bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Outcome: Is Adolescent Pregnancy a Risk Factor?
Authors: Zuckerman Barry , Alpert Joel J. , Dooling Elizabeth , Hingson Ralph , Kayne Herbert , Morelock Suzette , Oppenheimer Edgar
Published: December 2021

It has been widely reported that adolescent mothers are more likely to experience poor pregnancy outcome, especially low-birth-weight and/or premature infants. Recent data suggest that this poor outcome may be attributed to confounding health and social characteristics of adolescent mothers. A study of maternal health and neonatal development at Boston City Hospital provided an opportunity to assess whether adolescent mothers deliver infants with poorer outcomes at birth than nonadolescents independent of numerous social and health differences between adolescent and nonadolescent mothers. A total of 275 infants of primiparous adolescents (aged 13 to 18 years) were compared at birth with 423 infants of primiparous nonadolescents. Size at birth, length of gestation, Apgar scores, and birth trauma were examined. The only statistically significant difference between the two groups was that adolescent mothers delivered infants whose mean weight was 94 g less (P < .03) than infants of nonadolescent mothers. Multiple and logistic regression analyses demonstrated that several health and social factors, but not adolescent status, were independently associated with the measures of adverse infant outcome. A subsequent regression analysis demonstrated similarly that being a younger adolescent (16 years and younger) did not independently predict low birth weight at delivery or other measured adverse neonatal outcomes. These data support the view that health and social factors are more important to poor fetal outcome among primiparous mothers than adolescent status. Some of the health factors are amenable to clinical intervention.
Double-Blind Evaluation of Methylprednisolone Versus Placebo for Acute Asthma Episodes
Authors: Shapiro Gail G. , Furukawa Clifton T. , Pierson William E. , Gardinier Rhonda , Bierman C. Warren
Published: December 2021

Twenty-eight children with persistent bronchospasm after outpatient therapy were treated for eight days with methylprednisolone or placebo in a prerandomized double-blind manner, in addition to treatment with optimal oral bronchodilators. At follow-up visits 1, 7, and 14 days after onset of therapy, a history was taken and physical examination and pulmonary function tests were performed. Initially and on the 14th day, patients underwent cosyntropin tests of adrenal function. Patients kept daily peak flow charts. Both groups improved with time. However, by 24 hours after starting methylprednisolone therapy, the placebo group continued to show reversibility after isoproterenol inhalation whereas the methylprednisolone group did not. By day 7 there were significantly more patients with normal 1-second forced expiratory volume (FEV1) and forced expiratory flow in the middle half of the forced vital capacity (FEF25-75%) in the methylprednisolone group and mean FEF25-75% was significantly higher for this group (P < .02). By day 14, six days after finishing treatment with the study drugs, more patients in the placebo group had residual wheezing, but pulmonary function tests were now similar for the two groups. Although both groups showed a decline in cosyntropin responsiveness on day 14 compared with day 1, there was no difference between the steroid- and placebo-treated patients. This study proves that short-term corticosteroid therapy will accelerate resolution of moderately severe and severe-acute attacks of asthma without significant suppression of adrenal function.
Incidence of Postextraction Bacteremia Under Penicillin Cover in Children with Cardiac Disease
Authors: Hess J. , Holloway V. , Dankert J.
Published: December 2021

To assess the efficacy of penicillin prophylaxix as recommended by the American Heart Association to prevent the onset of bacterial endocarditis, the incidence of postextraction bacteremia was determined in 82 children with cardiac disease who were receiving prophylactic penicillin. Aerobic and anaerobic blood cultures were taken five minutes after dental extraction, as was a blood sample to assay the serum penicillin concentration. The incidence of postextraction bacteremia was 21%. Streptococcal species accounted for half of the number of aerobes isolated. Of the isolated microorganisms, 16% were strict anaerobes. Susceptibility testing of the isolates showed that 24 penicillin-sensitive and eight penicillin-resistant microorganisms caused the bacteremia. There was neither a significant difference between the serum penicillin concentrations of children with and without bacteremia, nor between the serum penicillin concentrations of children with bacteremia due to penicillin-sensitive microorganisms and children with bacteremia due to penicillin-resistant microorganisms. It is concluded that the occurrence of postextraction bacteremia is not prevented by penicillin prophylaxis and that the serum penicillin concentration at extraction is not the discriminating factor in preventing this bacteremia. None of the children developed bacterial endocarditis. It is speculated that mechanisms not thoroughly studied are involved in the prevention of bacterial endocarditis after dental extraction.
Short Stature Associated with Normal Growth Hormone and Decreased Somatomedin-C Concentrations: Response to Exogenous Growth Hormone
Authors: Bright C. M. , Rogol A. D. , Johanson A. J. , Blizzard R. M.
Published: December 2021

Two prepubertal males with low somatomedin-C concentrations in their sera, but normal growth hormone concentrations, had positive metabolic responses when human growth hormone was administered. An accelerated velocity of growth accompanied the longterm administration of growth hormone. This response was dependent upon the administration of exogenous hormone inasmuch as linear growth was subnormal both before and after administration of growth hormone. The extreme short stature in these individuals may be secondary to a biologically inactive growth hormone molecule that is immunologically reactive or to a decreased dose responsiveness of the cells that produce somatomedin when exposed to the usual concentrations of endogenous growth hormone.
Elevated Amylase Levels as a Result of Self-Induced Hypersalivation
Authors: Belik Jacques , Tishler Carl , McClung Juhling
Published: December 2021

