bluuebunny/crossref_metadata_2025 huggingface dataset:
Centronuclear Myopathy in the Newborn Period Causing Severe Respiratory Distress
Authors: Raju T. N. K. , Vidyasagar D. , Reyes Marcelino G. , Chokroverty Sudhansu
Published: December 2021

Centronuclear myopathy can be classified into four clinical varieties based on age, severity at onset, and rapidity of progress. In the severe form with involvement of respiratory muscles at birth, the progress is rapid and fatal before 3 years of age. The case described in this report illustrates rapid progression of muscle paralysis and death in a neonate. However, in a majority of cases the disease is either moderately severe or mild with the affected individuals confined to wheel chair by adolescence or early adult life. Diagnosis of the disease is based on appropriate muscle histopathology and electron microscopic studies.
Prediction of Morbidity in Hemophilus influenzae Meningitis
Authors: Herson Victor C. , Todd James K.
Published: December 2021

A dramatic decrease in mortality from Hesnophilus influenzae meningitis has occurred in recent years. Morbidity and long-term sequellae remain significant problems. A follow-up investigation of 73 cases of H. influenzae meningitis seen over a three-year period revealed: 2 deaths, 6 children with major sequellae (retardation, spastic quadriplegia, blindness, persistent seizure disorder), 10 with minor residua, and 55 with no detectable disability. Statistical analysis of clinical parameters demonstrated a significant risk of death or major morbidity in those patients who, at the time of admission, had seizures, coma, hypothermia, shock, age less than 12 months, hemoglobin less than 11 gm/100 ml, pretreatment symptoms for longer than three days, a spinal fluid white blood cell count less than 1,000/cu mm, or a spinal fluid glucose value less than 20 mg/100 ml. Using these parameters, those patients at highest risk of having lasting major morbidity with H. influenzae meningitis can be predicted, allowing more vigorous intensive care which may reduce the mortality and morbidity further.
Value of Esophageal Manometric Studies in the Gastroesophageal Reflux of Infancy
Authors: Euler Arthur R. , Ament Marvin E.
Published: December 2021

Fifteen infants with symptoms of gastroesophageal reflux (GER) were evaluated with esophageal manometric studies. Six infants failed on a medical regimen of frequent thickened feedings and an upright position 24 hours per day for three weeks. These infants had Nissen fundoplications. Their mean lower esophageal sphincter (LES) pressure was 12.7 mm Hg. The nine infants who did well on the medical regimen had a mean LES pressure of 19.6 mm Hg. These means are significantly different (P < .001). Esophageal manometric studies should be included in the evaluation of all infants with symptoms of chronic GER.
Hypocalcemic Coma Following Two Pediatric Phosphate Enemas
Authors: Sotos Juan F. , Cutler Edward A. , Finkel Martin A. , Doody Dennis
Published: December 2021

Coma, tetany, dehydration, hypotension, tachycardia, and hyperpyrexia developed in a 21/2-year-old girl following two hypertonic phosphate pediatric enemas. She had marked hyperphosphatemia, hypocalcemia, hypernatremia, and acidosis. Hypocalcemia due to hyperphosphatemia can explain all of these findings. Calculations indicate that about one third of the phosphorus and sodium contents of the enema were absorbed. Physicians should be aware of the potentially lethal complication of this treatment, which is a part of everyday practice.
OUR KLEENEX CULTURE
Authors: H. R. J.
Published: December 2021

. . . It takes about 850 acres of Canadian timber to print one Sunday's New York Times. . . . The New York Times sells for 50¢ (1972) and contains more paper and typography than an unillustrated novel selling for $7.95. While the Times carries about 500 photographs and drawings in its Sunday edition and a novel does not, book-binding costs average 22¢ per book. It costs the city of New York nearly 10¢ per copy each week to clean up discarded copies of the Sunday New York Times.
The Role of the Pediatrician in Adoption With Reference to "The Right To Know"
Authors:   Committee on Adoption and Dependent Care, Lewis Donald , Cypress George C. , Davis Joseph H. , Harris Ruth C. , Sherry S. Norman
Published: December 2021

The adoption process in our country traditionally has been designed to safeguard the rights of adoptive parents, insure the solidarity of the adoptive family, and preserve the anonymity of the natural parents. To accomplish this, when adoptions are finalized, the original birth certificate is "sealed" and a new certificate is issued in the name of the adoptive parents. Once sealed, the laws of most states specify that the original record can be opened only by court order and for "just cause." A few states have provisions for opening of the records on demand of the adoptee when that person becomes an adult. This provision often turns out to be true in theory but not in practice, and the definition of "just cause" has varied greatly from court to court.

Most adoptive parents have warm and loving relationships with their adoptive children. Most try to pass on to them, at appropriate times, as much of the birth information as they know and are able to provide. Most adoptees have a warm and loving and truly bonded relationship with their adoptive parents. In spite of this, and regardless of their attachment to the adoptive parents, some adoptees, as they reach maturity, have a compelling desire to learn of their natural parent or parents.

