bluuebunny/crossref_metadata_2025 huggingface dataset:
Lettrt To The Editor
Authors: Falletta John M. , Starling Kenneth A. , Fernbach Donald J,
Published: December 2021

Our comments on the discordance of leukemia in monozygotic (MZ) twins were based on the assumption that such twins have an identical genome, at least prior to a leukemogenic event. Dr. Feehan correctly points out that this view requires some qualification. Although cytoplasmic inheritance may contribute to differences between MZ twins, asymmetry of implantation and circulation as well as somatic mutation and chromosal defect may also lead to discordance in the expression of a disorder.1,2
Minor Vulval Injury Presenting as Acute Urinary Retention
Authors: Mattar Mary E.
Published: December 2021

Traumatic tear of the fourchette should be strongly considered in any case of urinary retention of acute onset in girls through the active years of early childhood. Relief of the problem is dramatic, following the measures described.
Chemoreceptor Reflexes in Preterm Infants: II. The Effect of Gestational and Postnatal Age on the Ventilatory Response to Inhaled Carbon Dioxide
Authors: Rigatto Henrique , Brady June P. , de la Torre Verduzco Rafael
Published: December 2021

We studied nine "healthy" preterm infants (birthweight, 1,000 to 2,000 gm) 58 times during postnatal life to define the effects of gestational and postnatal age on the ventilatory response to carbon dioxide. The infants were given air and 2% and 4% carbon dioxide in air to breathe for five minutes each. We determined respiratory minute and tidal volumes, frequency, heart rate, and alveolar Pco2 and Po2. We measured ventilation with a nosepiece and a screen flowmeter, using a constant flow-through to eliminate valves and reduce dead space. Analyses were made during the fifth minute while the baby breathed the various gas mixtures. The slope of the carbon dioxide response increased 42% from 32 to 37 weeks gestation (P < .05) and 62% from 2 to 27 days of age (P < .025). However, the intercept at .3 liter/mm/kg was the same at different gestational ages, but significantly greater at 2 compared with 27 days of age (P < .05). We suggest that the unresponsiveness with increasing prematurity is primarily central and that after birth is primarily dependent on the mechanical abnormalities of the lung.
CULTIVATING THE FAMILY
Authors: Mumford Lewis
Published: December 2021

The culture of the family requires time, patience, and fuller participation by all its members; and for its personal sustenance, interest must be awakened on its spiritual side: its history and biography. The antiquarian search for a family tree is too often the lowest snobbism; but the actual planting and cultivating of the family tree is a different matter. That is worthy of everyone's highest skill and immediate attention. . . . So for us the widespread keeping of family records is at least mechanically an easy job: spiritually it will require immense effort, before we pour into the work all the love and skill that it demands. The writing of journals, psychological records, and family histories beginning with the here and now should be one of the most grateful tasks for parents: the gathering of souvenirs, memorabilia, drawings, the recording of anecdotes and stories—all these things will build up that past which will form a bridge, over the most turbid autumnal torrent, to a firmer, finer future.
Percutaneous Cardiac Catheterization of the Neonate
Authors: Carter Guy A. , Girod Donald A. , Hurwitz Roger A.
Published: December 2021

A modified Seldinger percutaneous approach for catheterization was used for cardiac evaluation and monitoring of infants weighing less than 4,520 gm. From January 1968, through April 1971, 160 left- and 230 right-sided cardiac procedures were done. After July 1969 81% of all left- and 42% of all right-sided procedures were done percutaneously. After October 1969 catheters were also inserted percutaneously in 20 infants for intensive care monitoring. During this period three children were noted to have diminished pulse on discharge, two were noted to have vascular thrombosis, and two had episodes of bleeding from the catheter site requiring transfusion of fresh blood. Both instances of vascular thrombosis occurred in infants with monitoring catheters.

The percutaneous method of catheter insertion into the femoral vessels offers a safe method for cardiac catheterization of the neonate and of insertion of monitoring catheters where the umbilical route is not feasible. Vessel continuity is also preserved, providing a route for repeated studies if necessary.
COMPLETION OF THE 1,000 FAMILY STUDY
Authors: H. R. J.
Published: December 2021

Long awaited, the final book in the trilogy reporting the remarkable longitudinal study of 1,000 families and their children in Newcastle Upon Tyne, England has now appeared.1 No summary can do justice to the data, the quality of the writing, or the insights into the health needs of children which reading this book will provide. "The chief determinants of performance—biologic growth, injury and disease, social adaptation, and educational attainments—are so interrelated that separation, even for classification and description, brings a sense of artificiality." This statement from the book emphasizes the dangers of compartmentalization and specialization in child health work. Reading the book will be a good antidote to some of the necessary compartmentalization that we all must do in our practice or research. Happy reading!
Current Status of the Use of Theophyllines in Children
Authors: Simons F. Estelle R. , Pierson William E. , Bierman C. Warren
Published: December 2021

Theophyllines have gone through cycles of popularity and unpopularity as therapeutic agents since they were first used for relief of asthma in 1936. By competitive inhibition of the enzyme phosphodiesterase, they prevent the breakdown of cyclic 3',5'—AMP (adenosine monophosphate) to 5'—AMP and act synergistically with beta-adrenergic agents to increase the intracellular concentration of 3' 5 cyclic AMP. In lung tissue cyclic 3',5'—AMP leads to relaxation of bronchial smooth muscle, perhaps by direct effect or perhaps by suppression of local histamine release.1 Theophyllines are of particular value in the epinephrine-resistant patient with asthma.

