bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary Tract Infection in High-Risk Newborn Infants
Authors: Maherzi Mustapha , Guignard Jean-Pierre , Torrado Antonio
Published: December 2021

The prevalence of neonatal urinary tract infection (UTI) was studied in 1,762 high-risk neonates. Symptomatic bacteriuria was found in 1.9% and asymptomatic bacteriuria in 0.5% of these neonates. Male preponderance was 5:1. Clinical manifestations were extremely variable-vomiting, weight loss, and diarrhea being the prominent symptoms. Bacteremia was associated with UTI in six infants. The organisms identified in the urine obtained by suprapubic aspiration were Escherichia coli, Klebsiella, and Proteus. A mixed infection was found in four patients. Roentgenographic examination of the urinary tract showed abnormalities in 44% of the symptomatic patients. It is concluded that symptomatic high-risk newborn infants should be screened for bacteniuria, and that radiological investigations be performed in those with proven infection.
X-RAY TREATMENT OF TONSILS AND ADENOIDS IN CHILDREN, VIEWED AS ABSOLUTELY HARMLESS IN 1921
Authors: C. T. E.
Published: December 2021

Medical literature when read with the advantage of hindsight is filled with many false statements, as is evident from these which were abstracted from a pediatric paper published in 1921.

The development of x-ray therapy of tonsils and adenoids and the absolute safety of this method as compared with the incomplete and partial removal of tonsils and adenoids, not to mention the possible dangers and complications attending operative procedure, indicate a marked advance in the therapy of rheumatism, endocarditis, pericarditis, and all those conditions resulting from the focal infection of the throat. . . .

That the x-ray method of treating tonsils and adenoids is not only safe but absolutely harmless has been definitely proven by the large number of cases of tubercular glands of the neck that have been treated by x-ray in the past 10 years throughout the world. These cases require vastly more treatment and a much more extensive area of exposure than the x-ray treatment of tonsils. . . .

The possibility of an x-ray burn is even more remote than injury to the adjacent glands provided the technique is properly carried out. This is largely due to the perfection and constancy of the present day interrupterless machine and Coolidge tube.
Congenital Rectal Stenosis: A Sign of a Presacral Pathologic Condition
Authors: Malangoni Mark A. , Grosfeld Jay L. , Ballantine Thomas V.N. , Kleiman Martin
Published: December 2021

Congenital rectal stenosis may be detected in the newborn during the initial physical examination. Failure of conservative therapy (dilatation) should alert the physician to the presence of an associated pathologic condition in the presacral space. Presacral teratoma, anterior sacral meningocele, or bony anomalies may be the underlying extrinsic causes of congenital rectal stenosis. Prompt recognition and appropriate operative management directed at the presacral lesion will relieve obstructive symptoms and minimize morbidity.
High Fever and Diagnostic Expenses
Authors: Todd James K.
Published: December 2021

Although McCarthy and co-workers put a great deal of clinical effort into their study of children less than 24 months of age who had a temperature of 40°C more (Pediatrics 59:663, May 1977), their insufficient statistical analysis brings us no closer to an appropriate outpatient approach to such children. Their comparison of the sensitivity and predictive value of each test in an independent fashion is similar to trying to predict the winner of a long-distance race without knowing who has the fewest laps to go.
Traveler Beware! (of Over-the-Counter Drugs in Spain)
Authors: Hervada Arturo R.
Published: December 2021

The letter of Dr. Julian H. Fisher concerning the abuses of the pharmaceutical industry in Peru (Pediatrics 59: 476, March 1977) poignantly describes what has become a serious, worldwide public health problem.

In Spain, two decades of industrial and economic growth have attracted a multitude of Swiss, French, German, British, American, and Italian pharmaceutical firms. These companies, together with the Spanish pharmaceutical firms, enjoy total freedom to literally inundate the market with all kinds of dubious and, at times, dangerous products.
CHILDREN OF HARLEM
Authors: O'Gorman Ned
Published: December 2021

The children who come to me are children who exist in a colonial "outpost" of the American empire. I have been eleven years in Harlem, eleven full years: I have watched a place on this earth decay while the nation in which that place exists grows in power and wealth. It is as if Harlem, like Biafra or the gutters of Calcutta, had become a dispensable pant of the fabric of national life. Nothing has happened in eleven years to make one jot of difference in the lives of the children conceived during that time or in the lives of the children who came to my nursery since 1966.
The Use of Furosemide in the Treatment of Edema in infants and Children
Authors: Engle Mary Allen , Lewy John E. , Lewy Peter R. , Metcoff Jack
Published: December 2021

One hundred thirty-seven courses of furosemide therapy were given to 106 hospitalized pediatric patients with salt and water retention associated with cardiac or renal disease. The diuretic was effective and safe in the pediatric age group when administered acutely as a parenteral medication and over a long-term course by the oral route in the doses and at the time intervals used in this study. On the basis of each kilogram of body weight, the infants with edema as a result of cardiac failure and the children with edema secondary to renal disease responded equally well to furosemide therapy.
Urinary Tract Infection in School-Age Girls: Correlations Among Significant Bacteriuria and Symptoms, Patient History, and Family History
Authors: Etkin Tom , O'Shea John S.
Published: December 2021

