bluuebunny/crossref_metadata_2025 huggingface dataset:
School Placement for Human Immunodeficiency Virus-Infected Children: The Baltimore City Experience
Authors: Santelli John S. , Birn Anne-Emanuelle , Linde James
Published: December 2021

Over the past 6 years, the city of Baltimore has successfully implemented a school placement policy for human immunodeficiency virus (HIV)-infected children and children with acquired immiunodeficiency syndrome (AIDS). Both policy and specific procedures are based on nationally promulgated guidelines. School placement policy is part of an overall AIDS policy that includes education of students and staff and adoption of universal precautions to prevent transmission of communicable diseases in school. Implementation has been marked by excellent collaboration between the departments of health and education. Important policy components include expedited clinical investigation of each case, an interagency review panel, strict protection of confidentiality, a restricted setting for certain children, a school site visit for each placement, and continued monitoring of the school placement by school nurses. Many HIV-infected students need special educational services and/or school health services. The Baltimore City school placement process has avoided the exaggerated publicity endured by some communities, where media reporting has aggravated community fears and invaded the lives of families with HIV-infected children. Baltimore City has succeeded in ensuring access to education, protecting families' confidentiality, and providing special care for HIV-infected students. Local communities should emphasize national guidelines in designing school placement policies for HIV-infected children. School placement policies work best in the context of a comprehensive policy incorporating AIDS education and care.
Trampolines Revisited: A Review of 114 Pediatric Recreational Trampoline Injuries
Authors: Woodward George A. , Furnival Ron , Schunk Jeff E.
Published: December 2021

A search of the medical literature failed to reveal any articles that discuss pediatric injuries acquired on privately owned recreational trampolines. This study was undertaken to quantify and qualify pediatric injuries from recreational trampoline use. A group of 114 patients who presented to the Emergency Department at Primary Children's Medical Center in Salt Lake City, Utah, with injuries directly related to use of a trampoline are discussed. There was a 1.2:1 male-female ratio. The average age was 8.0 years. Forty-eight percent of the patients were injured on their family's trampoline, with the remainder injured on a friend's, neighbor's, relative's, or gymnasium's equipment. The majority of injuries involved group use of the trampoline and the youngest person in a group was most often the injured participant. Extremity injuries were seen in 55% of the patient and head or neck injuries in 37%. Seventy-five percent of the patients required radiographs, 23% hospitalization, and 17% operative intervention. The history of the trampoline and medical literature discussions concerning injuries and safety are reviewed.
Cricopharyngeal Dysfunction Associated with Chiari Malformations
Authors: Putnam Philip E. , Orenstein Susan R. , Pang Dachling , Pollack Ian F. , Proujansky Roy , Kocoshis Samuel A.
Published: December 2021

Dysphagia due to upper esophageal sphincter (UES) dysfunction can be a manifestation of Chiari malformation. We evaluated five young children with dysphagia and a Chiari malformation before and after craniocervical decompression.

Preoperatively, esophageal manometry with a multilumen perfused catheter revealed failure of complete relaxation of the UES in three patients, pharyngo-UES incoordination in one patient, and both abnormalities in the last patient.

Preoperative barium esophagograms were obtained in four of the patients and were normal in two. One patient had nasal regurgitation of barium and delayed passage of barium through the UES. One patient had a posterior pharyngeal impression (bar) at the level of the UES and delayed transit of barium.

All patients had clinical and manometric resolution of UES dysfunction following surgical decompression of the Chiari malformation. All swallows were coordinated, and UES relaxations were complete.

However, the posterior pharyngeal bar persisted on postoperative esophagogram in the only patient who had had the abnormality preoperatively, although it no longer interfered with passage of barium. Another patient had a narrowed UES with decreased relaxation. Swallowing was radiographically normal in three patients postoperatively.

Conclusion: Surgical decompression of Chiari malformation may lead to complete clinical and manometric resolution of dysphagia due to upper esophageal sphincter dysfunction. Esophageal manometry is more likely than barium swallow to demonstrate the abnormality, and correlates better with symptomatic improvement postoperatively.
Variability in Response to a Low-Fat, Low-Cholesterol Diet in Children with Elevated Low-Density Lipoprotein Cholesterol Levels
Authors: Quivers Eric S. , Driscoll David J. , Garvey Colleen D. , Harris Ann M. , Harrison Jay , Huse Diane M. , Murtaugh Paul , Weidman William H.
Published: December 2021

