of Parenteral Fat Emulsion on the Pulmonary and Reticuloendothelial Systems in the Newborn Infant
Authors: Friedman Zvi , Marks Keith H. , Maisels M. Jeffrey , Thorson Rebecca , Naeye Richard
Published: December 2021

Analysis of phospholipids (PL), cholesterol esters, triglycerides (TG), and free fatty acids (FFA) was performed on plasma and RBCs in two sick low-birth-weight infants who received total parenteral nutrition including Intralipid for the first 9 and 12 weeks of life, respectively. There was an increase in the total concentration of the plasma TG and FFA in the infants receiving Intralipid as compared with controls. These elevated lipid levels were not detected by visual inspection of the plasma. When compared with control infants, higher levels of linoleic acid were found in the plasma and RBCs of infants receiving Intralipid while plasma PL contained less arachidonate. Histological examination of the lung in both infants who received Intralipid revealed numerous globules of sudanophilic material in alveolar macrophages and capillaries. There is a possibility that prolonged administration of Intralipid may be associated with altered pulmonary and reticuloendothelial system function.
Unruly Scalp Hair in Infancy: Its Nature and Relevance to Problems of Brain Morphogenesis
Authors: Smith David W. , Greely Michael J.
Published: December 2021

A relationship has been deduced between aberrant scalp hair directional patterning and problems in early brain development and function. The unusual scalp hair patterns noted by Smith and Gong1,2 were frontal upsweep and aberrant parietal whorl(s). The purpose of this article is to report a third type of unusual scalp hair patterning, unruly hair over the top of the scalp, and its association with problems in brain development. This feature was initially observed by Freund in 1910,3 who noted its association with neuropathic dysfunction in infants.

METHODS

The definition of unruly hair is that which naturally and persistently tends to stand up over the top of the head from the area of the posterior parietal whorl toward the frontal hairline.
Transient Diabetes Insipidus as a Complication of Haemophilus Meningitis
Authors: Lam A. , Sibbald W. J. , Boone J.
Published: December 2021

Diabetes insipidus has been described as a consequence of many acquired CNS lesions. It may develop following craniocerebral trauma,1 subarachnoid or intraventricular hemorrhage,2 hypothalamic lesions and pituitary tumors,3-5 leukemia,6 hypoxic encephalopathy,7 and neurohypophyseal inflammation.8 Although it is also reported as a late complication of tuberculous meningitis9-13 associated with suprasellar calcification, it most often occurs in this circumstance as part of the clinical picture of panhypopituitarism. The occurrence of diabetes insipidus, either temporary or permanent, as a complication of bacterial meningitis has rarely been reported. It is the purpose of this report to describe a case of transient vasopressin (Pitressin)-responsive diabetes insipidus complicating Haemophilus meningitis, to discuss the possible pathophysiology, and to outline the diagnosis and management.
Scoliosis Screening
Authors: Dunn Barbara H. , Hakala Michael W. , McGee Mary E.
Published: December 2021

The term "scoliosis" orginates from the Greek word meaning crooked, and involves lateral curvature and rotation of the spine. Although it can span all age groups, the deformity is most frequently seen in normal, rapidly growing, preadolescent or adolescent children. Because most of the serious consequences of scoliosis can be prevented, it is a deformity particularly amenable to early diangosis and proper treatment. It is therefore important that the health care community and general public be knowledgeable about the deformity; that screening programs be promoted in every locality; and that pediatricians focus particular attention on the spine during the adolescent growth spurt.
Delivery of Emergency Care to Children: Who Is Responsible?
Authors: Wingert Willis A.
Published: December 2021

