bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Terbutaline and Theophylline Alone and in Combination in Exercise-Induced Bronchospasm
Authors: Shapiro Gail G. , McPhillips Joseph J. , Smith Kevin , Furukawa Clifton T. , Pierson William E. , Bierman C. Warren
Published: December 2021

Theophylline and terbutaline, alone and in combination, were evaluated for effectiveness in treating exercise-induced bronchospasm (EIB) when used at doses that should be tolerated by adolescents taking them intermittently: theophylline, 250 mg (fast release), and terbutaline, 2.5 mg. Twenty-one subjects, 12 to 19 years of age, with EIB performed standardized exercise tests on four separate days and received either theophylline, terbutaline, the combination, or placebo in a prerandomized double-blind manner prior to exercise. Exercise tests were performed two and five hours after each study drug administration. Blood samples were drawn before and again two and five hours after drug administration for theophylline level. Pulmonary function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory flow rate (FEF25% to 75%)] was recorded before and after exercise. All of the active treatments were better than placebo in diminishing EIB. The combination was statistically better than terbutaline or theophylline alone. The effect of theophylline was not significantly different from that of terbutaline. The combination induced significantly more tremor than either agent individually. Either drug alone or the two in combination is effective for diminishing EIB. Although the combination may have additive properties for some patients, the increased incidence of tremor may diminish its appeal. Either drug alone or in combination is effective in decreasing EIB for at least five hours, which makes them practical choices for treatment of school-aged children.
Influenzae b Epiglottitis and Meningitis
Authors: Walker Stuart H.
Published: December 2021

The report by Campbell et al1 extends the evidence that acute epiglottitis is pathogenetically different from other manifestations of bacteremic Haemophilus influenzae type b infection. Previously accumulated evidence indicating such a distinction includes.

1. Clinical Distinction. Epiglottitis almost never occurs in association with meningitis. Among the large number of cases of epiglottitis reported I can find but five instances2-6 in which a child with epiglottitis simultaneously or subsequently developed meningitis (and personally know of but one additional such case).
Breast-feeding by a Mother with Cystic Fibrosis
Authors: Welch Michael J. , Phelps Dale L. , Osher Alan B.
Published: December 2021

A 20-year-old white woman with cystic fibrosis who breast-fed her normal infant is described. Extensive breast milk analysis revealed normal sodium and chloride concentrations but elevated total protein and low total fat content; IgG and IgM levels were low to absent. The infant tolerated breast-feeding well, with normal growth and without infections, but the nutritional status of the mother appeared to be adversely affected. This case illustrates that breast-feeding by a mother with cystic fibrosis appears to be feasible but is fraught with difficulties.
Percutaneous Transluminal Angioplasty of Homograft Renal Artery Stenosis in a 10-Year-Old Girl
Authors: Barth Klemens H. , Brusilow Saul W. , Kaufman Stephen L. , Ferry Francis T.
Published: December 2021

Hypertension caused by 90% stenosis of a transplant renal artery was effectively treated by percutaneous transluminal angioplasty of the stenosed artery. Following dilation no pressure gradient existed across the stenosis. Hypertension had developed in a 10-year-old girl with caudal regression syndrome and recurrent pylonephritis five months following homograft transplantation for chronic renal failure. Since percutaneous transluminal angioplasty was performed, the blood pressure has remained within age-related normal limits.
Varicella Arthritis
Authors: Barton Leslie
Published: December 2021

I read with interest Dr Borgenicht's account of a patient with presumed varicella arthritis.1 Although this disease entity is rare, it is not as rare as the author would have us believe. In contrast to his statement that "no previous reports have been able to culture the virus directly from the [joint] fluid," Priest et al2 isolated varicella zoster from the joint fluid of a child with varicelia complicated by arthritis. One further point may be made.
Was the Study ‘Contaminated?’
Authors: Altemeier William A.
Published: December 2021

The article by Leib et al1 may have important implications. If, in fact, we can improve the premature infant's mental and motor development at age 6 months by enriching sensory experience through nurse orientation, we should consider widespread adoption of this practice, especially if further studies indicate the improvement persists beyond six months. This article, therefore, could have important widespread implications for the standard care of premature infants.

In the performance of behavioral research, it is important to be certain one is controlling all subjective variables because these can bias outcome to such an inordinate degree.
Dietary Chloride Deficiency
Authors: Blackman Patricia
Published: December 2021

With regard to the article entitled "The Dietary Chloride Deficiency Syndrome" (Pediatrics 66:366, 1980), if the infants mentioned had been cared for by pediatricians who believe in early feeding of infants, the problem of dietary chloride deficiency would not have occurred. In addition to their formula the infants would be getting other foods and would be unlikely to develop such a deficiency.