Toxic effects of theophyllines are related to serum theophylline levels and represent intensifications of pharmacologic effects. They include insomnia, irritability, restlessness, tremors, convulsions, flushing, tachycardia and other cardiac arrhythmias, hypotension or hypertension, abdominal pain, anorexia, nausea, vomiting, hematemesis, dehydration, and albuminuria. Gastrointestinal side effects are centrally mediated and are not prevented or ameliorated by giving theophyllines rectally or intravenously.2

In the 1960's many physicians virtually discontinued the use of aminophylline, which is 80% theophylline by weight and hydrolyzed to free theophylline in vivo, because of numerous reports of deaths following its administration.3-6 Most of the childhood deaths attributable to this drug occurred after use of rectal suppositories.5,6 Absorption from the suppository base is slow and unpredictable,7 and cumulative effects often occur. Administration of excessive amounts of theophylline or aminophylline (or administration of the latter by rapid intravenous injection, injection into a central venous catheter,8 or administration to patients with compromised cardiovascular or renal systems3,4) has also been associated with deaths, more often in adults than in children. Idiosyncratic reactions are exceptionally rare.
Reliability of the Booth-Nadler Technique for the Detection of Hunter Heterozygotes
Authors: Donnelly Patricia V. , Di Ferrante Nicola
Published: December 2021

Skin fibroblasts from three obligated and one potential heterozygotes for the Hunter gene displayed abnormal metabolism of glycosaminoglycans four to six weeks after rapid freezing in liquid nitrogen. The technique seems to be useful for the identification of Hunter carriers, especially when the degradation of 35SO4-labeled, intracellular glycosaminoglycans, rather than the uptake 35SO4, is measured.
Aspirin Intolerance in Chronic Childhood Asthma: Detected by Oral Challenge
Authors: Rachelefsky Gary Stuart , Coulson Anne , Siegel Sheldon Colman , Stiehm E. Richard
Published: December 2021

Most previously reported individuals with acetylsalicylic acid (aspirin, ASA)-induced asthma have been adults. This study was undertaken to define the prevalence of ASA intolerance among children with intractable asthma.

Fifty children (34 boys and 16 girls) ranging in age from 6 to 18 years with extrinsic (atopic) asthma were studied. None had a history of ASA sensitivity or nasal polyps; all required continuous medication including cromolyn sodium and daily or intermittent steroids.

Anti-asthmatic medications were stopped 12 hours prior to testing. At the same time of day, each subject, in a doubleblind manner, on two separate days, ingested either 300 mg of ASA or 100 mg of lactose (placebo). Measurements of FVC, FEV1, and FEF25-75 were obtained prior to challenge and one half, one, two, three, and four hours after. ASA intolerance required a decrease of 30% in lung function with ASA as compared to placebo. Fourteen of 50 (28%) were ASA-intolerant; a greater number were girls, and they had more sinusitis and an onset of disease prior to 2 years of age. Steroid dependency, frequency of eczema, nasal eosinophilia, ilia, serum IgE levels, and peripheral eosinophil counts did not differ between the two groups.

The use of aspirin in childhood asthma should be limited.
The Negative-Pressure Respirator: An Improved Design
Authors: Hakanson David O. , Cashore William J. , Gauvin Normand E. , Stern Leo
Published: December 2021

Modification of the standard negative-pressure respirator, which easily permits application of intermittent negative-pressure ventilation to the infant of less than 1,000 gm, has been described. Previously encountered problems of fixation of the infant, of maintenance of oxygen concentrations, and of inability to obtain chest films of the infant while in the device have been overcome.
Cholesterol Among Children of Men With Myocardial Infarction
Authors: Hennekens Charles H. , Jesse Mary Jane , Klein Barbara E. , Gourley Janet E. , Blumenthal Sidney
Published: December 2021

Plasma cholesterol levels were obtained on 90 children of 39 men with premature myocardial infarction and 86 children of 39 healthy men. The mean cholesterol among children of affected men (195.1 mg/100 ml) was higher than among children of healthy men (176.6 mg/100 ml) (P = .009). Higher mean levels were demonstrable at each of nine age groups from 1 to 21 years (P = .004). Levels greater than 230 mg/100 ml were found in 16.7% of children of affected fathers and 4.7% of children of healthy fathers, a ratio of 3.6 to 1 (P = .01). These findings are compatible with the hypothesis that elevated childhood cholesterol level offers a mechanism whereby family history predicts coronary disease.

A dip in cholesterol during adolescence, a finding that varies with population studied, was demonstrable among children of both affected and healthy men.
The Incidence of Birthmarks in the Neonate
Authors: Jacobs Alvin H. , Walton Robert G.
Published: December 2021

The presence of various types of birthmarks was determined in 1,058 newborn infants under 72 hours of age. Of these, 79.5% were white, 6.2% were black, 11.2% were ladinos, and 2.6% were Asiatic. Mongol spots were present in 9.6% of the white babies, 95.5% of the black babies, 81% of the Asiatic babies, and 70.1% of ladino infants. Pigmented lesions were present in 42 (4%) of the infants. Biopsies obtained in 34 (3.2%) revealed that only one-third (11) of these were melanocytic nevi. Salmon patches were present in 40.3% of the infants, recognizable early strawberry marks in 2.6%, and port-wine stains in 0.3%.