Many adult adoptees and adoption specialists see this search as essential to the establishment of a sense of identity. Most reports of reunions indicate that adoptees have been pleased with the meeting and that their ties to their adoptive parents have been strengthened thereby.
Privileged American children
Authors: Coles Robert
Published: December 2021

For almost 20 years now my wife and I have been working with the children of rather well-to-do, if not rich, families. We began, and have continued our work, on quite the other side of the railroad tracks. We started visiting white and black children from New Orleans at their homes in 1960, when that city was seized by rioting mobs bent on preventing school desegregation. As is often the case, the boys and girls caught up in a terrible and continuing social crisis (for them an intensely personal one) were without exception from relatively hard-pressed families—in the case of the blacks, extremely poor, in the case of whites, working-class at best.
Shots Are Not Abusive
Authors: Zanga Joseph R.
Published: December 2021

I feel compelled to comment upon Dr. Gorlick's letter to the editor in the November 1975 issue of Pediatrics (page 839). As director of a Children and Youth Program, I do not feel that, in any way, I am abusing a child by adequately treating him for an infectious disease. As director of a program which makes widespread use of family intervention,1 I can easily document the number of pills which remain on families' shelves long after their useful life; consequently, I can document the many unresolved cases of streptococcal pharyngitis, otitis media, impetigo, and the like.
What's a PCMPFC?
Authors: Silver Henry K. , Krugman Richard D. , McAtee Patricia R.
Published: December 2021

In their article discussing implications of the declining birth rate on the future need for pediatricians in the United States, Gorwitz and Smith (56:592, October 1975) conclude that three basic choices need to be considered in planning for the training of pediatricians:

1. Leave the number and content of pediatric residencies as previously constituted even though this has the potential of producing a surplus of physicians whose training bears an increasingly limited relationship to their practice.
Dr. Wegman Replies
Authors: Wegman Myron E.
Published: December 2021

Dr. Baum's point is well taken and emphasizes the importance of the cautionary note included in the introduction to the article each year. "All the United States data for 1974 are estimates based upon a 10% sample of material received in state offices. . . . Experience has shown that for the country as a whole the estimate is very close to the subsequent final figures. There are, however, considerable variations in a few of the states; state information should be interpreted cautiously."
Early Hypocalcemia Does Not Need to Be Treated
Authors: Kuhr Murray D.
Published: December 2021

The cosmetic hazards of calcium gluconate infusion described by Weiss et al. (Pediatrics 56:1084, December 1975) reinforce our contention that the commonest form of hypocalcemia seen in the nursery, the "early type" associated with prematurity and asphyxia,1 is a self-limited, usually subclinical disorder not requiring therapy. In the absence of calcium therapy, the chemical disturbance resolves spontaneously. Klaus and Fanaroff2 recommend correction of neonatal hypocalcemia only in symptomatic cases. The recommendation in Segal's manual3 is not explained or justified.
Kerion Treatment
Authors: Kahn Guinter
Published: December 2021

The article "Kerion Caused by Trichophyton verrucosum" by Stocker et al. (Pediatrics 59:912, June 1977) represents a case report in need of addition. The authors state that "Kerion is the clinical term for a deep . . . boggy skin infection caused by various fungi," but end their discussion by pointing out the immunological basis of kerion.

Would not the authors consider kerion to be the clinical term for a deep, boggy infection caused by an allergic reaction to various fungi?
Esophagrams Are Useful
Authors: McCauley Roy G. K. , Darling Donald B. , Leonidas John C. , Schwartz Alan M. , Leape Lucien L.
Published: December 2021

The data presented by Euler and Ament (Pediatrics 60:65, July 1977) would suggest that the barium esophagram is of no value in the diagnosis of gastroesophageal reflux (GER) in pediatric patients. Seven of their 24 patients with symptoms of GER required surgery (fundoplication). In none of these seven patients did the esophagram show GER. The esophagram showed reflux in only three of the 24 patients.

In our experience the barium esophagram has been very reliable in demonstrating GER. Reflux was demonstrated radiologically in all of the 47 cases requiring surgical fundoplication for relief of symptoms during the past three years at the Boston Floating Hospital.
In Reply: Questions About Complications of H. influenzae Meningitis
Authors: Grosson Francis J.
Published: December 2021

Lindberg et al., outlining the results of an eight-year retrospective study of Hemophilus influenzae type b meningitis, report an increased prevalence of neurologic and audiologic sequelae among children treated with ampicillin and chloramphenicol compared to children treated with either drug alone. The authors state, however, that cases treated with the combination of antibiotics occurred only in the last three years of the study. These patients, therefore, presumably had shorter-term follow-up than patients in other groups.
Gresham's Law of Evidence
Authors:   STUDENT
Published: December 2021

A recent review1 of the epidemiology of randomized clinical trials indicates very slow acceptance of this approach to evaluation of new medical treatments. If the proportion of randomized trials among therapeutic studies in gastroenterology continues to increase at the rate observed over the past decade, the reviewers estimate that the format will have taken over completely by the year 2010 provided the increase is exponential, and in about 700 years if it is linear. I write to suggest that a law, similar to Gresham's Law—cheap money will drive out dear money—operates in these matters.
Aspirin Overdosage: Incidence, Diagnosis, and Management
Authors: Done Alan K.
Published: December 2021

