bluuebunny/crossref_metadata_2025 huggingface dataset:
Another Case of Disseminated Candidiasis
Authors: Liberti John H. Di , Hughes Roberta A.
Published: December 2021

We would like to report a case of disseminated candidiasis quite similar to the one reported by Hill et al. in Pediatrics.1

CASE REPORT

A 1,350-gm infant girl developed severe idiopathic respiratory distress syndrome shortly after delivery. An umbilical artery catheter was inserted. By 7 hours of age mechanical ventilation was required. Cultures were obtained and antibiotic therapy instituted

Mechanical ventilation continued for about six weeks. During this time peripheral hyperalimentation was given along with continuous nasogastric tube feeding.
Inguinal Hernia: A Common Problem of Premature Infants Weighing 1,000 Grams or Less at Birth
Authors: Harper Rita C. , Garper Alfredo , Sia Concepción
Published: December 2021

Thirty percent of 37 consecutive surviving premature infants weighing 1,000 gm or less at birth were noted to develop inguinal hernias. Incarceration occurred in two infants. One infant suffered a cardiac arrest during repair of the hernia. In view of the increased survival now being reported in these tiny prematures, it is important that physicians recognize the high incidence and potential hazards of this congenital anomaly in surviving premature infants weighing 1,000 gm or less at birth.
Effects of Marihuana on Man
Authors: Yaffe Sumner J. , Bierman C. Warren , Cann Howard M. , Cohen Sanford N. , Freeman John , Segal Sydney , Soyka Lester F. , Weiss Charles F. , Chudzik Gregory , Ballin John C. , Del Prato Pierre S. , Done Alan K. , Farchione Louis , Oakley Godfrey , Sawchuk Steven , Scott C. P. , Simopoulos Artemis P.
Published: December 2021

The Committee on Drugs has reviewed the pharmacology of marihuana with special emphasis on effects in man because of the enormous impact of this drug on society. Much of modern day society's reaction to and attitudes about this psychoactive agent does not reflect its pharmacology, and it is only recently that pertinent biologic facts about marihuana have become known. The Committee reports these facts here, in part, to inform the Academy membership of these facts and, in part, to provide a perspective with which to consider the various societal controls (i.e., laws) on the use of marihuana.

COMPOSITION

Marihuana is a mixture of leaves and flowering tops of the plant Cannabis sativa L. It contains approximately 1% Δ-9-tetrahydrocannabinol (THC), the principal psychoactive substance in marihuana. Street preparations tend to vary in Δ-9-THC content; the range is 0% to 5%. An average marihuana cigarette contains 500 mg of marihuana and, therefore, about 5 mg of Δ-9-THC. Hashish, usually used in Eastern (Asiatic) countries and in North Africa, is the resinous substance of the flowers and leaves of Cannabis sativa L in which Δ-9-THC is found. Hashish contains 5% to 15% Δ-9-THC and is usually smoked as a mixture of the resin and tobacco. Generally, marihuana cigarettes do not contain tobacco, although some street preparations do.

USERS

In considering adverse effects of marihuana, it is important to appreciate some pertinent epidemiologic facts. It is estimated that 24,000,000 Americans have tried marihuana at least once and that there are 8,300,000 current users in this country.1 Approximately 70% of adults and youth (12 through 17 years) who were found by the National Commission on Marihuana and Drug Abuse1 to use marthuana used it so infrequently as to be considered experimental users.
Nutritional Supplements With Intravenously Administered Lipid, Protein Hydrolysate, and Glucose in Small Premature Infants
Authors: Cashore William J. , Sedaghatian Mohamed R. , Usher Robert H.
Published: December 2021

Nutritional support with intravenously administered fat, protein hydrolysate, and glucose was given to 23 premature infants weighing less than 1,500 gm at birth. Growth in the 19 survivors approximated intrauterine growth rates in all dimensions. Complications included sodium imbalance and transient intolerance of the smallest and sickest infants to all components: carbohydrate, protein, fat, and even water. Autopsies in four patients who died did not reveal any untoward findings clearly related to the use of intravenously given lipids. Intravenously given fat has a potentially useful role in the nutritional support of small premature infants.
IN DEFENSE OF THE MIND
Authors: Pearce Arnold
Published: December 2021

So far as we are aware man is unique in the animal kingdom for the wealth and complexity of the mechanisms which have evolved to protect his rational mind from the disturbing effects of emotion. Blithely, and without batting an eyelid, he projects his own faults and failings onto others; denies or dissociates himself from discreditable events in his own past; overcompensates for real or imagined deficiencies in his make-up; represses unacceptable facets in his character and rationalises his own prejudices: all this and yet remains firmly convinced of his own sweet reasonableness and the obduracy, or worse, of others. Thus liberated from the paralysing effects of shame, guilt, and kindred emotions he is free to use his intellect to manipulate events to his own advantage—and his survival. The belief that these mental-defense mechanisms operate only in others and not in ourselves is yet another example of such defence.
The Therapeutic Application of End-Expiratory Pressure in the Meconium Aspiration Syndrome
Authors: Fox William W. , Berman Lawrence S. , Downes John J. , Peckham George J.
Published: December 2021