The annual number of emergency room visits in the United States continues to increase progressively, and there is no reason to believe that this trend will be reversed. In 1974, almost 66 million visits were reported; in 1975, there were 71 million; and in 1976, there were 73.4 million.1 Lower socioeconomic groups have traditionally depended on the emergency room as their major resource for medical care. Recently, middle-class patients have been coming to emergency rooms in increasing numbers, presumably because of inability to contact their personal physician, the demise of the house call, the tendency of physicians to "sign out" to the local emergency rooms at night, or the desire to have the bill covered by medical insurance, which may cover only care that is rendered in a hospital rather than care in the patient's home or the physician's office.1
Interaction of Maternal and Neonatal Obesity
Authors: Udall John N. , Harrison Gail G. , Vaucher Yvonne , Walson Philip D. , Morrow Grant
Published: December 2021

Maternal weight and height before pregnancy and weight gain during pregnancy were recorded for each of 109 mothers who were delivered of normal infants after gestations of 37 to 43 weeks. Infant parameters obtained included gestational age, birth weight, bilateral mid-arm circumference, and eight skin fold thickness measurements. The eight skin fold thicknesses were summed (SSFT) for each infant. Infants with SSFTs greater than 40 mm (N = 8) for the group were classified as "fatter" infants. All of the fatter infants were large for gestational age (LGA), but accounted for only one third of the LGA infants in the study. Birth weight, length, and cross-sectional mid-arm fat area were significantly increased in the fatter LGA group when compared to other LGA infants. Cross-sectional mid-arm muscle area was not significantly different for the fatter LGA infants compared to the other LGA group. Mothers were defined as obese or nonobese according to pregnant weight for height. Obese mothers had infants with significantly increased SSFTs when compared with infants of nonobese mothers. Multiple regression analysis showed that both prepregnant weight for height and weight gain during pregnancy were associated with increased subcutaneous fat in the neonate. Weight gain during pregnancy was associated with increased neonatal fatness and length, while prepregnant weight for height was associated with neonatal fatness independent of neonatal length.
COULD THE HUSBAND'S PINCHING OF HIS WIFE'S HEAD DURING PREGNANCY CAUSE THE INFANT TO BE BORN WITH ANENCEPHALY? A SERIOUS QUERY IN 1809
Authors: C. T. E.
Published: December 2021

In 1809 Dr. P. J. Stryker of Somerset, New Jersey, asked the editor of the Philadelphia Medical Museum this question.1

On the_day of_I was requested to visit Mrs. F. in labour. Her pains [were] regular and of sufficient force, the os tincae [was] handsomely dilated, and much water [was] protruding the membranes; in the intervals between the pains [I] endeavoured to ascertain what part of the child presented; but could only satisfy myself that the presentation was not natural. I determined to introduce my hand, break the membranes, take advantage of the abundance of water to examine more accurately the part presenting, and then act agreeably to the exigencies of the case. The presenting part was, in fact, what must be termed the head, and the child was delivered with much facility: it proved an uncommonly large female, and, at the instant after delivery, lively and strong; in so much that, before I had time to reflect, [I] feared it would survive. The whole of the part of the cranium or brain case with its usual contents, which is naturally covered with hairy scalp, was absolutely wanting, and the foramen magnum occipitis covered with a bloody excrescence; its face and every other part perfectly formed. It lived, perhaps, three or four minutes, rolling its large full eyes about most part of the time. This was Mrs. F.'s fourth child; all daughters.

Mr. F. was a gentleman of uncommon vivacity, and frequently, during Mrs. F.'s pregnancy, when he came in her room and found no third person present, would walk up to her, seize her cranium with his fingers extended, and observe humorously, "that if she presented him with another daughter instead of a son, thus he would pinch it in the head."
Nonsurgical Management of Renovascular Hypertension in the Neonate
Authors: Adelman Raymond D. , Merten David , Vogel John , Goetzman Boyd W. , Wennberg Richard P.
Published: December 2021