A patient with recurrent vomiting, abdominal pain, and elevated serum amylase activity may have pancreatitis. Although elevated serum amylase levels are a sensitive indicator for acute pancreatitis, this test is not highly specific for pancreatic disease. A patient is described who illustrates the need for specific laboratory, historical, and occasional psychological evaluation in pediatric patients with elevated amylase values.
Dyskeratosis Congenita: Two Examples of This Multisystem Disorder
Authors: Womer Richard , Clark Joseph E. , Wood Pamela , Sabio Hernan , Kelly Thaddeus E.
Published: December 2021

Two brothers with the X-linked disorder, dyskeratosis congenita, are described. They showed the dermatologic triad of reticular hyperpigmentation, dystrophic nails, and leukoplakia oris as well as the other major feature of this disorder, aplastic anemia. Less common features observed included prenatal and postnatal growth retardation, mental retardation, elevated immunoglobulin levels, and gastrointestinal hemorrhage from mucosal ulceration. Previously unreported findings were intracranial calcifications and nutmeg-like cirrhotic changes of the liver. These brothers demonstrated that skeletal changes and bony fragility may predate anemia or steroid therapy. Although a DNA repair defect is postulated as a possible primary defect, cytogenetic studies revealed no evidence of increased chromosomal breakage.
Hemoperfusion in Theophylline Neurotoxicity
Authors: Sahney Shobha , Abarzua Jorge , Sessums Linda
Published: December 2021

Four patients with severe theophylline toxicity (theophylline levels of 60 to 180 µg/ml) are reported. Three patients with neurotoxicity were treated with hemoperfusion. Two of these were hemoperfused early after the onset of seizures; they recovered with no neurologic deficit. In the third patient hemoperfusion was delayed for 16 hours after uncontrolled seizures; severe brain damage resulted. The fourth patient, who had the highest peak theophylline level but no seizures, was successfully treated with conservative management and peritoneal dialysis. The role of hemoperfusion in severe theophylline intoxication is discussed.
Necrotizing Enterocolitis with Escherichia coli Heat-Labile Enterotoxin
Authors: Cushing Alice H.
Published: December 2021

Twenty-one babies occupied a newborn intensive care unit during two separate clusters of necrotizing enterocolitis (NEC). Seven babies had suspected NEC, seven had proved NEC, two had diarrhea only, and five were unaffected. Of affected babies, 15 had toxigenic Escherichia coli or heat-labile E coli toxin in feces detected by enzyme-linked immunosorbent assay. One of five unaffected babies had fecal toxin (P = .01). Four of 12 affected babies had a fourfold immunoglobulin M (Igm) antitoxin titer rise within 3 weeks of the fecal studies. None of five unaffected infants had a serologic immune response. The clinical disease seen in the babies was not characteristic of previously described E coli heatlabile toxin-associated diarrhea.
Another View of Carbon Dioxide and Retrolental Fibroplasia
Authors: GOLE G. A. , GANNON B. J.
Published: December 2021

To the Editor.—

Wolbarsht et al1 advanced several hypotheses in their letter regarding the role of CO2 in retrolental fibroplasia. We take issue with their letter on the following grounds: 1. No evidence is presented that levels of retinal Pco2 rise during O2 induced retinal vasoconstriction. CO2 has a high diffusion coefficient, 20 times that of oxygen2 and we suggest that such CO2 produced in the retina would rapidly diffuse the short distance to the high-flow choroidal circulation. 2.
Likelihood Ratio, Skull Roentgenograms, and Clinical Decision-Making
Authors: LEONIDAS JOHN C. , BINKIEWICZ ANNA , SCOTT R. MICHAEL , PAUKER STEPHEN G.
Published: December 2021

In Reply.—

We appreciate the thoughtful comments of Leventhal and Lembo and concur with their conclusion that the clinician needs to know "the probability of skull fracture in a patient with head trauma." Unfortunately, their proposed "clinical likelihood ratio" (CR) will not further that end because it compares the predictive value (or, more precisely, the posterior probability) of a skull fracture after a positive clinical finding to the posterior probability after a negative finding. After the patient has been examined, the patient does not have both findings; thus, the CR cannot apply to the individual patient.
Death of a Child at Home or in the Hospital: Subsequent Psychological Adjustment of the Family
Authors: Mulhern Raymond K. , Lauer Mary E. , Hoffmann Raymond G.
Published: December 2021

Twenty-four families who had participated in a Home Care Program for children terminally ill with cancer and 13 families of similar children who had died in the hospital completed inventories on parent and sibling personality as well as family functioning three to 29 months after the child's death. Parents of patients who received terminal care in the hospital were more anxious, depressed, and defensive and had greater tendencies toward somatic and interpersonal problems than parents of patients in the Home Care Program. Siblings of patients who received terminal care in the hospital were more emotionally inhibited, withdrawn, and fearful than their counterparts in the Home Care Program. Although some group differences in parental personality may have antedated terminal care, these results confirm parental reports of more adequate family adjustment following participation in a structured Home Care Program.
Predictability of Esophageal Injury from Signs and Symptoms: A Study of Caustic Ingestion in 378 Children
Authors: Gaudreault Pierre , Parent Marcelle , McGuigan Michael A. , Chicoine Luc , Lovejoy Frederick H.
Published: December 2021

