bluuebunny/crossref_metadata_2025 huggingface dataset:
Who Commits Suicide?
Authors: Eisenberg Leon
Published: December 2021

Permit me to correct a misleading statement which appeared in my paper on adolescent suicide.1 I stated (p 316) far too categorically that: "In all age groups, in all countries, and for all periods for which data are available, men consistently outnumber women by about 3 to 1 in completed suicides...."

Professor Toyomasa Fuse of York University (Canada) has called to my attention data on suicide in Japan,2 where suicide among women has been consistently high; in 1973, the male/female ratio was 1.37, similar to data for Hong Kong, Singapore, and Thailand.
Are Surveillance of Resistant Enteric Bacilli and Antimicrobial Usage Among Neonates in a Newborn Intensive Care Unit Useful?
Authors: White Robert D. , Townsend Timothy R. , Stephens Maureen A. , Moxon E. Richard
Published: December 2021

From March 1976 through December 1978, the prevalence of ampicillin- and gentamicin-resistant enteric bacilli was monitored in fecal cultures of neonates in an intensive care unit. Substantial fluctuations in colonization rates were observed which did not correlate with the occurrence of sepsis due to these organisms nor with variations in antibiotic use. This experience suggests that the availability of these surveillance data did not result in more effective control of neonatal sepsis due to enteric bacilli.
Pediatric Psychologists and Child Psychiatrists: Birds of a Different Feather
Authors: Aylward Glen P.
Published: December 2021

Pierog and Hill's letter1 underscores the value of involving a pediatric psychologist in a pediatric residency program. Although I agree with their cònclusions, I feel that their apparent emphasis on substituting a pediatric psychologist for a child psychiatrist may leave the wrong general impression. I would therefore like to suggest why pediatric psychologists, on their own merit, should be involved in pediatric residency programs.

As these authors state, in addition to physical ailments, a pediatric practice typically includes behavioral, social, and developmental problems.
CT Scans, Ultrasound, and Lumbar Puncture
Authors: Volpe Joseph J.
Published: December 2021

I read with interest the article by Silverboard et al, "Comparison of Lumbar Puncture with Computed Tomography Scan as an Indicator of Intracerebral Hemorrhage in the Preterm Infant."1 Although the report provides interesting and useful information, I believe that the authors' conclusions might be misinterpreted. I write to offer a few comments.

The authors' stated purpose was "to evaluate the reliability of lumbar puncture in comparison with [computed tomography] CT scan in the diagnosis of [subependymal/intraventricular hemorrhage] SEH/IVH."1
Neo-Mull-Soy's Deficiencies
Authors: Hollis Robert E.
Published: December 2021

The article on the metabolic effect of the Neo-Mull-Soy type formula by Grossman, et al1 seems to focus on an element of the problem that explains very little. The formula provides a low sodium alkaline load diet and should be recognized as such.

If Cl- is deficient, so are Na+ and/or K+, unless there are other anions present. As stated, Cl- is neither an acid (proton donor) nor a base (proton acceptor). Consideration should be focused on the more important anions that are proton acceptors or donors, depending upon the H+ concentration.2
Letters to the Editor
Authors: Keller Margaret A.
Published: December 2021

Our study of 100 patients with clinical pertussis1 included seven infants less than 3 months of age. Of these seven infants, six had positive nasopharyngeal cultures for Bordetella pertussis. Cultures for chlamydiae were not done in our 1970-1973 study.

The infant described by Garty et al had a markedly elevated white cell count (32,500/cu mm with 68% mononuclear cells) which has not been associated with chlamydial infection2,3 but is typical of infection with B pertussis
Questioning Conclusions on Prenatal Nutritional Supplementation
Authors: Strawbridge John E.
Published: December 2021

Rush, Stein, and Susser1 tell us that pregnant women receiving a high protein supplement were more likely to deliver prematurely than those receiving a complement (balanced calories and protein). Furthermore, they claim that these premature babies were significantly lower in birth weight than the premature babies of the complement and control groups. However, there was no statistically greater incidence of premature births in the supplement group than in the other two groups combined, nor were there significantly more perinatal deaths.
THOMAS JEFFERSON WRITES TO HIS 11-YEAR-OLD DAUGHTER ON THE SUBJECT OF DRESS
Authors: C. T. E.
Published: December 2021

Martha, Jefferson's oldest daughter, who was born on September 27, 1772, was temporarily placed under the care of relatives after her mother's death on September 6, 1782. A year later her father sent her this letter advising her "on the subject of dress."

Annapolis, Dec 22, 1783

... I omitted ... to advise you on the subject of dress, which I know you are a little apt to neglect. I do not wish you to be gaily clothed at this time of life, but what you wear should be fine of its kind. But above all things and at all times let your clothes be clean, whole, and properly put on. Do not fancy you must wear them till the dirt is visible to the eye. You will be the last who is sensible of this. Some ladies think they may, under the privileges of the dishabillé, be loose and negligent of their dress in the morning. But be you, from the moment you rise till you go to bed, as cleanly and properly dressed as at the hours of dinner or tea. A lady who has been seen as a sloven or a slut in the morning, will never efface the impression she has made, with all the dress and pageantry she can afterwards involve herself in. Nothing is so disgusting to our sex as a want of cleanliness and delicacy in yours. I hope, therefore, the moment you rise from bed, your first work will be to dress yourself in such style, as that you may be seen by any gentleman without his being able to discover a pin amiss, or any other circumstance of neatness wanting ....
THE VOICE OF ONE CHILD TOO MANY
Authors: Johnson Charles Felzen
Published: December 2021

She took her tiny hand from her swollen mouth only once, to slowly indicate her age with three trembling fingers.