The reduction of dietary cholesterol and fat lowers low-density lipoprotein cholesterol (LDL-C) and reduces risk of coronary heart disease in adults. The purpose of this study was to determine the individual variability of response of serum lipid and lipoprotein levels to a low-fat, low-cholesterol diet in children with elevated LDL-C levels. Thirty-two children (2 to 16 years of age) enrolled in a diet modification program, who had LDL-C levels of at least 110 mg/dL but normal triglyceride levels for their ages, were studied. Lipid levels and dietary nutrients were analyzed at the time of admission, and final assessments were made at least 3 months after entry. There was a significant correlation, for the group as a whole, between change in LDL-C concentration and change in grams of dietary saturated fat; however, there was marked individual variability in LDL-C response. There were no significant correlations between changes in LDL-C levels and changes in either total fat, polyunsaturated fat, or cholesterol intake. It is concluded that modest decreases in dietary saturated fat coincide with a lowering of LDL-C concentration, over a short term, in many children, but the degree of lowering varies considerably from one child to another. This variability is consistent with the concept that response of serum lipid levels to dietary changes is modified by genetic, metabolic, and other, as of yet, undefined variables.
Guidelines for Cardiac Monitoring of Children During and After Anthracycline Therapy: Report of the Cardiology Committee of the Childrens Cancer Study Group
Authors: Steinherz Laurel J. , Graham Thomas , Hurwitz Roger , Sondheimer Henry M. , Schwartz Ronald G. , Shaffer Elizabeth M. , Sandor George , Benson Lee , Williams Roberta
Published: December 2021

The anthracycline antibiotics, daunorubicin, doxorubicin, and the newer derivatives, are important components of many antineoplastic chemotherapeutic regimens. Their usefulness is limited by their cardiotoxicity. Sequential monitoring of cardiac function of patients undergoing chemotherapy allows identification of subclinical cardiotoxicity. In many patients monitoring can thus guide the modification of the chemotherapy to minimize cumulative cardiotoxicity, reducing acute and long-term clinical and subclinical sequelae. Such monitoring also aids in the comparison of cardiotoxicity produced by different drugs and different methods and schedules of drug administration. The considerable variability of monitoring regimens between institutions and in the literature has detracted from its usefulness. The Cardiology Committee of the Childrens Cancer Study Group has, therefore, reviewed the field and has formulated recommendations for standardized noninvasive monitoring of children during and immediately after chemotherapy and for the modification of the chemotherapy where indicated.
Neonatal Scrub Typhus: A Case Report
Authors: WANG CHIH-LU , YANG KUENDER D. , CHENG SHIN-NAN , CHU MONG-LING
Published: December 2021

Scrub typhus called tsutsugamushi disease, is a mite-born acute febrile disease caused by Rickettsia tsutsugamushi. To our knowledge, neonatal scrub typhus has not been reported in the literature. We report on a 26-day-old newborn with aseptic meningitis. The newborn showed an increased specific 1gM antibody to R.tsutsugamushi conjointly with his mother's 1gM titer to the organism. This is the first case in the literature documenting neonatal scrub typhus and may be related to infection in the mother.

CASE REPORT

A 26-day-old male newborn was well until 4 days prior to this admission. He suffered from intermittent high fever, abdominal distention, and skin pallor.
Bronchopulmonary Dysplasia: Twenty-five Years Later
Authors: NORTHWAY WILLIAM H.
Published: December 2021

The 25th anniversary of the recognition of bronchopulmonary dysplasia (BPD) occurs in 1992. Bronchopulmonary dysplasia was first described in 1967 in prematurely born infants with severe respiratory distress syndrome (RDS) treated with intermittent positive pressure mechanical ventilation and oxygen supplementation who developed a new type of chronic lung disease.1 Prior to treatment with mechanical ventilation, infants with RDS had a high mortality rate and either died by about 4 days of age or survived without respiratory difficulty or radiographic abnormality at 7 days of age.2 The descriptive name of the new chronic disease, bronchopulmonary dysplasia, was suggested by the progressive lung pathology which was characterized by injury and repair affecting both the parenchyma and the airways with alteration of the normal growth of the lung.
Painful Defecation and Fecal Soiling in Children
Authors: Partin John C. , Hamill Susan K. , Fischel Janet E. , Partin Jacqueline S.
Published: December 2021

Fecal soiling is a common complaint among school-age children. The fecal soiling is often accompanied by chronic constipation and so-called "idiopathic," "functional," or "psychogenic" megacolon, the cause of which is undetermined. The records of all children presenting to a pediatric gastroenterology clinic between 1981 and 1990 with difficult defecation were reviewed to determine the incidence of painful defecation and its relationship to chronic impaction and fecal soiling. There were 227 children; 74 were younger than 36 months of age and 153 were older than 36 months. Of the younger children, 86% presented with pain, 71% with impaction, and 97% with severe withholding. The younger children had painful defecation for a mean of 14 ± 9 (SD) months before presentation. Of the older children, 85% presented with fecal soiling, 57% with pain, and 73% with fecal impaction, and 96% exhibited withholding the older children had difficult defecation for a mean of 56 ± 42 months before presentation. Sixty-three percent of the children presenting with fecal soiling had a history of painful defecation beginning before 36 months of age. Painful defecation frequently precedes chronic fecal impaction and fecal soiling in American children. Early, effective treatment of painful defecation in infancy might reduce the incidence of chronic fecal impaction and fecal soiling in school-age children.
Prenatal Exposure to Heavy Metals: Effect on Childhood Cognitive Skills and Health Status
Authors: Lewis Michael , Worobey John , Ramsay Douglas S. , McCormack Michael K.
Published: December 2021