Significant bacteriuria affects between 0.5% and 3% of school-age girls.1.2 Currently controversy exists regarding the benefit of screening apparently healthy girls, the need for radiologic contrast studies in evaluating infected patients, the appropriate duration of antibiotic treatment, and the relationship of acute infection to chronic renal disease.3-6

Perhaps some of the disagreement about which patients should be screened would be resolved if certain characteristics were found more often in infected patients (even in those often described as "asymptomatic") than in noninfected ones. In fact, symptoms have been reported at the time of diagnosis in from 33% to 77% of infected patients.2.7
Sterilization and the retarded female: Is advocacy depriving individuals of their rights?
Authors: Vining Eileen P.G. , Freeman John M.
Published: December 2021

With the increasing awareness of individual rights and the rise of advocacy groups for the handicapped, the rights of retarded persons are now being defined and secured, and abuses of the past curtailed.1 However, in efforts to secure the rights of the group, rights of individuals are sometimes abrogated. Sterilization for the profoundly retarded female presents an example of the legal inability to make a competent decision preventing specific individuals from securing a procedure done in her best interests. This commentary explores the current status of sterilization of retarded females, and presents the need for changes in the stance of advocacy groups and the legal system to permit hysterectomy for certain severely or profoundly retarded female adolescents when the procedure would improve the quality of life and care for that individual.
Letter To The Editor
Authors: Sane Shashikant M.
Published: December 2021

I am pleased to respond to the thoughtful comments of Dr. Baker and Dr. Berdon.

The number of children showing abnormal preoperative chest roentgenograms is illustrated in the Figure by their age group. Although a greater number of abnormal chest roentgenograms were present in children less than 5 years of age, the age distribution of the patients admitted to Minneapolis Children's Health Center during the time period of the study showed a similar pattern. Hence, one could conclude that there is probably no significant variation in the frequency of abnormality on the preoperative chest roentgenograms in different pediatric age groups.
Group B Streptococcal Colonization
Authors: Herrera Alfredo J.
Published: December 2021

I read with interest the article by Speck et al. (Pediatrics 60:356, September 1977) about group B streptococcal colonization rate. They point out that infants receiving cord treatment had a higher incidence of group B streptococcal colonization.1

I think that this statement may be misleading. We know of the effectiveness of triple dye in controlling staphylococcal colonization and infection. This was proven after the routine use of hexachlorophene was discontinued in nurseries around the country when its neurotoxicity was discovered.
Impact of the Apnea Monitor on Family Life
Authors: Black Lois , Hersher Leonard , Steinschneider Alfred
Published: December 2021

The article "Impact of the Apnea Monitor on Family Life" by Black et al (Pediatrics 62:681, November 1978) carried an incorrect address for reprints. The correct address is Department of Psychology, Syracuse University, Syracuse, NY 13210.
Neonatal Apnea: Underlying Disorders
Authors: Naeye Richard L.
Published: December 2021

Data from a prospective study of 50,826 neonates were used to determine the frequency and significance of disorders related to apnea in newborns. Such apnea proved to be a significant prognosticator for neonatal death. Fifty-eight percent of preterm neonates with multiple apneic episodes and 18% with a single episode died, whereas only 6% of those without recorded apnea died. The rates were 44%, 5%, and 1% for full-term infants. Amniotic fluid infection was the underlying disorder in 35% of the preterm and 25% of the term neonates who had multiple episodes of apnea. A third of the preterm and 25% of the term infants who had such apneic episodes had antecedent hypoxia-related disorders, i.e., abruptio placentae, erythromblastosis fetalis, placenta previa, large placental infarcts, and umbilical cord compression. Among the apneic neonates, those who were infected were twice as apt to die as were those who had hypoxia-related disorders. Hypoplasia of the lungs and easily recognized central nervous system malformations were responsible for most of the apnea-related deaths associated with congenital malformations.
Neonatal Hypothyroidism Detected by the Northwest Regional Screening Program
Authors: LaFranchi Stephen H. , Murphey William H. , Foley Thomas P. , Larsen P. Reed , Buist Neil R.M.
Published: December 2021

The Northwest Regional Screening Program to detect congenital hypothyroidism in infants born in Oregon, Montana, Alaska, and Idaho (combined birthrate of 69,000/yr) was added to our ongoing screening program in 1975. The program utilizes dried blood filter paper specimens collected routinely in the first few days of life in all four states and again at about 6 weeks of age in Oregon only. The screening tests consist of an initial thyroxine (T4) measurement; a thyroid-stimulating hormone (TSH) determination is performed on those specimens with T4 concentrations in the lowest 3% group. Serum samples obtained by venipuncture are requested for confirmation of the diagnosis. In the first two years of the program, 25 infants with primary hypothyroidism were detected among 110,667 infants screened, a frequency of 1:4,430. Fourteen cases of thyroxine-binding globulin deficiency were also detected, a frequency of 1:7,900. Using the T4 followed by TSH testing approach, the frequency of requests for repeat specimens was 0.4% in Oregon and 0.05% in the other states. The cost per specimen was $1.96. The majority of infants lacked clinical signs or symptoms of hypothyroidism; only one infant was clinically suspected of having hypothyroidism prior to detection. The most common neonatal symptoms were constipation, lethargy, and prolonged jaundice, while the most common physical signs were hypotonia, umbilical hernia, and large fontanels. Thyroid scans showed the most common etiology to be thyroid aplasia, followed by an ectopic gland, hypoplasia, and goitèr. Serum T4 concentrations were lowest in those infants with aplasia, intermediate in infants with an ectopic gland or hypoplasia, and normal in the infant with the goiter. Neonatal hypothyroidism varies in degree and has several different causes; the capacity to secrete thyroid hormone, the duration before hypothyroidism becomes clinically manifest, and possibly the eventual prognosis for intellectual function depend on the nature of the underlying cause. While the mean age at treatment was 59 days, the goal of diagnosing congenital hypothyroidism and treating affected infants by 1 month of age seems realistic.
Vaccination of Children With Human Cell Culture Rabies Vaccine
Authors: Plotkin Stanley A. , Wiktor Tadeusz
Published: December 2021