In addition to birthmarks, it was determined that 30.3% of the 508 babies examined at one of the two hospitals had toxic erythema of the newborn.
Dr. Katz Replies
Authors: Katz Harvey P.
Published: December 2021

I thank Dr. Abello for his comment regarding our home culture approach to streptococcal throat infections.

As stated in our article, we evaluate patients only if the culture demonstrates the presence of group A,β-hemolytic streptococci. In the outcome measures described in our study and in subsequent evaluations, there have been no complications of this approach. In excess of 1,500 families are now trained in self-evaluation and home culture technique, and patients appear to understand the rationale.
A Question on Informed Consent and Measles Vaccine
Authors: Gorlick Gary
Published: December 2021

In this time of increasing interest and action in the medicolegal aspects of medical practice, and more specifically in the area of "informed consent," the possibility that some cases of subacute sclerosing panencephalitis may have been, and are being, caused by the routine measles vaccine is of real concern. Are we pediatricians obliged to inform parents of this possible association? More basically, just what information, and in how much detail, does the Academy advise the practitioner to relate to the child's parents when immunizations are given?
Significance of Radiographic Findings in Early-Onset Group B Streptococcal Infection
Authors: Lilien Lawrence D. , Harris Vivian J. , Pildes Rosita S.
Published: December 2021

Chest radiographs of 73 neonates with early-onset group B Streptococcus (GBS) infection were reviewed. Eighty-six percent of the infants were premature (< 38 weeks); 68% weighed ≤ 1,500 g. In infants weighing ≤ 1,500 g, the predominant radiographic pattern was hyaline membrane disease (HMD) (80%). There was a significant increase in radiographic HMD in 1,000 to 1,500-g neonates with GBS infection (77%) when compared to a control group of infants without GBS infection (44%). Mortality in 1,000 to 1,500-g infants with GBS infection and radiographic HMD (95%) was also significantly higher than in the control group of infants with HMD and no GBS infection (38%). In larger premature and full-term infants, the radiographic findings were not specific and also were not helpful in distinguishing GBS infection from other newborn respiratory disorders.
Concern Over High Infant Death Rate in Arizona
Authors: Baum Ted
Published: December 2021

The State of Arizona, and its pediatricians in particular, have taken considerable pride in recent years in the steady decline in infant mortality demonstrated by annual statistics for our State. We give credit for much of this decline to Arizona's Statewide Newborn Transport and Intensive Care Program, in which the majority of private pediatricians participate.

It is therefore with some dismay that we discover in Dr. Myron Wegman's "Annual Summary of Vital Statistics" (Pediatrics 56:960, December 1975) that in 1974 Arizona recorded an infant death rate of 16.0, an increase from the 1973 rate of 15.4.
"THERE IS NO EPIDEMIC OF CANCER IN THE UNITED STATES"
Authors:   Student
Published: December 2021

. . . there is no increase in the death rate ("mortality incidence") from cancer during the last 44 years; this despite constantly improving medical diagnosis and reporting procedures. The rate has hovered at about 131 cancer deaths per hundred thousand persons per year. If deaths from lung cancer are subtracted (and the conservative assumption is made by experts that 85 percent or more of them are due to cigarette smoking), the overall "incidence" of death from cancer would be less today than in 1933, by about 10 percent.

So there is no epidemic of cancer in the United States, but there is a disproportionate number of cancer deaths due to cigarette smoking. Given our current economic problems, provision of more tax money to the National Cancer Institute for more "research" should lie low on the list of our national priorities. Tax money should instead be substantially diverted from the "cancer establishment" and be channeled into a nationwide action program about the dangers of cigarettes, a program which ought to start in kindergarten.

Cigarettes cause not only lung cancer but a host of other, more numerous and debilitating diseases; many clinicians estimate that 25 percent or more of hospitalization, doctor and prescription drug bills are generated directly or indirectly by cigarette smoking. If we could save one-half of the $150 billion currently being spent each year on these items, the nation would enjoy a windfall profit.

I see no governmental leaders taking any bold, effective action to expurgate what is so obviously and offensively scandalous.
The Prevalence of Cholelithiasis in Sickle Cell Disease as Diagnosed by Ultrasound and Cholecystography
Authors: Lachman Barry S. , Lazerson Jack , Starshak Robert J. , Vaughters Frank M. , Werlin Steven L.
Published: December 2021

Gallbladder disease is known to be increased in sickle cell disease (SS). The prevalence of cholelithiasis in children with SS has been reported as 10% to 37%. Gallbladder ultrasound, cholecystography, and/or abdominal radiography were used to evaluate 31 patients aged 2 to 18 years with no systematic evidence of gallbladder disease for cholelithiasis. Overall prevalence of gallstones was found to be 29%. Cholelithiasis was detected in children as young as 4 years of age. Prevalence below the age of 10 years and above the age of 10 years was found to be 11% and 55% respectively. The increased prevalence of cholelithiasis in children with sickle cell disease suggests the use of diagnostic ultrasonography as a routine screening procedure.
Ontogeny of Human T Cells
Authors: Stites Daniel P. , Pavia Charles S.
Published: December 2021