The effectiveness of end-expiratory pressure (EEP) in relieving hypoxemia in the meconium aspiration syndrome (MAS) was studied in 14 patients with the disorder. These infants demonstrated a direct, mean Po2 response of 12 torr/cm H2O EEP. A maximum Po2 response was observed in an EEP range of 4 to 7 cm H2O. EEP was equally effective whether patients were breathing spontaneously or were being mechanically ventilated. EEP is useful in the treatment of hypoxemia in the infants with meconium aspiration syndrome.
EFFICIENCY OR EFFECTIVENESS
Authors: H. R. J.
Published: December 2021

The problem of rising costs of medical care has been attacked by two general methods: increased efficiency with business-like methods ("economies of scale," "managing the enterprise," etc.), and reducing use of the most expensive services-excessive hospitalization and laboratory tests—by utilization review. The second approach is more likely to be useful but still misses the real issue, i.e., how effective is what we do in medicine. As Drucker says, "It is effectiveness and not efficiency which the service institutions lack. Effectiveness can not be obtained by business-like behavior as the term is understood." If we could only set objectives, then determine how effectively we achieve them and concentrate our efforts in those areas where effectiveness has been demonstrated, we would have less emphasis on efficiency in health care.
A Chart Audit Peer Review System in an Ambulatory Service
Authors: Russo Raymond M. , Gururaj Vymutt J. , Laude Teresita A. , Rajkumar Solomon V. , Ventre Susan A.
Published: December 2021

A system of providing rapid review of ambulatory patient records using a set of criteria was developed and tested. Of 337 records selected for review, 25% were not reviewable. Of the remaining 75%, virtually one half proved to be lacking in one or more of the established criteria. Deficiencies tended to occur most often in criteria related to the physical examination of the child.

Physician compliance with the criteria could not be conclusively shown to improve during the five-month study period, although physician acceptability was judged as good.

A large percentage (47.3%) of deficient records could be corrected by the responsible health professional.

The chief advantages of the system are that it is rapid and easy to perform. It focuses on the major service provided by the facility, i.e., acute medical care, and on the performance of the individual providing that service.
Screening Procedures for Neuroblastoma: False-Negative Results
Authors: Johnsonbaugh Roger E. , Cahill Richard
Published: December 2021

Since elevation of 3-methoxy-4-hydroxymandelic acid (VMA) excretion frequently occurs in patients with neuroblastoma, simpler methods have been developed to differentiate between high and low levels of VMA in the urine, namely the LaBrosse spot test and VMA test strips. Sensitivity of these two procedures depends upon the concentration of VMA in the urine rather than total amount of VMA excreted. VMA excretion data from patients with neuroblastoma show that even though the total amount of VMA excreted in a 24-hour period may definitely be elevated, the concentration of VMA in the 24-hour urine samples may vary greatly from one day to the next and from one patient to another. Therefore, these rapid screening methods for urinary VMA would appear to be too insensitive to use as the sole means of detection or follow-up of patients with neuroblastoma since these techniques require a high concentration of VMA.
Acute Suppurative Otitis Media
Authors: Rowe D. Stewart
Published: December 2021

Most pediatricians recognize and treat acute otitis media several times each day. Yet there is wide disagreement about certain aspects of its diagnosis and treatment, despite a large and growing literature on the subject. This review attempts to summarize what is known about acute otitis media in children.

DEFINITION

Acute suppurative otitis media is distinguished from secretory (serous) otitis media by the presence of purulent fluid in the middle ear. Pathogenic bacteria may be cultured from the majority of needle aspirates of this purulent fluid. In secretory otitis media, relatively few polymorphonuclear cells are present in the middle ear fluid, which is either thin and straw-colored (serous) or thick and translucent grey (mucoid). The fluid has the chemical characteristics either of a transudate of plasma or of a mucoid secretion, presumably produced by goblet cells and mucous glands which are greatly increased in the middle ear mucosa of patients with secretory otitis media. Cultures of this middle ear fluid are usually negative for pathogenic bacteria and viruses. Suppurative otitis media can be diagnosed positively only by aspiration of purulent fluid from the middle ear, but this procedure is rarely necessary for initial diagnosis and management. Clinical findings helpful in distinguishing suppurative from secretory otitis media are discussed below.

INCIDENCE

In a study of 847 British children during the first five years of life, 19% had at least one episode of otitis media; one third of these had more than one episode. This was considered to be a minimal estimate in these children, since otorrhea was the chief criterion for diagnosis.
AAP Code of Ethics for the Use of Fetuses and Fetal Material for Research
Authors: Hodes Horace L. , Brown Rowine H. , Holliday Malcolm A. , James L. Stanley , Katcher Avrum L. , Katz Samuel L. , Sparling David , Yaffe Sumner J. , Kretchmer Norman
Published: December 2021

Research on the fetus and newborn is of the greatest importance in contributing to the health and welfare of the entire population. Such research, motivated by humane concern, should be continued and fostered, subject to adequate and clearly defined safeguards.*

The American Academy of Pediatrics recognizes that through research involving previable fetuses, new knowledge may be gained which would ultimately benefit viable infants. The American Academy of Pediatrics also recognizes that some of these areas of research, while not jeopardizing the health and welfare of the fetus, are not of direct benefit to that particular fetus. In such cases express consent should be obtained from the parent. "The whole previable fetus has offered an important opportunity that cannot be obtained in any other way for making observations of great value on the transfer of substances across the human placenta, the reaction of the immature fetus to drugs, and on the endocrinological development of the fetus and the development of the placenta."1