One finger was swollen and painful.

Then her expressionless face turned away, bruised side up, and she lapsed into herself again.

No sounds were uttered as I gently mapped the yellow, brown and blue patches which covered her body.

A brutal camouflage hiding the greater distress which lay inside.

Inside a tangle of scars, confusion, fear.

Inside this delicate child whose mother could not, or did not protect her.

From him?

Or was he a diversion, from her?

Was he really the perpetrator of the repeated physical and sexual attacks?

If so, why did she not protect?

Mothers are supposed to protect or call for help?

Mothers are supposed to help.

"They would take my children away if I reported the incidents" she defended.

"I need my children", she importuned.

"Please help me".

The nurse, usually a cool model of composure left before the tears completely dissolved her facade.

It was painful to see the child, to hear the story.

For a moment the rest of us stood silent and vacuous.

The quiet child recoiled from my touch good bye.

No Trust.

No Love.

No Tomorrow?

We slowly trailed out of the room in disbelief; (in frustration) in anguish.

As we closed the door I distinctly hear a small voice inside say "Please help me."

The voice is still echoing in my mind.

The voice of one child too many.
Sleep Parameters and Respiratory Variables in ‘Near Miss’ Sudden Infant Death Syndrome Infants
Authors: Guilleminault Christian , Ariagno Ronald , Korobkin Rowena , Coons Susan , Owen-Boeddiker Margaret , Baldwin Roger
Published: December 2021

Twenty-nine near miss for sudden infant death syndrome and thirty normal infants between the ages of 3 weeks and 6 months were monitored polygraphically for 24 hours. The distribution of sleep and abnormal respiratory events were analyzed for both groups. On the basis of mixed and obstructive apnea, 12-hour nocturnal segments (8 pm to 8 am) consistently distinguished near miss from normal infant groups between the ages of 3 weeks and 4.5 months. Daytime naps do not provide statistical differences sufficient to differentiate between the two groups. During sleep, abnormal respiratory events are more likely to occur between 1 am and 6 am, at least 40 minutes after sleep onset. Respiratory pauses show a significant increase just prior to waking (a strong respiratory stimulus). Any impairment of the arousal threshold during sleep will place near miss infants at increased risk.
Hemolytic Uremic Syndrome Associated with Kawasaki Disease
Authors: Ferriero Donna M. , Wolfsdorf Joseph I.
Published: December 2021

Renal failure has not previously been described as a manifestation of Kawasaki disease. We report a 2[unknown]-year-old girl with Kawasaki disease in whom the clinical picture of hemolytic uremic syndrome occurred during the acute phase of her illness.
Chlamydia trachomatis Infection in Infant Delivered by Cesarean Section
Authors: Givner Laurence B. , Rennels Margaret B. , Woodward Celeste L. , Huang Shih-Wen
Published: December 2021

Neonatal Chlamydia trachomatis infection is thought to be acquired as a result of contact with infected cervical secretions during vaginal delivery. An infant, delivered by cesarean section, who was infected with C trachomatis has been described. At 31 days of age he had conjunctivitis and respiratory distress. Nasopharyngeal aspirate grew C trachomatis and serum IgM antibody titer was 1:32 for serotype J. The patient's mother had serum IgG antibody against C trachomatis serotype J. Her cervical culture was negative for Chlamydia; however, cultures were not taken until two months after delivery and she had received antibiotics for postpartum fever and abdominal pain. The literature has been reviewed and possible modes of transmission have been discussed.
Fatalities Caused by Electrically Operated Garage Doors
Authors: Satran Leon
Published: December 2021

Although there have been remarkable advances in the field of pediatrics during this century there is, unfortunately, no chance of developing a vaccine to prevent injury and death from accidents. More children 1 to 4 years of age die from accidents than from the combined seven next ranking causes of death.1 An estimated 40,000 to 50,000 children are permanently injured each year, and a minimum of 1 million seek medical care because of accidental injuries.2 The proliferation of electronic apparatus in the home environment can only add to the hazards which are already considerable. One such piece of equipment which is rapidly growing in popularity is the electrically operated garage door.
JEREMY BENTHAM'S LIST OF DATA NEEDED TO UNDERSTAND THE GROWTH AND DEVELOPMENT OF CHILDREN (1797)
Authors: C. T. E.
Published: December 2021

Jeremy Bentham (1748-1832), English philosopher, jurist, political theorist, and founder of the doctrine of utilitarianism, was also influential in the field of medical theory and practice.

Spector1 has called attention to the following data set down by Bentham more than a century and a half before the emergence of modern interest in child development. This list shows Bentham's prescience in conceptualizing the data that would need to be collected before one could properly understand the temporal steps in a child's development.