Current knowledge of human T cell ontogeny is reviewed in terms of appearance of T cells in central and peripheral lymphoid organs, maturation of T cell markers, and development of immune functions. Extrapolation of growth curves derived from cell counts from fetal thymus, spleen, and bone marrow indicates the appearance of lymphocytes at 3.5 weeks gestation. Erosette-forming cells are present in thyrnus at 11 weeks and in peripheral organs 15 to 16 weeks gestation. β-2-Microglobulin is associated with all lymphoid cells by 13 weeks gestation. Lymphocyte responses to the T cell mitogen phytohemagglutinin (PHA) are first detected in thymus at 10 weeks and in spleen and blood 3 to 4 weeks later. Allogeneic responses in mixed lymphocyte reactions develop at about 7.5 weeks in fetal liver and later in thymus and peripheral organs. Lymphocytotoxicity for xenogeneic cells is a property of bone marrow cells and not thymocytes. Several aspects of development of a suppressor T cell in human neonates is discussed and related to similar findings in the mouse. These studies indicate a relatively high degree of maturation of human T cells during fetal life.
Detection of Risk Factors for Coronary Artery Disease in Children: Semmelweis Revisited?
Authors: Glueck Charles J.
Published: December 2021

Can we detect children at risk for coronary disease?

Focusing upon screening for hyperlipidemia in childhood, Holtzman1 recently concluded "...at this juncture we do not know how to detect most children at risk for coronary disease, and even if we did, we would not know what to do when we found them." Holtzman's conclusions, however, seem to be incongruent with multiple, extensive, population-based studies of coronary heart disese (CHD) risk factors in children.

One hundred twenty-nine years ago, Semmelweis2 summarized his data relative to etiologies of puerperal fever, and suggested preventive medical approaches, much to the derision of his contemporaries.
Antibiotic-Associated Pseudomembranous Colitis in Siblings
Authors: Schussheim Arnold , Goldstein Ellie J. C.
Published: December 2021

Pseudomembranous colitis induced by antibiotics is not commonly diagnosed in children. Recent developments have clarified the pathogenesis and suggested that agents such as cholestyramine are therapeutically useful. Two siblings with pseudomembranous colitis were carefully studied and may serve to alert pediatricians to an approach to this entity.
Episodic Complete Airway Obstruction in Infants
Authors: Kelly Dorothy H. , Shannon Daniel C.
Published: December 2021

Four infants with episodic silent complete obstructed apnea are described. All had central sleep apnea, three had hypoventilation, and none had obstructive apnea observed on polygraphic recordings. Two infants were siblings of a sudden infant death syndrome victim and one was a sibling of a "near miss" infant. One infant died as a result of a prolonged episode that began while she was awake. In two infants apnea has been controlled with theophylline administration and in the third infant resolution of the episode was temporally related to atropine administration.
Leters to the Editor
Authors: Weiss Jeffrey C. , De Jong Allan R.
Published: December 2021

We thank Dr VanDervoort and Ms Bloom for their comments. The methods that we used allowed us to evaluate our program within the setting of our facility and our institution. Perhaps financial analysis of housestaff practices could be standardized in the future. However, no matter which method is used, it is clear that resident education is expensive and housestaff practices require continued cost and revenue analysis.
Correlates of Intelligence Test Results in Treated Phenylketonuric Children
Authors: Williamson Malcolm L. , Koch Richard , Azen Colleen , Chang Christina
Published: December 2021

The Collaborative Study of Children Treated for Phenylketonuria was initiated in 1967. The data presented are based on findings in 132 children treated from near birth to 6 years of age. Two treatment groups were randomly formed. The target for blood phenylalanine was 1.0 to 5.4 mg/100 ml for group 1 and 5.5 to 9.9 mg/100 ml for group 2. Although mean blood phenylalanine levels for both groups initially fell within the prescribed ranges, a steady increase over time resulted in mean six year levels of 11.4 mg/100 ml and 13.0 mg/100 ml for the two groups, respectively. Because it was not possible to maintain the prescribed difference in blood phenylalanine levels between the two groups, they were combined for further analyses. The mean IQ of the total sample at age 6 years was 98 on the Stanford-Binet Intelligence Scale. Multiple regression analysis showed that, among selected treatment and psychosocial factors, the most important predictors of IQ for 6-year-old children were: (1) mothers' intellectual ability (as measured on the Wechsler Adult Intelligence Scale); (2) age at which the subjects were first treated; and (3) how well the subjects adhered to the phenylalanine-restricted diet. It was concluded that optimal early treatment will result in normal levels of intelligence at 6 years of age.
Neonatal Polycythemia: I. Criteria for Diagnosis and Treatment
Authors: Ramamurthy Rajam S. , Brans Yves W.
Published: December 2021