Three children exposed to the bites of proved or probably rabid animals were immunized with human rabies immune globulin and human diploid cell culture vaccine. There were no significant clinical reactions, and all three developed high levels of rabies antibody. The patients have remained well from four to 18 months.
President's Address—The Politics of Pediatrics
Authors: Robinson Saul J.
Published: December 2021

It took a long time for pediatrics to be recognized as a separate specialty, and it was only after World War II that medical schools and teaching institutions gave this area a recognizable identity in their programs. The "baby boom" of the postwar era gave the pediatrician a busy practice, limited only by the large amount of "well-baby care" that caused him to have little time for difficult cases. The end of that same baby boom in the late sixties, however, along with the regionalization of care, the involvement of closed panel health programs at contract rates, and the use of public health clinics for routine procedures, forced the pediatrician to reassess once again his changing and, in many cases, diminishing practice. The question still remains: What must the pediatrician do now to convince others that he or she is, indeed, the specialist to handle children's problems, be they physical, developmental, mental, or behavioral? How can pediatricians present their role as preventionists and ambulatory care specialists so that they will be recognized among colleagues and by community agencies as the center of comprehensive care and the spokespersons for the child in our society?

By an overview of the nature of the changes in our population and practice since World War II, and an evaluation of where the pediatrician now stands in relation to other professionals who handle the health and well-being of the child, I believe we can once again answer the question so often posed by presidential addresses to the pediatric societies in the early 1960s: "Whither pediatrics?"
THE CHILDLESS FUTURE?
Authors: Westoff C. F.
Published: December 2021

...there seems to be little doubt that work and fertility are negatively correlated and that an increasing proportion of women will work in the future. Imagine, ultimately, a society in which men and women have the same incomes, in which there are as many women as men who are lawyers, engineers, corporation executives, physicians, and salespeople. What would the consequences be for marriage and fertility?

Certainly the institution of marriage would lose one of its few remaining sociological rationales, if one thinks of marriage in functional economic terms as a system whereby the woman offers her childbearing and domestic services in exchange for the security and status of a man's income and occupation. This concept of marriage is unromantic, but there is no doubt that it goes a long way toward explaining the universality and persistance of the institution. If the economic rationale were lost, what then would provide the motivation for marriage? It is hardly necessary these days for companionship or for sexual gratification. Given the growing acceptability of cohabitation (and the ease of divorce), does it not seem likely that traditional marriage will become still less prevalent?
SOME PEOPLE ARE CRITICAL
Authors: Lewontin Richard C.
Published: December 2021

The causes of the tremendous decline of mortality from infectious diseases in the last 100 years are not certain. All that is certain is that "scientific medicine" played no significant part. Water supply and sanitation are not involved, since water-borne diseases have not been the major killers. The suggestion that a reduction in crowding may have reduced the rate of transmission of respiratory diseases is not altogether convincing, since measles remains pandemic although it kills virtually no one in advanced countries. The most likely explanation, both for the historical trend and for the differences between regions of the world today, is in nutrition, although hard evidence is not easy to come by.
Letter To The Editor
Authors: Cook Donald E.
Published: December 2021

The Committee on School Health would like to thank the journal for the opportunity to answer the comments by Drs. Stern, Boat, et al. The problem of medication in the schools was researched at great length over a two-year period before publication of the aforementioned guidelines. Competent school administrators from across the country were consulted, as were numerous school physicians, so the recommendations were not made lightly or without the utmost consideration.

We agree that many of the concerns of Dr. Stern and his colleagues seem logical and have considerable immediate emotional appeal to the practicing physician.
What Is the Best Treatment for Wegener's Granulomatosis?
Authors: Moorthy A. Vishnu , Chesney Russell W.
Published: December 2021

We have read with interest the article by Orlowski et al. (Pediatrics 61:83, January 1978) in which they describe six patients between the ages of 13 and 20 years who have Wegener's granulomatosis (WG). The authors recommend initial treatment using nitrogen mustard and adrenocorticotropic hormone (ACTH) for induction of remission, followed by oral cyclophosphamide and prednisone as maintenance drugs.