The importance of aspirin as a cause of poisoning in children has declined dramatically with safety packaging and reductions in the dose of flavored children's aspirin per package. Although flavoring entices children to ingest more tablets, the increment is less than the dose differential between the children's and adults' preparations, and so the latter pose the greater hazard in the individual case. Chronic poisoning of children during therapy with aspirin is aggravated by the peculiar kinetics of the drug, but is preventable and constitutes no essential basis for the substitution of acetaminophen, which may not be devoid of risk factors in sick children. Salicylate levels are essential in the diagnosis and management of intoxication. In treatment, emphasis should be on trapping salicylate in the plasma and eventually the urine-through ionization to prevent its entry into the brain.
Chronic Salicylate Administration in Juvenile Rheumatoid Arthritis: Aspirin "Hepatitis" and Its Clinical Significance
Authors: Schaller Jane G.
Published: December 2021

Salicylates provide the backbone of therapy in juvenile rheumatoid arthritis. They are effective in controlling the disease approximately 75% of the time if they are properly used. Salicylate administration is relatively safe if carefully done. Serum salicylate levels should not exceed 30 mg/dl routinely. Patients, physicians, and parents should be alert to early clinical signs of toxicity. Chief hazards of chronic salicylate administration other than salicylism (which should be uniformly preventable) include gastric irritation with questionable relationship to peptic ulcer disease, and rare serious hepatotoxicity, bleeding diatheses, or hypersensitivity reactions.
Salicylate and Gastric Mucosal Damage
Authors: Fromm David
Published: December 2021

The mechanism(s) of salicylate-induced dam-age of the gastric mucosa is complex. The presence of acid in the lumen is essential for the occurrence of such injury. Although the absorption of salicylate is greater in the presence of acid, salicylate can selectively increase cation permeability both in the absence and presence of acid. Recent studies suggest that this permits increased diffusion of luminal acid into the tissue, which leads to major permeability changes of the mucosa. Salicylate also affects metabolic processes of the gastric mucosa, which appear to be independent of the increased diffusion of acid into the tissue also caused by salicylate. The release of histamine, which has been shown to occur in vivo as a result of mucosal damage, does not appear to intensify existing mucosal injury in an isolated system.
Clinical Implications of Preseptal (Periorbital) Cellulitis in Childhood
Authors: Smith Thomas F. , O'Day Dennis , Wright Peter F.
Published: December 2021

The available hospital records of all pediatric patients diagnosed as having periorbital, preseptal or orbital cellulitis over a five-year period were reviewed and compared to previously reported series. Only two of 39 patients had orbital cellulitis. The 37 patients with preseptal cellulitis had two characteristic clinical presentations. Twenty-two children had local trauma, abscesses, insect bites, or impetigo as the inciting event for their cellulitis. Infection was usually caused by staphylococci or streptococci. In contrast, 15 children, 12 of whom were under 36 months, had associated upper respiratory tract infections and otitis. Haemophilus influenzae was the most commonly implicated pathogen and the children were at risk of bacteremia and metastastic infection. Determination of the location of the infection in the orbit and consideration of the clinical presentation of the patient with infection in and about the orbit are of assistance in choosing appropriate therapy. Young children who have upper respiratory tract symptoms in association with preseptal cellulitis should receive antibiotic coverage for Haemophilus.
Measles immunization: 12 or 15 months?
Authors: Brunell Philip A.
Published: December 2021

The objective of immunization is to reduce morbidity produced by natural illness. Ideally, we would like to eradicate natural infection. This goal, which has been presumably accomplished for smallpox, has clearly eluded us in the case of measles. Eradication requires reduction in the number of susceptible subjects to the point where transmission of natural infection is interrupted. It is clear in the case of measles that we continue to have pockets of susceptible subjects that permit perpetuation of this disease. Clusters of cases occur in neighborhoods where immunization levels are low and in situations where susceptible subjects are brought together in close contact, such as in high schools, colleges, and military installations.
DOES THE WORLD NEED A NEW TEXTBOOK OF PEDIATRICS?
Authors: Haggerty Robert J.
Published: December 2021

A major new text on pediatrics, the first in more than a decade, justifies breaking our recent decision to discontinue book reviews in Pediatrics, for many of our readers will want to know about the new text.

There is much that is different in this text including: the opening chapter on ecology of patient care; obtaining the data base (a good description of history taking and physical examination that is generally missing from standard texts, and also covers computers in medicine and record systems); an elegant, competent and practical chapter on nutrition; perinatal care (including much more on intrauterine and birth processes, human sexuality, contraception, and abortion than is usual in pediatric texts); social pediatrics (family change, day care, divorce, foster care, rights of children); organization of health services for children; adolescent pregnancies, rape, runaway children, substance abuse; sleep disorders; inherited disease (well-done, with branching logic trees for assisting in diagnosis); common orthopedia problems; and tests for infectious diseases. These chapters are among those that I found most useful.

But there are also good chapters on disorders of each organ-system, covering diseases seen in the office or the hospital. Indeed, very little is missing from this book. It deals with traditional pediatric problems as well as new ones.