In order to better define criteria for diagnosis and treatment of neonatal polycythemia, 74 neonates with peripheral venous hematocrit levels ≥65% were studied. The hematocrit levels of capillary (Cap Hct), peripheral venous (PV Hct), and umbilical venous (UV Hct) blood were measured. Viscosity of umbilical venous blood (UVη) was determined. Mean ± SE Cap Hct (75 ± 0.5%) was significantly higher than PV Hct (71 ± 1.0%, P < .001) and PV Hct was higher than mean UV Hct (63 ± 0.6%, P < .001). Cap Hct correlated with neither PV Hct nor UV Hct, but PV Hct and UV Hct correlated moderately (r = .54, P < .001). Of the neonates with UV Hct ≥63%, 80% had UVη in excess of 3 SD above the normal mean (in excess of 14.6 cps at shear rate 11.5 sec-1), whereas 94% of the neonates with UV Hct <63% had UVη within normal range. Neonates with hyperviscosity were seen with two or more clinical symptoms more often than their peers with normal viscosity (P < .04). Partial exchange transfusion in 21 neonates reduced mean UV Hct from 61 ± 1.1% to 50 ± 1.0% (P < .001) and mean UVη from 13.0 ± 0.64 cps to 8.6 ± 0.54 cps (P < .001). These data suggest that Cap Hct and PV Hct may be used to screen neonates for polycythemia, but that the final diagnosis and therapeutic decisions should be based on UV Hct or even preferably on UVη. They further suggest that UV Hct ≥63% is strongly indicative of hyperviscosity and should be treated by partial exchange transfusion.
Meconium Peritonitis and Increasing Sweat Chloride Determinations in a Case of Familial Progressive Intrahepatic Cholestasis
Authors: Hillemeier A. Craig , Hen Jacob , Riely Caroline A. , Dolan Thomas F. , Gryboski Joyce D.
Published: December 2021

A case of familial progressive intrahepatic cholestasis syndrome is presented in which the infant had the radiographic fidings of meconium peritonitis and normal sweat chloride determinations in the newborn period. At age 12 years the child has elevated sweat chloride determinations and normal pancreatic drainage studies. The occurrence of meconium peritonitis and its possible relationship to this cholestatic syndrome are discussed.
Flunisolide Aerosol for Treatment of Severe, Chronic Asthma in Steroid-Independent Children
Authors: Meltzer Eli O. , Kemp James P. , Orgel H. Alice , Izu Allen E.
Published: December 2021

The efficacy and safety of flunisolide aerosol were studied in 46 steroid-independent children with asthma inadequately controlled by nonsteroid drugs. This was a double-blind, placebo-controlled, parallel study lasting eight weeks. Patients were randomly assigned either flunisolide by inhalation, 0.5 mg twice a day, or placebo. Effectiveness was evaluated daily by symptom scores, by Wright peak flow measurements twice daily, and weekly by spirometry and physical examination. Adrenal function and throat cultures for Candida were evaluated before and after the test-drug treatment period. Flunisolide was administered to 25 patients and 21 received placebo. Most symptom scores were statistically significantly better in flunisolide-treated than in placebotreated patients; these included severity of wheezing (P = .01), chest tightness (P = .01) and shortness of breath (P = .02), and frequency (P = .001) and severity of asthma attacks (P = .03). In addition, placebo-treated patients used significantly more bronchodilators than flunisolidetreated patients. In the final therapeutic effectiveness evaluation, 72% of flunisolide-treated patients received very good or good ratings, whereas only 29% of placebotreated patients received these ratings (P = .005). No patient developed thrush, evidence of adrenal suppression, or other severe adverse reaction. Flunisolide aerosol was shown to be effective and safe in controlling asthma in children who were candidates for oral steroid therapy.
Clinical and Metabolic Abnormalities in a Boy with Dietary Deficiency of Biotin
Authors: Sweetman Lawrence , Surh Linda , Baker Herman , Peterson Raymond M. , Nyhan William L.
Published: December 2021

In the article "Clinical and Metabolic Abnormalities in a Boy with Dietary Deficiency of Biotin," by Sweetman et al (Pediatrics 68: 553-558, 1981), Table 3 as shown on page 556 is incorrect. The correct version is as follows:

See Table in the PDF File
TERRAMYCIN HYDROCHLORIDE IN THE TREATMENT OF SALMONELLA CHOLERAESUIS BACTEREMIA
Authors: SCOTT ROLAND B. , WOODING CLINTON H.
Published: December 2021

Three cases of S. choleraesuis bacteremia have been presented. They were treated with terramycin, a new antibiotic. Encouraging results were obtained in all cases. The average duration of toxicity and temperature (above 37.2°C. rectally) was approximately five days after administration of the antibiotic. Blood cultures became negative within 48 hours in two cases. In the other case blood culture on the fifth day of treatment was positive but four subsequent daily cultures were negative. No untoward reactions were observed. The drug was readily accepted when administered orally. Though appraisal of the therapeutic effect of terramycin is difficult because of the variability of duration of the untreated disease, it would appear that terramycin may be superior to the sulfonamides and to the other currently available antibiotics in the treatment of S. choleraesuis septicemia in children.
DIPLOCOCCUS CRASSUS SEPTICEMIA IN A PREMATURE INFANT
Authors: CARDULLO HUGO M. , SCHULMAN IRVING , SMITH FRANCES CAPRON
Published: December 2021