We have recently reported our experience in treating two children with the generalized form of WG.
Ketotic Hypoglycemia and Hypopituitarism
Authors: Lorentz William B.
Published: December 2021

A 5-year-old girl had hypoglycemia and was of short stature. Studies of pituitary function demonstrated combined growth hormone and adrenocorticotropic hormone (ACTH) deficiency. She was shown to have ketotic hypoglycemia. In contrast to patients previously reported with hypopituitarism and ketotic hypoglycemia, she had no deficiency of gluconeogenic substrate. Serum levels of alanine and other gluconeogenic amino acids were normal during fasting and hypoglycemia.

These studies suggest that inadequate gluconeogenic precursors are not the cause of her ketotic hypoglycemia. Ketotic hypoglycemia in association with hypopituitarism may be secondary to multiple biochemical defects.
CLINICAL ACUMEN—FIFTY YEARS AGO!
Authors: Hess Julius H.
Published: December 2021

There can be no comparison between the results to be expected in feeding premature infants on human milk, and those to be obtained with artificial food. With human milk taken from a well-regulated department for wet-nurses, the milk can be obtained fresh, practically sterile; it is more digestible; its constituents are of the quality and in the proportions required for the growth and development of the human body; and it is live, and contains many of the immunity-comferring properties, as evidenced by the resistance of a breast-fed infant to infections and contagious diseases. Most of these properties and advantages are lacking in the dead foods used in artificial feeding.
HEALTH CARE PLANNING: STRATEGY AND TACTICS—ENDS AND MEANS
Authors: White K. L.
Published: December 2021

Much health and health care planning has been preoccupied with tactical minutiae at the expense of overall strategic thinking. Plans are made for training new types of health care manpower or for designing new laboratories, with no consideration being given to what each is to do, whether it meets a perceived need, or how it is to be related to other modalities of care. Health and health care planning, particularly with respect to resource allocation, is much more a matter of strategy than of tactics; what to do should take precedence over how to do it.

A clear ordering of the objectives of a health care system provides a guide to the planning of solutions. Every major objective can be thought of in terms of a set of immediate objectives that are a series of necessary steps towards acheiving that major objective. If immediate objectives are properly formulated and carefully planned, the allocation of resources and the implementation of measures will probably be effective, as immediate objectives are usually more realistic and more easily attainable within a specified time than are higher-level objectives.
Intravenous Alimentation and Insensible Water Loss in Low-Birth- Weight Infants
Authors: Marks Keith H. , Farrell Timothy P. , Friedman Zvi , Maisels M. Jeffrey
Published: December 2021

Insensible water loss (IWL) was measured in six premature infants, betWeen 4 and 21 days of age, by continuous weight monitoring on an electronic balance inside an incubator. Multiple measurements of IWL were made during the sequential infusion of 10% dextrose in 0.225% NaCl, 10% dextrose-amino acid solution, or 10% dextrose-amino acid and a commercial intravenous fat emulsion. Each solution was administered for three hours by constant infusion through a scalp vein needle. The order of the infusion was random and a 30-to 60-minute infusion with 5% dextrose water was given between each solution. During the infusion of 10% dextrose in 0.225% NaCl and 10% dextrose + amino acid solution, IWL was 1.0 ± 0.8 gm/kg/ hr and 1.1 ± 0.8 gm/kg/hr, respectively. In contrast, IWL increased significantly to 1.6 ± 0.7 gni/kg/hr when additional calories were given using the 10% dextrose-amino acid with the intravenous fat emulsion (P < .005). There was a positive correlation between caloric intake and IWL. These data suggest that parenteral nutrition solutions with intravenous fat emulsion are rapidly metabolized and the increase in IWL is probably secondary to an increase in thermogenesis.
THE LAW'S DEFECTIVE PREMISE
Authors: Morris A. A.
Published: December 2021

The laws that could culminate in criminal liability for the proper administration of euthanasia to a severely defective child share one common and basic premise with much of early medical practice in America and with dogmatically held popular beliefs against all euthanasia. This premise antedates and is made obsolete by the rise of modern health sciences and medical technology. The defective premise is that life, whatever its form, nature, or content, is necessarily and always a good, and that death, on any event that hastens death, is always and necessarily an evil and should be illegal. Law has a felt obligation to protect life to the fullest for each individual and seeks to assure each person's right to live out his life until its natural and inevitable end, which is legally defined as "cessation," meaning a total stoppage of the circulation of the blood and a cessation of all the animal and vital functions resting on blood circulation, such as pulse, respiration, etc. The problem is that, as commendatory as the law is in this regard, the law's basic premise applies only to the usual and ordinary person and was created with him in mind.... [T] his commonly shared premise is false. There simply is no plain, straightforward, and necessary connection between all human life itself, in each and every instance, whatever its character, and its always being a good.
Hyperbilirubinemia in Association With Late Onset Group B β-Hemolytic Streptococcal Infection
Authors: Leitner Marc , Clarke Thomas A. , Feldman Bernard H.
Published: December 2021

Various features of late onset group B β-hemolytic streptococcal disease reported previously include asymptomatic bacteremia, otitis media, septic arthritis, osteomyelitis, ethmoditis, cellulitis, pleural empyema, conjunctivitis, breast abscess, and impetigo.1.2 The following case report demonstrates that jaundice can be another manifestation of late onset group B β-hemolytic streptococcal disease.