1. Advances independent of instruction:

First indication of fear, smiling, recognizing persons

Indication of a preference for a particular person

Indication of a dislike for a particular person

Attention to musical sounds

Appearance of first tooth

Appearance of each of the successive teeth; duration and degree of pain and illness in cutting teeth

Giving toys or food to others

Attempt to imitate sound laughter

General progress in bodily or intellectual requirements whether uniform or by sudden degree

2. Advances dependent upon instruction:

Standing, supported by one arm

Standing, supporting itself by resting the hands

Token of obedience to will of others

Command of natural evacuation

Walking, supporting itself by chairs

Standing alone

Walking alone

Pointing out the seat of pain.
Newborn Screening for Urea Cycle Disorders
Authors: Naylor Edwin W.
Published: December 2021

Mass screening of newborn infants for inherited metabolic disorders began in the early 1960s with the development of the Guthrie bacterial inhibition assay for the detection of phenylketonuria (PKU).117 This simple assay utilizing dried filter paper blood specimens collected by heel prick from newborn infants has resulted in mass screening for PKU throughout most of the world. The field of newborn screening, however, has not remained limited to search for patients with PKU. It has evolved into an exciting area of preventive medicine which has seen the introduction of additional bacterial inhibition assays for other inborn errors of metabolism,118-120 automation of the screening laboratories,121 and multistate regionalization of screening programs.122 This field has also seen the introduction of other specimens for mass screening including the use of cord blood, follow-up blood specimens,122 and urine specimens collected on filter paper.123,124 In order to obtain an optimum number of specimens, the multitest laboratory might be a centralized laboratory serving a single large state or a regional laboratory serving a newborn population of several smaller states.125

APPROACHES TO UREA CYCLE SCREENING

In the development of any screening test, there are a number of different parameters that may be examined. An investigator may choose to develop a simple screening test which measures the presence or absence of an enzyme or he may choose one which measures the accumulation of a substrate or secondary metabolic product. In the case of urea cycle disorders, there are a number of important markers that can be used as the basis for developing simple screening tests.
Letters to the Editor
Authors: Gall D. Grant , Barker Geoffrey , Cutz Ernest
Published: December 2021

The recent report by Starko and co-workers (Pediatrics 66:859, 1980) attempts to incriminate salicylates in the pathogenesis of Reye's syndrome. We would like to express caution in such an interpretation. From 1973 to 1978 at The Hospital for Sick Children in Toronto, 27 cases of Reye's syndrome were identified by elevated bevels of serum glutamic-oxaloacetic acid and blood ammonia and prolonged prothrombin times. The diagnosis was confirmed by liver histology in 26 of the 27 patients.
Letters to the Editor
Authors: Faden Howard
Published: December 2021

Thank you for your letter of inquiry about my article, "Treatment of Haemophilus influenzae Type B Epiglottitis" (Pediatrics 63:402, 1979). Only one child died in the series of 48 children. This child experienced a respiratory and cardiac arrest upon arrival at our hospital and could not be rapidly intubated. After successful intubation, the child failed to breathe spontaneously and required respirator therapy until she died three days later. In each case the respiratory arrests occurred prior to intubation and not during the procedure.
New Formula Confuses Old Test
Authors: Wickham Lawrence K. , Smith Franklin R. , Baden Melvin
Published: December 2021

We recently cared for a premature infant with suspected chylothorax in whom the diagnosis was delayed presumably because our feeding protocol utilized a prescribed 24 calorie premature formula (Similac Special Care Formula, Ross Laboratories, Columbus, OH).

Our patient, a 1.25-kg, 28-week gestation male, was the second born of twins to a gravida 2, para 1, Abortus 0, O+, serology negative mother. The infant's Apgar scores were 7 and 9 at one and five minutes, respectively.
Letters to the Editor
Authors: Nelson David B. , Kimbrough Renate D. , Landrigan Philip S. , Hayes A. Wallace , Yang George C. , Benanides Jeannette
Published: December 2021

Dr Wray's comments are, of course, very appropriate and encouraging. Aflatoxin was first detected in food commodities from other parts of the world. As concentrations in other parts of the world have usually been higher, little attention has been paid to the possibility of aflatoxin exposure in humans in the United States except by those who are directly involved in monitoring the human food supply (US Department of Agriculture, the food industry, and the US Food and Drug Administration).
ON THE LIBERAL USE OF ALCOHOL IN THE TREATMENT OF THE DISEASES OF CHILDREN (1890)
Authors: C. T. E.
Published: December 2021

At the 1890 meeting of the American Pediatric Society several of the founding members of the Society, in their discussion of a formal paper on the use of alcohol in the treatment of ill children, favored its liberal use, even for small infants.

For example, L. Emmett Holt (1854-1924) commented:1

I am almost afraid to mention the amount of alcohol which I have given some young children. Recently I treated a baby two months old, weighing about seven pounds, for a severe broncho-pneumonia. The child took for twenty-four hours a teaspoonful of whiskey every half-hour, and for the two succeeding days almost as much. To a boy sixteen months old at the Infant Asylum, who had first pneumonia, followed by pleurisy with effusion, and then diphtheria, all in the course of a few weeks, with complete recovery, we gave half a pint of whiskey a day for several days; this, too, without producing any cerebral symptoms, although they were carefully watched for. It seems to me, therefore, that we should be guided in dosage by the effect produced, and not by any preconceived idea as to how much the child ought to have.

Victor C. Vaughan (1851-1929), of Ann Arbor, Michigan, also supported Holt's view of the therapeutic value of alcohol, especially in diphtheria and typhoid fever.