The accuracy of signs and symptoms as predictors of the presence and severity of esophageal injury was evaluated in 378 children admitted to three pediatric hospitals between 1970 and 1980. The signs and symptoms analyzed included nausea, vomiting, dysphagia, refusal to drink, abdominal pain, increased salivation, oropharyngeal burns, and abdominal tenderness. The severity of lesions found at esophagoscopy in 378 children was graded from grade 0, no lesion, to grade 3, perforation. Of the 298 patients demonstrating signs or symptoms, 243 (82%) had a grade 0 or 1 lesion, 55 (18%) had a grade 2 lesion, none had a grade 3 lesion, and five (2%) developed a stricture of the esophagus. Among the 80 patients without signs or symptoms, 70 (88%) had a grade 0 or 1 lesion, ten (12%) had a grade 2 lesion, none had a grade 3 lesion, and one (1%) developed a stricture of the esophagus. When individual signs or symptoms were correlated with the severity of esophageal lesion, vomiting (33%) followed by dysphagia (25%), excessive salivation (24%), and abdominal pain (24%) were most frequently associated with a grade 2 or 3 esophageal lesion. A similar percentage of a grade 0 or 1 (82% v 85%), a grade 2 (18% v 15%), and a grade 3 (0%) esophageal lesion followed the ingestion, respectively, of an alkali (324 patients) or an acid (54 patients). In six patients (2%) stricture occurred only following an alkali ingestion. These data demonstrate that signs and/or symptoms do not adequately predict the presence or severity of an esophageal lesion following the ingestion of a caustic substance.
Diabetic Nephropathy in Adolescence: Appearance During Improved Glycemic Control
Authors: Ellis Demetrius , Avner Ellis D. , Transue David , Yunis Eduardo J. , Drash Allan L. , Becker Dorothy J.
Published: December 2021

Two girls, aged 15 and 14 years, with poorly controlled insulin-dependent diabetes (IDD) of 9 and 7 years duration, respectively, developed overt and persistent proteinuria shortly after rapid increases in insulin therapy and improved glycemic control. Renal biopsies showed diffuse diabetic glomerulosclerosis. Both patients maintained normal or increased creatinine clearances. Direct ophthalmoscopy and fluorescein retinal angiography demonstrated nonproliferative diabetic retinopathy in the first patient, which deteriorated after 6 weeks of strict metabolic control; the second patient had normal retinas. The appearance of clinical proteinuria during this brief period of good glycemic control suggests that the latter may have unmasked a preexisting condition. Possible pathophysiologic mechanisms initiating the proteinuria in these patients are reviewed.
Intoxication from Accidental Marijuana Ingestion
Authors: WEINBERG DIANA , LANDE ARTHUR , HILTON NANCY , KERNS DAVID L.
Published: December 2021

The increasing availability and use of marijuana in children, adolescents, and adults have been well documented in recent years. Adverse reactions have been described in adults who absorb the drug via inhalation or by oral and intravenous routes.1-5 To our knowledge, no cases of oral intoxication in very young children have been reported in the pediatric literature. We describe the adverse effects experienced by three children after an accidental oral ingestion of marijuana.

CASE REPORTS

Case 1

J.H., a 3-year-old previously healthy, white girl, was noted by her baby-sitter to be behaving abnormally a short time after lunch. Approximately two hours later, her mother observed the child to have an ataxic gait and a voracious appetite.
NMR Imaging in Pediatric Practice
Authors: SMITH FRANCIS W.
Published: December 2021

Since before Roentgen's discovery of x-rays, man has been searching for a noninvasive method for assessing the soft tissue organs of the body. For many decades this need has been met by standard x-ray techniques. When x-rays pass through a body, they are absorbed by that body in differing amounts depending upon their density. Because most soft tissues have similar densities, conventional radiography is unable to differentiate overlapping soft tissue structures. In the early 1970s this difficulty was overcome by the development of x-ray computed tomography (CT). This advance in radiodiagnosis utilizes the same principle of measuring different coefficients of absorption, but collects data from many different directions and reconstructs them mathematically to display them as a cross-sectional image.
Donors for Liver Transplantation
Authors: STARZL THOMAS E. , HAKALA THOMAS R. , ROSENTHAL J. THOMAS , DENNY DON
Published: December 2021

There is good evidence that the decade of the 1980s will witness an expansion of efforts to transplant extrarenal organs. This will have a profound effect in pediatrics, and particularly in the field of hepatology. The number of infants born with biliary atresia is not known with certainty, but it is likely that there are approximately 500 new cases each year in the United States. The number of lethal hepatic based inborn errors of metabolism that can be effectively treated with liver replacement has steadily grown. Other acquired hepatic disorders are not uncommon in infancy and childhood.