The patient, weighing 3.3 kg, was the product of a full-term, uncomplicated pregnancy and was in good health until 5½ weeks of age, when she developed fever and jaundice.
Apnea Recordings of Healthy Infants at 40, 44, and 52 Weeks Postconception
Authors: Stein Israel M. , White Ann , Kennedy Joseph L. , Merisalo Roberta L. , Chernoff Harvey , Gould Jeffrey B.
Published: December 2021

A total of 129 recordings of the respiratory activity of 46 normal full-term infants were obtained continuously for 24 hours in the hospital nursery at 3 days of life and in the home environment at 4 weeks and 12 weeks after birth. The pediatric pneumogram (PPG) technique, an impedance method, was used. Pneumogram data over longer than 16 hours was obtained on 77% of infants monitored. No infants experienced apnea longer than 15 seconds in duration at 40 and 44 weeks postconception. or greater than 11 seconds at 52 weeks postconception. Twenty-four hour plots of hourly apnea frequency revealed a marked variability, with evidence of clustering of apneic episodes during periods of reported sleep. Longest apnea time and hourly frequency of apneic episodes were highly correlated.
Lung Function in Adolescents Receiving High-Dose Methotrexate
Authors: Wall Michael A. , Wohl Mary Ellen B. , Jaffe Norman , Strieder Denise J.
Published: December 2021

Methotrexate (MTX) has been implicated as a cause of interstitial pneumonitis and/or fibrosis, but the mechanism by which the drug causes these processes is not known. The purpose of this study was to determine whether patients receiving high-dose MTX developed a consistent decrease in pulmonary function, which would implicate a role for total dose of MTX received in the pathogenesis of the lung toxicity. Pulmonary function studies, including spirometry, plethysmography, and diffusing capacity at two levels of alveolar Po2, were performed in 38 adolescents treated for osteogenic sarcoma. The patients were divided into three groups including 12 patients (group 1) studied before and during therapy, 15 patients (group 2) studied during therapy, and 11 patients (group 3) studied after completion of treatment. While total dose received at the time of the study varied from 0 to 256 gm/sq m, pulmonary function showed no change, with one exception. A mild restrictive defect and decrease in diffusing capacity due to unilateral pleural and diaphragmatic disease, whose relationship to MTX therapy is uncertain, developed in one patient. MTX, when administered in high dose to young patients by the described protocol, causes no dose-related decrease in pulmonary function.
Ferrochelatase Deficiency in an Infant With Anemia and Growth Delay
Authors: Carpentieri Ugo , Buck Ernest D. , Minguell Jose J. , Balachandran Suppiah , Haggard Mary Ellen
Published: December 2021

A 5-month-old infant with hypochromic anemia and iron overload secondary to ferrochelatase (heme synthetase) deficiency is described. Decreased activity of iron-containing enzymes in the absence of any other proven cause is suggested as the main cause of the associated growth retardation.
WORLD HEALTH ORGANIZATION: FROM 1948 TO 1990
Authors: Mahler H.
Published: December 2021

In the early days of WHO, efforts were concentrated on trying to control specific diseases. But the world itself has changed and we realize this is only a part of the story. As stated in WHO's constitution, health is much more than the absence of disease. Health development has to go hand in hand with social and economic development, and all activities for such development have to be properly coordinated. Elaborate technology is no longer seen as the key to health care. Similarly our health manpower policies seek to make the best possible use of the health personnel that can be made available in a reasonable time at a reasonable cost.

It is a tremendous achievement that the world has agreed on certain specific health targets—the access of all the world's children by 1990 to immunization against the six major infectious diseases of childhood, and the supply of safe drinking water to all families by the same year. In an entirely different field, confidence is growing that certain cardiovascular diseases can be tackled at the community level through active programmes of prevention.
Hirschsprung's Disease and Waardenburg's Syndrome
Authors: Brancki David , Dennis Nicholas R. , Neale John M. , Brooks Lee J.
Published: December 2021

There are several reports of an association of congenital deafness with Hirschsprung's aganglionic megacolon.1,2 This patient is described because she has Hirschspning's disease in association with Waardenburg's syndrome. The genetic mechanisms and a possible causal relationship are discussed.

CASE REPORT

A black girl was born at 37 weeks' gestation, with a birth weight of 2,380 gm, following an uncomplicated pregnancy and a breech delivery. Apgar scores were 2 at one minute and 6 at five minutes, and the perinatal course was uncomplicated. On day 2, when no stools had been passed and abdominal distention was noted, the infant was transferred to Buffalo Children's Hospital.
α1-ANTITRYPSIN AND EMPHYSEMA
Authors: Lieberman J.
Published: December 2021

Preliminary data from a study of 917 California seventh graders reinforces the suspicion that Caucasians are at most risk of both an inherited deficiency of α1-antitrypsin, and the emphysema with which the genetically-formulated blood chemical has been linked.

A serum protein, α1-antitrypsin inactivates trypsin, one of the enzymes that checks bacteria infecting the lungs. When α1-antitrypsin is reduced or absent, the trypsin can attack and destroy the lung tissue itself. The result is a particularly devastating form of emphysema that strikes during the productive years. An inherited deficiency of α1-antitrypsin may be one reason why some nonsmokers develop emphysema.