He noted1:

In the treatment of mild cases of diphtheria, and more expecially in the typhoid fever of children, there has been no other remedy at my command so good as alcohol. In the typhoid fever of children the temperature often runs up as high as 105° to 106° F.
Heat Stress in Motor Vehicles: A Problem in Infancy
Authors: King K. , Negus K. , Vance J. C.
Published: December 2021

Children have died from heat stress because they have been left in closed automobiles. Changes in the internal temperature of various sized automobiles left in the Brisbane summer sun were examined. With all windows and doors closed, this temperature rose from an ambient level of 36 C to a maximum of 67 C within 15 minutes and remained there until the doors were opened. Slightly lower temperatures were found for light colored sedans and station wagons. However, all readings were significantly above ambient and all produced an environment unacceptable for a child. Temperatures approaching ambient were only achieved with ventilation provided by windows at least 200 mm (half) open. A lesser gap (50 mm) resulted in interior temperatures exceeding 50 C, which is still too hot for children. Infants left in such an environment will lose fluid quickly from sweat and could become as much as 8% dehydrated in four hours. Subsequently the cerebral manifestations of heat stroke would ensue. Parents and pediatricians should be warned of the danger of heat stress if children are left in a closed automobile.
X-Linked Mental Retardation and the Fragile-X Syndrome
Authors: Gerald Park S.
Published: December 2021

A recent issue of a human genetics journal (American Journal of Medical Genetics) devotes nearly 100 pages to nine different presentations on X- linked mental retardation. This expression of tremendous interest stems primarily from a cytogenetic finding that appears to define a new cause of mental retardation (MR), which is generally referred to as the fragile-X syndrome. The accumulated information concerning this syndrome indicates that it is one of the most frequent of the diagnosable forms of MR. For this reason, every physician, and especially every pediatrician, should become thoroughly acquainted with the fragile-X syndrome.

Inasmuch as it is unusual for new syndromes of significant frequency to be discovered, a brief account of how this was achieved is in order.
Intercountry Adoption
Authors: Sherry S. Norman , Riecke William C. , Sokoloff Burton , Sterne George G. , Wagner Virginia
Published: December 2021

Intercountry adoption is the adoption of a child native to one country by citizens and/or residents of another country and the subsequent removal of the child from his native country to the second country. The Adoption and Dependent Care Committee recognizes that such procedures are fraught with problems for the countries involved and for the members of the traditional adoption triad–adoptee, birth parents, and adoptive parents. The motivation of adoptive parents, the country of origin, and the country of destination have all been challenged.

The motivation of parents seeking to adopt children from other countries should be examined, as should the motivation of any prospective adoptive parents. Specific attention should be paid to those who see such adoptions as expiation for perceived sins committed against the child's native country. Although such reasoning may sound admirable, it does not provide a sound foundation for beginning a parent-child relationship.

The Committee supports efforts to improve the situations of all children: that is, each child should have a permanent nurturing home and a family, preferably his biologic family in his native country. International assistance should first support services that strengthen the biologic family and child welfare services within the native country. In addition to this assistance, there are occasions in which the interest of the child may be met by intercountry adoption.

CONTRIBUTING FACTORS

Many factors have contributed to the increasing number of intercountry adoptions by natives of the United States (current rate is approximately 6,000 per year). In the United States, the declining birth rate and the increasing tendency of unmarried mothers to keep their infants rather than giving them up for adoption, have led to shortages of healthy infants for prospective adoptive parents.
Stressed Interns
Authors: Schaff Eric A. , Hoekelman Robert A.
Published: December 2021

The findings of Adler, Werner, and Korsch1 in their study of 94 pediatric interns at the Los Angeles Children's Hospital (LACH) should be viewed with concern. At the end of their first year of training, these interns expressed less satisfaction from patient care in general and a decrease in appreciation for the social and emotional factors contributing to the ills of their patients. They also showed little or no improvement in their interpersonal communication skills during the year.
Diagnostic Accuracy of Hepatobiliary Scintigraphy with 99mTc-PIPIDA Questioned
Authors: Byrne William J. , Euler Arthur R. , Golladay Eustes S. , Seibert Joanna J.
Published: December 2021

Majd et al (Pediatrics 67: 140, 1981) refer to hepatobiliary scintigraphy with 99m-labeled p-isopropylacetanilido iminodiacetic acid (99mTc-PIPIDA) as a highly accurate test for differentiating biliary atresia from other causes of neonatal jaundice. We agree that this technique is superior to rose bengal. However, their conclusion that it is highly accurate may be premature in view of the limited number of patients. Indeed the test is very sensitive (100%), but prior to their innovative use of phenobarbital it was not very specific (58%).
Letters to the Editor
Authors: Majd Massoud , Reba Richard C. , Altman R. Peter
Published: December 2021

We are grateful to Byrne et al for their comments and for their willingness to share their experience using 99mTc- PIPIDA in the evaluation of neonatal jaundice. We are sympathetic to their concern regarding the total number of patients we reported; however, we felt compelled to report our early encouraging results so as to invite comments and to stimulate other groups to use phenobarbital therapy prior to scintigraphy. We have now expanded our prospective study to 40 patients, and the results reinforce our initial conclusion.
Salicylate and Reye's Syndrome
Authors: Pascoe John M.
Published: December 2021

Starko et at1 have written an interesting paper, their observations concerning the interaction of fever, viral illness, and salicylates in the pathogenesis of Reye's syndrome appear plausible. However, their data do not unequivocally support their conclusion "salicylate causes Reye's syndrome."