Having lived through the problems of diarrhea due to oversterilization and breaking down of sugars in the formula, seizures in infants due to pynidoxine deficiency in the formula, and now chloride deficiency, it still seems to me that when the child is finishing off about 4 oz per feeding, solid food can be introduced.
Subglottic Cysts: A Complication of Neonatal Endotracheal Intubation?
Authors: Couriel Jonathan M. , Phelan Peter D.
Published: December 2021

Three patients with severe upper airway obstruction due to subglottic cysts and their subsequent progress and management are described. The relationship of the lesions to intubation in the neonatal period is discussed.
The Chemically Abused Child
Authors: Shnaps Y. , Frand M. , Rotem Y. , Tirosh M.
Published: December 2021

The case of an 18-month-old child poisoned by her mother with chlorpromazine is described. Fifteen other cases of child poisoning have been previously reported. In all of these cases the assailant was the mother (who in 11 cases was described as mentally disturbed); in 14 cases the presenting sign was a change in the level of the child's consciousness; and in ten cases the agent was a psychotropic drug. These poisonings were always well planned and manipulative, usually of long duration (1½ to 48 months), and often continued during hospitalization, but lacked homicidal intent. Three children died. It is suggested that this subgroup of child abuse be more rigidly defined and possibly be named "the chemically abused child." A higher degree of suspicion and alertness to this problem would increase the number of cases identified and the number of children who receive professional care.
Letters to the Editor
Authors: Hellerstein Stanley , Duggan Eileen , Grossman Harvey
Published: December 2021

Dr Hollis states that the Neo-Mull-Soy formulas that led to the development of severe hypokalemic metabolic alkalosis in infants provided a "low sodium alkaline load diet." Based on this assumption, he outlined a mechanism for the pathogenesis of severe metabolic alkalosis in which low sodium intake is an essential feature. The data we have at hand do not confirm Hollis' assumption that the Neo-Mull-Soy marketed during the period in question showed "a very low Na+ content" relative to recommended levels.
Sepsis Screen Questioned
Authors: Murray Patrick R.
Published: December 2021

The article by Philip and Hewitt (Pediatrics 65:1036-1041, 1980) on the early diagnosis of neonatal sepsis was interesting, but their conclusions may be misleading. They demonstrated that when at least two of five screening tests were positive (band/total neutrophils, leukocyte counts, latex C-reactive protein, erythrocyte sedimentation rate (ESR), and latex haptoglobin), neonatal sepsis could be accurately predicted in 28 of 30 (93%) infants. Two or more tests were also positive for 43 of 346 (12%) infants without proven sepsis.
State of Awakeness During Visual Fixation in Preterm Infants
Authors: Hack Maureen , Muszynski Susan Yulish , Miranda Simon B.
Published: December 2021

To demonstrate the presence of discriminable awake states in preterm infants, facial behaviors and visual fixation to a single patterned stimulus were recorded. Five healthy preterm infants born at a mean of 29 weeks' gestation were followed from 30 to 35 weeks' postmenstrual age. Behaviors (eye openness, movements, mouthing, and vocalizations) were recorded simultaneously with visual fixation measured by the corneal reflection technique. Test time was determined by the duration of time the infant remained awake before crying or closing eyes. The presence of both quiet awakeness and drowsiness was demonstrated. Younger infants spent more time in drowsiness, whereas older infants had more quiet awakeness. Visual pattern fixation was observed as early as 30 weeks. Fixation time increased with increasing postmenstrual age. More fixation was observed during quiet awakeness than during drowsiness.
Newborn Risk Factors and Costs of Neonatal Intensive Care
Authors: Phibbs Ciaran S. , Williams Ronald L. , Phibbs Roderic H.
Published: December 2021

To understand the sources of the high costs of neonatal intensive care, financial and medical information on 1,185 admissions to an intensive care nursery was gathered. Multiple regression analysis showed that a significant portion of the variation in individual costs was explained by three measures of risk: low birth weight, surgical intervention, and assisted ventilation. There was a highly skewed distribution of costs. Nearly half of all admissions had none of the above risk factors, had an average cost of about $2,000, and accounted for only 13% of the total costs for the whole sample. In contrast, less than one quarter of the admissions had two or more of the risk factors, had an average cost of $19,800, and accounted for nearly 60% of the total costs. Models that predict costs and length of stay on a basis of seven risk factors were developed to allow for differences in patient populations.
Preparation of Children for Hospitalization in Acute Care Hospitals in the United States
Authors: Azarnoff Pat , Woody Patricia D.
Published: December 2021

To study the prevalence and nature of psychological preparation for pediatric care, children's hospitals and acute care general hospitals were surveyed, and 24 hospitals were visited. Of 1,427 hospitals responding, 468 (33%) provided regular, planned preparation services. Prior to hospitalization, group tours and group discussion were the two most frequently used methods. During hospitalization, children learned informally as events occurred, usually through conversations.
Treasured Objects in School-Aged Children
Authors: Sherman Miriam , Hertzig Margaret , Austrian Rochelle , Shapiro Theodore
Published: December 2021

Infants and young children often form tenacious, persistent attachments to soft objects. No investigation has focused, specifically, on an older school-aged population. Data were collected from parents of 171 normal children between 9 and 13 years of age from the middle to upper socioeconomic class. The study (1) compared current behavioral characteristics of children with or without a history of attachment; (2) compared the current behavioral characteristics of the children who have or have not maintained that attachment; (3) explored the relationship between parental attitudes and the persistence or disappearance of the object; and (4) explored family demographics and object use among siblings. Approximately half (54%) had formed an attachment to an object in infancy. Of the group of "users" approximately half kept it until age 9 years (49%). There were no significant behavioral differences among those children who were or were not attached to an object, or among those children who continued to use a soft object after age 9 years compared to those who never used one at all. Parents felt they had little to do, directly, with their child's relinquishing the object. Sibling use, the number of siblings, ordinal rank of the child, parents' marital status, sex of the child, and history of thumbsucking were all unrelated to object attachment.
Juvenile Ankylosing Spondylitis and Aortic Regurgitation: A Case Presentation
Authors: Gore Johnny E. , Vizcarrondo Felipe E. , Rieffel Clement N.
Published: December 2021