All 25 of the students in this study found to have deficiencies of α1-antitrypsin were Caucasian, as were nearly 90% of those discovered to have "variants" of α1-antitrypsin molecules....Abnoraml results include a severe deficiency, inherited from both parents; intermediate deficiencies, inherited from one parent; and a number of antitrypsin variants also suspect in the development of emphysema. Although those with severe deficiencies nearly always develop emphysema, intermediate deficiencies and combinations of variants also predispose a person to the disease, particularly if they smoke cigarett.
Drs. Galant, Croncy and Shaw Reply
Authors: Galant Stanley P. , Groncy Charles E. , Shaw Kathryn C.
Published: December 2021

We agree with Dr. Morin's contention that the marked increase in negative intrapleural pressure seen in the severely obstructed asthmatic patient during inspiration, which results in a significant increase in pooling of blood in the pulmonary veins, is an important cause of the pulsus paradoxus (PP) phenomenon.1 However, other mechanisms can also be contributing to the decreased left ventricular stroke volume. Rebuck and Pengelly2 conclude that the pulmonary hyperinflation and high intrapulmonary pressures could decrease right atrial filling by compressing intrathoracic, extracardiac vessels and limiting atrial distensibility.
Hypoglycorrhachia in the Survivors of Neonatal Intracranial Hemorrhage
Authors: Mathew Oommen P. , Bland Harold E. , Pickens James M. , James Elizabeth J.P.
Published: December 2021

Fifteen survivors of intracranial hemorrhage were studied to determine the incidence of hypoglycorrhachia. All infants developed hypoglycorrhachia one to several days after the hemorrhage. It persisted for a variable period before returning to normal. Alteration of the glucose transport system by blood breakdown products is the likely mechanism. Hypoglycorrhachia may have useful diagnostic implications.
Abnormal Lung Surfactant Related to Essential Fatty Acid Deficiency in a Neonate
Authors: Friedman Zvi , Rosenberg Abraham
Published: December 2021

A low-birth-weight infant, suffering from chronic bronchopulmonary dysplasia following hyaline membrane disease and recurrent episodes of necrotizing enterocolitis, developed biochemical evidence of essential fatty acid (EFA) deficiency in the plasma. Fatty acid composition of phosphatidylcholine and phosphatidylglycerol in the lung lavage fluid was abnormal. Plasma changes includcd a decrease in the level of linoleic acid and an increased level of palmitic, palmitoleic, oleic, and 5,8, 11-eicosatrienoic acids, the ratio of 5,8,11-eicosatrienoic acid to arachidonic acid being > 0.4:1. A lower than normal level of palmitic acid and an increased level of palmitoleic and oleic acids were seen in pulmonary surfactant phospholipid components. Upon treatment and recovery from EFA deficiency, the fatty acid pattern both in plasma and surfactant phospholipids returned to normal along with clinical improvement. An association between EFA deficiency and altered fatty acid composition of pulmonary surfactant phospholipids is suggested.
Night-Waking in Infants During the First Year of Life
Authors: Anders Thomas F.
Published: December 2021

Two groups of infants, 2 and 9 months of age, were monitored for one night by time-lapse videotape recording in the natural setting of their homes. Developmental changes in sleep-wake state proportions, ease of falling asleep, nighttime waking patterns, maternal interventions, and sleeping through the night were observed. A suggestion of differential parental handling of male infants was noted. Further research to clarify some of these issues is indicated.
Report by The Latin-American Committee on Pediatric Residencies
Authors: Golden Archie S. , Carey Donald , Fleshman J. Kenneth , Neumann Charlotte Grantz , Sifontes Jose E.
Published: December 2021

Since 1970, the Committee on International Child Health of the American Academy of Pediatrics has supported COPREP, The Latin American Committee for Promotion of Residency Programs in Pediatrics. During the coming year, 1978-1979, the Academy will phase out its present level of economic support and the Latin American group will continue more independently. A report, educational in nature, is in order at this time.

BACKGROUND

During the 12th International Pediatric Congress in Mexico City in 1968, the American Academy of Pediatrics proposed discussions concerning the quality and content of pediatric residencies in Latin America. Two years later this was brought to fruition in Paipa, Colombia as the First Seminar on Education for Pediatric Residents under the sponsorship of the Committee on International Child Health (COICH) of the American Academy of Pediatrics with the support of the Johnson and Johnson Institute for Pediatric Service. This Seminar was organized by a Committee of District X of the Academy, under the leadership of Dr. Jorge Camacho Gamba, Chairman of that District, and with consultation by Dr. Nelson Ordway, Chairman of the COICH.