If transplantation of the liver (or of the kidney, heart, intestine, pancreas, and possibly other organs) is to reach its full potential, pediatricians will have to be more acutely aware of the need for organs, and will need to collaborate actively in the procurement process.
Croup: An 11-Year Study in a Pediatric Practice
Authors: Denny Floyd W. , Murphy Thomas F. , Clyde Wallace A. , Collier Albert M. , Henderson Frederick W. , Senior R. S. , Sheaffer C. I. , Conley W. G. , Christian R. M.
Published: December 2021

The etiology and epidemiology of croup were studied in a pediatric group practice over an 11-year period, 1964 to 1975. Croup was diagnosed in 951 instances in 6,165 cases of lower respiratory tract infection (LRI) studied. As census figures of the practice clientele were available, attack rates were calculated. The incidence of total LRI was highest in the first year of life. In contrast, the attack rate for croup was highest in the second year of life; the rate declined gradually after that age. Croup was not diagnosed in the first month of life. Boys were 1.43 times more likely to develop croup than were girls. Three hundred sixty agents were isolated from the 951 croup cases. The parainfluenza viruses accounted for 74.2% of all isolates; 65% of the parainfluenza isolates were classified as parainfluenza virus type 1. Respiratory syncytial virus, influenza viruses A and B, and Mycoplasma pneumoniae were the only other agents isolated in appreciable numbers. The propensity of various agents to produce croup symptoms in children with LRI due to specific microorganisms was 58% for parainfluenzae type 1, 60% for parainfluenzae type 2, and 29% for parainfluenzae type 3; similar figures for the other agents varied from 5% to 16%. The role of the various agents in the etiology of croup varied with patient age and depended on the propensity of the agent to produce the croup syndrome and the frequency of isolation of the agent at that age. The parainfluenza viruses were the most important croup agents at all ages; respiratory syncytial virus caused croup in children less than 5 years of age whereas the influenza viruses and M pneumoniae were significant causes of croup only in children more than 5 to 6 years old. Croup occurred predominately in late fall and early winter, times when the parainfluenza viruses, especially type 1, occurred most frequently. The epidemiology of croup differs from that of bronchiolitis, pneumonia, and tracheobronchitis; knowledge of this should be helpful to the clinician caring for children with LRI.
Isolation of Trichomonas vaginalis from the Respiratory Tract of Infants with Respiratory Disease
Authors: McLaren Leroy C. , Davis Larry E. , Healy George R. , James Charles G.
Published: December 2021

Trichomonas vaginalis was isolated from the respiratory tracts of two infants with respiratory disease. Bacterial and viral cultures of tracheal aspirates and nasopharyngeal specimens did not detect bacterial pathogens or viruses; however, T vaginalis was found to be present in inoculated cell cultures. Both infants were delivered vaginally by mothers with known previous episodes of T vaginalis infection. The possibility that this organism may, on occasion, cause respiratory tract disease needs further evaluation.
Seasonality of Reported Poison Exposures
Authors: Paulozzi Leonard J.
Published: December 2021

Review of 3,381 records from New Hampshire Poison Center for July through September 1981 and January through March 1982 revealed no seasonal difference in the total number of calls. A significant predominance in the summer reports was noted for plants, pesticides, envenomations, and acetaminophen exposures. During the winter a predominance was noted for aspirin, vitamins, cold and cough remedies, liniments, foods, and calls with no specific agent identified.
Influence of Age on Serogroup Distribution of Endemic Meningococcal Disease
Authors: Baker Carol J. , Griffiss J. McLeod
Published: December 2021

The age distribution of 126 infants and children with disseminated meningococcal disease hospitalized consecutively in Houston between January 1977 and June 1979, and between January 1981 and June 1981 was analyzed and compared with that in the United States as a whole and to that during outbreaks of group B disease in North America and epidemics of group C disease in South America. Eighty-one (64.3%) isolates from Houston cases were serogroup B and 37 (29.4%) were serogroup C Neisseria meningitidis. Children with serogroup C disease were significantly older than those with group B disease (P = .017). Of the children with serogroup B infections, 33% were less than 12 months of age and 8.6% were less than 3 months of age. Of those with serogroup C disease, only 2.7% were less than 3 months of age and the majority (73%) were more than 2 years of age. These age distributions are similar to those reported for the entire United States during endemic periods. In contrast, focal outbreaks of group B meningococcal infection occurred in populations that were significantly older (0.02 > P < .05). Similarly, epidemic disease in South America due to serogroup C strains also occurred in older children when compared with the occurrence of endemic group C disease in the United States (P = .02).
Hypertension in Children with Neurogenic Tumors
Authors: Weinblatt Mark E. , Heisel Margaret A. , Siegel Stuart E.
Published: December 2021

Fifty-nine children with neurogenic tumors were examined for the presence of hypertension. Eleven of the 59 (19%) were found to have elevated blood pressure levels at the time of diagnosis or with progression of their disease. Several antihypertensive agents produced poor or only partial pressure control. All blood pressure levels returned to normal values after tumor excision or administration of effective antitumor therapy. There was no correlation of hypertension with urinary catecholamine levels. The etiologies of hypertension in children with neurogenic tumors are discussed.
Differing Opinions on the Emergency Treatment of Choking
Authors: DAY RICHARD L.
Published: December 2021

In this issue, Montgomery1 criticizes Heimlich's article2 published last year and goes on to cast doubt on the Heimlich maneuver and Heimlich's fear of back blow. Valid research on choking is difficult, and impossible to conduct in children because it would be unethical. Experimental and anecdotal data concerning adults, although scarce, do exist. The reader is referred to Gordon et al,3 Ruben and MacNaughton,4 Redding,5 and Day et al.6

The last of these four studies introduces measurement of the ballistic forces on the neck in response to the momentary straightening of the spine induced by a back blow. A supraglottic foreign body would be expected to be forced downward with more than three times the pull og gravity.
Sudden Infant Death Syndrome and Phenothiazines
Authors: KAHN A. , BLUM D.
Published: December 2021

In Reply.—

Stanton reminds us of the hypothesis that overheating could be a major factor in some unexpected infant deaths.1 Phenothiazine, by impairing normal temperature regulation, could induce overheating and hence the sudden death of the baby.