Over an 18-month period nine infants in a neonatal intensive care unit developed hypertension (blood pressure, 115/88 to 280/140 mm Hg) at 2 to 45 days of age. Eight of the nine infants had indwelling umbilical artery catheters prior to onset of hypertension; six of the nine infants had evidence of a patent ductus arteriosus. Peripheral plasma renin activity was 300 ng/ml/3 hr in six of eight infants. Angiograms were abnormal in six of seven infants and computerized renal scans were abnormal in all nine infants. One infant had congenital renal artery stenosis. Eight of nine infants had evidence of unilateral or bilateral renal artery thrombi which were felt to have emanated from an umbilical artery catheter or a ductus arteriosus. Hypertension in all infants was successfully controlled medically (follow-up of 3 to 27 months; mean, 14.4 months). Blood pressures remained normal when medication was discontinued. In our experience, neonatal renovascular hypertension is no longer uncommon, responds to aggressive medical management, and rarely requires early nephrectomy. Neonatal renovascular hypertension was usually associated with umbilical artery catheters positioned above the level of the renal arteries.
Initial Urinary Catecholamine Metabolite Concentrations and Prognosis in Neuroblastoma
Authors: Laug Walter E. , Siegel Stuart E. , Shaw Kenneth N. F. , Landing Benjamin , Baptista Joyce , Gutenstein Morris
Published: December 2021

Initial urinary catecholamine metabolite and amino acid excretion patterns were examined in 54 children with neuroblastoma. The relationships between prognosis and age at diagnosis, stage of disease, primary site, and histologic grade of tumor were similar in this population to those found in previous studies, but only age and stage were found to be independent prognostic variables. Prognosis in disseminated disease was found to correlate directly with the urinary vanilmandelic acid (VMA)/homovanillic acid (HVA) ratio but not with the absolute levels of HVA. The presence of the dopa metabolite, vanillactic acid, as well as increased amounts of cystathionine and/or low levels of VMA indicated poor prognosis. These results are consistent with the hypothesis that biochemically primitive neuroblastomas deficient in dopamine β-hydroxylase are more virulent than their mature analogues which produce epinephrine, norepinephrmne, and their metabolites.
CHILDREN OF THE COUNTERCULTURE
Authors: HOWARD MAUREEN
Published: December 2021

In these modern times, when neither economic advantages nor the nation's good is well-served by fecundity, we reproduce mainly to project ourselves, in some form, into the future not via time machine but by the transmission of our own values, culture and traditions. If the next generation rejects these in toto, we lose that rickety bridge to a kind of immortality that makes the often dreary business of child-rearing worthwhile.

What had turned the recent past into a nightmare for many middle-class parents was the loss of their future in just such terms. Here was the legend given flesh in which their own fine children were stolen from the hearth by the elf thieves of the counterculture who left in their place changelings—bewitched mystics, madmen, bombers and junkies—none of whom would take a place in the continuum of the traditional community....The children of those changelings [are being reared in] urban and rural communes, and institutes of the new religions (those of Lamas and Hare Krishnas). [In one] a 10-year-old girl managed to keep an immaculately conventional bedroom—gingham bedspread, curtains, mirror and hairbrushes carefully placed on a dressing table. "If you want to have a straight kid, then be a freaky mother" her mother, everlastingly spaced, complained one day.
Thoracoabdominal Ectopia Cordis With Mosaic Turner's Syndrome: Report of a Case
Authors: Garson Arthur , Hawkins Edith P. , Mullins Charles E. , Edwards Sam B. , Sabiston David C. , Cooley Denton A.
Published: December 2021

A child was treated for thoracoabdominal ectopia cordis and an associated chromosomal defect. Contrary to most cases in which death is due to the externally situated heart and abdominal viscera, this patient died from congenital heart disease.
Feline Rhinotracheitis-Calici-Panleukopenia Vaccine
Authors: Bittle James L.
Published: December 2021

With reference to Dr. Turner's letter on feline rhinotracheitis-calici-panleukopenia vaccine (Pediatrics 61:675, April 1978) and his concern for its potential infection in man, I believe he has overreacted to the coincidental occurrence of herpetic-type dermatitis in children from two households in which cats had received FVR C-P vaccination.