Research activities involving the fetus in utero or pregnant women may be undertaken1 for the purpose of benefiting that particular fetus or to respond to the health needs of the mother,2 as part of the procedure to terminate the pregnancy, and for the purpose of evaluating or improving methods of prenatal diagnosis, methods of prevention of premature birth, or methods of intervention to offset the effects of genetic abnormality or congenital injury or to ascertain the safety and efficacy to the fetus of drugs which might be needed by pregnant women.2
Overview Statement on Medical Records
Authors: Thompson Hugh C. , Barron Stanton J. , Connelly John P. , Margileth Andrew , Olmsted Richard , Rectanus Daniel R. , Ushkow Martin C. , Osborne Charles E.
Published: December 2021

Historically, medical records have been maintamed by individual physicians to record specific information concerning patients. This information was often understandable only to the writer. The data were of outstanding events. This was thought to be sufficient documentation for patient care.

Records are now read by others than the individual physicians. Groups of physicians working together often share the same patients and their records. Patients may have multiple sources of care. Our population has become more mobile which makes it necessary to transfer vast amounts of medical information. The medical record many times is the one instrument which gives a complete and continuous documentation of the patient's medical history.

Third-party payers are requesting access to medical records to document services provided. Chart audit is being tested as a mechanism for evaluating physician performance. Records must reflect what the physician does in order to be useful in such an appraisal. Much clinical research on the delivery of health care depends on accurately kept records which are easily interpreted. A chart is also a legal document for the protection of the physician as well as the patient. Thus, records will be used in other than traditional ways. Proper confidentiality must be maintained when such uses are necessary.

Physicians generally agree as to the essential content of a medical record. However, there is little unanimity as to the structure of the chart. No one system of keeping records is now appropriate for all situations.

The maintenance of adequate charts requires additional cost in both time and money.
Remarks on Receiving the C. Anderson Aldrich Award
Authors: Freud Anna
Published: December 2021

I take the honour which is being bestowed on me today as another welcome sign that the estrangement between pediatrics and child psychology is nearing its end and the partners on either side are contemplating a serious engagement, if not the propect of future marriage with each other. There are many other indications which point in the same direction. I only need to mention the fact that there are now places of learning where the head of the department combines in his own person training and functions in physical as well as mental child care; or that pediatricians are considered essential consultants in child guidance clinics, or that some pediatricians participate in the discussions of interdisciplinary hospital groups, or that, occasionally, child psychiatrists and even child analysts are called to the bedside of hospitalized children for consultation.

There is no reason, on the other hand, to feel entirely optimistic and to relax efforts towards further re-alignment. Cooperative attitudes between the two disciplines can also be regarded still as few and far between and, above all, confined to selected medical specialities and a small number of selected, furthest advanced, and enlightened centers. There exist still many children's wards where bodily care is so paramount that any thought about the child's mental concerns is excluded as intrusive and disruptive. There are, above all, the many surgeons who, rightly or wrongly, feel that their difficult task cannot be accomplished except by determined and exclusive concentration on the defective body part which needs repair.
Kanamycin and Gentamicin Treatment of Neonatal Sepsis and Meningitis
Authors: Chang Margan J. , Escobedo Marilyn , Anderson Donald C. , Hillman Laura , Feigin Ralph D.
Published: December 2021

Mortality from neonatal meningitis due to gram-negative microorganisms remains 50% despite use of aminoglycoside antibiotics. Blood was obtained on 238 occasions from 77 neonates with putative or documented sepsis; paired blood and cerebrospinal fluid (CSF) samples were obtained on 14 occasions from ten neonates with meningitis. Kanamycin and gentamicin were measured by a radioisotopic assay procedure. Kanamycin was administered at 15 mg/kg/day in three divided doses intravenously; serum concentrations peaked at one hour (mean, 7.77µg/ml). Gentamicin was administered at 7.5 mg/kg/day in three divided doses intravenously; serum concentrations peaked at two hours (mean, 5.34µg/ml). Both aminoglycosides generally were nondetectable within the CSF; survival of neonates with gram-negative meningitis correlated specifically with the sensitivity of their isolates to ampicillin which was administered concurrently. This study suggests that alternative approaches to the treatment of neonatal sepsis should be explored; administration of an antibiotic which crosses the blood-cerebrospinal fluid barrier more readily should be considered.
Hospital Management of Patients and Personnel Exposed to Communicable Diseases
Authors: Gardner Pierce , Oxman Michael N. , Breton Sylvia
Published: December 2021

Patients and personnel who are exposed to certain communicable diseases in a hospital setting often require therapeutic or epidemic control measures which may differ from measures employed following community exposure. This paper offers guidelines for reducing the hospital spread of communicable diseases by preventive measures (admission screening procedures, immunizations for personnel), and post-exposure management of patients and personnel. It is intended as a companion to the "Hospital Isolation and Precaution Guidelines" for patients with clinically manifest infections which appeared previously.
The Adaptation of Parents to the Birth of an Infant With a Congenital Malformation: A Hypothetical Model
Authors: Drotar Dennis , Baskiewicz Ann , Irvin Nancy , Kennell John , Klaus Marshall
Published: December 2021