Juvenile ankylosing spondylitis has its onset in childhood. Aortic insufficiency occurs in children and may precede the onset of symptoms of spondylitis. It may first be seen as peripheral arthritis and aortic valvulitis before clinically evident sacroiliitis is apparent. The HLA B27 marker makes it possible to identify those patients at increased risk for development of ankylosing spondylitis.
Does a Vote of 118 to 1 Mean the USA Was Wrong?
Authors: Lucey Jerold F.
Published: December 2021

Picture yourself, a doctor living in a Third World country frustrated by the failure of your efforts to change poverty, malnutrition, and poor sanitation. Little wonder that you would choose to attack rich foreign companies if you thought they contributed to your problems. You would also feel great if the whole world joined you in condemning such companies. When the turmoil had settled, however, and you realized that you may have been wrong, or at least lacked proper evidence, you might not feel so self-righteous.

The final vote in the World Health Organization was 118 to 1. The United States was the one! Does that mean that the United States was wrong?
STATEMENT ON TERMINOLOGY FROM THE NATIONAL SIDS FOUNDATION
Authors: Friedman Stanford B. , Bergman Abraham B. , Mandell Frederick , Vales-Dapena Marie A. , Connelly John P. , Merritt T Allen
Published: December 2021

We are concerned about increasing usage of the terms ‘near-miss for SIDS’and ‘aborted SIDS’ which tend to create confusion about the relationship between apnea and the sudden infant death syndrome. The latter was defined in 1969 as the sudden, unexpected and unexplained death of an apparently healthy infant. The role of apnea in the causation of these inexplicable deaths is currently the subject of intensive scientific investigation—and not yet fully clarified. Some infants who die suddenly and inexplicably may well represent instances of death due directly to episodes of not breathing. However, it is probable that there remain other as yet unidentified or unproven causes.

Therefore, we propose that the term ‘infantile apnea’ be used when appropriate, in place of ‘near-miss for SIDS’ or ‘aborted SIDS.’ Apnea has many causes, some known and some unknown.
Neonatal Manifestations of Maternal Phencyclidine (PCP) Abuse
Authors: Strauss Arthur A. , Modanlou Houchang D. , Bosu Sogba K.
Published: December 2021

Two cases concerning newborn infants whose mothers used phencyclidine (PCP) during pregnancy are described. The neonatal symptoms of maternal PCP abuse were jitteriness, hypertonicity, vomiting, and one case of diarrhea. In both infants, PCP was detected in the urine during the first few days of life. Both infants were successfully treated with phenobarbital but they continued to remain jittery and slightly hypertonic following discontinuation of the therapy. In one case the infant was noted to be microcephalic. In the neonate, the symptoms of maternal PCP abuse are similar to the symptoms of narcotic withdrawal. The diagnosis of PCP effects in the neonate can be confirmed by urinalysis for the drug. The teratogenicity of PCP remains a possibility. The metabolism and treatment of PCP effects in the newborn need further clarification.
ANTHONY TROLLOPE ON THE SUPERIORITY OF AMERICAN FREE SCHOOLS COMPARED TO THOSE IN ENGLAND (1862)
Authors: C. T. E.
Published: December 2021

Anthony Trollope (1815-1882) followed most of his English predecessors who wrote about their American travels in attributing the chief glory of our country to our provision for universal free education.

He wrote1:

The one thing in which, as far as my judgment goes, the people of the United States have excelled us Englishmen, so as to justify them in taking to themselves praise which we cannot take to ourselves or refuse to them, is the matter of education; and unrivalled population, wealth, and inteffigence have been the results; and with these, looking at the whole masses of the people, I think I am justified in saying, unrivalled comfort and happiness. It is not that you, my reader, to whom, in this matter of education, fortune and your parents have probably been bountiful, would have been more happy in New York than in London. It is not that I, who, at any rate, can read and write, have cause to wish that I had been an American. But it is this: if you and I can count up in a day all those on whom our eyes may rest, and learn the circumstances of their lives, we shall be driven to conclude that nine tenths of that number would have had a better life as Americans than they can have in their spheres as Englishmen.

If a man can forget his own miseries in his journeyings, and think of the people he comes to see rather than of himself, I think he will find himself driven to admit that education has made life for the million in the Northern States better than life for the million is with us.
Subgaleal Hematoma from Hair Combing
Authors: Falvo Cathey E. , San Filippo J. Anthony , Vartany Alexandre , Osborn Emilie H. S.
Published: December 2021

We have seen two young black girls with massive subgaleal hematoma apparently caused by traction on their scalp during hair combing.