Although the authors are investigating the suspected cause of a disease, they chose their subjects based on the presence (case) or absence (control) of disease. This case-control design "is crude and widely used only because studies are feasible and can be carried out swiftly."
Pneumatosis Pulmonalis
Authors: Moskowitz Peter S. , Bensch Klaus G. , Carrington Charles B.
Published: December 2021

We read with interest the paper by Leonidas et al entitled, "Persistent Localized Pulmonary Interstitial Emphysema and Lymphangiectasia: A Causal Relationship?" (Pediatrics 64: 165, 1979) We have reported1 our experience with five neonates in whom clinical, roentgenographic, and morphologic findings were nearly identical with those demonstrated by Leonidas et al. However, with respect to their hypothesis that intralymphatic air dissection is responsible for the apparent pulmonary lymphangiectasia and persistent pulmonary overinflation, we wish to point out that the authors have failed to establish one crucial point.
Letters to the Editor
Authors: Williams Allan F.
Published: December 2021

Dr Beuf's comment that air bags "can be more hazard than help" to children is incorrect. The concern had been expressed that some unrestrained children in crashes would be in positions in which they would be contacted by an air bag early in its deployment, and possibly injured as a result. Some years ago both Volvo and General Motors raised this issue after conducting research using pigs as child surrogates. Volvo cautioned, however, that "it would be extremely unfortunate if either government or industry allows the emotionality of the standing child/inflatable restraint issue to overshadow the potential that such systems have for preventing fatalities and injuries in a much larger segment of the American population" (letter submitted to Docket 74-14; Notice 1-FMVSS208, Occupant Crash Protection, Oct 18, 1974).
ANTHONY TROLLOPE ON THE EATING HABITS OF YOUNG AMERICAN CHILDREN (1864)
Authors: C. T. E.
Published: December 2021

Anthony Trollope (1815-1882), the English novelist, like his mother had thirty years earlier, wrote a travel book describing his impressions of American life and costumes during his visit to North America between 1861 and 1862.

His description of the eating habits of three- or four-year-old American children in the 1860s will surprise parents of the 1980s.

And then the children—babies I should say, if I were speaking of English bairns of their age; but, seeing that they are Americans, I hardly dare to call them children. The actual age of these perfectly civilized and highly educated beings may be from three to four. One will often see five or six such seated at the long dinner table of the hotel, breakfasting and dining with their elders, and going through the ceremony with all the gravity and more than all the decorum of their grandfathers. When I was three years old, I had not yet, as I imagine, been promoted beyond a silver spoon of my own, wherewith to eat my bread and milk in the nursery; and I feel assured that I was under the immediate care of a nursemaid, as I gobbled up my minced mutton mixed with potatoes and gravy.

But at hotel life in the States, the adult infant lisps to the waiter for everything at table, handles his fish with epicurean delicacy, is choice in his selection of pickles, very particular that his beefsteak at breakfast shall be hot, and is instant in his demand for fresh ice in his water.
Insect Sting Treatment
Authors: Fikar Charles R.
Published: December 2021

Hymenoptera stings can be quite discomforting and as mentioned by Yunginger (Pediatrics 67:325, 1981), ice compresses and time are an accepted form of therapy. I would like to discuss briefly two additional forms of treatment that may prove to be even more effective in certain instances.

Personal and anecdotal experience, as well as a textbook of emergency pediatrics,1 suggest that the topical application of papain in the form of unseasoned meat tenderizer can relieve much of the discomfort of an insect sting, particularly when applied immediately.
Letters to the Editor
Authors: Linnemann Calvin C.
Published: December 2021

The paper by Starko and colleagues (Pediatrics 66:859, 1980) supports the association between salicylates and Reye's syndrome. Back in 1974, when we first demonstrated the association of Reye's syndrome with documented influenza B virus infection, the use of salicylates in 100% of cases suggested the same association.1 We started a similar case-control study of salicylates, studying five patients with biopsy-proven Reye's syndrome and seven symptomatic contacts matched for age. The only difference was that control subjects were interviewed at the same time as case subjects, to avoid recall bias.
Circumcisions: Knowledge Isn't Enough
Authors: Bennett Howard J. , Weissman Mark
Published: December 2021

In their article, Osborn et al1 discuss the results of a study in which physicians were questioned about their knowledge of the natural history of the foreskin and about the advice they give parents concerning hygienic care of uncircumcised infants. We agree completely with their recommendations and have routinely cautioned parents against too vigorous retracting and cleansing of the foreskin. We were surprised, however, that 80% of the physicians surveyed felt that only 10% or less of their male infants are uncircumcised.
Air in the Ductus?
Authors: Calmes S. H.
Published: December 2021

The article "Paraplegia Due to Peripheral Venous Air Embolus in a Neonate: A Case Report" (Pediatrics 67:472, 1981) needs further discussion.