A reviewer presumably looks for faults. I found several. The major ones are redundancy and difficulty in looking up topics. Because the book is organized under several different subjects, the same topics are often dealt with under sections on diagnosis, organ-system disorders, and causes of disease.
Skull Roentgenography of Infants and Children With Convulsive Disorders
Authors: Felman Alvin H. , Glazer Norman , McSweeney William , Northway William , Goldman Horold S.
Published: December 2021

The report by the Committee on Radiology entitled "Skull Roentgenography of Infants and Children With Convulsive Disorders" (Pediatrics 62: 835-837, November 1978) had as its primary author Dr. John C. Leonidas, acting as consultant to the committee.
Injuries From Exploding Bottles
Authors: Gardner H. Garry
Published: December 2021

Accidents take the lives of more children 1 to 4 years of age than the next seven ranking causes combined.1 In 1973, accidents were responsible for 42% of the mortality from all causes among boys 1 to 4 years old and 37% of that among girls of the same age group.1, Two recent injuries from exploding pop bottles, one of them fatal, prompted me to emphasize the extreme danger that glass bottles containing carbonated beverages under pressure pose to small children.

CASE REPORTS

Case 1

The parents of a 15-month-old child, after hearing a bottle explode, discovered the child crouching with a piece of glass in the perineum and innumerable pieces of glass scattered about the room.
INTRODUCTION
Authors: New Maria I.
Published: December 2021

This is the report of a conference held December 6 through 9, 1977, at the Kroc Foundation headquarters in Santa Ynez, California. The Lawson Wilkins Pediatric Endocrine Society and the National Institute of Child Health and Human Development cosponsored the meeting with the Foundation.

The conference was conceived at a time when prescribing estrogens had become controversial among physicians and the public. The treatment of tall girls to limit growth was sufficiently newsworthy to appear as an article in the New York Times Magazine. The occurrence of adenocarcinoma in the daughters of women treated prenatally with diethylstilbestrol was the subject of congressional hearings. It seemed the right time to bring together experts on the risks and benefits of prescribing estrogens to analyze what was known on the subject and to make recommendations on the use of estrogens in treating the young.

The publication includes the presentations at the conference, reports of the general discussions, and a summation of conclusion and recommendations. An article is included by Dr. Zev Rosenwaks and colleagues that was not presented but seemed appropriate to the symposium. The reports of the general discussion were made by Dr. Allan Root, University of South Florida. The final summation was drafted by a committee composed of Drs. Conte, Crawford, Gurpide, Levine, New, and Root, and was submitted for comment to all the participants. Carole Bergstein was copy editor. I wish to thank all these people for their help.
Estrogen Use in Children and Adolescents: A Survey
Authors: Conte Felix A. , Grumbach Melvin M.
Published: December 2021

Members of the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society of Pediatric Endocrinology (ESPE) were mailed a questionnaire to survey their views and practices with respect to the use of estrogens in children and adolescents. The purpose of this survey was to ascertain the prevalence of estrogen therapy in children and adolescents, as well as the estrogen preparation used, dose, benefits, and observed complications. Seventy-four of 213 LWPES members or groups and 29 of 106 ESPE members or groups returned the survey. The lack of rapid retrieval systems in many clinics and the necessity for return of the survey data within a ten-week period precluded many respondents from the exhaustive, careful chart reviews necessary to answer many of the questions posed. Accordingly, data generated in this survey must be interpreted in this light.

Estrogens are used primarily in children and adolescents for (1) the treatment of tall stature, (2) replacement therapy in hypogonadal adolescents, and (3) as a component of contraceptive pills given to sexually active teenagers.

ESTROGEN TREATMENT OF TALL GIRLS

The treatment of "excessively" tall adolescent girls with pharmacologic doses of estrogen, in an attempt to decrease mature height, has been a subject of controversy since its inception by Goldzieher1 in 1956; 50% of the LWPES and 17% of the ESPE respondents indicated that they never treat "tall" girls with pharmacologic doses of estrogen, basing their decision primarily on the fact that the long-term side effects of such doses of estrogens are unknown. In addition, the risk-benefit ratio and the fact that tall stature is not a disease were other important reasons for not treating these girls.
Metabolic Influences on the Action of Estrogens: Therapeutic Implications
Authors: Gurpide Erlio
Published: December 2021

Several metabolic barriers in the route leading from intake or endogenous secretion of estrogens to their final site of action influence their biologic potency. Among them, four are clearly defined: (1) intraluminal and mucosal intestinal metabolism, (2) overall clearance from blood, (3) transcapillary exchange, and (4) target tissue metabolism.

Of these four steps, the first two have been extensively studied, whereas the third remains largely unevaluated. The importance of target tissue metabolism of estrogens is discussed here in some detail.