We presently have no data to appreciate the proposed mechanism. In our hospital, among 98 victims of SIDS, the skin temperature was reported to the abnormally hot in seven (7.1%), normal in 43 (43.9%), and abnormally cold in 48 (49%) when discovered.
Multiple Anaerobic Pulmonary Abscesses
Authors: STERN ROBERT C. , BERKOWITZ ROBERT J.
Published: December 2021

In Reply.—

Behrents and colleagues reemphasize some of the points we made in our article, and so it is difficult for us to find much fault with their ideas. We feel that we presented a strong case for a cause-effect relationship between the beginning of orthodontic treatment and the development of multiple localized pulmonary abscesses whose etiologic agent was an organism found in oral secretions. Behrents and colleagues are not convinced. We stand by our conclusions and invite the readers of Pediatrics to reread our article and decide for themselves.
Attitudes of Pediatricians Toward Maternal Employment
Authors: Heins Marilyn , Stillman Paula , Sabers Darrell , Mazzeo John
Published: December 2021

The largest number of women in history is employed outside the home including 55% of mothers with children less than 18 years of age. The attitudes of pediatricians toward employed mothers were assessed by a mail survey to the entire membership of the American Academy of Pediatrics. Usable responses were received from 5,758 pediatricians (31%). Adequacy of child care and economic necessity were ranked as the most important factors considered by responding pediatricians when advising a mother inquiring whether she should work outside the home. One third of the respondents stated the child can be any age when the mother becomes employed. The majority of respondents did not feel there was a difference between children of employed mothers and homemaker mothers. Special considerations for employed mothers were provided by half of the respondents, more frequently by female than male pediatricians. Most respondents are supportive of mothers working outside the home, but bias against employed mothers does exist. Pediatricians whose spouses do not work outside the home, those in older age groups, and male pediatricians tended to hold more traditional attitudes toward maternal employment.
Factors Associated with Infections Among Breast-Fed Babies and Babies Fed Proprietary Milks
Authors: Holmes Grace E. , Hassanein Khatab M. , Miller Herbert C.
Published: December 2021

Correlation of first postnatal year infections among 251 babies was made with the infant feeding mode, socioeconomic status of family, maternal educational level, age, and maternal behavioral factors including smoking habit and number of siblings in the family. Initially, 127 mothers intended to breast-feed and 124 intended to formula-feed their infants. In the correlation matrix maternal education was the highest variable inversely correlated with infection; it was the first to enter in stepwise regression analysis and was highly significant (P <.0001). Maternal weight gain during pregnancy and infant feeding mode were the next two variables, respectively, to be added during the stepwise regression but they were not significant in the presence of maternal education. The statistical significance of increased maternal education in inverse relation to infection persisted in the presence of the other two factors (P <.0064). The t test showed no significant difference in the number of infections among the breast-fed and formula-fed babies within any of the three maternal education groups. It may be concluded that in the population studied, the infant feeding mode itself was not significantly related to the number of infections during the infant's first postnatal year when the education of the mother was taken into account.
Dietary Composition and Macronutrient Storage in Preterm Infants
Authors: Reichman Brian , Chessex Philippe , Verellen Gaston , Putet Guy , Smith John M. , Heim Tibor , Swyer Paul R.
Published: December 2021

A comparison has been made of the influence of feeding own mother's milk and formula on the oxidation and accretion of energy and macronutrients in the growing preterm infant of very low birth weight (<1,300 g) by using the combined techniques of nutrient balance and computerized indirect calorimetry. There were 22 studies in formula-fed infants and 15 studies in premature infants fed own mother's milk. Despite their lower metabolizable energy intake, the infants fed own mother's milk grew in weight, length, and head circumference at a rate approximating those of the formula-fed group. The metabolic rate was significantly lower in the infants fed own mother's milk (56.0 ± 0.9 v 62.6 ± 0.8 kcal/kg/d; P < .001). The protein intake, oxidation, and accretion were similar in the two groups. The infants fed own mother's milk had a significantly lower fat intake (P < .001), higher fat oxidation (P < .025) and consequently lower fat accretion (P < .001) than the formula-fed infants. The proportional fat content of the daily weight gain was lower in the infants fed own mother's milk (16% v 33%; P < .001) but protein content was similar (13% v 12%). The accretion of energy, fat, and protein correlated with the respective metabolizable intakes in both groups (r = .81 to .98; P < .001), suggesting that accretion rates and hence composition of weight gain are dependent on levels of energy and macronutrient intake.
Benzyl Alcohol: Toxic Agent in Neonatal Units
Authors:   Committee on Fetus and Newborn,   Committee on Drugs
Published: December 2021

As advances have been made in the care of very low-birth-weight infants, some techniques or practices have caused unexpected complications. One such practice is umbilical vessel catheterization to monitor an infant's arterial blood pressure, infuse fluids and medications, and obtain blood specimens for laboratory examinations. The catheters frequently are flushed with sterile isotonic saline or a 5% solution of dextrose in water, with the flush solution frequently being obtained from a multiple-dose vial. The United States Pharmacopeia requires all medications or solutions marketed in a multiple-dose vial to contain an antimicrobial preservative. Benzyl alcohol, an aromatic alcohol, is used for this purpose in a wide variety of medications and fluids for parenteral therapy, usually in a concentration of 0.9%.