A report is made of a case of D. crassus septicemia in a premature infant characterized by sudden onset and marked lymph node involvement with recovery following the use of combined chemotherapy.
SPIROMETRIC MEASUREMENTS OF LUNG FUNCTION IN HEALTHY CHILDREN
Authors: TURNER JAMES A. , MCLEAN ROSS L.
Published: December 2021

A group of 50 normal children between the ages of 5¾ and 14 years has been studied by means of gross spirometry in an attempt to derive base line results for comparison with patients suffering from pulmonary disease. The results of these studies are summarized below:

1. The normal range of vital capacity for a given height is estimated on the basis of these observations to be given by the equation y = -2.41 + 0.0341 x ± 2(0.199), where y = vital capacity in liters, and x = standing height in cm.

The subdivisions of vital capacity are expressed in terms of per cent of vital capacity. For this group the average inspiratory reserve was 76.0% and the standard deviation of the distribution was 4.6%. Correspondingly, the average expiratory reserve was 24.0%, and the standard deviation was 4.6%.

2. The normal range of maximum voluntary ventilatory capacity is estimated as y = -39.001 + 0.7712 x ± 2(8.077), where y = maximum voluntary ventilatory capacity in 1./min. and x = standing height in cm.

3. The average breathing reserve in the group studied was 89.7%, and the standard deviation 3.4%.

These studies compared favorably with those observed by other investigators.

4. The results of resting ventilation, average tidal air and oxygen consumption revealed more variation than similar studies in adults as illustrated by wider standard deviations. This variability would be expected in view of the apprehension and excitability of young children. The mean resting ventilation for the group studied was 5.94 l./min./m2 with a standard deviation of 1.64. The mean oxygen consumption was 174.64 ml./min./m2 and the standard deviation was 39.20.

The group studied was a relatively small one and the results must thus be subject to review as more data on pulmonary function in children becomes available.
STUDIES ON THE LABORATORY DIAGNOSIS OF CYSTIC FIBROSIS OF THE PANCREAS
Authors: JOHNSTONE DOUGLAS E. , NETER ERWIN
Published: December 2021

A study of 78 patients with cystic fibrosis of the pancreas was carried out to determine whether gelatin-liquefying bacteria may be responsible for gelatin liquefaction of gelatin film by feces and duodenal juice. In addition, the records of 254 children with cystic fibrosis of the pancreas were reviewed relative to the incidence of apparently false positive gelatin film tests. The following data were obtained:

1. Fecal specimens of 48 out of 78 patients yielded positive gelatin film tests. Only 9 of these 48 specimens were positive in a dilution of 1:25 or higher, but 33 gave positive tests in a dilution of 1:10. Likewise, a review of 254 charts of proved cases of cystic fibrosis revealed that of 131 tests on 59 patients, 71 or 54% were positive.

2. Gelatin-liquefying bacteria were present in the feces of 44 out of 45 patients whose stool specimens gave a positive gelatin film test and which also were examined bacteriologically, but in only 2 out of 28 whose feces gave negative gelatin film tests.

3. Treatment with penicillin may be associated with an increase in the percentage of positive gelatin film tests. Of 42 patients whose feces were obtained prior to or without penicillin therapy only 4 gave positive gelatin film tests, whereas the feces of 55 of 80 patients who had received treatment with penicillin did so.

4. Soy bean trypsin inhibitor partially or completely prevented gelatin liquefaction by fecal specimens of patients with cystic fibrosis of the pancreas only if the latter were diluted to 1:5 or less, possibly indicating the presence of small amounts of trypsin. This titer of soy bean trypsin inhibitor-neutralizable enzyme is far below normal.

5. Gelatin-liquefying bacteria were found in all 10 of the cultured duodenal juice specimens which gave apparently false positive gelatin film tests in a dilution of 1:10 or higher.

6. The incidence of gelatin-liquefying bacteria in the throat and feces of patients giving apparently false positive fecal gelatin film test was far greater in the penicillin-treated patients than in untreated patients.

7. The importance of the apparently false positive gelatin film test is discussed and modifications of this test are outlined which make for greater reliability.
PLASMA AND ERYTHROCYTE CHEMISTRY OF THE NORMAL INFANT FROM BIRTH TO TWO YEARS OF AGE
Authors: OVERMAN RICHARD R. , ETTELDORF JAMES N. , BASS ANNE C. , HORN G. B.
Published: December 2021

One hundred eighty-eight normal infants from birth to 2 years of age have been studied in a serial manner with regard to concentrations of Na, K, and Cl in plasma and erythrocytes; plasma Ca, NPN, protein and CO2; plasma pH and venous hematocrit. These values have been compared with those of normal women at term and with other adult normal values. Nineteen samples of blood from the umbilical artery were likewise analyzed for comparison.