Prenatal exposure to seven heavy metals (cadmium, chromium, cobalt, lead, mercury, nickel, and silver) was determined for amniotic fluid taken from 92 pregnant women undergoing amniocentesis at approximately 16 to 18 weeks' gestation. Follow-up assessment of their children's cognitive skills and health status was conducted when the children were approximately 3 years of age. The presence of these metals co-occurred in amniotic fluid. A prenatal toxic risk score was derived which was a weighted score reflecting the presence of the various metals in amniotic fluid. The toxic risk score was negatively related to performance on the McCarthy Scales of Children's Abilities and positively related to the number of child illnesses reported. These results suggest the need for further prospective research on the adverse effects of prenatal exposure to various metals in combination.
Growth of Breast-Fed and Formula-Fed Infants From 0 to 18 Months: The DARLING Study
Authors: Dewey Kathryn G. , Heinig M. Jane , Nommsen Laurie A. , Peerson Janet M. , Lönnerdal Bo
Published: December 2021

Anthropometric data were collected monthly from birth to 18 months as part of the Davis Area Research on Lactation, Infant Nutrition and Growth study, which followed infants who were either breast-fed or formula-fed during the first 12 months. The two cohorts were matched for parental socioeconomic status, education, ethnic group, and anthropometric characteristics and for infant sex and birth weight, and neither group was given solid foods before 4 months. While mean weight of formula-fed infants remained at or above the National Center for Health Statistics median throughout the first 18 months, mean weight of breast-fed infants dropped below the median beginning at 6 to 8 months and was significantly lower than that of the formula-fed group between 6 and 18 months. In contrast, length and head circumference values were similar between groups. Weight-for-length z scores were significantly different between 4 and 18 months, suggesting that breast-fed infants were leaner. The groups had similar weight gain during the first 3 months, but breast-fed infants gained less rapidly during the remainder of the first year: cumulative weight gain in the first 12 months was 0.65 kg less in the breast-fed group. Length gain was similar between groups. These results indicate that weight patterns of breast-fed infants, even in a population of high socioeconomic status, differ from current reference data and from those of formula-fed infants. Thus, new growth charts based on breast-fed infants are needed.
Birth Spacing and Child Health in Urban Brazilian Children
Authors: Huttly Sharon R. A. , Victora Cesar G. , Barros Fernando C. , Vaughan J. Patrick
Published: December 2021

The associations between birth interval and a range of child health outcomes were examined in a population-based cohort of approximately 3500 urban Brazilian children. The effects of several socioeconomic and maternal confounding factors were controlled for in the analyses. Children born after shorter birth intervals (<18 and 18 through 23 months) were disadvantaged with respect to most of the health outcomes when compared with children born after intermediate birth intervals (24 through 35, 36 through 47, and 48 through 71 months). Effects were particularly marked for birth weight, postneonatal mortality, and anthropometric status at mean age 19 months. Children born after a long birth interval (>71 months) also showed some disadvantage for birth weight, perinatal mortality, and infant mortality. However, this group experienced lower risks of hospitalizations during the first 19 months of life and better anthropometric status at mean age 19 months. This study provides data that are scarce from such settings and contributes to the quantification of associations between birth spacing and child health. This information is important in the planning of appropriate intervention strategies.
3-Methylglutaconic Aciduria: A New Variant
Authors: Zeharia Avraham , Elpeleg Orly N. , Mukamel Masza , Weitz Raphael , Ariel Raya , Mimouni Marc
Published: December 2021

3-Methylglutaconic aciduria has been described in two distinct syndromes. In one there was deficient 3-methylglutaconyl coenzyme A hydratase in fibroblast extracts where the only clinical manifestation was retarded speech development. In the second syndrome, the enzyme activity was normal but prominent neurological deterioration was noted. We describe two siblings with 3-methylglutaconic aciduria with normal enzyme activity who had choreoathetoid movements, optic atrophy, and mild developmental delay. The boy demonstrated developmental improvement in his second year of life, and his sister developed well, with normal school performance. These patients represent a new clinical variant of the second syndrome with a relatively favorable prognosis.
Summary of the Annual Meeting of the Section on Urology, American Academy of Pediatrics
Authors: Skoog Steven J. , Rushton H. Gil
Published: December 2021

The Section on Urology of the American Academy of Pediatrics met for 2½ days in conjunction with the 60th annual meeting of the American Academy of Pediatrics in New Orleans, LA, October 26 through 28, 1991. This conference remains the most important meeting in the United States for pediatric urology. The number and quality of papers presented continue to grow and there is a rich, international participation. The meeting was presided over by Chairperson Edward S. Tank, Jr, MD, of the University of Oregon Health Sciences Center, Portland, OR. The papers presented at this meeting that are of interest to the practicing pediatrician are summarized here according to topic.

OBSTRUCTION

Investigation of structural, biochemical, and functional changes in both the developing bladder and in the upper urinary tract were studied in the fetal lamb model of bladder outlet obstruction by Peters et al from Boston Children's Hospital and by Cendron et al from Johns Hopkins Hospital. Their findings included an increase in bladder weight due to hypertrophy and hyperplasia, increase in the cholinergic receptor density of the smooth muscle cells of the bladder, and alterations in the myosin heavy-chain isomer ratio. Following birth these alterations in growth and differentiation resulted in functional bladder abnormalities as measured by urodynamic studies. These abnormalities included an increase in bladder capacity, an increase in maximal intravesical pressure with filling, and an increase in postvoid residual urine volumes. Further study in this model should allow better understanding of the spectrum of bladder dysfunction resulting from in utero outflow obstruction of the bladder.
Endothelin and Hemolytic Uremic Syndrome
Authors: SIEGLER RICHARD E.
Published: December 2021

In Reply.—

Yasutomo is correct. We were careful to point out that endothelin is produced not only by endothehial cells, but also by cultured rat mesangial cells and porcine renal epithelial cells, and that its elevation in the urine of children with the hemolytic uremic syndrome may only be a marker of renal injury.