Two groups of investigators, Gershanik et al1 (New Orleans) and Brown et al2 (Portland), independently concluded that an intravascular infusion of flush solutions containing 0.9% benzyl alcohol caused severe metabolic acidosis, encephalopathy, respiratory depression with gasping, and perhaps other abnormalities leading to the death of a total of 16 infants. Blood and urine from several affected infants had high levels of both benzoic and hippuric acids, known metabolites of benzyl alcohol. Both groups stated that no additional cases occurred after solutions with benzyl alcohol preservative were banned in their nurseries.

Subsequently, in May 1982, the Food and Drug Administration3 with the concurrence of the American Academy of Pediatrics and the Centers for Disease Control,4 urged pediatricians and other personnel in hospitals not to use fluids preserved with benzyl alcohol (or other antimicrobial agents) as intravascular flush solutions for newborn infants and not to use diluents with this preservative to reconstitute or dilute medications for infants.
Differences in Polymorphonuclear Cell Counts Between Healthy White and Black Infants: Response to Meningitis
Authors: Sadowitz P. David , Oski Frank A.
Published: December 2021

Both black adults and black children have significantly lower total WBC counts and absolute polymorphonuclear WBC counts than do white adults and white children. In an effort to determine whether similar differences existed in infancy, 50 healthy black infants and 50 white infants were examined. The black infants, 9 to 12 months of age, were found to have significantly lower total WBC counts, absolute neutrophil counts, and absolute lymphocyte counts. In ten of the 50 black infants, the absolute neutrophil counts were less than 1,000/µL; none of the white infants had absolute neutrophil counts of less than 1,000/µL. Even in the presence of a serious infection, meningitis, significantly fewer black infants had absolute neutrophil counts greater than 10,000/µL than did their white counterparts.
Treatment of Occult Bacteremia: A Prospective Randomized Clinical Trial
Authors: Carroll William L. , Farrell Michael K. , Singer Jonathan I. , Jackson Mary Anne , Lobel Jeffrey S. , Lewis Edward D.
Published: December 2021

Antibiotic therapy for children without foci of infection and at risk for bacteremia is controversial. A prospective randomized clinical trial was conducted using expectant antibiotic therapy in children at risk for bacteremia. A total of 96 children (aged 6 to 24 months) with temperature of more than 40°C, no identifiable source of infection, and a leukocyte count ≥15,000/µL and/or sedimentation rate ≥30 were enrolled. The following tests were performed on all children: blood culture, chest roentgenogram, urinalysis, and urine culture. A lumbar puncture was performed if a child was 12 months or less. Patients were randomized to receive either no antibiotic therapy or Bicillin C-R, 50,000 U/kg intramuscularly, followed by penicillin V, 100 mg/kg/d, orally four times a day for three days. Patients were examined at 24 and 72 hours. Fifty patients were treated expectantly and 46 received no antimicrobial therapy. Ten of the 96 patients were bacteremic (nine had Streptococcus pneumoniae, one had Haemophilus influenzae). Four of the five children treated for bacteremia showed improvement at the first follow-up visit (afebrile and no obvious focus of infection). The five untreated patients showed no improvement; four patients developed focal infections (two had meningitis, two had otitis media) (P ≤ .05, Fisher exact test). No complications of expectant therapy were detected. Thus, expectant antibiotic therapy for children who have no obvious source of infection and who meet these criteria associated with occult bacteremia is warranted.
Ribavirin Aerosol Treatment of Bronchiolitis Associated with Respiratory Syncytial Virus Infection in Infants
Authors: Taber Larry H. , Knight Vernon , Gilbert Brian E. , McClung Harvey W. , Wilson Samuel Z. , Norton H. James , Thurson Jeffrey M. , Gordon Wayne H. , Atmar Robert L. , Schlaudt W. Robin
Published: December 2021

In a double-blind study, bronchiolitis associated with respiratory syncytial virus infection in 12 randomly selected patients treated with ribavirin aerosol improved more rapidly than in 14 control patients given saline aerosol (P = .044, Wilcoxon rank sum test, two-tailed). An estimated 10 mg of ribavirin per kilogram of body weight was administered in daily 12-hour treatments over a five-day period. Respiratory syncytial virus disappeared from secretions at about the same rate in treated and control patients. There was no local or systemic intolerance, and there was no evidence of hematologic or other organ toxicity in the ribavirin-treated patients.
Medical History Associated with Adolescent Powerlifting
Authors: Brown Eugene W. , Kimball Richard G.
Published: December 2021