INTESTINAL ABSORPTION AND METABOLISM OF ESTROGENS

Orally administered estrogens are subjected to metabolism by the intestinal flora and in the intestinal wall before entering the portal circulation or the lymphatic system. Conversions of estradiol to estrone and estrone glucuronide in a jejunal loop of a patient were shown by Diczfalusy et al.1 Substitutions in the estradiol molecule, such as introduction of an ethinyl group in the l7α position and further etherification of the phenolic hydroxyl group, limit metabolism. They also increase lipophilicity and uptake by the lymphatic vessels,2 thus reducing the "first passage" of the ingested estrogen through the liver. Longcope and Williams3 concluded that orally administered ethinyl estradiol and mestranol are completely absorbed, since similar blood levels of radioactive compounds are obtained by oral administration or intravenous injection of the estrogens. The absorption of estradiol is also almost complete, as evaluated from the isotope ratios of urinary metabolites following the simultaneous administration of carbon 14-labeled estradiol orally and tritiated estradiol intravenously.4 However, due to intestinal metabolism, the ratio of estradiol to estrone in circulation resulting from oral administration of estradiol is lower than the ratio resulting from intravenous injection of the hormone.
Differential Biological Activity of Estradiol Metabolites
Authors: Fishman Jack , Martucci Charles
Published: December 2021

Assessment of the biological potency of an estrogen in the human has been and remains a formidable task. The problem arises not only from the lack of a readily distinguished physiological endpoint, but also from the diversity of the biological actions of the estrogens. Estrogens exert proliferative effects in recognized target tissues such as endometrium, vagina, and breast,1 and this action is the one commonly associated with the term "estrogenicity." Estrogens, however, also participate in inducing a host of other peripheral responses in tissues such as blood, bone, skin, and others.2 More importantly, the estrogens also exercise major regulatory functions in the central nervous system, including control of pituitary hormone secretion3 and influencing behavior such as food intake4 and sexual receptivity.5

Much attention had been devoted to the design of estrogen structures that would exhibit a specific type of estrogenic activity, such as gonadotropic regulation, without retaining any uterotropic action. Despite the vast numbers of structures synthesized, little clear-cut separation of these activities has been achieved, suggesting that these dual actions of estrogens may be inextricably linked to each other. On the other hand, much effort has also gone into the study of the mechanism of estrogen action in the uterus and in the central nervous system; despite much progress in both directions, little evidence of a commonality between these two responses to estradiol has so far emerged, suggesting that they may not be directly linked.

In our studies, we sought to examine whether estradiol metabolism may play a critical role in the expression of the biological activity of the female sex hormone.
The Newborn Mouse as a Model for Study of the Effects of Hormonal Steroids in the Young
Authors: Kohrman Arthur F.
Published: December 2021

The use of the fetal and neonatal mouse to study the effects of steroidal and nonsteroidal substances on development and carcinogenesis has a long history. Since the early 1960s, this animal model system has been exploited by several groups throughout the world, and it is useful to recount some of the more significant points in this history. I shall also point out areas of inquiry where the mouse model continues to be used in a search for the fundamental nature of the processes by which steroid hormones cause permanent effects during development, with the hope that some of those experiments may provide clues to the causes of present or yet unseen situations in the human.

Early studies1,2 showed vaginal and cervical tumor formation in adult mice treated with estrogens in the newborn period. As early as 1963, concern was expressed about the possibility of similar consequences in humans who might be exposed to hormonal substances early in development. Subsequent investigations2-4 showed that administration of estrogen and androgen to newborn female mice in the first five days of life led to permanent vaginal and cervical changes in the adult, which were in many cases (depending on the dose administered) ovary independent; that is, the changes persisted after ovariectomy of the animal at day 40. Studies on the vaginal tissues of the adult animals that had been treated with steroids in the newborn period showed that there were permanent alterations of rates of DNA, protein, and RNA synthesis in those tissues, and that those changes apparently occurred with out modification of the fundamental characteristic of specific binding of estrogen by the vagina.3
Measles Vaccine Efficacy: Influence of Age at Vaccination vs. Duration of Time Since Vaccination
Authors: Shelton James D. , Jacobson John E. , Orenstein Walter A. , Schulz Kenneth F. , Donnell H. Denny
Published: December 2021

To evaluate the recent decision of the Advisory Committee on Immunization Practice to increase the recommended age for initial measles vaccination from 12 to 15 months, we carried out a case control study of vaccine failure in a recent measles epidemic. Compared to children vaccinated at ages 15 months or older, we found an increased risk of vaccine failure among those vaccinated at 12 to 14 months (relative risk = 19.2, 95% confidence interval = 4.6 to 80.1). In order to sort out the influence of age at vaccination from elapsed time since vaccination, we subjected the data to discrminant analysis. Age at vaccination subsumed all of the effect of duration of time since vaccination. Thus, we find no evidence of waning immunity over time.
Current Status of Mumps and Mumps Vaccine in the United States
Authors: Hayden Gregory F. , Preblud Stephen R. , Orenstein Walter A. , Conrad J. Lyle
Published: December 2021

Reported mumps in the United States has declined to all-time low levels following the increasingly widespread use of mumps-virus vaccine. Mumps vaccine has proven safe and effective. Its incorporation into combined live-virus vaccines, especially measles-mumps-rubella, has made mumps vaccination a practical and economically feasible component of routine immunization activities. Because of the favorable experience to date with mumps vaccine and the associated drop in mumps morbidity and mortality, mumps control programs likely will receive increasing public health attention in the coming years.
Synthetic Food Colors and Hyperactivity in Children: A Double-Blind Challenge Experiment
Authors: Harley J. Preston , Matthews Charles G. , Eichman Peter
Published: December 2021