Showing that elevated urine levels are limited to hemolytic uremic syndrome would certainly strengthen (but not prove) the argument that it plays a role in the pathogenesis of the acute renal failure of the syndrome.
Lethal Toxic Encephalopathy Due to Childhood Shigellosis in a Developed Country
Authors: Goren Avner , Freier Serem , Passwell Justen H.
Published: December 2021

Shigellosis results in considerable morbidity in endemic areas, but mortality is rare in developed countries. All pediatric deaths (n = 15) in Israel following shigellosis in the past 10 years were reviewed. The patients' ages ranged from 5 months to 11 years; there were eight boys and seven girls. Three were institutionalized mentally retarded patients, 11 were healthy children. Twelve had definite clinical signs of brain death within 48 hours of onset of disease. Cause of death in all patients was consistent with toxic encephalopathy. No other systemic complication was implicated as the cause of death except for one case consistent with a "Reye-like" syndrome. Shigella species were as follows: 8 flexneri, 4 sonnei, 1 dysenteriae, and 2 were not identified. Case-control study of these patients vs surviving, hospitalized patients with shigellosis showed similar severity of fever, diarrhea, vomiting, and dehydration and similar incidence of convulsions. Headache was a prominent feature of patients who died; 5 of 7 verbal patients complained of this symptom as opposed to 2 of 20 in the control group (P < .01). There were no significant differences in the hematological and biochemical profile (except for an increased incidence of hyponatremia in the study group), pattern of shigella species, or antibiotic sensitivity. These findings indicate that mortality from shigellosis in a developed country is due primarily to the toxic encephalopathy syndrome.
Enhancing the Cognitive Outcomes of Low Birth Weight, Premature Infants: For Whom Is the Intervention Most Effective?
Authors: Brooks-Gunn Jeanne , Gross Ruth T. , Kraemer Helena C. , Spiker Donna , Shapiro Sam
Published: December 2021

The Infant Health and Development Program is a national collaborative study to test the efficacy of combining early child development and family support services with pediatric follow-up to reduce the incidence of health and developmental problems among low birth weight, preterm infants in eight medical school sites. Its efficacy in enhancing intellectual outcomes at age 3 in more and less environmentally vulnerable, low birth weight, preterm children, as defined by maternal education (high school completion or less vs some college) and race (black vs white/other), is explored. Children whose mothers had a high school education or less benefited from the intervention. This was true for both the black and white samples. Children whose mothers had attended college did not exhibit significant enhancement in IQ scores at 3 years. Birth weight affected the response to treatment for one of the four subgroups: Among white mothers with some college, the lighter (less than 2000 g) low birth weight, preterm children were less influenced by the intervention than were the corresponding heavier children. Implications for targeting certain subgroups of low birth weight, preterm children for services are considered.
Accuracy of the Denver-II in Developmental Screening
Authors: Glascoe Frances Page , Byrne Karen E. , Ashford Linda G. , Johnson Katherine L. , Chang Bernard , Strickland Bryan
Published: December 2021

One of the oldest and best known developmental screening tests was recently restandardized and revised as the Denver-II. Because it was published without evidence of its accuracy, the present study was undertaken with 104 children between 3 and 72 months of age attending one of five day-care centers. To determine the presence of developmental problems, children were administered individual measures of intelligence, speech-language, achievement, and adaptive behavior. A second psychological examiner, blind to the outcome of the diagnostic battery, administered the Denver-II. Developmental problems including language impairments, learning disabilities, mild mental retardation, and/or functional developmental delay were found in 17% of the children. The Denver-II identified correctly 83% and thus had high rates of sensitivity. However, more than half the children with normal development also received abnormal, questionable, or untestable Denver-II scores. Thus the test had limited specificity (43%) and a high overreferral rate. The alternative scoring method, categorizing questionable/untestable scores as normal, caused sensitivity to drop to 56% although specificity rose to 80%. Since neither scoring method produced acceptable levels of accuracy, an effort was made to locate the sources of accuracy and inaccuracy within the test. Only items in the language domain were modestly helpful in discriminating children with and without difficulties. The findings suggest that the authors of the Denver-II need to engage in further development of the instrument including revising scoring criteria and item placement in relation to children's ages. In the interim, test users should employ screening tests which are more accurate such as the Minnesota Inventories or the Battelle Developmental Inventory Screening Test.
Children in Foster Care in California: An Examination of Medicaid Reimbursed Health Services Utilization
Authors: Halfon Neal , Berkowitz Gale , Klee Linnea
Published: December 2021