Although it is possible that the foramen ovale (FO) was the site of cross-over of air from venous to arterial circuits, it is equally possible that the ductus was the shunt site in this 24-hour-old infant. The ductus is usually functionally closed by age 24 hours but is capable of reopening in response to hypoxia.
Drunk Infant
Authors: Fitzsimons Robert B.
Published: December 2021

The recent report of the Committee on Drugs on Naloxone use in Newborns1 did not consider its possible use for neonatal respiratory depression secondary to intrapartum maternal ethanol intoxication. It has been postulated that ethanol intoxication is mediated in part by an action on central opiate receptors,2 and naloxone has been used to reverse coma of adult ethanol intoxication.3 For the ethanol-intoxicated newborn, this may be one positive benefit of naloxone's actions on enkephalinor endorphin-mediated stress responses.4
THE FIRST PUBLISHED MORTALITY TABLE OF AMERICAN CHILDREN UNDER FIVE YEARS OF AGE (1842)
Authors: C. T. E.
Published: December 2021

Mortality data for American children under five years of age, prior to the middle part of the last century, were rarely reported in anything resembling a statistical presentation.

See Table in the PDF File

The first to publish such data was Robert M. Hartley (1796-1881) in his Essay on Milk (Figure shows mortality table).1 His mortality figures were from Boston between the years 1811 to 1839.
MARGARET FULLER, A NINETEENTH CENTURY AMERICAN TRANSCENDENTALIST AND FEMINIST, ON CHILDREN'S BOOKS (1845)
Authors: C. T. E.
Published: December 2021

Margaret Fuller (1810-1850), friend and intellectual equal of Thoreau, Emerson, Hawthorne, and Bronson Alcott, was one of the very few writers of her time to show an interest in the content of children's books.

In an article published in the New-York Daily Tribune of February 5, 1845 she wrote1:

There is no branch of literature that better deserves cultivation, and none that so little obtains it from worthy hands as this of Children's books. It requires a peculiar development of the genius and sympathies, rare among the men of factitious life, who are not men enough to revive, with force and beauty, the thoughts and scenes of childhood....

There is too much among us of the French way of palming off false accounts of things on children to do them good, and showing nature to them in a magic lantern, "purified for the use of childhood," and telling stories of good little girls, and sweet little girls, or brave little boys; oh! all so good! or so bad! and, above all, so little, and every thing about them so little!—Children, accustomed to move in full-sized apartments, and converse with full-grown men and women, do not need so much of this baby-house style in their literature. They like, or would like, if they could get them, better things much better. They like the "Arabian Nights," and "Pilgrim's Progress," and "Bunyan's Emblems," and Shakespeare, and the "Iliad" and "Odyssey"; at least, they used to like them; and, if they do not now, it is because their taste has been injured by so many sugar-plums.
Letters to the Editor
Authors: Diamond Eugene F.
Published: December 2021

The Medical Community owes a debt to Dr Raymond Duff as an author of an exploratory work1 regarding the care of newborn defective children. In the eight years that have followed its publication, there has been a salutary intraprofessional and interprofessional dialogue which has led to the defining of issues and the clarification of the background of the controversy. If we have not found a total solution to every agonizing aspect of the care of handicapped newborns, we have reached a consensus on some important matters.
Letters to the Editor
Authors: Duff Raymond S.
Published: December 2021

In a previous publication, Dr Eugene Diamond1 has seen fit to distort our writings, and others including Senator Jesse Helms and Dr C. Everett Koop (whom President Reagan wishes to appoint United States Surgeon General) have compounded this abuse by distorting Diamond's distortion even risking libel.2 In Diamond's remarks above, he has distorted another article of mine. He states, "The handicapped newborn child's right to life should, according to Duff, be considered only insofar as it fulfills ‘the need of society, the family and future generations.’"
Letters to the Editor
Authors: Duff Raymond S.
Published: December 2021

I infer that Dr Bartholome distrusts parents more than I. I do not know why he feels as he does. I do know that I feel as I do because I believe that when an authority figure like a doctor, parent, or teacher relates to others with a feeling of trust, those others, (patients, family members, children, or students as the case may be) usually respond to meet the implied challenge. They grow personally, and that is good.
Don't Be Fatalistic
Authors: Marks Dennis N.
Published: December 2021

Dr Duff's article has prompted these comments from a pediatrician who has viewed these issues from a different perspective and chosen another role in response to the challenges.

In 1965 we founded the Laurel Hills Developmental Living Center, Inc, which has grown to provide residential and nursing services to 114 people from 5 to 75 years of age. The programs at Laurel Hills have shown tremendous improvement over the years in spite of restrictive governmental fiscal policies.
Evaluation of the Minolta Bilirubin Meter as a Screening Device in White and Black Infants
Authors: Hannemann Robert E. , Schreiner Richard L. , DeWitt David P. , Norris Steven A. , Glick Melvin R.
Published: December 2021

The only currently available method for the determination of the serum bilirubin concentration is blood sampling followed by analysis in the laboratory. Yamanouchi et al1 have presented data concerning a two-wavelength (460, 555 nm) transcutaneous bilirubin meter (Minolta Camera Company, Ltd). They found a significant correlation with serum bilirubin concentrations of 0 to 20 mg/100 ml in full-term Oriental infants. However, there are no published data concerning the use of the instrument in white or black full-term or premature infants. The purpose of this study was to evaluate the Minolta transcutaneous bilirubin meter in these populations.