Nine hyperactive male subjects, selected on the basis of showing a favorable "response" to the Feingold diet in an earlier study, were maintained on a strict elimination (Feingold) diet for 11 weeks, and were given multiple trials of placebo and challenge food materials. Parental and teacher ratings, classroom behavior observations, and neuropsychological test scores obtained during baseline, placebo, and challenge conditions, in general, were not found to be adversely affected by the artificial color challenge materials. As expected, comparable data gathered on a matched control group showed them to receive substantially better ratings than the hyperactive subjects on the majority of the comparison measures employed. Possible explanations for the discrepancy between the dramatic clinical-anecdotal reports that have been given and the much more equivocal findings from format experimental projects are presented.
Cholestatic Tendencies in Premature Infants on and off Parenteral Nutrition
Authors: Sondheimer Judith M. , Bryan Heather , Andrews Wayne , Forstner Gordon G.
Published: December 2021

We measured the levels of serum conjugates of cholic acid (SCCA) by radioimniunoassay in 32 newborn infants during the course of intravenous (IV) alimnentation (study group 1, birth weight > 2 kg; study group 2, birth weight <2 kg) and compared them to those of two groups of weight-matched control subjects and one group of normal infants and adults. Fasting SCCA levels in the two newborn control groups were significantly higher than those of normal infants and adults, and a significant postprandial elevation in SCCA level was present in the smaller of the two newborn control groups. During the first two weeks of alimentation only one patient had an elevated SCCA level (< 2 SD above that of control subjects), without other abnormalities of liver function. In study group 1 patients who received alimentation for more than two weeks, significant increases in mean peak SCCA level occurred and seven of eight patients had elevated levels. Three patients became jaundiced and had high alkaline phosphate values. Group 2 patients who received alimentation for more than two weeks were unaffected. Therefore, the appearance of liver abnormalities was related to body mass and duration of IV alimentation. The presence of documented or suspected sepsis, withholding of oral feedings, or the use of Intralipid could not be specifically related to SCCA levels. These results indicate that the small premature infant has a limited hepatic excretory function and suggest that excretory immaturity is an important factor in the susceptibility of these infants to cholestasis associated with long-term IV alimentation.
Incubator-Baby Side Shows
Authors: Silverman William A.
Published: December 2021

On the morning of Thursday, March 2, 1950, I read the following obituary in the New York Times:

MARTIN A. COUNEY, "INCUBATOR DOCTOR"

Dr. Martin A. Couney, a specialist in the care of prematurely born infants, who had shown such babies to the public for an admission price at fairs and other exhibitions throughout the United States and in Europe for more than fifty years, died last night at his home, 3728 Surf Avenue, Sea Gate, Coney Island. He was 80 years old. "The Incubator Doctor" as Dr. Couney was informally known, was born in Germany, studied medicine in Breslau, Berlin and Leipzig, receiving an M.D., and later in Paris under Dr. Pierre C. Budin, noted pediatrician, who developed a method of saving the prematurely born.

At the Berlin Exposition in 1896, Dr. Couney operated an exhibit of prematurely born babies to show the Budin technique. The exhibit was a financial success, as was a second one at Earl's Court in London. In 1898 Dr. Couney paid his first visit to the United States and staged an exhibit at the Omaha Trans-Mississippi Exposition. He returned to Paris for the exposition of 1900, but was back in this country for the Buffalo Exposition the next year, and then decided to remain here for good.

For years he had shows at both Dreamland and Luna Park, and the night Dreamland was destroyed by fire the babies were saved by a quick transfer to the Luna Park incubators, some of the lodgers doubling up.
Indomethacin Therapy for Large Patent Ductus Arteriosus in the Very Low Birth Weight Infant: Results and Complications
Authors: Halliday H. L. , Hirata T. , Brady J. P.
Published: December 2021

Of 36 very low birth weight infants (<1,500 gm) with large patent ductus arteriosus, 24 (67%) showed satisfactory constriction or closure after indomethacin therapy (mean total dose 0.4 mg/kg). Twelve infants (33%) responded inadequately with seven infants requiring surgical ligation. Response was better in infants 8 to 14 days old compared to those more than 14 days old (89% vs 33%, P = .048) irrespective of birth weight or gestational age. Major complications were renal and unrelated to ductus response. Urine output fell significantly (3.65 to 1.63 ml/kg/hr, P < .001) and in 47% of infants serum creatinine increased ≥1.5 mg/dl. Creatinine was less likely to rise in infants more than 14 days old. Hyponatremia was found in 36% of infants. Serum potassium increased more frequently in infants more than 8 days old and was >6.0 mEq/liter in 25%. Indomethacin caused a reduction in PaCO2 (41 to 37 mm Hg, P < .01) and an increase in pH (7.32 to 7.36, P < .02) with no change in base deficit. These changes occurred even in the absence of clinical ductus closure. No other side effects of indomethacin therapy were noted. Three infants died but death was unrelated to indomethacin therapy. Overall survival was 92%, and nine infants (25%) developed mild bronchopulmonary dysplasia.
The Pediatrician and Congenital Heart Disease—1979
Authors: Rowland Thomas W.
Published: December 2021