Serial and progressive alterations in the measured variables occurred and in several regards the normal infant body fluid chemical anatomy departs sharply from normal adult values.
ENDOCARDIAL SCLEROSIS
Authors: EDMONDS HENRY W. , SEELYE WALTER B.
Published: December 2021

Six cases of heart disease have been presented, with a hint that they may be type specimens for a distinct species of congenital cardiac malformation. They are representative of a syndrome characterized pathologically by hypertrophy of the left side of the heart, thickening of the mural endocardium of the left ventricle, and varying distortion of the aortic and mitral valves, and characterized clinically by radiologically demonstrable cardiac enlargement, nondiagnostic murmurs and sudden death in infancy. The older concept of an inflammatory pathogenesis of so-called "fetal endocarditis" is rejected in favor of developmental origin of the lesions.
Endemic Giardiasis and Day Care
Authors: Sealy David P. , Schuman Stanley H.
Published: December 2021

Five surveys of 1,731 children for stool ova and parasites (1971 to 1981) in a rural county provide a unique perspective on naturally occurring, nonepidemic giardiasis. Currently white children in day care centers in Hampton County, South Carolina, experience attack rates of 26%. They enter the first grade with at least six times as much infection as those who do not attend day care. A trend toward more giardiasis linked to working mothers and day care is evident among white preschool children. This has not yet occurred among black preschool-aged children. These and other epidemiologic data indicate that as few as 100 children can maintain endemic levels of infection in a county of 18,000 residents. Person-to-person transmission in the day care setting is sufficient to explain this county's rising rate of stool positivity of infection (8% of all stool specimens submitted to the state laboratory).
JOHN LOCKE ON THE TREATMENT OF ‘CONVULSION FITS BEFORE TOOTHEING’ (1682)
Authors: C. T. E.
Published: December 2021

Although John Locke (1632-1704), physician and philosopher, is best known for his Essay Concerning Human Understanding (1690), his medical journals contain a wealth of information about seventeenth-century English medical practice. Among his entries concerning diseases of infants and children is the following description of his treatment of "convulsion fits before tootheing."1 (Teething was frequently blamed for convulsions until this century.)

Mond. Jul. 3. [1682] Convulsion fits before tootheing are from gripeings in the belly. Method [of treatment] 1st. Syrup of Meconium gr. 20 [diacodium or syrup of poppies], and when that has abated as it will do next fit, give sweet [oil] of [almonds] 1 oz., and when that had done purgeing as it will in 12 howers, allay the pain again with syrup of meconium, the fits ariseing only from pain. And so it is afterwards in tootheing, if they are bound purge with sweet [oil] of [almonds] and then allay with syrup of meconium. If they are loose syrup of meconium alone will do, for tis the pains along that cause convulsions in children. If the child be vigorous and a year old [bloodlet] also to prevent height of blood and feaver.
Screening for Iron Deficiency with the Erythrocyte Protoporphyrin Test
Authors: Yip Ray , Schwartz Samuel , Deinard Amos S.
Published: December 2021

Elevation of erythrocyte protoporphyrin (EP) level is one of the consequences of iron deficiency. As the EP test has been established to be a screening test for lead poisoning, the screening capability of the EP test for iron deficiency was investigated. A total of 4,160 children between ages 6 months to 12 years had EP determined together with serum ferritin and hematocrit. Comparing the relationship of EP to serum ferritin and using a serum ferritin value ≤15 µg/L as the criterion of iron deficiency, the optimal cutoff limit for the EP test appears to be 35 µg/dL of whole blood. At this level, 88% of the subjects with low levels of serum ferritin can be detected (sensitivity), in contrast to the 53% detected at a higher cutoff value (≥50 µg/dL) used to screen for lead toxicity, or to the 59% detected by age-related hematocrit value. At an EP screening level of 35 µg/dL of whole blood, 90% of the subjects with normal serum ferritin level are correctly determined to be screen negative (specificity). The predictive value of low levels of serum ferritin for all subjects above screening level is 38%. In general, an elevated EP level, by itself, represents inadequate iron supply for hematopoiesis and signals iron deficiency regardless of whether the serum ferritin value is below the diagnostic level or not. A trial course of orally administered iron is suggested for children who are found to have an elevated EP value, with an increase in hemoglobin or hematocrit value serving, retrospectively, as confirmation of prior iron deficiency.
The Community Physician and Liver Transplantation
Authors: Sharp Harvey L. , Ascher Nancy L.
Published: December 2021

Jamie Fiske is a child who underwent a successful liver transplant for extrahepatic biliary atresia at the University of Minnesota Health Sciences Center. Nationwide publicity resulted when the father received permission to address the American Academy of Pediatrics with regard to a donor liver for his daughter. The parents of the child who donated the liver were aware of this dramatic form of public appeal. It is extremely unlikely that the liver transplantation in this case would have occurred without media involvement. Also unlikely is that two commentaries on this subject (Starzl et al1 and this paper) would have been sought by Pediatrics without the publicity surrounding this case.
Mothers and Hepatitis B
Authors: Rosenthal Philip
Published: December 2021

I read with interest the commentary on prevention of chronic hepatitis B virus infection.1 An important issue that was not discussed concerns the use of the hepatitis B vaccine and transmission of the newly recognized acquired immune deficiency syndrome (AIDS). The etiology of AIDS is unknown. AIDS occurs among the populations that donate plasma for hepatitis B vaccine manufacture.2,3 The safety of plasma donated for hepatitis B vaccine by persons with chronic hepatitis B who may have unrecognized or early AIDS is not known.
Infectivity of Anti-hepatitis Be-Positive Hepatitis B Carrier Mothers
Authors: Sacher Michael , Eder Gerald , Baumgarten Kurt , Thaler Heribert
Published: December 2021