To determine the course of parental reactions to the birth of a child with a congenital malformation and the process of parental attachment, the parents of 20 children with a wide range of malformations including mongolism, congenital heart disease, and cleft palate were interviewed. Structured interviews took place 7 days to 60 months after birth. Despite the wide variation of malformation, analysis of the interviews demonstrated five stages of parental reactions—shock, denial, sadness and anger, adaptation, and reorganization—in dealing with a congenitally malformed child during the course of his development and care. Observations of these patients suggest that early crisis counseling in the first months of life may be particularly crucial in parental attachment and adjustment.
Locomotor Skills and School Accidents
Authors: Angle Carol R.
Published: December 2021

This is a report of the association of immature or deficient locomotor skills with school accidents, predominantly falls, in children aged 6 to 9. An association of superior physical skills with increased accidents was not apparent until grades 4 to 6 (ages 9 to 12).

Medical care of an accidental injury is given each year to 30% of children aged 5 to 15. Falls and collisions account for 60% of annual accidental injuries. The frequency of injury from falls is highest in the young boy; fatalities, however, increase at the extremes of the age spectrum and relate to the poor locomotor skills and decreased tissue resistance of the very young and the very old.
Rucksack Palsy
Authors: Rothner A. David , Wilbourn Asa , Mercer Robert D.
Published: December 2021

In recent years there has been an increase in the use of backpacks and rucksacks by nonmilitary ary personnel. An estimated 3 million individuals engage in hiking and mountain climbing, and countless others use these packs on campus. We report a case of brachial plexus injury sustained by an individual wearing such a pack.

CASE REPORT

A 15-year-old right-handed white boy was examined for pain in the left shoulder of two weeks' duration. The youngster had been well, but two weeks' before evaluation was on a hiking expedition. During this trip he wore a rucksack which when filled weighed 20.4 kg (Fig. 1).
Oscilloscopic Monitoring To Determine Endotracheal Tube Position
Authors: Nelson Michael A. , Merenstein Gerald B.
Published: December 2021

Observation of oscilloscopic respiratory sine wave with ventilatory assist permits rapid diagnosis and correction of endobronchial intubation. Continuous oscilloscopic monitoring will permit early detection of extubation or malposition of endotracheal tubes.
Letter to the Editor
Authors: H. R. J.
Published: December 2021

We are pleased that Dr. Bloom finds the contents of Pediatrics helpful as a resident in family practice. This is what we are trying to achieve—a journal that will help those who care for children, whether they be pediatricians, family physicians, or nurse practitioners. My own view about the current conflict between pediatrics and family medicine is that we need both types of physicians. There are advantages ages and disadvantages to each profession, and the strength of our position in Canada and the United States is that we can have both types of physicians providing care to children. We hope that both groups will continue to work for the best interest of children and that Pediatrics can continue to assist them in this work.
It's the Right Direction
Authors: Davis Starkey D.
Published: December 2021

I was pleased to see the paper by McAtee and Silver on the recent expansion of the role of the nurse practitioner1. It provides another push in what I think is the right direction. Pediatricians are overtrained for the delivery of wellchild care. Primary care for children should be provided by well-trained family physicians, nurse practitioners, MEDEX, and other assistants. Most pediatricians should be hospital-based consultants. Some of these would have welldefined subspecialties such as neonatology, neurology, immunology, and hematology.
The Significance of the Babinski Sign in the Newborn—A Reappraisal
Authors: Ross Elliott D. , Velez-Borras Jesus , Rosman N. Paul
Published: December 2021

A study of the clinical significance and the stimulus methods used to elicit the Babinski sign in normal newborns has been carried out. Although the most frequent response to cutaneous nociceptive stimulation of the lateral sole in neonates was extension of the great toe, a small but significant number of flexor responses were obtained. Consequently, the Babinski sign has limited clinical usefulness as a reflex indicating the presence or absence of neurological disease in the newborn.

In reviewing previous studies in the literature, it was apparent that the widely differing percentages of extensor plantars reported in newborns was related directly to differences in the technique of examination.
Hepatic Hemangioendothelioma: Hemodynamic Observations and Treatment
Authors: Rocchini Albert P. , Rosenthal Amnon , Issenberg Henry J. , Nadas Alexander S.
Published: December 2021

The clinical course of five infants with hepatic hemangioendothelioma is reviewed. Hemodynamic abnormalities observed at cardiac catheterization included an increased cardiac output (range, 9.2 to 10.5 liters/min/sq m) with over 50% of this output being shunted through the arteriovenous malformation, an elevated right and left end diastolic pressure (8 to 10 mm Hg and 9 to 15 mm Hg respectively), a small systolic pressure gradient across the pulmonary outflow tract (4 to 6 mm Hg), and mild elevation of pulmonary artery pressure (range, 35/16 to 37/12 mm Hg).