Technologic advances in the diagnosis and treatment of children with congenital heart disease have created new, expanded roles for the practicing pediatrician. Early identification of infants with serious lesions continues to be vital, and support of children and their families following surgery is central to the solution of emotional, employment, and childbearing problems these patients may eventually face.
Streptobacillary Rat-Bite Fever: A Pediatric Problem
Authors: Raffin Betty J. , Freemark Michael
Published: December 2021

A case of streptobacillary rat-bite fever in an 11-year-old boy from rural North Carolina is described. The child's clinical course was unique in that he developed a subglottic mass and bilateral parotid swelling. He responded initially to tetracycline but relapsed after therapy. Cure was ultimately achieved with a three-week course of penicillin. A review of the literature concerning this unusual clinical entity is presented.
Disease Due to Serogroup W135 Neisseria meningitidis
Authors: Griffiss J. McLeod , Brandt Brenda L.
Published: December 2021

Five cases of disseminated meningococcal disease due to serogroup W135 Neisseria meningitidis are presented. The cases ranged in age from 16 months to 23 years, and spanned a clinical spectrum from mild meningitis without rash or evidence of meningococcal septicemia to severe meningoencephalitis with fulminant meningococcemia, disseminated intravascular coagulation, and death. These cases demonstrate that serogroup W135 N meningitidis is fully pathogenic for man and capable of producing the full spectrum of disseminated meningococcal disease associated with other serogroups. Since this serogroup has recently emerged as a significant cause of disease in Europe, attention should be focused on the correct serogroup designation of strains of N meningitidis isolated from clinical material and reported as "nongroupable" by clinical laboratories, so that additional clinical and epidemiologic information may be obtained.
Neurologic Sequelae in the Survivors of Neonatal Intraventricular Hemorrhage
Authors: Krishnamoorthy K. S. , Shannon D. C. , DeLong G. R. , Todres I. D. , Davis K. R.
Published: December 2021

We report our experience with the neurologic sequelae (at a mean follow-up of 24 months) among the 15 surviving infants who have had neonatal intraventricular hemorrhage (IVH) documented by computerized tomographic (CT) brain scan. Neurologically six infants (40%) are normal, six infants (40%) mildly impaired, and three infants (20%) moderate to severely impaired. The neurologic outcome correlated to the degree of hemorrhage seen in the CT scans when IVH was classified into four grades. None of the other neonatal factors examined showed significant correlation with the outcome.
Neonatal Intraventricular Hemorrhage Due to an Intracranial Arteriovenous Malformation: A Case Report
Authors: Schum Timothy R. , Meyer Glenn A. , Grausz John P. , Glaspey John C.
Published: December 2021

A full-term newborn infant with intraventricular hemorrhage due to a small arteriovenous malformation draining into the vein of Galen is presented. Other reported series are reviewed, and differences between this case and the usual pattern of morbidity are discussed. The use of computerized tomography is demonstrated.
Lipid and Lipoprotein Tracking in 108 Children Over a Four-Year Period
Authors: Laskarzewski Peter , Morrison John A. , deGroot Ido , Kelly Kathe A. , Mellies Margot J. , Khoury Philip , Glueck Charles J.
Published: December 2021

This study was designed to assess "tracking" of plasma cholesterol, triglyceride, and high and low density lipoprotein cholesterol (C-HDL, C-LDL), in 108 children followed over a four-year period in the Cincinnati Lipid Research Clinic's Princeton School study. The correlations between initial and subsequent measurements of plasma cholesterol were respectively 0.65, 0.66, and 0.68 for observations one, two, and three years apart, P < .001; for plasma triglyceride they were 0.47, 0.37, and 0.39, P < .001. Initial and subsequent C-HDL and C-LDL levels were also highly correlated, r = .60, .53 (for C-HDL), r = .67 and .61 (for C-LDL), for observations two and three years apart, P < .001. Six of 13 children initially in the top decile for plasma cholesterol remained there over the four-year period. Only three of 11 children initially in the top decile for plasma triglyceride remained there over the four-year period. Plasma C-HDL levels initially in the top decile generally remained there, with 82% and 64% of children initially in the top decile remaining in the top two deciles on follow-up. Plasma C-LDL levels were more dispersed than C-HDL, with three of 11 children initially in the top decile remaining there after four years. A considerable proportion of the decrement in group mean levels of lipids and lipoproteins for children initially in the top deciles could be accounted for by regression toward the mean. Although initial and subsequent measures of lipids and lipoproteins in school children are closely correlated, and there is a moderate degree of tracking for children initially in the top deciles, only small numbers of children after four years of follow-up will retain persistent elevations of cholesterol, triglyceride, and C-LDL. Longitudinal assessment of children with elevated lipid and lipoprotein levels may permit early identification of risk factors which both increase risk to coronary heart disease in adulthood (cholesterol, triglyceride, C-LDL), or decrease it (C-HDL).
GROWTH AND DEVELOPMENT OF THE CHILD
Authors:   Student
Published: December 2021

Deaths of infants and of their mothers may be the most dramatic consequence of ill health, but there are other serious consequences which affect the child and, indeed, may follow it throughout adult life. The damage done by infections and associated malnutrition to a young child in its formative years is manifested in retarded physical growth and mental development, which it may never be able to catch up on, thus impairing the potential for a full and active adult life. Poverty, ignorance, and ill health thus create a vicious cycle spanning from one generation to the next, and from which the individual has little chance of escape.