The number of children in foster care in California doubled from 27 534 in 1980 to more than 62 419 in 1988, representing approximately 1% of the child population in the state. Past studies have domonstrated that children in foster care have high rates of medical and mental health problems. An examination of all Medi-Cal-paid claims was undertaken to describe the utilization of health services by children in foster care. Although children in foster care represent 4% of Medi-Cal-eligible children younger than 18 years of age, they account for approximately 5% of children using Medi-Cal services and 6.7% of expenditures, representing a 23% greater utilization rate and 41% greater expenditure rate than all children covered by Medi-Cal. Using the entire Medi-Cal population younger than 18 years of age as a comparison group, examination of inpatient and outpatient service utilization for specific condition categories showed few differences between children in foster care and the comparison group except for mental health service utilization, where children in foster care were much higher users of services.
Case Fatality Rates Associated with Conditions Originating in the Perinatal Period: United States, 1986 through 1987
Authors: BECERRA JOSÉ E. , ROWLEY DIANE L. , ATRASH HANI K.
Published: December 2021

In 1986, two thirds (65%) of all infant deaths in the United States occurred within the first 27 days of life. The underlying cause of death in almost one-half (47%) of all infant deaths was nonteratologic conditions originating in the perinatal period. Maternal complications of pregnancy was the fifth leading cause of infant mortality.1

National estimates of morbidity associated with conditions originating in the perinatal period have been examined in a study using the National Hospital Discharge Survey (NHDS).2 A high proportion (33.7%) of newborns experienced morbidity due to conditions arising in the perinatal period.2

In the present study, we sought to quantify the severity of conditions originating in the perinatal period by estimating the proportion of deaths that occur among them.
Poisoning by Pickup Truck
Authors: MOFENSON HOWARD C. , CARACCIO THOMAS R.
Published: December 2021

To the Editor.—

The policy statement,1 "Children in Pickup Trucks," was useful and constructive. However, the statement failed to mention the exposure to carbon monoxide of children who ride in the back of pickup trucks and station wagon vans.

We recently saw two healthy children who had developed acute carbon monoxide poisoning from a defective exhaust system after riding in the back seat of an air-conditioned station wagon van. Their initial carboxyhemoglobin levels were 21.3% and 10%, respectively.
ANOMALIES OF THE PULMONARY VEINS AND THEIR SURGICAL SIGNIFICANCE
Authors: PARSONS HARRY G. , PURDY ANN , JESSUP BRUCE
Published: December 2021

The successful operations upon abnormalities of the outflow tracts of the heart suggest that surgical measures may also be applied to the correction of abnormal inflow tracts.

Technically the anastomosis of veins to the auricle has been proved feasible in the experimental animal. Therefore, it should be possible to correct abnormally placed pulmonary veins in man.

A wide variety of such anomalies occur. In 55 of 136 reported cases, all the oxygenated blood from the lungs was returned to the right heart through anomalous vessels. Thirty-five per cent of these cases of complete diversion were accompanied by other major cardiac defects. It is estimated that 50% or more of the return flow from the lungs must reach the right heart to produce clinical symptoms.

Two cases are presented of persistence of the left superior vena cava which transmitted all the freshly oxygenated blood to the right auricle, by way of the left innominate and the right superior vena cava.

The clinical picture was that of growth retardation, minimal cyanosis, a huge hyperactive heart, a loud left mesocardial systolic murmur, pulsating shadows in both upper pulmonary fields, and nearly identical oxygen-saturation of blood obtained from the right heart and femoral artery.

One case is reported in which all the oxygenated blood from the lungs is carried to the right auricle by way of the ductus venosus.

Surgical correction of the abnormality of these cases by transplantation of one or more of the veins would have been possible. However, no case known to the authors has yet been successfully corrected.
FURTHER STUDIES ON THE INFLUENCE OF HISTAMINE ON PLATELET ACTIVITY, WITH ESPECIAL REFERENCE TO ITS ACTION ON THE BLOOD OF THE HEMOPHILIAC PATIENT
Authors: SANFORD HEYWORTH N. , HALL F. RICHARD , BUTLER STUYVESANT
Published: December 2021

Clinically and experimentally intravenous and subcutaneous injections of histamine increase directly the qualitative disintegrative ability of the blood platelets. It has no effect on the total platelet count (quantitative action) until shocklike levels are obtained. It then causes a decrease in the number of the circulating platelets in the blood.

This qualitative action may be in part due to an antagonistic action between heparin and histamine. Heparin in high concentrations does not inhibit completely the increased tendency toward in vitro agglutination of the platelets exposed in vivo to histamine.

In 22 hemophiliac boys, intravenous and subcutaneous injections of histamine decreased the coagulation time of the blood by increasing the platelet disintegration in 19 patients. It was a complete failure in three of the boys. The action of the histamine is not permanent, and tends to become less efficient as more injections are given. However, it is sufficient to cause a cessation of bleeding and to decrease the coagulation time of the blood to its normal value for that person in the majority of instances.
LOCALIZED HYPERTROPHIC EMPHYSEMA
Authors: SHAW ROBERT R.
Published: December 2021

Localized hypertrophic emphysema is a distinct clinical entity occurring in infants which seems to be congenital in etiology. The possible explanations of the mechanical factors causing this condition are discussed. Resection of the involved segments or lobe is indicated to improve respiration and prevent the occurrence of pectus excavatum.
Round Table Discussion
Authors: WHEATLEY GEORGE M. , ARENA JAY M. , KOTTE ROBERT H. , HOYER BENJAMIN J.
Published: December 2021

Chairman Wheatley: Our theme is a discussion of prevention. We want to discuss the question: How can we help prevent accidents in children? The meeting will be divided into 2 parts. Dr. Arena and I will outline the accident problem for the first part. For the second part, we will discuss the preventive aspects and what pediatricians can do about preventing accidents. We want you to do most of the talking in this part.