From this first seminar emerged COPREP, the Comité Latinoamericano para la Promocion de Programas de Residencia en Pediatria. This Committee has held a seminar on the training of pediatric residents every three years at the time of the Pan-American Congress of Pediatrics and elected committee membership at each seminar, one faculty member and one resident from each Latin-American district of the Academy plus a consultant from the previous committee for purposes of continuity.
Failure to Thrive
Authors: Laws Harry F.
Published: December 2021

Failure to Thrive

There once was a baby named Nell

Who at three weeks we could tell

Her growth was small hardly an ounce at all

Breast milk wasn't doing so well

Her mother was quite well endowed

but when watching of feeding was allowed

A scar so neat was below each teat

To mark where the Surgeon had ploughed

I wanted them smaller, said she

So they explained the complications to me

It all sounded so simple, (no sensation to the nipple)
Letters to the Editor
Authors: Breslow Jan L.
Published: December 2021

Dr. Cohen asks, "What are the risks of dietary therapy?" In my article I have tried to point out that the modified low fat diet that is recommended by the American Heart Association might have the following risks: (1) Diets high in polyunsaturated fat may lead to the formation of gallstones (Sturdevant RL, et al: N Engl J Med 288:24, 1973); (2) Diets too low in fat such as those based on no fat skim deprive infants and children of a substantial caloric source (Fomom SJ, et al: Acta Pediatr Scand 66:17, 1977).
Letters to the Editor
Authors: Goldberg Frederick , Berne Alfred S.
Published: December 2021

We were interested to read of Dr. DeNicola's experience with ultrasound in a patient with orbital cellulitis. We have no personal experience with this technique and know of no studies using it for this particular clinical problem.

It does seem, however, that orbital sonography should define proptosis and displacement of the globe and establish the presence of any sizeable intraorbital mass (abscess). However, we doubt that sonography has the resolution to provide the detailed information about sinus disease and its relationship to orbital disease that computed tomography (CT) can.
Inaccuracy of the Clinitemp Skin Thermometer
Authors: Reisinger Keith S. , Kao Joan , Grant Deborah M.
Published: December 2021

The Clinitemp Fever Detector (Clinitemp) is a newly marketed thermometer consisting of plasticencased thermophototropic esters of cholesterol that change color over a specific short-range of temperature. The manufacturer states that the instrument can identify fever by measuring skin temperature in children. On the basis of a patient's report of one inaccurate Clinitemp, we undertook to investigate the accuracy of this thermometer. One hundred fifty-two children presenting to the Children's Hospital Emergency Room had their temperature taken with two thermometers, an electronic thermometer that had been checked for accuracy with a National Bureau of Standards thermometer and the Clinitemp. Clinitemps, purchased over a two-month period from three pharmacies, were tested on different children. Thirteen of thirty children (43%) with fever (rectal temperature ≥38.3 C (101 F) or oral temperature ≥(37.8 C) (100 F) identified by the electronic thermometer, were correctly classified as having fever using the Clinitemp. When fever was defined to include children with a rectal temperature ≥38.0 C (100.5 F) or an oral temperature of ≥37.4 C (99.5 F), the Clinitemp correctly identified 13 (32.5%) of 40 children with fever. There appears to be an appreciable risk that someone with a serious illness may delay seeking medical attention on the basis of a normal temperature as measured by the Clinitemp.
TWIN-TO-TWIN TRANSFUSION—AN HISTORIC NOTE
Authors: Lanzkowsky Philip
Published: December 2021

Polycythmia as a result of twin-to-twin transfusion in monozygotic twins has only been recognized as a clinical entity in the last few decades. The first recorded case of polycythemia in the newborn due to twin-to-twin transfusion, however, was reported in the Bible: "And when her (Rebekah) days to be delivered were fulfilled, behold, there were twins in her womb. And the first came forth ruddy, all over like a hairy mantle; and they called his name Esau . . .". Genesis XXV, 24-26. A ruddy newborn twin is a clear description of polycythemia in the newborn presumably due to twin-to-twin transfusion. According to Hirsch,1 despite the contrastrating differences between Esau and Jacob, they were identical twins with complete exterior similarity. Twin-to-twin transfusion occurs in 15% of identical twins. One may further speculate that because of the marked intellectual and emotional differences between Esau and his brother Jacob, that Esau's intellectual restrictions might very well have been evidence of brain damage due to cerebral sludging as a result of polycythemia or kernicterus due to uncorrected hyperbilirubinemia pursuant to polycythemia. ". . . nothing is new under the sun . . . . It has already been in the ages before us."2
Experimental Pneumothorax Detected by Thermography
Authors: Stein Robert T. , Kuhns Lawrence R. , Wall Patrick M. , Kriewall Timothy J. , Zierolf Eileen
Published: December 2021

After induction of pneumothorax in rabbits, thermograms showed decreased heat emission from the involved side. These observations suggest that noninvasive monitors of thoracic wall temperature might be useful for early detection of air-leak phenomenon in high-risk neonates.
Pathogenesis of Brain Edema and Hemorrhage: Role of the Brain Capillary
Authors: Goldstein Gary W.
Published: December 2021

It has recently been shown that the endothelial cells in brain capillaries are the anatomic site of the blood-brain barrier, and that these endothelial cells act to maintain a constant composition and volume of brain interstitial fluid.1-3 Defects in brain capillary function appear to play a role in the pathogenesis of brain edema and hemorrhage in a wide variety of diseases. Conditions as diverse as intraventricular hemorrhage of the premature, asphyxia neonatorum, lead poisoning, head injury, Reye's syndrome, osmolar coma, and the brain edema surrounding a tumor or abscess may all share the common feature of brain capillary failure. In this review, I will consider some recent advances in our understanding of the brain microvasculature that may explain their unusual susceptibility to injury.