CASE REPORTS

Case 1

A 9-year-old girl was seen in the emergency room with the complaint of tender swelling of the entire scalp. Trauma was denied. The child wore her hair in rows of tight braids. There was fluctuant swelling of the entire scalp. No other stigmata of battering were found. Results of the following laboratory tests were normal: hemoglobin, hematocrit, prothrombin time (PT), partial thromboplastin time (PTT) and platelet count. Skull roentgenogram showed only soft tissue swelling. Aspiration produced 130 ml of nonclotting blood.
Diagnosis of Dihydropteridine Reductase Deficiency by Erythrocyte Enzyme Assay
Authors: Narisawa Kuniaki , Arai Nobuhiro , Hayakawa Hiroshi , Tada Keiya
Published: December 2021

Patients with hyperphenylalaninemia caused by dihydropteridine reductase (DHPR) deficiency, who show progressive cerebral degeneration despite adequate dietary treatment, may respond to neurotransmitter therapy if the diagnosis is made early.1 The diagnosis of this disorder is therefore urgent. A number of methods that had been shown to be of value in the diagnosis of the disease were discussed previously.2-4 A newer screening method for DHPR mutants that was based on measurement of the reduction state of biopterin in urine by high performance liquid chromatography was described by Milstien et al.5 Furthermore, recently leukocyte enzyme assays6,7 have been used in the diagnosis of DHPR deficiency.
Letters to the Editor
Authors: Leonidas John C. , Bhan Ina , McCauley Roy G. K.
Published: December 2021

We appreciate the comments of Moskowitz et al regarding our hypothesis of intralymphatic air entrapment in persistent pulmonary interstitial emphysema of the newborn. It is true that electron microscopy was not carried out in our tissue specimens. There is, however, substantial indirect evidence, in addition to morphologic features by light microscopy, lending support to our thesis that relatively large amounts of interstitial gas dissect into lymphatics and set up events leading to persistent interstitial pulmonary emphysema in ventilated newborns.
What's the Difference? Pediatric Residents and Their Inaccurate Concepts Regarding Statistics
Authors: Friedman Stanford B. , Phillips Sheridan
Published: December 2021

Two multiple-choice questions were designed to assess pediatric residents' knowledge of two statistical concepts: (1) correlation and (2) probability values for statistical significance. One question was administered to 684 residents from 24 major pediatric training programs; this response rate represented 84% of all residents in these programs (PL-1, PL-2, and PL-3 years). In 20 of these programs, the second question was administered to 437 residents, representing a 79% response rate. Less than 20% of the residents responded correctly to the first question, and approximately half chose correctly on the second question. Further, no trend toward improvement was apparent with additional years of residency training. This limited knowledge of statistical concepts suggests that pediatricians are not well equipped to evaluate the scientific merit of research reported in pediatric journals.
"VULTURE, INDEED!"
Authors: Pulver Nathaniel J.
Published: December 2021

How, now, Dr. Callanan! Wouldst picture us as vultures? Hovering to "devour"

Would you pull the tubes The life-giving tubes? The "magic" of medicine?

Do we not wait with Hope that the magic of our gift will infuse Life?

Is not our craft God-given. Are we not frustrated that the tubes and wires do not always Fulfill our Hopes.

We could hover and circle and watch like manacled prisoners, but not like vultures.

Vultures await Death. Physicians anticipate Life. We do not profit from death as vultures do.

How, now, Dr. Callanan, If thou thinkest of thyself as a vulture, Do not include us!
Apparent Resurgence of Tuberculosis in Urban Children
Authors: Inselman Laura S. , El-Maraghy Nadia B. , Evans Hugh E.
Published: December 2021

An apparent increase in incidence of pulmonary and extrapulmonary forms of tuberculosis was observed in children in an inner-city community in New York City. This occurred during years in which the case rates of tuberculosis declined in the city and the nation. Two unusual presentations of childhood tuberculosis are described. This experience suggests that physicians should be more aware of the diagnosis of tuberculosis in children and that routine tuberculin skin testing with 5 TU of purified protein derivative (PPD) should be continued, with emphasis on testing in high-risk areas. Adequate funding of detection and treatment programs may prevent reemergence of this disease.
Nature and Rates of Adverse Reactions Associated with DTP and DT Immunizations in Infants and Children
Authors: Cody Christopher L. , Baraff Larry J. , Cherry James D. , Marcy S. Michael , Manclark Charles R.
Published: December 2021

In 784 DT and 15,752 DTP immunizations given to children 0 to 6 years of age who were prospectively studied for reactions occurring within 48 hours following immunization, minor reactions were significantly more frequent following DTP vaccine. The ratio of reaction rates associated with DTP and DT immunizations (DTP/DT) for selected local and systemic reactions was as follows: local redness, 37.4%/7.6%; local swelling, 40.7%/7.6%; pain, 50.9%/9.9%; fever, 31.5%/14.9%; drowsiness, 31.5%/14.9%; fretfulness, 53.4%/22.6%; vomiting, 6.2%/2.6%; anorexia, 20.9%/7.0% and persistent crying, 3.1%/0.7%. Following DTP immunization nine children developed convulsions and nine developed hypotonic hyporesponsive episodes. No sequelae were detected following these reactions.
SIR WILLIAM WILDE, ONE OF IRELAND'S GREATEST EYE AND EAR SURGEONS AND FATHER OF OSCAR WILDE, ON EYESTRAIN AS A CAUSE OF VISUAL IMPAIRMENT
Authors: C. T. E.
Published: December 2021

Sir William Wilde (1815-1876) is remembered today, if at all, as the father of Oscar Wilde. Largely forgotten is that he was not only a distinguished archeologist and statistician but also the dominant figure in otology and ophthalmology of the Dublin School of Medicine, which was at its peak during his lifetime.1

Like most of his ophthalmologic contemporaries he believed that eyestrain led to visual impairment.