I would like to give you a brief picture of the dimensions of the accident problem.

1. It is the leading cause of deaths ages 1-14; kills about 14,000 at these ages annually—more than the next 6 combined (pneumonia, congenital anomalies, cancer, tuberculosis, leukemia, heart disease).

2. Every year between ages 1-5 kills twice as many children as rubeola, scarlet fever, pertussis, diphtheria, dysentery, tuberculosis and poliomyelitis combined.

3. For every fatal accident, it is estimated there are 90-150 severe injuries. No comprehensive studies are available to show the magnitude in terms of injury, cost of treatment, permanent disability in the United States child population. English hospital admission study showed 22% of the accidents requiring hospital treatment happened to children under the age of 5 years, though this age group constituted only 8% of the population.

4. About a third of all fatal accidents to children (1-14) occur in the home; for those under 5 years of age, nearly half the fatal accidents are home accidents. The home is a much more important site than this for injury to children, if we include nonfatal accidents because deaths caused by motor vehicles influences the fatal accident picture.
DISORDERS OF GLYCOGEN METABOLISM
Authors: LANGEWISCH WILLIAM H. , BIGLER JOHN A.
Published: December 2021

Five cases have been presented with evidence of disordered glycogen metabolism.

Two cases of glycogen storage disease of the liver are included which were confirmed by biopsy, together with clinical and laboratory evidence. Treatment of one of the cases with adrenocorticotropic hormone resulted in a disappearance of hypoglycemia and acetonuria during the period of therapy.

Two cases of glycogen storage disease of the heart are reported together with clinical histories and necropsy reports. An ECG which was recorded on one of the patients is included.

A case of galactosemia is reported together with extensive laboratory evidence of marked galactose intolerance.

The criteria for the diagnosis of these entities are reviewed and the symptomatology, physical findings, treatment, prognosis and pathologic manifestations are discussed.
OSTEOID OSTEOMA IN CHILDHOOD
Authors: PURCELL HOWARD M. , MILLS STEPHEN D. , LIPSCOMB PAUL R.
Published: December 2021

Osteoid osteoma is a small, benign tumor usually of endochondral bone, affecting mainly the long bones of the extremities and occurring not uncommonly among children. It produces pain which may disturb sleep and interfere with normal activities. The roentgenogram reveals a radiolucent area surrounded by osteosclerosis. This is suggestive of osteoid osteoma but differential diagnosis from certain other neoplastic, inflammatory and metabolic lesions of bone must be made. Thirteen children with osteoid osteoma have been treated by excision of the lesion at the Mayo Clinic. The results have been uniform alleviation of symptoms. This experience and that obtained elsewhere has shown that incomplete removal of the nidus may lead to recurrence of the symptoms.
ACTH, CORTISONE AND ALLIED SUBJECTS
Authors: CONN JEROME W.
Published: December 2021

Congenital adrenal hyperplasia in females causes pseudohermaphroditism which must be differentiated on the one hand from various types of genetic intersexuality and on the other from virilization due to adrenal tumor. In males it causes macrogenitosomia precox which must be differentiated from other types of sexual precocity and from adrenal tumor. The major manifestations of the disorder are due to the excessive secretion of adrenal androgen which causes progressive virilization throughout embryonic and postnatal life. In some cases there is a defect of electrolyte regulation which may head to death with Addisonian symptoms or heart block.

Partial adrenalectomy and the administration of estrogens or inert androgens have failed to check the progressive virilization, but cortisone has succeeded in doing so by suppressing the excessive activity of the abnormal adrenals. This effect of cortisone can be accomplished with small doses which do not exceed physiologic requirements, whereas in the treatment of hypersensitivity states and various other conditions large doses of cortisone are required for its pharmacodynamic action.

We have now treated 11 patients continuously for periods of 6 to 17 months without ill effects. It is important to determine in each case the minimum dose required to maintain adequate suppression of the adrenals. This is measured by the level of urinary 17 ketosteroids. In patients over 8 years the ketosteroid excretion should be maintained below 8 mg. per day (preferably 4 to 6 mg. per day) and in young infants at 0.5 to 1.5 mg. per day. This degree of suppression can be brought about rapidly in older children by the administration of 25 to 50 mg. of intramuscular cortisone daily.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: SOLOMON MILDRED WHITE
Published: December 2021

The child with rheumatic fever presents a problem that involves not only himself, his joints and his heart, but the entire family, the parents and the other children as well. All families normally have problems of various kinds; some manage them and some don't. But having a child come down with a serious long-term illness can mobilize these problems, can become the straw that breaks the camel's back. The child and his illness can become the focus not only of the related but all the unrelated and pent-up feelings in the family.