MATERIALS AND METHODS

During a two-month period, measurements were taken with the Minolta transcutaneous bilirubin meter on any infant for whom a serum bilirubin determination had been ordered.
Fragile Sites on Chromosomes
Authors: Hecht Frederick , Glover Thomas W. , Kaiser-Hecht Barbara
Published: December 2021

A fragile site on the X chromosome is associated with a common form of mental retardation in males and a proportion of females.1-3 This association was not fully appreciated when the fragile site on the X was first described in 1969,4 but it is crystal-clear today.

Chromosome fragility can be random, as in Fanconi anemia, Bloom syndrome, and ataxia-telangiectasia, the chromosome instability syndromes.5 Breaks and rearrangements of chromosomes are seen in these disorders, all of which are autosomal recessive conditions predisposing to cancer.

Fragile sites are special spots in the genome where gaps and breaks occur nonrandomly. The balance of the chromosome complement is normal.
Growing Up Too Fast
Authors: Palumbo Francis
Published: December 2021

"Luscious lips" and "mysterious eyes" ... ready to "go out on the town" and "be a real sensation" ... provocative advertising even for Glamour or Mademoiselle, but this particular appeal is pitched at children, little girls aged 4 to 9 years. Remco's new "crayon cosmetics" have hit the market and the market is a big one—children. I was involved with the aborted attempt by the Federal Trade Commission to ban television advertising aimed at young children. The money spent yearly trying to sell items to America's children is staggering—approximately 400 million dollars. Four hundred million dollars is spent to peddle cereals with little nutritional value, toys that injure our youngsters, games that fall apart, and dolls that break.
Neurologic Findings with Maternal Hyperthermia
Authors: Bennett Forrest C.
Published: December 2021

The critical consideration of first trimester maternal hyperthermia as a possible teratogenic and developmentally deleterious agent is an important task which has been further enhanced by the retrospective report of Pleet and co-workers.1 However, I am troubled by their contention that they have described a somewhat unique and unusual pattern of neuromotor dysfunction in their study subjects and that this pattern of neurologic findings provides a major basis for the suggested similarity of their exposed subjects.
Letters to the Editor
Authors: Graham John M.
Published: December 2021

In general, I agree with the comments expressed above. We did not intend to imply that the pattern of neuromotor dysfunction was in any way specific to gestational hyperthermia. What we find provocative about our study is that the timing of gestational hyperthermia in the human, and the defects associated with such hyperthermia, are very similar to the timing and defects which are seen in experimental animals. In fact, the studies by Edwards (cited in our paper) would appear to suggest that the predominant effect of prolonged hyperthermia during early pregnancy is on the central nervous system.
Sex and Respiratory Distress Syndrome
Authors: Hutchison Alastair A. , O'Herlihy Colm , Drew John H. , Beischer Norman A.
Published: December 2021

We read with interest the recent paper by Papegeorgiou et al.1 We have studied the incidence of the idiopathic respiratory distress syndrome (IRDS) in 132 newborn infants, with gestational ages between 26 and 36 weeks, whose mothers had a urinary estriol (E3) assay during the week prior to delivery. Of the 132, 101 did not receive either antenatal steroid nor any other drug that might have interfered with estrogen synthesis. The urinary E3 excretion was defined as low (< tenth percentile for gestational age) or normal (> tenth percentile).2 The sex incidence is shown in the Table.
Letters to the Editor
Authors: Papageorgiou A. N. , Colle E.
Published: December 2021

We appreciate the opportunity of seeing the interesting data of Hutchinson et al which suggest an association between the incidence of idiopathic respiratory distress syndrome (IDRS) and maternal urinary estriol excretion. We offer the following comments on their data:

1. Of the 101 infants studied, 51% were born to mothers having urinary E3 in the lowest tenth percentile for gestational age. The group under study is, therefore, highly selected.

2. Likewise, the overall incidence of IDRS is high (39%) especially when one considers that infants of up to 36 weeks of gestation are included in the sample.
SLAVE TORCH—infectious Agents for Hepatitis in Infants
Authors: Naveh Yehezkel
Published: December 2021

Despite the fact that there are more infectious agents causing the hepatitis syndrome in infants than are specified by the well-known term "TORCH," pediatricians are still satisfied with this term. We suggest using the more appropriate "SLAVE TORCH"1 which encompasses all the infectious agents implicated in this syndrome:

S Syphilis; septicemia

L Listeria

A Australia Ag & Ab; adenovirus

V Varicella zoster; vaccinia

E Epstein-Barr virus (EBV)

T Toxoplasma

O Others like urinary tract infection

R Rubella

C Cytomegalovirus; Coxsackie B virus

H Herpesvirus simplex
Transpyloric and Intermittent Gavage Feeding
Authors: Minoli I. , Moro G.
Published: December 2021

Pereira and Lemons (Controlled study of transpyloric and intermittent gavage feeding in the small preterm infant. Pediatrics 67:68, 1981) compared techniques of feeding low-birth-weight infants: transpyloric (nasoduodenal) feeding and intermittent gavage. They observed no significant differences for several parameters, and concluded that there was no difference between the two techniques in supplying nutrition to the low-birth-weight infants and that the transpyloric feeding could not be recommended because it was risky and difficult. According to our experience1 one of the advantages of the transpyloric feeding is that it permits a greater caloric and nutritional intake (140 to 150 kcal/kg/day) in the early days of life without the complications caused by the introduction of the same amount of nutrients into the stomach.
Letters to the Editor
Authors: Ernhart Claire B. , Landa Beth , Schell Norman B.
Published: December 2021

First, we must point out and apologize for a clerical error in our report.1 In table 2, the correlation between Parent IQ and Dentine lead level should be -.34§, not .34§.