All four patients treated with prednisone improved while on therapy; three are well one to three years after cessation of therapy. One patient died from unrecognized congestive heart failure following discontinuation of prednisone and another before prednisone was started. We conclude that prednisone in high doses (2 to 4 mg/kg/day) with the addition of digitalis and diuretics for control of congestive heart failure is an effective treatment regimen for infants with hepatic hemangioendothelioma.
Acute Epiglottitis in Children—Treatment With Nasotracheal Intubation: Report of 14 Consecutive Cases
Authors: Weber Michel L. , Desjardins Roger , Perreault Gilles , Rivard Guy , Turmel Yvon
Published: December 2021

Fourteen consecutive cases of acute epiglottitis were treated by nasotracheal intubation during a ten-month period. The duration of intubation averaged 47.2 hours. No mortality or morbidity occurred. Mean hospitalization was 4.6 days. This study demonstrates the ease of maintaining an assured airway by nasotracheal intubation in cases of acute epiglottitis.
Dr. North Replies
Authors: North A. Frederick
Published: December 2021

I can only agree with Dr. Thorpe that the advice given in "Screening in Child Health Care"1 and "A Guide to Screening, EPSDT, Medicaid"2 has numerous limitations. I would argue, however, that these limitations are clearly described in both publications, along with the reasons for the limitations.

The interview schedules (and physical examination forms) published in the guide and summarized in the symposium were derived through an extensive set of correspondence and interviews with the panel of experts listed in the guide.
Dr. Pildes Replies
Authors: Pildes Rosita S.
Published: December 2021

We appreciate the opportunity to reply to Dr. Price concerning the possible effects of corticosteroids on brain development in children treated for neonatal hypoglycemia. In our prospective study of 39 children with neonatal hypoglycemia matched with 41 controls, 26 of the 39 had been treated with steroids. Of the 13 who did not receive steroids, ten had long-term follow-up. The mean (± SD) intelligence quotient of these children, 94 ± 15, was similar to those of the control group and significantly higher (P < .01) than the IQ of children with hypoglycemia who were treated with steroids (84 ± 13).
Hyperkinetic Behaviors and Learning Disabilities Followed Over Seven Years
Authors: Huessy Hans Rosenstock , Cohen Alan Howard
Published: December 2021

A seven-year follow-up study of 500 children was conducted by teacher questionnaire in the second, fourth, and fifth grades for the presence of behavior problems and learning disabilities. These children represent all the second-graders in a number of rural school districts. The three scores on each child were summed. The 20% of children with the highest scores (i.e., most symptoms or disabilities) showed a rate of behavioral or academic maladjustment in ninth grade of 35%. The 30% of children with the lowest scores (i.e., fewest symptoms or disabilities) did not have a single member functioning poorly in ninth grade. Of the group between the 30th and 70th percentile, 5% were adapting poorly and most of their scores placed them in the upper range. Consistent correlations are also shown when the group is divided according to IQ, grade point average, and school systems.
Effect of Breast-Feeding on Seroresponse of Infants to Oral Poliovirus Vaccination
Authors: John T. Jacob , Devarajan L. V. , Luther Leelavathy , Vijayarathnam P.
Published: December 2021

Three hundred Indian infants between 6 and 51 weeks of age were divided into six groups and given three doses of trivalent oral polio vaccine (OPV) of known adequate potency. One group was on unrestricted breast-feeding, with a mandatory breast-feed during the interval between 30 minutes before and 15 minutes after each dose of OPV. In four groups of infants breast-feeding was withheld for three, four, five, and six hours both before and after each dose of OPV. The sixth group was bottle-fed. Samples of blood were collected from all infants before vaccination and from 227 infants further samples were collected four weeks after the first and/or third doses of OPV. Antibody responses to poliovirus types 1, 2, and 3 were determined following one dose and three doses of OPV, and the rates of response were found to be approximately equal in all groups of breast-fed infants irrespective of their feeding schedules, as well as in bottle-fed infants. Thus breast-feeding is shown to have no inhibitory effect on antibody response of infants beyond the newborn period to OPV.
ONE OF THE EARLIEST AMERICAN CASE REPORTS OF A CHILD WITH CONGENITAL HEART DISEASE (1816)
Authors: C. T. E.
Published: December 2021

Clinical descriptions of heart disease in children, congenital or acquired, are extremely rare prior to 1784 when Michael Underwood published his textbook on The Diseases of Children. In a chapter in his book Underwood summed up what had already been discovered about congenital heart disease and for the first time attempted to connect it with clinical symptoms.

Dr. Robert Thaxter's case report of a child with a malformed heart is one of the earliest I have found in American medical journals.

The subject of this case, a male, was at birth apparently well formed and healthy and remained very well 8 or 10 days. At this time he was attacked with the ordinary symptoms of cold which continued a long time very troublesome.