The mother who was previously overprotective of her child will react to the illness in one way; the mother who previously neglected her child will react in another way. Some mothers feel that they must give up their former life entirely, friends and social activities, and devote their entire time to watching over the child and doing things for him. They are being "good" mothers. Others give up nothing, refuse to accept the fact that the child has rheumatic fever and completely ignore it. These I know sound like pretty extreme points of view, but I have found that it is not too rare to find mothers fitting into these pictures.
RETROLENTAL FIBROPLASIA: ANIMAL STUDIES
Authors: HEPNER W. R.
Published: December 2021

A condition similar to the early retinal stages of retrolental fibroplasia, along with persistence of the ocular embryonic vascular system, is induced by repeated massive blood transfusions of chronically edematous kittens.
Panel Discussion
Authors: HILL LEE FORREST , CLINE GERALD M. , SENN MILTON J. E. , RAMCHARAN S. , MCKHANN CHARLES F. , WEECH A. ASHLEY , MITCHELL JOHN MCK. , COE HERBERT E.
Published: December 2021

Chairman Hill:. In 1944, the Academy inaugurated a Study of medical services available to the children of America. Included in the Study was a detailed survey of the Pediatric Departments of the 70 medical schools in the U.S. Out of this Study, requiring some 4 years and costing over a million dollars, a vast amount of important information was assembled. As might be expected, the Study clearly showed the enormous advantages possessed by the majority of American children in quantity and quality of medical care, but it also revealed gaps and deficiencies not only in medical care in the field but in the teaching of pediatrics in the medical schools.

In undertaking its Study the Academy assumed a position of leadership among organizations interested in the health and welfare of children. This phase of the Academy's work is now in progress, and while not as spectacular as the Study, it nevertheless is proceeding along a number of fronts on a sound basis. In 1950 and 1951, day-long conferences were held in 9 areas in the U S. in which pediatric educators, state and regional chairmen participated. This year for the first time in history, the heads of pediatric departments of the Canadian medical schools met under the sponsorship of the Academy's Committee on Medical Education for a 2 day conference.

It seems fitting, therefore, that a place should be made on the program of the Academy's national meeting for consideration by the entire membership of some of the more pressing problems which come under the heading of pediatric education used in a broad sense.
IDIOPATHIC HYPOPROTEINEMIA
Authors: WYNGAARDEN JAMES B. , CRAWFORD JOHN D. , CHAMBERLIN HARRIE R. , LEVER WALTER F.
Published: December 2021

A 3½ year old Negro boy with an obscure syndrome of inexplicable, transient, acquired hypoproteinemia, involving plasma albumin and especially gamma globulin, has been observed. Edema, oliguria and weight gain were noted 10 days following an attack of acute tonsillitis. Hypertension, renal impairment, proteinuria and hematuria were conspicuously absent, and an associated eosinophilia subsided as recovery progressed. Plasma protein regeneration was complete in 10 weeks. The patient has since developed mild asthma but has otherwise remained well.

This appears to be an unusual case of transient derangement of plasma protein metabolism. Possible relationships to the syndromes of acute nephritis without proteinuria, nephrosis, serum sickness and idiopathic acquired hypoproteinemia are discussed.
CONVULSIONS AND DEAFNESS FOLLOWING INGESTION OF DDT
Authors: CUNNINGHAM ROBERT E. , HILL FONTAINE S.
Published: December 2021

A case of DDT Poisoning in a two year old child is presented. Transitory deafness and severe convulsive seizures dominated the clinical picture, but uneventful recovery ensued.

Effects of DDT intoxication on the nervous system are discussed.
Retinoid Therapy for Severe Dermatological Disorders
Authors:   Committee on Drugs
Published: December 2021

This Policy Statement was retired January 2006.

Isotretinoin is approved for the treatment of severe recalcitrant cystic acne, and etretinate is approved for the treatment of severe recalcitrant psoriasis. Women of childbearing age place their infants at risk should these compounds be used during pregnancy and, in the case of etretinate, even before pregnancy. The purpose of this statement is to describe the indications for the use of these drugs and to advise physicians of their common side effects and their teratogenic potential.

Isotretinoin, 13-cis-retinoic acid (Accutane, Hoffmann-LaRoche), is a vitamin A derivative that is effective in the treatment of severe cystic acne. This type of acne, affecting adolescents and young adults, is severe, nodular, cystic, and conglobate—a scarring disease that resists treatment with topical or systemic antibiotics, benzoyl peroxide, all-trans-retinoic acid, and intralesional corticosteroids. Adolescents with less severe forms of acne who learn about the therapeutic triumphs of isotretinoin in severe recalcitrant nodular and cystic acne may assume that the drug also would be beneficial for them. Physicians should explain to these adolescents why isotretinoin is not indicated in the treatment of typical acne.