It has been shown that the virus of feline viral rhinotracheitis is a herpesvirus, but is highly specific for the feline species. Numerous attempts have been made to propagate the virus in the tissues of other animals, including man, without success.
Ventricular Tachyarrhythmia Due to Cardiac Sarcoidosis in a Child
Authors: Serwer Gerald A. , Edwards Sam B. , Benson D. Woodrow , Anderson Page A. W. , Spach Madison
Published: December 2021

Cardiac involvement by systemic sarcoidosis is well known, but occurs rarely. It usually manifests as either heart block, heart failure due to direct myocardial involvement, or cor pulmonale. We present the case of a patient with cardiac sarcoidosis who had ventricular tachycardia and congestive heart failure. Although there was other organ system involvement, the cardiac manifestation was the first to become clinically apparent. Therapy consisted of quinidine sulfate to control the arrhythmias and chronic diuretic therapy to control congestive heart failure. Steroid therapy was initially associated with recurrence of the ventricular tachycardia and was discontinued. It was reinstituted 18 months later when other organ system involvement developed with no recurrence of the ventricular tachyarrhythmia. The patient responded well to therapy and is currently doing well. This case is presented to illustrate a somewhat unusual, but nevertheless important, etiology of ventricular tachyarrhythmias. The recognition of underlying sarcoidosis is critical because of the propensity for other organ system involvement by this disease process.
Hemorrhagic Retinopathy in a Patient With Cystic Fibrosis
Authors: Rimsza Mary E. , Hernried Lucy S. , Kaplan Allen M.
Published: December 2021

A 21-year-old woman with a history of chronic lung disease secondary to cystic fibrosis (CF) developed an acute hemorrhagic retinopathy during exposure to moderately high altitude. Although retinal hemorrhages are known to occur in patients with CF, we speculate that the retinopathy in this case was partially related to altitudinal change and that patients with chronic hypoxemia may be predisposed to high-altitude retinopathy at much lower altitudes.
SOMETHING REALLY NEW TO WORRY ABOUT
Authors: Adler Cy A.
Published: December 2021

We live in mortal danger of being struck dead by watermelons inadvertently dropped from passing airplanes. Technology is obviously to blame for this hazard to life, because, if technologists had not developed airplanes, we would not have to worry about the danger of falling watermelons. However, when we examine the probability that a person will be struck by a falling watermelon, we must conclude that this environmental danger is not worth worrying about.

It is not easy to compute the probability of rare and unlikely events, such as death from eating mercury in tuna fish, cancers in human beings due to DDT ingestion, or the likelihood that polychlorinated biphenyls will have a deleterious effect on the environment. But many people prefer to conclude that new methods and new substances "may" be harmful and therefore should be banned until—if ever—they are proved innocuous.

The belief of many that the environmental impact of new chemicals and processes be studied before being released into the environment is commendable in theory. But more than a million products now result from man's activities. There are at least two million species of fauna and flora on the earth. Assuming that a team of biologists can assess the environmental impact of a man-made product on a species in one-year's time, it would require some two trillion biologist-person years to complete this worthy evaluation.
Sustained-Release Theophylline Therapy for Chronic Childhood Asthma
Authors: Bell Thomas , Bigley Joseph
Published: December 2021