He wrote2:

In these days of forced education on the one hand, when unhappy children are compelled, both by parents and teachers, to pore over books, often of very small type, for hours and hours together, with the head bent, the shoulders stooped, the abdomen compressed, and the legs often dangling in the air, in crowded, badly illuminated, and illventilated apartments;— when young ladies in the upper circles, and those girls in the middle ranks who are preparing to be governesses and teachers, are obliged to "practice" and read music for five and six hours a day;—when young gentlemen are induced, either by threats or emulation, to read for eight and ten hours a day, and in addition several hours of the night, under the glare of a strong gas light, in order to uphold the character of a school or master at the risk—often at the expense of sight and life—when on the other hand, unfortunate tradesmen are compelled by low wages, the high price of provisions, and scarcity of work, to support their almost starving families by working in dark, damp cellars and garrets for fourteen or sixteen hours a day;—and when poor seamstresses and milliners are necessitated by the fashionable luxuries of the upper classes to work for no less than eighteen hours out of the twenty-four;—and when we add to this the various factories and private trades which require the continuous application of the eye to minute objects, we wonder not that near-sightedness and impaired or altered vision should be now so common amongst us.
Teenagers' Preferences Regarding the Presence of Family Members, Peers, and Chaperones During Examination of Genitalia
Authors: Phillips Sheridan , Friedman Stanford B. , Seidenberg Michael , Heald Felix P.
Published: December 2021

During physical examinations that include the genitalia, teenagers are typically separated from their parents and females are provided with a chaperone. To assess teenagers' attitudes regarding this practice, 140 females and 60 males awaiting treatment in a general adolescent clinic were asked their opinion about a physical examination that included the genitalia. Teenagers indicated whether they would want to be accompanied during the examination, and by whom, as a function of the hypothetical clinical situation that varied the sex and familiarity of the physician. Choices reflected teenagers' age and sex, rather than physician characteristics. Young males and females strongly preferred to be accompanied, generally by a family member. With increasing age, males preferred to be alone with the physician whereas females preferred to be accompanied. Regardless of sex and age, virtually none chose the company of peers. Despite strong developmental differences, however, there also were pronounced individual differences among teenagers of the same age. Our results suggest that service delivery be adapted to the particular preference expressed by individual teenagers. Needs assessment for adolescent programs may best be achieved by conducting similar surveys in local clinical settings.
Cholesterol, Children, and Heart Disease: An Analysis of Alternatives
Authors: Berwick Donald M. , Cretin Shan , Keeler Emmett
Published: December 2021

Cost-effectiveness analysis is used to compare proposed cholesterol control programs. The analysis employs estimates of such biologic variables as effect of diet on cholesterol level, stability of level, and change in morbidity with level. Sensitivity analysis identifies the biologic and behavioral uncertainties that most critically affect policy choices. At a discount rate of 5%, a cholesterol-screening program for all 10-year-old children would cost about $10,000 per year of life saved. Rescreening would not improve efficiency. Targeted screening of high-risk children could improve efficiency by 25%, but would benefit only one sixth as many people. Community-wide interventions without screening may be more efficient by a factor of 3. The cost per year of life saved is most affected by the rate of discount and the dollar cost of changing behavior, but is insensitive to stability of cholesterol rank order and to the cost of screening.
Speech Effect of Theophylline
Authors: McCarthy Michael M.
Published: December 2021

Although symptoms of generalized central nervous system stimulation (eg, irritability, restlessness, and insomnia) are recognized side effects of oral theophylline therapy,1,2 I have recently encountered a patient who exhibits a single, isolated behavioral change while receiving theophylline. Review of pertinent literature reveals no similar reported cases.

This 4-year-old white boy developed asthma at age 17 months. Poor symptomatic control during the past six months has necessitated two hospitalizations and three short courses of oral corticosteroids.
Retrolental Fibroplasia and Blood Transfusion in Very Low-Birth-Weight Infants
Authors: Sacks Linda M. , Schaffer David B. , Anday Endla K. , Peckham George J. , Delivoria-Papadopoulos Maria
Published: December 2021

The relative contribution of transfusions of adult blood to the development of retrolental fibroplasia (RLF) in very low-birth-weight infants was examined. Five years of experience with the expanded use of replacement and exchange transfusions in 90 infants with birth weight ≤1,250 gm was reviewed. Twenty percent of the infants developed cicatricial RLF. Exchange transfusion was not related to development of cicatricial RLF. The incidence of RLF in infants receiving ≥130 ml of packed red blood cells per kilogram of birth weight as replacement blood transfusion (RBT) was significantly higher (42.9%) than that in infants receiving 61 to 131 ml of packed red blood cells per kilogram (15.4%) and infants receiving ≤60 ml of packed red blood cells per kilogram (0%), P < .001. The need for RBT, however, was strongly correlated (r = .85, P < .001) with increasing duration of O2 therapy. When O2 therapy was controlled for, the association between RBT and RLF did not achieve statistical significance (P = .07). The association between RBT and RLF remained significant when adjusted for duration of therapy in fractional inspired oxygen (FIO2) >0.4. Further detailed studies of large numbers of susceptible infants are warranted to assess the magnitude of the contribution of transfusions of adult blood to development of RLF.
Response to Rapid Volume Expansion During the Postnatal Period
Authors: Daniel Salha S. , James L. Stanley , Strauss Jose
Published: December 2021

The relationship between V, CIN, and CPAH before and during diuresis as a result of infusion of D5W is shown in Figs 3 and 4; the relationship between V, osmolal clearance (COSM), and free water clearance (CH2O) is represented in Figs 5 and 6. The various clearances have been plotted against urine volume and compared with the regression lines for 17 infants (including seven in this paper) during the first three hours of life and prior to receiving an infusion.4 Despite a considerable scatter of data, there is no significant difference in the various correlations before and after infusion.