We appreciate the points made by Spector and Brown and regret that we failed to include or emphasize sufficiently in our report some details that would have averted some of their concerns.

The outcome (school age) data sets were analyzed twice by Hotteling's T2 test with the results shown in table 3.
Decrease in Pulsatile Flow in the Anterior Cerebral Arteries in Infantile Hydrocephalus
Authors: Hill Alan , Volpe Joseph J.
Published: December 2021

The effect of ventriculomegaly with or without elevated intracranial pressure (ICP) on pulsatile flow in the anterior cerebral artery has been studied by a noninvasive Doppler technique in 11 infants with hydrocephalus. The cause of hydrocephalus was intraventricular hemorrhage in nine infants, Arnold-Chiari malformation in one, and bacterial meningitis in one. The pulsatility index (PI) (inversely related to pulsatile flow) was calculated from the systolic and diastolic amplitudes of flow in the anterior cerebral artery. All 11 patients with elevated PI had marked ventriculomegaly, and all but two had raised ICP. Four patients with massive ventriculomegaly and elevated ICP had maximal PI (ie, 1.00). The finding of elevated PI with ventriculomegaly and normal ICP, observed in two patients, suggested that ventriculomegaly is a more critical factor than ICP in the pathogenesis of the impaired flow. Treatment of ventriculomegaly in seven patients resulted in a decrease in PI. Of the four untreated patients, three died and one was not available for further study. Compromised flow in the anterior cerebral artery may be a sensitive barometer of impending ischemic injury with evolving ventriculomegaly, particularly following intraventricular hemorrhage. The PI may be a valuable parameter for the study of the mechanism of brain injury and for determination of optimal timing of corrective intervention.
Genetic Counseling in Prenatally Diagnosed Trisomy 18 and 21: Psychosocial Aspects
Authors: Adler Bernard , Kushnick Theodore
Published: December 2021

Aminocentesis detected 15 fetuses with trisomy 18 or 21 during a three-year period. Of the 15 families, 14 elected to terminate the pregnancy; 12 of the 15 families responded to a questionnaire that explored the various psychosocial aspects and the effectiveness of genetic counseling associated with their decisions.
Association of Coronavirus Infection with Neonatal Necrotizing Enterocolitis
Authors: Chany C. , Moscovici O. , Lebon P. , Rousset S.
Published: December 2021

From the clustered occurrence of numerous cases of necrotizing enterocolitis in newborns, it was possible to associate this disease significantly with infection due to coronavirus-like agents. Prematurity or low birth weight did not seem to affect the development of the disease, at least during the present epidemic. However, associated gas-producing bacteria could influence its severity and play a role in the appearance of pneumatosis. In many aspects the human disease is reminiscent of experimental necrotizing enterocolitis obtained by infection of germ-free newborn animals, as reported in the literature.
Radiodensity of the Proposed New Penny
Authors: Dorst John P. , Reichelderfer Thomas E. , Sanders Roger C.
Published: December 2021

In 1973 the United States Mint proposed replacing the bronze penny with a less expensive penny made of aluminum. Pediatricians and pediatric radiologists, by testifying that aluminum coins are difficult to see on radiographs, helped defeat that legislation. Now the Mint again proposes a less expensive penny, one made principally of zinc. This proposed penny is radiopaque and will be easily identified on radiographs.
Psychotropic Drugs in Pregnancy and Lactation
Authors: Segal Sydney , Pruitt Albert W. , Anyan Walter R. , Hill Reba M. , Kauffman Ralph E. , Mofenson Howard C. , Shinefield Henry R. , Singer Harvey S. , Weinberger Miles M. , Ballin John C. , Catz Charlotte , Farchione Louis , Freeman Martha M. , Frigoletto Fred , Licata Sam A. , Oakley Godfrey , Sawchuk Steven , Smith Dorothy L. , Soyka Lester F.
Published: December 2021

Accurate prediction of fetal/neonatal risks following maternal psychotropic drug consumption by the human will require much additional study. Based upon our present understanding of fetal exposure to psychotropic drugs, there would appear to be an increased risk for spontaneous malformations in the case of lithium. There have been inconsistent reports of structural abnormalities following exposure to phenothiazines and benzodiazepines. In animal models that demonstrate structural changes due to neuroleptic exposure, in general, extremely large dosages of medication had been given. Thus, their correlative value is limited.

Behavioral alterations in animals following drug exposure during pregnancy tend to support increased concerns about the safety of psychotropic drugs for the fetus but cannot be used alone in making a final decision. Behavioral studies evaluating drugs in breast milk have been restricted to experimental animals; hence, the associated risks from this form of drug dosing in man remain unknown. At present, neither gross anatomic nor motor side effects have been apparent in the infant. The question of the development of subtle behavioral changes as a long-term consequence will remain undetermined until careful assessments have been completed.