A striking expression of this generation link is the frequency of "low birth weight" (LBW) babies, ie, babies weighing less than 2500 gm at birth. It is now known that this frequency is closely determined by the same adverse maternal and environmental factors which determine the nutritional status of the mother. It has also been observed in developed countries that the frequency is higher among mothers who smoke during pregnancy. About 21 million LBW (small for date) babies are born each year, the greatest majority of them in developing countries. The observed incidence rate ranges from about 4% in the most developed countries to over 30% in some poor rural populations. It is also known that LBW is the single most important factor determining the survival chances of the child. The infant mortality rate is about 20 times greater for all LBW babies than for other babies, and the lower the birth weight the lower is the survival chance.
Impaired Cell-Mediated Immune Response in Patients with Congenital Rubella: Correlation with Gestational Age at Time of Infection
Authors: Buimovici-Klein Elena , Lang Paul B. , Ziring Philip R. , Cooper Louis Z.
Published: December 2021

Lymphocyte transformation, interferon, and leukocyte migration inhibition factor synthesis were studied in purified lymphocyte cultures for 20 children with congenital rubella and 18 healthy children (seven susceptible and 11 immune to rubella). Lymphocyte transformation after phytohemagglutinin stimulation was significantly lower in children with congenital rubella as compared to healthy controls. Responses to purified rubella virus were absent in the susceptible controls and absent or at least two times lower in congenital rubella children than in immune controls. After purified rubella virus stimulation, leukocyte migration inhibition factor production was detected in all immune controls, but in none of the susceptible controls, or the congenital rubella-infected children. The results varied with gestational age of intrauterine infection: the impairment of cellular immune response, both after phytohemagglutinin or rubella virus stimulation, was more severe in the children infected in the first two months than in the latter stages of gestation.
Do Parents Utilize Physician Follow-up After the Death of Their Newborn?
Authors: Clyman Ronald I. , Green Charlotte , Mikkelsen Cynthia , Rowe Jane , Ataide Linda
Published: December 2021

Numerous authors have advocated appropriate physician-patient counseling following a perinatal death. We examined, in a prospective manner, how many families utilized physician follow-up when such follow-up was offered. Seventy-six percent of the 108 families who experienced a neonatal death chose to have physician follow-up in the weeks after the death. A family's utilization of subsequent physician contact was not related to the distance they lived from the medical center, the duration of survival of the infant, or the racial background of the mother. Parents utilized follow-up visits whether or not an autopsy was performed or an interpreter was needed. Certain features distinguished the parents who did not utilize the physician follow-up service: parents were less likely to utilize the service if they were not married, the mother was a teenager, the head of the household was unemployed, or there was no phone at home.
"Felicitas Liberorum Suprema Lex" (IYC in Poland and the World)
Authors: Kulczycki Lucas L.
Published: December 2021

The year 1979, the 20th anniversary of the Declaration of the Rights of Children, formulated by the United Nations, is declared an International Year of the Child (IYC).

During this year each nation is focusing on the problems and needs of its own children, and attempting to share its resources with needy children of the world. An International Secretariat of UNICEF is coordinating world activities of the IYC.

In the United States a National Commission of the IYC was established with Mrs. Jean Young as chairperson. The National Institutes of Health launched an exhibit entitled "NIH Research: Helping Children Grow into Healthy Adults."
The Telephone Syndrome
Authors: Heagarty Margaret C.
Published: December 2021

Over the past ten years the telephone, that ubiquitous instrument of modern communication, has been the subject of several health care research studies. Perhaps because pediatricians, of all health professionals, are most closely bound by Ma Bell's umbilical cord, most of these studies have focused upon the use of the telephone in pediatric practice. The work of Levy et al1 and Strasser et al2 in this issue of Pediatrics represents examples of the continuing interest of health care researchers in this topic. On the basis of this as well as previous research at least one generalization can be made.

Conventional pediatric residency programs do not seem to provide young physicians with adequate training and necessary experience to use the telephone effectively or perhaps even safely.
Obese-Writing
Authors: Leonidas L. Leo
Published: December 2021

I enjoyed reading the article "Diphtheria-pertussis-tetanus vaccine: Reactogenicity of commercial products" (Pediatrics 64:256, 1979) and found it useful in explaining to the parents the expected reactions from DPT.

However, I have a comment on the word REACTOGENICITY. I can't find it in my Dictionary (World Book Dictionary, 1971) and in our library's Websters 3rd New International Dictionary (1971).

Reactogenicity was used five times in the report. If I am right, reactogenicity was used to mean reactions, adverse obviously, from DPT.