A small decrease in fractional water reabsorption was observed after infusion, but not during spontaneous diuresis. No change in fractional osmolal reabsorption was observed during either spontaneous or infusion diuresis (Tables 2 and 3).

In Table 4 the mean changes in the various measurements of renal function measured with infusion are compared with those occurring during spontaneous diuresis in the same infants. Again, except for the percentage of water reabsorbed after the infusion, there were no differences in the responses with the spontaneous diuresis compared to those observed after the infusion.

See Images in the PDF File

See Images in the PDF File

See Images in the PDF File

See Images in the PDF File

See Table in the PDF File

DISCUSSION

Newborn infants during the first four hours of life are capable of having a prompt diuresis in response to an infusion of isotonic glucose. This diuresis is accompanied by an increase in renal plasma flow (RPF) and glomerular filtration rate (GFR).
Iron Deficiency and Behavioral Deficits
Authors: Deinard Amos , Gilbert Anne , Dodds Michele , Egeland Byron
Published: December 2021

In an attempt to investigate the relationship of iron deficiency and mental status, cognitive development and attending behavior were assessed in nonanemic children aged 11 to 13 months who were severely or mildly iron deficient or were iron replete. Using two different approaches to the assessment of cognitive development and an habituation measure as an index of attending behavior, no statistically significant differences could be demonstrated in the overall level of performance between the iron-depleted and the iron-replete children. Isolated differences were demonstrated on a scale that measured fearfulness and on several of the scales that measured sensory areas of interest displayed.
Milk Feeding Patterns in the United States During the First 12 Months of Life
Authors: Martinez Gilbert A. , Dodd David A. , Samartgedes Jo Ann
Published: December 2021

From 1955 to 1980, mail questionnaires were administered to a nationally representative sample of mothers to determine the use of various milks for feeding infants during the first 6 months of life. Data from these surveys have demonstrated the resurgence of breast-feeding both in incidence and duration, and this increase has occurred across all income and educational levels. Statistical analysis indicated that the trends were significant (P < .01) for all demographic categories surveyed. In January 1980, a bi-monthly telephone survey of mothers of infants 8, 10, and 12 months of age was initiated to determine milk use during later infancy. A combination of data from the mail and telephone surveys for 1980 provided information on milk feeding patterns for the first 12 months of life.
Schatzki Ring in a Newborn
Authors: Klein Michael D. , Waltner James , Ball William , Kosloske Ann M.
Published: December 2021

The lower esophageal contraction ring was first described by Templeton,1 but Schatzki and Gary2 in 1953 defined it as a distinct entity. Since this initial report, a consensus about some features of the lower esophageal ring has been reached. Most authors agree that it can be either symptomatic or asymptomatic. Symptoms of esophageal obstruction or inflammation can be associated with or ascribed to this ring, and its occurrence in association with symptoms indicates some form of therapy. The ring can be found in association with hiatal hernia. It occurs at the junction of squamous and columnar mucosa,3 and histologically it demonstrates minimal inflammation involving only the mucosal layer.4
Biliary Atresia
Authors: Altman R. Peter
Published: December 2021

Since Kasai et al1 demonstrated convincingly that biliary atresia was a treatable, and in some instances curable condition, the approach to the jaundiced infant has changed dramatically. Efforts to identify infants with this disease were greatly accelerated as the "hands off" philosophy, predicated on the assumption that attempts to correct biliary atresia would be futile, gave way to a more aggressive approach. Inevitably, this led to a proliferation of diagnostic studies, each attempting to discriminate between intrahepatic cholestasis and extrahepatic atresia of the bile ducts. Many of these studies purported to be helpful are, in fact, of little value. Undoubtedly, this is because biliary atresia is not exclusively a condition afflicting the bile ducts, ultimately resulting in obstruction.
Secondary Citrullinemia with Hyperammonemia in Four Neonatal Cases of Pyruvate Carboxylase Deficiency
Authors: Coude F. X. , Ogier H. , Marsac C. , Munnich A. , Charpentier C. , Saudubray J. M.
Published: December 2021

Numerous cases of pyruvate carboxylase (PC) deficiency have been reported since its first description in 1968.1 We had the opportunity to study four neonates with this disorder. All patients had similar clinical and biochemical findings. Symptoms started during the first day of life with acute metabolic acidosis and lethargy. Serum lactic acid was always high (10 to 20 mM) with a lactate-pyruvate ratio between 50 and 100. Serum βOH butyrate was normal or slightly elevated but the βOH butyrate-acetoacetate ratio was constantly less than 1.
Asymptomatic Neonatal Familial Hypercalcemia
Authors: Orwoll Eric , Silbert John , McClung Michael
Published: December 2021

Although rare, primary hyperparathyroidism in infancy has been characterized as a universally severe, potentially lethal disorder. In the 18 reported cases,1-15 the clinical presentation has been one of moderate to severe hypercalcemia and failure to thrive, with anorexia, hypotonia, constipation, and bone disease. Nine of the eighteen cases resulted in death.2-5,7-9,11-13,15 No untreated infants have survived. Several authors4,8,11 have stressed the fatal outcome of untreated infantile hyperparathyroidism and have recommended early parathyroidectomy.