Brain capillaries have a number of important differences from capillaries in other organs. A schematic of a typical brain capillary is shown in the Figure. Unlike systemic capillaries, the endothelial cells in brain capillaries are joined together by tight junctions.3 These cellular junctions are present around the entire circumference of the capillary tube. The result is a continuous layer of endothelial cells that effectively separate the plasma from the interstitial fluid of the brain. The tight junctions are composed of a series of complex interdigitations that create a barrier so complete that water-soluble molecules and ions are unable to move into the brain between the endothelial cells. In other organs, the capillaries do not have tight junctions, and sugars, amino acids, ions, and drugs readily diffuse between endothelial cells into the interstitial fluid.
Neurologic Abnormalities in Near Miss for Sudden Infant Death Syndrome Infants
Authors: Korobkin Rowena , Guilleminault Christian
Published: December 2021

As part of the Sudden Infant Death Research Project at Stanford University School of Medicine, we have performed systematic neurologic examination of 41 near miss infants, 7 normal siblings of babies who died a sudden infant death, and 21 normal control infants. Many infants were examined longitudinally until 2 years of age. We found that near miss infants under 3 months of age had consistent abnormalities of muscle tone, particularly shoulder hypotonia. These abnormalities disappeared with maturation, but only 60% of older infants who had suffered near miss episodes were neurologically and developmentally normal. In addition, only one of the seven apparently normal siblings had an entirely normal neurologic examination when first seen. Thus, infants who present with near miss episodes may have an underlying central nervous system abnormality or may acquire some abnormality as a result of the episode.
Pertussis Immunization
Authors: Simon Frank A.
Published: December 2021

The attempt by Drs Barkin and Pichichero to evaluate the reactions associated with routine diphtheria-pertussis-tetanus (DPT) immunizations is quite commendable (Pediatrics 63:256, 1979). It has become increasingly appropriate to reevaluate such "routine" procedures in order to balance the benefits and risks associated with them and to revise our practices accordingly. The altered recommendations for smallpox vaccination is an ideal example.1 This type of study must also serve as a stimulus to improve the ratio of advantages to disadvantages in a procedure as can be accomplished by the development of a better immunization.
In Reply: Pertussis Immunization
Authors: Barkin Roger M.
Published: December 2021

I appreciate Dr Simon's thoughtful letter and his restatement of the need to constantly reevaluate current practices to provide an appropriate balance between risks and benefits. Our study was undertaken to provide further objective information on the reactogenicity of diphtheriapertussis-tetanus vaccine in the ongoing dialogue regarding pertussis vaccine.1 It is clear that reaction rates are but one small component of the controversy regarding this immunizing agent and that other investigators are focusing on improved vaccines for the prevention and control of pertussis.
Vagal Myocardial Necrosis?
Authors: Bachman David S.
Published: December 2021

A recent article in Pediatrics1 indicates an association of multifocal myocardial necrosis with pancreatic diseases in children. Three possible pathologies of the myocardial lesions are discussed: (1) the possibility of some type of deficiency; (2) a consequence of release of an active enzyme; or (3) secondary to acute destruction of the pancreas with release and activation of mediators.

We recently reported identical myocardial lesions in a primate following vagal stimulation.2 This finding can imply a quite different association between pancreatic disease and myocardial necrosis.
In Reply: ? Herpes Simplex Virus in Breast Milk
Authors: Dunkle Lisa M. , Schmidt Rose Rita , O'Connor Dennis M.
Published: December 2021

We appreciate Dr. Kibrick's delineation of the stability and infectivity of herpes simplex virus in various media. The remainder of his comments concur with our conclusions and reiterate the potential possibility of risk of herpes simplex infection to some breast-fed infants. The problem would appear to deserve investigation.
Methylphenidate in Hyperkinetic Children: Differences in Dose Effects on Impulsive Behavior
Authors: Brown Ronald T. , Sleator Esther K.
Published: December 2021

This research tested the hypothesis that in hyperactive children a low dose of methylphenidate (0.3 mg/kg) would produce scores superior to those with a high dose (1.0 mg/kg) or placebo on the matching familiar figures test (MFF), a primary index of impulsivity. The hypothesis was based on an earlier finding that the highest percentage of correct responses on a short-term memory task were found in hyperactive subjects who were receiving 0.3 mg/kg of methylphenidate whereas at 1.0 mg/kg the percentage correct returned to the placebo level. The hypothesis was verified in that the low dose reduced the number of errors on the MFF significantly more than did placebo or the high dose. This work demonstrates that, for both learning and impulsivity in hyperactive children, the lower dose of the two doses of methylphenidate studied produced the preferable effect.
The Langer-Giedion Syndrome: Report of a 22-Year-Old Woman
Authors: Wilson William G. , Herrington Robert T. , Aylsworth Arthur S.
Published: December 2021

A 22-year-old woman with the Langer-Giedion syndrome and delayed puberty is presented. Pertinent features include a bulbous nose, sparse hair, protruding ears, multiple cartilaginous exostoses, cone-shaped phalangeal epiphyses, short stature, microcephaly, and mental retardation. She is the oldest patient thus far described with this condition, and is compared to the ten previously published cases. The clinical course of patients with the Langer-Giedion syndrome and the possibility of malignant change in the exostoses have not been established.