The efficacy of continuous, around-the-clock sustained-release (S-R) theophylline therapy, adjusted to approximate serum or plasma steady state theophylline concentrations (Tc) of 15 µg/ml three hours following the last dose, was assessed in 18 children suffering from moderately severe chronic asthma. Two of the three formulations studied, Slo-Phyllin Gyrocaps and Theo-Dur, had excellent bioavailability and produced stable therapeutic Tc, throughout an eight-hour dosing interval, using average doses of 8.7 ± 0.5 and 8.4 ± 0.6 (SE) mg/kg/dose, respectively. Pulmonary function responses paralleled Tc and were also stable throughout the dosing interval. Aerolate provided comparatively less stability, and higher doses (11.3 ± 0.7 mg/kg) were necessary to produce therapeutic Tc. Toxicity was not evident when dosage was adjusted to avoid Tc exceeding 20 µg/ ml. S-R theophylline therapy, with the use of formulations of acceptable bioavailability, provides excellent control of chronic childhood asthma, offers the advantage of extended dosing intervals, and encourages improved patient cooperation in drug compliance.
Health Care for the Underprivileged in the Land of Affluence: California Native Americans
Authors: Montgomery Theodore A.
Published: December 2021

The American Indian has demonstrated all too clearly, despite his recent move to urban centers, that he is not content to be a poverty statistic. He has demonstrated the strength and fiber of strong cultural and social ties by maintaining an Indian identity in many of the nation's largest metropolitan centers. At the same time, he aspires to the same goal of all citizens—a life of decency and self-sufficiency.

The non-Indian population of California needs to keep in mind that at the time the Indians agreed (under coercion in most cases) to turn their ancestral lands over to the white man, treaties were signed by the Indians which promised that, in exchange for Indian lands, the white man would provide for the health care, education, and welfare of Indians.

Indians are attempting to achieve a life-style compatible with individual dignity and personal peace—the base of Native American culture. There must be rediscovery and preservation of that culture to insure the physical, mental, and environmental well-being of its members.
The Infant's Response to Entrapment between Contradictory Messages in Face-to-Face Interaction
Authors: Tronick Edward , Als Heidelise , Adamson Lauren , Wise Susan , Brazelton T. Berry
Published: December 2021

The normal feedback infants receive from their mothers in face-to-face interaction was distorted by having the mothers face their infants but remain facially unresponsive. The infants studied reacted with intense wariness and eventual withdrawal, demonstrating the importance of interactional reciprocity and the ability of infants to regulate their emotional displays.
A Question About a Committee Statement
Authors: Homan William E.
Published: December 2021

The Committee on Nutrition is to be commended for the excellence of "Iron Supplementation for Infants" (Pediatrics 58:765, November 1976). This modification and modernization of their 1969 and 1971 recommendations is invaluable to practicing pediatricians.

I would appreciate clarification of the article "Iron Sufficiency in Breast-Fed Infants and the Availability of Iron From Human Milk" by McMillan et al. (Pediatrics 58:686, November 1976). The authors' carefully stated conclusion is that "human milk ... was adequate to preserve a positive iron balance in four infants."
Parent-Child Associations at Upper and Lower Ranges of Plasma Cholesterol and Triglyceride Levels
Authors: Morrison John A. , Kelly Kathe A. , Mellies Margot J. , deGroot Ido , Glueck Charles J.
Published: December 2021

This study examines the hypothesis that children of parents who have very high and very low levels of cholesterol and triglyceride are more likely than other children to have cholesterol and triglyceride levels at the same ends of the distribution as their parents. For each lipid studied (cholesterol and triglyceride), 1,944 households were separated into three categories: "low," "intermediate," and "high," based on parental fasting plasma levels and using the fifth (low) and 95th (high) percentiles of the parental distributions. The children were first categorized according to the classification of their parents and then further classified on the basis of their own levels, again using the fifth and 95th percentiles as cutoff points. The agreement between parental and child classifications was then measured. Children from high-cholesterol-level households were 2.7 times more likely than children from the total pediatric population to have cholesterol levels above 205 mg/dl, the pediatric 95th percentile, (P < .01). Children from high-triglyceride-level households were 2.1 times more likely than children from the general pediatric population to have elevated triglyceride levels (P < .01).

By the simple expedient of focusing on parental cholesterol and triglyceride levels, which are commonly quantitated in adults, a pediatric sample was identified that contained significant numbers of hypercholesterolemic and hypertriglyceridemic children.