In marked contrast to previous descriptions of infantile hyperparathyroidism, we report hypercalcemia in a neonatal member of a kindred with familial hypercalcemia. In this infant hypercalcemia has thus far been unassociated with any apparent impairment of growth or development.
Hypervitaminosis A: A Case Report
Authors: James Melton B. , Leonard Joe C. , Fraser John J. , Stuemky John H.
Published: December 2021

In his textbook, Pediatric X-Ray Diagnosis, Caffey1 makes the statement that "until the whole truth becomes available to the public, all authentic cases of Vitamin A poisoning be carefully recorded and widely published in the medical literature." Since Josephs2 first described this condition in children in 1944, more than 50 cases have appeared in the literature.3 The following case, initially viewed as a diagnostic dilemma, was subsequently recognized to have typical clinical, biochemical, and rediographic changes of hypervitaminosis A. In addition, bone scintigraphy demonstrated evidence of involvement in radiographically normal areas.

CASE REPORT

A 5-year-old, nonimmunized, white girl was diagnosed as having measles in late April 1980.
Retardation of Neuronal Maturation in Premature Infants Compared with Term Infants of the Same Postconceptional Age
Authors: Takashima Sachio , Becker Laurence E. , Chan Fu-Wah
Published: December 2021

Neuronal morphologic development and the number of soma and spines in the visual cortex were investigated. Ten premature infants surviving at least three weeks were compared with control infants who had been born at term gestation and had the same postconceptional age. In six cases of sudden infant death syndrome, bronchopulmonary dysplasia, or patent ductus arteriosus, neuronal development was similar to that in the control cases. The persistence of immature neurons in two of the remaining four cases suggested a developmental neuronal delay or arrest.
Fever in Full-Term Newborns in the First Four Days of Life
Authors: Voora Sambasivarao , Srinivasan Gopal , Lilien Lawrence D. , Yeh Tsu F. , Pildes Rosita S.
Published: December 2021

Over a period of 18 months, 100 full-term newborns developed an axillary or a rectal temperature ≥37.8 C during the first four days of postnatal life. These febrile term newborns represented 1% of all full-term newborns in the normal nursery. Of the febrile newborns, 10% had culture-proven bacterial disease (BD). Fever developed in 54%, 27%, 13%, and 6% on the first, second, third, and fourth days, respectively. In 17 newborns fever developed within the first hour of life; 13 of these had mothers with fever and two others were under a radiant warmer in the birth room. Fever occurring on the third day of postnatal life had a significantly higher chance of being associated with BD than fever occurring at any other time in the first four days of postnatal life. Newborns with temperature ≥39 C had a significantly higher incidence of BD than newborns with temperature <39 C. The incidence of fever among breast-fed newborns (0.98%) was similar to that of formula-fed newborns (1.01%). Of the 100 febrile newborns, 45 had other symptoms compatible with BD, and eight of these had proven BD (group B Streptococcus in five, group D Streptococcus in one, Shigella D in one, and Propionibacterium species in one). The two other febrile newborns with proven BD had no other symptoms of infection (group B Streptococcus and Escherichia coli). Mean WBC count of febrile newborns with BD was significantly lower than that of febrile newborns without BD. Only three febrile newborns had WBC count <5,000/cu mm and two of them had proven BD. Febrile newborns should be evaluated and treated with antibiotics when they have symptoms of infection other than fever or when the fever persists or recurs.
Fetal Gonorrhea with Deep Tissue Infection Occurring in Utero
Authors: Oppenheimer Ella H. , Winn Kevin J.
Published: December 2021

An unusual case of gonorrhea in utero is reported. The 30-week-old fetus died in utero at least four hours prior to delivery. Infection, therefore, occurred by aspiration of infected amniotic contents rather than by the more common route of passage through an infected birth canal. The infection resulted in deep-seated fetal tissue inflammation. Neisseria gonorrhoeae was cultured from maternal and fetal tissues and Gram-negative diplococci were stained in microscopic sections.
Selenium Sulfide: Adjunctive Therapy for Tinea Capitis
Authors: Allen Herbert B. , Honig Paul J. , Leyden James J. , McGinley Kenneth J.
Published: December 2021

Selenium sulfide lotion used as a shampoo has been shown to be an effective adjunctive agent to griseofulvin in the treatment of tinea capitis. Of 16 children with Trichophyton tonsurans infections 15 had negative fungal cultures at two weeks following a regimen of daily oral griseofulvin and selenium suffide shampooing twice weekly. All patients treated with griseofulvin alone or in combination with either a bland shampoo or topical clotrimazole had positive cultures not only at the two-week interval but also as long as eight weeks later. In vitro analysis shows selenium sulfide to be sporicidal, correlating well with the in vivo observations. It is postulated that selenium sulfide usage may lessen the chances for spreading of infectious spores to other individuals.
Effect of Duration and Frequency of Breast-Feeding on Postpartum Amenorrhea
Authors: Ojofeitimi E. O.
Published: December 2021