He became very emaciated; which was attributed partly to the above cause, and partly to the mother, whose health was at this time bad. He remained in this emaciated state till he was about a year old at which time he began to grow corpulent and continued so till his death; though his extremities were small compared with his body and head. As soon as he began to move much, he was observed to breathe with difficulty, and his countenance to become livid. Rest generally restored him to a natural state. Cold, especially a cold wind, affected his respiration, sometimes almost producing suffocation, and rendered his surface very livid. Very hot weather had nearly as bad an affect as cold. Eating anything very hot produced the same effect.
Cardiovascular Abnormalities Associated With Congenital Diaphragmatic Hernia
Authors: Greenwood Ronald D. , Rosenthal Amnon , Nadas Alexander S.
Published: December 2021

Cardiovascular abnormalities were present in 11 of 48 (23%) patients with congenital diaphragmatic hernia. Cardiac abnormalities included congenital heart disease, compression of a major vascular structure, cardiac malposition, and abnormalities in pulmonary circulation. The differential diagnosis between isolated congenital diaphragmatic hernia and coexisting cardiac abnormality may be difficult and may require echocardiographic or invasive studies. Mortality in infants with diaphragmatic hernia and cardiovascular abnormalities is 73% in contrast to 27% in those without cardiac abnormalities.
Criteria and all that
Authors: Fielding Jonathan E.
Published: December 2021

A major criticism of traditional institutional utilization review activities has been the lack of objectivity in assessing the necessity and appropriateness of care. The review systems for Professional Standards Review Organizations (PSROs) and for utilization review require the use of objective measures in assessing care provided to Medicare, Medicaid, and Title V patients admitted to short stay general hospitals. The PSRO Manual defines these measures as follows:

Norms—Numerical or statistical measures of usual observed performance, e.g., the average length of stay for a particular diagnostic category in a hospital is 4.6 days.

Criteria—Predetermined elements against which aspects of the quality of a health service may be compared.
Abnormal Fatty Acid Composition and Impaired Oxygen Supply in Cystic Fibrosis Patients
Authors: Campbell Ian M. , Crozier Douglas N. , Caton Robert B.
Published: December 2021

Impaired oxygen supply and deteriorating health, in cystic fibrosis patients, correlates with abnormal changes in the fatty acid composition of blood lipids. As the proportion of oleates increases and that of linoleates decreases, erythrocyte membrane interference with the formation of intracellular oxyhemoglobin increases and arterial oxygen pressure decreases. The physical-chemical basis for these changes seems to be that oleic and linoleic acid differ in their ability to undergo reversible oxygenation in response to changes in oxygen pressure. The oxygen complex of linoleic acid dissociates at relatively high pressures, whereas that of oleic dissociates only at low pressures. Accordingly, excessive substitution of oleic for linoleic acid in membrane lipids would be expected to decrease the intracellular oxygen pressure to a level where hemoglobin oxygenation and any other oxygen-requiring processes would be impaired.
On Deciding the Care of Severely Handicapped or Dying Persons: With Particular Reference to Infants
Authors: Duff Raymond S. , Campbell A. G. M.
Published: December 2021

Two philosophies of deciding the care of severely handicapped or dying persons are commonly used. The first is "disease-oriented" which places death in the extreme negative position. The second is "person-oriented" which regards some kinds of severely compromised living as worse than death. The first philosophy is convenient for the development and the use of medical technology but its unbridled application commonly dehumanizes patients and aggravates suffering. The second philosophy may protect persons from the indignities of pointless treatment or the cruelties of disease. But its use in some respects is illegal and may be unwise; also, in caring for infants, children, and incompetent adults, the second philosophy creates special problems since the patient himself cannot participate in decision-making.

In deciding which philosophy to follow in a given situation, we believe the patient (when able), the sorrowing family, and the concerned physician are the best judges. Since these persons vary widely, they must be entrusted with more freedom to change or to ignore commonly accepted principles if the values of patients and families in the many unique situations of living, illness, and dying are to be protected. We believe with few exceptions that these persons are now worthy of this trust and with experience they would use it with growing wisdom.
Importance of Radiant Flux in the Treatment of Hyperbilirubinemia: Failure of Overhead Phototherapy Units in Intensive Care Units
Authors: Bonta Bedford W. , Warshaw Joseph B.
Published: December 2021

Prior to 1972, radiation used to treat neonatal hyperbilirubinemia was based upon the photometric unit, the foot-candle, a measure of light illumination. Measurements in terms of microwatts per square centimeter for selective wavelengths is more precise. We compared the effectiveness of phototherapy provided by overhead phototherapy units in intensive care modules vs. conventional phototherapy units. Forty-two infants were studied over a six-month period and divided into three groups based upon radiant flux measurements as follows: Group 1 (No. = 6), 1.0µw to 1.9µw/sq cm/nm; group 2 (No. = 15), 2.0µw to 3.9µw/sq cm/nm; group 3 (No. = 21), 4.0µw to 6.0µw/sq cm/nm. All flux determinations were made within the 400- to 500-nm range. All infants in group 1 were treated with overhead phototherapy units in the intensive care modules. Because of multiple factors known to increase the risk of kernicterus, evaluation of effectiveness of phototherapy at low radiant flux was limited in group 1. Significant changes in bilirubin were noted by 48 hours when comparing group 3 with groups 1 and 2. A minimum of 4.0µw/sq cm/nm appears necessary for effective phototherapy. As designed, phototherapy units in intensive care modules are ineffective in delivering this therapeutic level of radiant flux.
Effects of Phototherapy on Platelet Counts in Low-Birthweight Infants and on Platelet Production and Life Span in Rabbits
Authors: Maurer Harold M. , Fratkin Melvin , McWilliams Nancy B. , Kirkpatrick Barry , Draper David , Haggins Joyce C. , Hunter Cheryl R.
Published: December 2021

The effects of conventional phototherapy on platelets in vivo were studied in rabbits and in low-birthweight infants.