Another retinoid, etretinate (Tegison, Hoffmann-La Roche), is now available for the treatment of severe psoriasis that is unresponsive to standard therapies (topical tar with UVB light, anthralin, UVA light and psoralens, systemic corticosteroids and methotrexate). Etretinate is used for severe psoriasis of both the erythrodermic and generalized pustular types. Individualization of etretinate dosage is important. Most patients are started at a dosage of 0.75 to 1.0 mg/kg of body weight per day in divided doses.
Acellular Pertussis Vaccines: Recommendations for Use as the Fourth and Fifth Doses
Authors:   Committee on Infectious Diseases
Published: December 2021

In December 1991, the US Food and Drug Administration (FDA) licensed the first diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) for administration to children as the fourth and fifth doses of diphtheria, tetanus, and pertussis immunization. The product consists of an acellular pertussis vaccine produced by Japan's Takeda Chemicals and diphtheria and tetanus components produced by Lederle Laboratories, Division of American Cyanamid. It is expected that one or more additional acellular pertussis vaccine(s) will be licensed in the future.

The American Academy of Pediatrics (AAP) recommends that children routinely receive a series of five doses of vaccine against diphtheria, tetanus, and pertussis before 7 years of age.1,2 The FDA-approved DTaP vaccine (ACEL-IMUNE) is licensed for use only as the fourth and fifth doses for children who have been immunized previously with at least three doses of diphtheria and tetanus toxoids and whole-cell pertussis (DTP) vaccine. It is not licensed for the initial series of three doses in infants and children or for use in children younger than 15 months of age or after the seventh birthday. The following recommendations supplement previous AAP guidelines for use of whole-cell pertussis vaccines as the fourth and fifth doses and provide a follow-up to a previous AAP statement on acellular pertussis vaccines,3 which contains more complete background information.

BACKGROUND

The whole-cell pertussis vaccines currently used in the United States are prepared from inactivated cells of Bordetella pertussis and contain multiple antigens (Table 1). In contrast, the acellular vaccines contain one or more immunogens derived from the B pertussis organism.
ECMO and Sepsis
Authors: HOCKER JAMES R. , SIMPSON PIPPA M. , RABALAIS GERARD P. , STEWART DAN L. , COOK LARRY N.
Published: December 2021

In Reply.—

In reviewing our experience with Early Onset Group B Streptococcal Sepsis infection, we attempted to determine which clinical factors best predict mortality in this subset of patients and to evaluate the outcome of patients who receive this relatively new therapy. We acknowledge that there are many problems inherent in performing this type of study. However, we were not willing to randomize prospectively this group of newborns to one therapy or the other.

The outcome data shown for all patients from Phases 1 and 2 are included to give the reader an idea of the severity of illness of newborns with Early Onset Group B Streptococcal Sepsis infection treated at Kosair Children's Hospital and to show the relative numbers from each phase.
Would Breast-Feeding Decrease Risks of Lead Intoxication?
Authors: NEWMAN JACK
Published: December 2021

To the Editor.—

As Shannon and Graef1 point out, lead intoxication may be an important public health problem in young infants. And it is indeed likely that some babies receive too much lead from formula feeding. But this may be due to more than the fact that the lead content of the water is too high. Lead concentration of the formula itself, before dilution and even when packed in lead-free cans, may be several times that of human milk.2
The Bilirubin Debate
Authors: NEWMAN THOMAS B. , MAISELS M. JEFFREY
Published: December 2021

To the Editor.—

We would like to respond to Dr Lois Johnson's commentary1 on our paper "Evaluation and Treatment of Jaundice in the Term Newborn: A Kinder, Gentler Approach."2 One of Dr Johnson's concerns was that summarizing the effect of bilirubin on IQ in the Collaborative Perinatal Project (CPP) with linear regression could be misleading if the relationship between bilirubin and IQ were nonlinear. We are able to reassure her on this point. Since the submission of our paper, Newman and Klebanoff have re-analyzed the CPP data and found no association between bilirubin and IQ (adjusted for confounding variables) in either linear or nonlinear models.3
Primary Hemochromatosis in Children: Report of Three Newly Diagnosed Cases and Review of the Pediatric Literature
Authors: Kaikov Yigal , Wadsworth Louis D. , Hassall Eric , Dimmick James E. , Rogers Paul C.J.
Published: December 2021

Hereditary hemochromatosis was diagnosed in three asymptomatic siblings following the unexpected finding of elevated serum iron concentrations. This diagnosis was confirmed by hepatic biopsy. Repeated phlebotomies resulted in a significant decline of serum iron and ferritin concentrations and a decrease of hepatic iron content. This report and a review of the literature indicate that the diagnosis of hereditary hemochromatosis must be considered more frequently in childhood. Organ dysfunction from iron overload may be minimized in children by the early commencement of regular phlebotomy.
Diabetic Gastroparesis due to Postprandial Antral Hypomotility in Childhood
Authors: Reid B. , DiLorenzo C. , Travis L. , Flores A. F. , Grill B. B. , Hyman P. E.
Published: December 2021

Nausea, vomiting, chronic abdominal pain, and constipation developed in three children with insulin-dependent diabetes mellitus beginning 1 to 7 years after the onset of diabetes. All three had considerable difficulty in achieving satisfactory glycemic control. All had delayed gastric emptying of solids and postprandial antral hypomotility. Diabetic autonomic neuropathy must be considered in the differential diagnosis of gastrointestinal symptoms even in the young diabetic patient.