A questionnaire, designed to elicit information about the training, experience, and medical history of adolescent powerlifters, was administered to 71 contestants entered in the 1981 Michigan Teenage Powerlifting Championship. The average subject had participated in 4.1 workouts per week for 17.1 months. Each workout lasted an average of 99.2 minutes. The population sustained 98 powerlifting injuries which caused a discontinuance of training for a total of 1,126 days. The incidence and severity of pain in 13 regions of the body, as well as the site and type of powerlifting injury, were investigated. The low back region was shown to be the site with the greatest number of injuries (49). This region also had the highest percent of subjects recording an elevated occurrence and level of pain associated with powenlifting.
Relationship Between Pressure Passivity and Subependymal/Intraventricular Hemorrhage as Assessed by Pulsed Doppler Ultrasound
Authors: Ahmann Peter A. , Dykes Francine D. , Lazzara Anthony , Holt Philip J. , Giddens Don P. , Carrigan Timothy A.
Published: December 2021

A prospective study was undertaken using a range-gated, pulsed Doppler velocimeter to study flowpressure relationships in the anterior cerebral artery. Serial velocity and pressure studies were performed with each infant serving as his or her own control. The hypothesis tested was that ill preterm infants sustaining subependymal/intraventricular hemorrhage would have absent autoregulation. The hypothesis has been tested in 88 studies on 32 infants. Of 32 infants studied, 15 were judged to be pressure passive; nine of these children bled. The other 17 infants were not pressure passive; eight of these children bled (P > .05). From these studies, it may be concluded that the pressure passive state is not the final common link in the genesis of subependymal/intravertricular hemorrhage. Pulsed Doppler ultrasound may provide an extremely useful noninvasive technique for studing both the arterial and venous sides of the cerebral circulation.
Feeding the Low-Birth-Weight Infant Iv. Fat Absorption as a Function of Diet and Duodenal Bile Acids
Authors: Järvenpää Anna-Liisa
Published: December 2021

Fat absorption and fasting duodenal bile acids were studied at 11 to 68 days of age in 66 healthy preterm infants, gestational age of 31 to 36 weeks and birth weight of 1,230 to 2,160 g. The infants fed human milk received pooled, expressed milk (55%), partly supplemented (35%) with their own mother's expressed milk. Approximately 10% of the milk was given by breastfeeding once per day. All expressed human milk not fed immediately was pasteurized at 62°C for 30 minutes. The other three groups of infants received an adapted formula (Fl), Fl supplemented with taurine (F2), or Fl supplemented with taurine and cholesterol (F3). In each group, fat was provided at 6.75 g/kg/d. The formulas had a fat concentration of 4.5 g/l00 mL, containing 57.6% of unsaturated fatty acids from vegetable oils. In the infants fed human milk, fat absorption was consistently high, and no correlation was found between fat absorption and postnatal age. In the formula-fed infants, fat absorption increased with postnatal age (r = .310 P < .05). When the duodenal concentration of total bile acids was above the median (3.6 mmol/L), fat absorption in the formulafed infants exceeded 80%. There was a linear correlation between fat absorption and duodenal bile acids (r = .630, P < .001) in the formula-fed infants. In the infants fed human milk, such correlation was not observed, and their intraluminal concentration of bile acids always exceeded 3.6 mmol/L. The fats from human milk were absorbed more efficiently (93%) than those from the formulas (82%, P < .001). Supplementation of formula with taurine or with taurine plus cholesterol did not improve fat absorption from this formula.
Vitamin and Mineral Supplementation in Down's Syndrome
Authors: Bennett Forrest C. , McClelland Stephen , Kriegsmann Elinor A. , Andrus Lori Brazee , Sells Clifford J.
Published: December 2021

The claim that large, nonspecific doses of vitamins and minerals improve the performance of mentally retarded children has recently reappeared in both the scientific literature and the public media. This hypothesis was examined in a double-blind, case-control study involving 20 home-reared children with Down's syndrome between 5 and 13 years of age. Children were randomly assigned by matched pairs to either a vitamin/mineral group or placebo group for an 8-month study period. No significant group differences or suggestive trends were found in any tested area of development or behavior, including intelligence (IQ), school achievement, speech and language, and neuromotor function. No group differences in appearance, growth, or health were seen. No support was found for the orthomolecular hypothesis in school-aged children with Down's syndrome.
Neonatal Screening for Cystic Fibrosis: Position Paper
Authors:   Ad HOC COMMITTEE TASK FORCE ON NEONATAL SCREENING, CYSTIC FIBROSIS FOUNDATION, Taussig Lynn M. , Boat Thomas F. , Dayton Delbert , Fost Norman , Hammond Keith , Holtzman Neil , Johnson Wendy , Kaback Michael M. , Kennel John , Rosenstein Beryl J. , Stolz Walter S. , Trause Mary Ann ,   Cystic Fibrosis Foundation Medical Staff, Beall Robert J. , Keramidas Sherry L.
Published: December 2021

Neonatal screening represents the search for a disorder in a general newborn population. The purpose of screening may be to improve the health of the affected infant, to provide counseling, or for research. Screening tests have been widely accepted for conditions such as phenylketonuria, hypothyroidism, and other metabolic conditions. Cystic fibrosis (CF) is the most common lethal genetic disorder among the white population (with a lower incidence among blacks), and thus there has been interest in screening newborns for CF1 However, proposals emanating from this interest have remained controversial.2-4 The recent development of a relatively simple test—the dried blood immuno-reactive trypsinogen (IRT) assay—has increased this interest.5-12

Besides considering technical reliability and validity of newborn screening methods, it is crucial that all other aspects of screening (including medical, ethical, psychosocial, and economic aspects) be rigorously examined before implementing mass screening.13-15 To address these issues the Cystic Fibrosis Foundation convened a Task Force on Neonatal Screening. Although the Task Force considered the current status of the IRT test, it focused on the generally accepted criteria for newborn screening, summarized in the Table,14 and the relationship of these criteria to the present state of knowledge related to CF. The issues identified by the Task Force, are summarized in this paper, and recommendations are presented at the conclusion.