Rabbits were divided into three groups and individually treated continuously for 96 hours, with blue light, daylight, or no phototherapy. Incorporation of selenomethionine Se 75 was used to evaluate platelet production and life span. Platelet turnover was significantly increased in the blue-light phototherapy group, and was also increased in the daylight group but to a lesser degree.

Daily platelet counts and hematocrits were performed in infants weighing less than 2,000 gm at birth randomized at 24 ± 12 hours of life to receive daylight phototherapy continuously for 96 hours (31 infants) or no phototherapy (26 infants). In 12 treated infants (38.7%) platelet counts fell below 150,000/cu mm whereas this occurred in only 3 (11.5%) of the controls. These two lower platelet count subgroups differed significantly in mean gestational age and birthweight with the phototherapy group being the more mature. Pre-phototherapy, the mean platelet count of these 12 infants was lower than the mean of the entire control group, suggesting that these infants had borderline marrow reserve before phototherapy was given. These results suggest that phototherapy increases the rate of platelet turnover. When bone marrow compensation is inadequate, the platelet count may fall.
Urethral Condyloma Accuminata in Male Children
Authors: Mininberg David T. , Rudick Donald H.
Published: December 2021

Two cases of urethral condyloma accuminata in 12-year-old boys are presented, with reference made to etiology and to the possibility of increasing numbers of cases in the pediatric age group, owing to greater sexual contact in the young.
A Protest About Kempe's Views
Authors: Rubenstein Herbert A.
Published: December 2021

I must vehemently protest the commentary article by Dr. Kempe published by the Academy in the November 1975 issue.1

It is despicable that the Academy would be party in the propagation of such totalitarian-egalitarian views. Dr. Kempe may be a fine physician but his political views should not be given publicity and apparent credence by the official Academy magazine. Those who think they can solve world problems with simplistic solutions become politicians, not physicians. Those who feel they can, because of their own inclinations, subjugate others should become dictators, not healers.
Pediatric Education–For What?
Authors: Cochran William D. , H. R. J.
Published: December 2021

I thought the article by Bergman1 was delightful but I would like to comment in three parts.

(1) Dr. Bergman states that "diagnosis is really not the tough part of medicine; management is" (p 111). I feel that diagnosis is important, admitting the treatment plan also is important. Pediatricians would be extremely happy to know, for all of those infants with high fever either seen and carried along without therapy, or not even seen but only heard about over the telephone, that such children had benign cerebrospinal fluid and no bacterial pneumonia.
The risks of screening
Authors: Solnit Albert J.
Published: December 2021

In our efforts to disseminate widely the most useful knowledge that can serve children and their families, we should be aware of the risks of shortcuts that may overbalance the promise of good for children. Much of our developmental knowledge1-7 is sound, based on solid empirical findings. The knowledge, however, is not useful if it is applied without regard to the qualifications of those who put it to work. Love is not enough! It requires a disciplined mind to observe, evoke, and interpret observations and the emerging mosaics of data that identify and forecast health, deviation, illness, or deprivation.

Our intent, in screening, is to find a more effective way of safely applying our knowledge to the advantage of more children and their families.
Chest Pain in Children: A Prospective Study
Authors: Driscoll David J. , Glicklich Lucille B. , Gallen William J.
Published: December 2021

In a prospective study of children with the primary complaint of chest pain, 43 patients were identified. This gave an occurrence (per patient visits) of 0.288%. The average age was 12.9 years for boys and 11.80 years for girls. Diagnostic categories identified were idiopathic chest pain (45%), costochondritis (22.5%), chest pain secondary to bronchitis (12.5%), miscellaneous (10%), chest pain secondary to muscle strain (5%), and chest pain secondary to trauma (5%). These six categories are discussed in terms of age, sex, resolution of symptoms, duration of the complaint, return for follow-up examination, quality of pain, psychiatric profile, and results of laboratories studies. It is concluded that chest pain in children is not as ominous a symptom as it is in adults, and that it infrequently signals underlying cardiac disease or other serious disease that is not apparent from a thorough history and physical examination.
Tachyarrhythmias and Ectopic Beats With Aberrant Intraventricular Conduction in Children
Authors: Mody Gita , Whitman Victor , Edelstein Joseph , Liebman Jerome , DeJoseph Robert L.
Published: December 2021

Ectopic foci associated with aberrant intraventicular conduction (AIVC) may either be ventricular foci or supraventricular foci. The electrocardiogram may not help in this differentiation. Knowledge of the site of origin is essential to determine appropriate therapy for patients who develop sustained tachycardias and may be of prognostic value in those who have frequent premature contractions. To determine the site of the ectopic focus, His bundle electrograms were performed in seven children whose conventional ECGs showed arrhythmias with frequent premature ectopic beats and runs of bigeminy with AIVC. In two patients the focus was in the supraventricular area while the other five had a ventricular focus. Incomplete right bundle branch block was noted in one patient with a supraventricular focus but complete bundle branch block occurred in both patients with both ventricular and supraventricular foci.
Propranolol and Exercise as a Screening Test for Growth Hormone Deficiency
Authors: Shanis Bonnie S. , Moshang Thomas
Published: December 2021