The relationships among duration and frequency of breast-feeding, age, level of education, and parity on postpartum amenorrhea were investigated retrospectively in selected married Nigerian women attending the two local maternity centers in Ile-Ife, Nigeria, between January and May 1980. The mean values for duration and frequency of breast-feeding per day were 16.48 ± 5.43 (SD) months and 4.43 ± 1.46 (SD), respectively. The mean length of postpartum amenorrhea was 12.54 ± 6.97 (SD) months. Duration and frequency of breast-feeding were positively related to length of postpartum amenorrhea, whereas parity and years of maternal education were negatively related to it. Duration and frequency of breast-feeding were statistically significant (P < .05), whereas maternal level of education, parity, and age were not. The implications of the findings for pediatricians and other health workers who may wish to promote breast-feeding among their nursing clients are highlighted.
Acrodermatitis in Breast-Fed Premature Infants: Evidence for a Defect of Mammary Zinc Secretion
Authors: Zimmerman Andrew W. , Hambidge K. Michael , Lepow Martha L. , Greenberg Robert D. , Stover Mary L. , Casey Clare E.
Published: December 2021

Two 9-week-old, breast-fed premature infants developed acrodermatitis and hypozincemia because of low zinc content in their mothers' breast milk. All symptoms of zinc deficiency disappeared within seven days after the infants were treated orally with zinc and did not recur when zinc was discontinued after 11 months (infant 1) and three weeks (infant 3). After a subsequent term pregnancy, one of the mothers had lower breast milk zinc content (P < .025) and greater exponential decline (P < .025) of zinc content through 40 weeks of lactation compared with 34 control subjects. Her second infant (infant 2) had hypozincemia at 7 months of age but did not develop clinical zinc deficiency. When the mothers of the affected infants took oral zinc supplements, there was no increase in their breast milk zinc content. Zinc secretion into breast milk appears to be a controlled process that is independent of maternal zinc intake or serum zinc level. Breast milk may be low in zinc because of defective mammary secretion and this may lead to severe symptomatic zinc deficiency in premature infants.
Basophil Releasability in the Newborn: Factors Limiting Immunoglobulin E-Mediated Histamine Release
Authors: Mendoza Guillermo R. , Minagawa Kiminobu , Orner Francine B. , Stiehm E. Richard
Published: December 2021

Cord basophil preparations from 53 term neonates were studied for various factors affecting immediate hypersensitivity reactions including: basophil IgE receptor density and histamine releasability following incubation with calcium ionophore A23187, zymosan-activated serum (C5a), and anti-IgE. Basophil histamine content (geometric mean, 0.4 pg/basophil, with content in 14/28 cord blood samples below 0.2 pg/cell) is considerably below that of atopic and nonatopic individuals (geometric mean, 2.3 pg/basophil). Histamine release is normal with both A23187 (range 33% to 88%) and C5a (range 11% to 58%). Normal release with anti-IgE was shown in five of nine cord blood samples (range 13% of 52%), but four of five cell preparations required IgE preincubation. Indirect evidence indicates that basophils from newborns contain less than 30,000 total IgE receptors /cell. IgE-mediated histamine release in basophils from newborns is minimized by suboptimal IgE binding. Optimal IgE binding is not favored in basophils from neonates because of low serum IgE and low IgE receptor density. Serum IgE and IgE receptors increase to a variable degree as the child grows older and may determine the clinical onset of allergic disease.
Serum Antibody Response to Pneumococcal Vaccine in Children with Nephrotic Syndrome
Authors: Spika John S. , Halsey Neal A. , Fish Alfred J. , Lum Gary M. , Lauer Brian A. , Schiffman Gerald , Giebink G. Scott
Published: December 2021

Children with nephrotic syndrome are susceptible to serious pneumococcal disease and may be immunodeficient on the basis of abnormal humoral immune responses to natural antigens or immunoglobulin loss during relapse. As part of an ongoing study to evaluate pneumococcal anticapsular antibody concentration and immunologic competence, 27 steroid-responsive and six steroid-resistant patients with nephrotic syndrome, and 12 age-matched control subjects, were vaccinated with polyvalent pneumococcal vaccine. Antibody responders were defined as patients with at least a twofold increase in antibody after vaccination, as well as an antibody concentration greater than 200 ng of anticapsular antibody nitrogen per milliliter (ngN/ml) after vaccination. Pneumococcal antibody concentrations before and after vaccination were significantly depressed in steroid-resistant patients when compared with control subjects (P < .002) and with the steroid-responsive nephrotic syndrome group (P < .001). Steroid-responsive nephrotic children who were not receiving corticosteroid therapy at the time of vaccination had significantly higher antibody concentrations to five pneumococcal types before vaccination and to seven types after vaccination compared with control subjects (P < .05). Fewer steroid-responsive patients receiving corticosteroids achieved antibody concentrations ≥200 ngN/ml against type 19F compared with patients not receiving steroids or with control subjects (P < .05). These results suggest that pneumococcal vaccine is immunogenic in children with steroid-responsive nephrotic syndrome and may protect these patients from disease due to pneumococcal types contained in the vaccine.