EFFECTIVENESS OF PRESYMPTOMATIC TREATMENT

Evidence suggesting that the initiation of treatment before clinical manifestations of CF first appear improves prognosis has been controversial. Whereas some studies have yielded supportive data,16 others have not.4 There are no generally accepted treatment protocols for use in symptomatic or asymptomatic patients.
Circumcision
Authors: MAISELS M. JEFFREY
Published: December 2021

In Reply.—

Contrary to Wallerstein's opinion, the fact that we admitted to certain limitations in our study design does not "invalidate the study." Whether or not the mothers received additional information from other sources, pro or con, is irrelevant because the process of randomization makes it highly likely that similar information was received by both groups. Our written material expressed, quite clearly, the opinion of the American Academy of Pediatrics—that circumcision is not a medically justified procedure.
Pediatric Bone Marrow Transplantation: Current Progress and Future Prospects
Authors: SONDEL PAUL M. , TRIGG MICHAEL E. , HONG RICHARD , FINLAY JONATHAN L. , BOZDECH MAREK J.
Published: December 2021

Allogeneic bone marrow transplantation (BMT) has been applied with increasing frequency and success to the treatment of children with severe immune deficiency disease,1,2 aplastic anemia,3,4 and the acute leukemias.5,8 Patients with these otherwise rapidly fatal diseases receive an intravenous infusion of marrow from a healthy donor. The healthy marrow either "replaces" the deficient marrow of children with immune deficiency or aplastic anemia, or "rescues" the marrow of children who have received ablative antileukemic therapy. The resultant engraftment makes the patient a chimera, with reconstitution of mature hematopoietic and immunologic cells of donor origin. When successful, this results in long-term survival with normal marrow function, no recurrence of the original disease, and a return to normal childhood activity and function with only a few irreversible but major side effects (such as infertility following total body irradiation).9
Causes of Increased Renal Echogenicity in Pediatric Patients
Authors: Krensky Alan M. , Reddish Joseph M. , Teele Rita Littlewood
Published: December 2021

Review of 2,700 abdominal ultrasonic examinations revealed 56 patients whose kidneys showed increased echogenicity. Echogenic kidneys were associated with medical renal disease in 94% of cases (30% glomerular, 48% tubulointerstitial, 16% end-stage) and with no detectable renal disease in 6% (three patients). Patterns of increased echogenicity and renal size were evaluated. Specific patterns occurred in end-stage renal disease and polycystic kidney disease. Other medical renal diseases had overlapping ultrasonographic features. Some generalizations could be made although increased echogenicity was often nonspecific.
Car Seat Burns
Authors: CARTER BOYD A.
Published: December 2021

To the Editor.—

In our office we have recently seen two children with burns obtained while being placed in a car seat. The first child was a 2-year-old toddler with a mild first degree burn to the right thigh area requiring minimal further care. However, the second child was a 15-month-old infant who was seen in our office with a second degree burn requiring debridement as well as local antibiotic care. The burn healed well, but these occurrences suggest the possibility of severe burns.
Effects of Marginal Hypoxemia on Recovery from Oxygen-Induced Retinopathy in the Kitten Model
Authors: Phelps Dale L. , Rosenbaum Arthur L.
Published: December 2021

Prolonged oxygen administration in premature infants is the most predictive variable for severe retinopathy of prematurity, after degree of prematurity itself. It was noted that infants receiving prolonged oxygen supplementation are probably hypoxemic relative to their healthy counterparts. Therefore, hypoxemia during recovery from a hyperoxic-induced retinal vascular injury was tested in the kitten model of oxygen-induced retinopathy. Twelve litters were exposed to 80% inspired O2 for 65 hours on day 3, and recovered in room air, 13% or 17% oxygen. The retinas were scored at 4 weeks, and 13% oxygen recovery (PO2 = 39 ± 18 torr) was found to worsen significantly the retinopathy compared with that in room air-recovered littermates (P < .01). Hemorrhages occurred more frequently in the retinas from the hypoxemic-recovered kittens. Clinical trials of this hypothesis are indicated in humans.
Prescribing Practices and Knowledge of Tricyclic Antidepressants Among Physicians Caring for Children
Authors: RAUBER ALBERT , MARONCELLI REGINA
Published: December 2021

We did not find any significant difference between pediatricians and family practitioners with regard to their knowledge of the potentially serious toxicities of the tricyclic antidepressants. One of this group, imipramine, is in widespread use for the treatment of enunesis. A lange proportion of the pediatricians (40%) and family practitioners (50%) surveyed use this drug as the first or only approach to enuresis. It is disquieting to discover that, of those physicians choosing to use the drug, one third appear to be unaware of its toxic potential. Other effective treatment modes are available, and it is to be hoped that more physicians will explore them before turning to the more hazardous pharmacologic alternatives. Pediatricians, although not more knowledgeable than family practitioners, exhibited more careful prescribing practices.