There is a need for a safe, inexpensive, and reliable screening test for growth hormone (GH) reserve. Exercise has been utilized for this purpose but false-negative responses (inadequate GH release in non-GH-deficient patients) has limited the effectiveness of this stimulus as a screening test. Beta-adrenergic blockade (propranolol) was used to enhance the effect of exercise on GH release. Thirty-two non-GH-deficient children and five GH-deficient children were evaluated. All of the non-GH-deficient children responded to propranolol and exercise with serum GH levels exceeding 7 ng/ml. The peak serum GH levels in the five GH-deficient patients did not exceed 4 ng/ml. Propranolol and exercise appears to be an effective screening test for GH function.
Anaerobic infections in children: A prospective study
Authors: LM Dunkle , TJ Brotherton , RD Feigin
Published: December 2021

Dunkle LM, Brotherton TJ, Feigin RD: Anaerobic infections in children: A prospective study. Pediatrics 57:311, 1976.

The headings for Table I on page 317 should be identical to the headings on page 315.
HUMAN SCIENCE
Authors: H. R. J.
Published: December 2021

It is in the sciences of living things that we find the greatest confusion, but also the clearest demonstrations of the ways in which the two kinds of observations—the observation of human beings by human beings and of physical nature by human beings—meet. One group of students of living things have attempted to adopt as far as possible the methods of the physical sciences through the use of controlled experiments, the deliberate limitation of the number of variables to be considered, and the construction of theories based on the findings arrived at by these means. The other group, taking their cue from our human capacity to understand through the observation of natural situations, have developed their methods from a natural history approach in which the principle reliance is on the integrative powers of the observer of a complex, non-replicable event and on the experiments that are provided by history and by animals living in a particular ecological setting.

I would argue that it is not by rejection by one or another but by appropriately combining the several methods . . . that we are most likely in the long run to achieve a kind of scientific activity that is dominated neither by the arrogance of physical scientists nor by the arrogance of humanists who claim that the activities which concern them cannot meaningfully be subjected to scientific inquiry.
Educational Intervention for Preschool Children in a Pediatric Clinic
Authors: Morris Anne G. , London Robert , Glick Joseph
Published: December 2021

A parent education program aimed at promoting cognitive development in 2- and 3-year-olds was instituted in both a pediatric clinic of a general hospital and a child health station in the community. Parent participants were asked to work at home daily with their children using age-graded play materials supplied by the program. They were tutored individually, in the clinic playroom, by bilingual playroom assistants using role-playing techniques. One hundred fifty children completed the program out of a total of 468. Subjects were tested before and after training on the Cattell: Stanford-Binet and showed a positive gain in performance. Parents reported that their program experiences made them aware of their ability to teach their children. This was reflected in their changing view of the children's activities which were previously seen as aimless and "bad" and were now viewed as constructive and amenable to modification by the parents.
Special Diets for Infants With Inborn Errors of Amino Acid Metabolism
Authors:   Committee on Nutrition, Holliday Malcolm A. , Anderson Arnold S. , Barness Lewis A. , Forbes Gilbert B. , Goldbloom Richard B. , Haworth James , Jesse Mary Jane , Mauer Alvin M. , Scriver Charles R. , Winick Myron , Kline O. L. , Miller Robert W. , WInters Robert W. ,   Subcommitee on Amino Acid Modified Diets, Holliday Malcolm A. , Chopra Joginder , Freeman Martha M. , O'Brien Donough , Scriver Charles R. , Snyderman Selma , Justice Parvin
Published: December 2021

A sufficient variety of semisynthetic dietary products is now available to permit control of amino acid imbalance in several inborn errors of metabolism. However, they must be used carefully, and their effects monitored closely. Continuing development of products for this type of special diet—to provide a wider variety—is necessary.

Regionalization of treatment programs for patients with inborn errors of metabolism is recommended. Metabolic centers which are accumulating experience and have good laboratory support may be the most efficient way of providing adequate treatment for patients with inborn errors of metabolism.
Neonatal Hypoglycemia Revisited, 1975
Authors: Gutberlet Ronald L. , Cornblath Marvin
Published: December 2021

Between 1971 and 1973, the frequency of neonatal hypoglycemia was 4.4/1,000 total inborn live births or 15.5/1,000 low-birthweight infants. During that same time, of 257 transferred infants, 13 or 5.1% were hypoglycenic. The hypoglycemic manifestations differed between the inborn and outborn infants as well as from those previously described for transient symptomatic hypoglycemia. This required a new classification for low blood glucose values in the neonate, based on intrauterine nutrition, stress, symptoms, and underlying pathology. Four categories were defined: category I: early transitional hypoglycemia; category II: secondary hypoglycemia; category III: classical transient hypoglycemia; and category IV: recurrent, severe hypoglycemia. One outborn infant was in the latter group due to β-cell hyperplasia and was only cured after a 90% pancreatectomy.

Data revealed that early treatment of perinatal asphyxia was associated with a decreased frequency of hypoglycemia. While not a prospective survey, the evidence suggested that current neonatal intensive care may decrease the frequency of transient symptomatic neonatal hypoglycemia.