We have read with interest the paper by Sinatra et al,1 in which the vertical transmission of hepatitis B virus (HBV) from anti-HBe-positive carrier mothers to their infants was reported. From the point of view of our own data2 we want to stress the importance of these findings: 4,400 pregnant women were tested consecutively for hepatitis B markers. Of 23 mothers who were hepatitis B surface antigen positive (healthy carriers), 18 were anti-HBe positive, three were HBe antigen positive, and in two women neither anti-HBe nor HBe antigen was detected.
Letter to the Editor
Authors: Silverman William A.
Published: December 2021

I don't want to denigrate the views expressed by Ziegler, but I wonder about the relevance of attitudes and preferences of professionals in the trying circumstances under discussion. The important question to ask is, "What do parents want?"

In this connection, I am reminded of George Bernard Shaw's advice: "Do not do unto others as you would have them do unto you. They may have different tastes."
Sialic Acid Storage Disease with Sialuria: Clinical and Biochemical Features in the Severe Infantile Type
Authors: Stevenson Roger E. , Lubinsky Mark , Taylor Harold A. , Wenger David A. , Schroer Richard J. , Olmstead P. M.
Published: December 2021

Two unrelated infants with a new disorder characterized biochemically by elevated levels of free sialic acid in urine, serum, and cell lysates have exhibited severe mental and physical impairments since the early weeks of life. Three other biochemically diagnosed cases and two possible cases from the earlier literature are reviewed to delineate this condition. Clinical features including sparse, white hair, coarse facies, hepatosplenomegaly, profound inactivity, diarrhea, and anemia permit early diagnosis of this neurovisceral storage disease.
Epidural Abscess and Vertebral Osteomyelitis Following Serial Lumbar Punctures
Authors: Bergman Ira , Wald Ellen R. , Meyer John D. , Painter Michael J.
Published: December 2021

Lumbar epidural abscess and vertebral Osteomyelitis were diagnosed in a 3-month-old infant, born prematurely, who had had repeated lumbar punctures for the treatment of posthemorrhagic hydrocephalus. Staphylococcus aureus was the causative organism. Successful treatment was achieved with 6 weeks of intravenous antibiotics without surgical drainage. Infectious complications of lumbar punctures are rare, but may occur when multiple punctures are attempted in small premature infants whose subarachnoid space contains large amounts of blood. Infection can be introduced directly by a contaminated spinal needle, or trauma to the tissues with bleeding can create a favorable site for bacterial adherence and multiplication. Posthemorrhagic ventricular dilation often resolves spontaneously and serial lumbar punctures should be used to treat this condition only when CSF flow is easy to establish and maintain.
Cold Air Inhalation Challenge in the Diagnosis of Asthma in Children
Authors: McLaughlin F. John , Dozor Allen J.
Published: December 2021

A study was designed to determine the usefulness of cold air inhalation challenge testing in children with asthma and to determine the magnitude and duration of the response. A total of 17 children with asthma, mean age 11.7 years (range 6 to 16 years) and eight nonasthmatic children, mean age 11.5 years (range 7 to 15 years) were studied. The average response to isocapneic hyperventilation with cold air in the asthmatic children was a decrease in vital capacity of 10%, a decrease in forced expiratory volume in 1 second (FEV1) of 19%, a decrease in peak flow rate (PFR) of 24%, and a decrease in maximal midexpiratory flow rate (MMFR) of 36%. This was significantly different from the response to the same level of hyperventilation with warm, fully saturated air. The response to isocapneic hyperventilation with cold air in nonasthmatic children was significantly different from the asthmatic children's response with a mean decrease in vital capacity of 0.9%, a decrease in forced expiratory volume in 1 second of 2.5%, a decrease in peak flow rate of 7%, and a decrease in maximal midexpiratory flow rate of 10%. The response in the asthmatic children occurred four to eight minutes after challenge and resolved in eight to 12 minutes. Although the response was highly significant, none of the children developed respiratory distress. It was concluded that isocapneic hyperventilation with cold air is a safe and simple test for diagnosing asthma in children.
Sternum Length, Torso Length, and Internipple Distance in Newborn Infants
Authors: Sivan Yakov , Merlob Paul , Reisner Salomon H.
Published: December 2021

In order to define standards for sternal length, torso length, and internipple distance in the newborn infant, 198 term and preterm infants (27 to 41 gestational weeks) were examined. In every case, the gestational age was determined chronologically and clinically. Sternal and torso length and internipple distance were measured by two observers using standard measurement techniques. Normal values are presented by plotting the mean ±2 SD for each gestational week v the gestational age.
The Decision to Forgo Life-Sustaining Treatment for Seriously III Newborns
Authors: STRAIN JAMES E.
Published: December 2021

The specter of government intervention in the care of handicapped infants has reappeared in the form of a new "Baby Doe" regulation issued by the Department of Health and Human Services. If nothing else, the regulation has caused us to reexamine the process by which decisions are made in the care of the handicapped. The outcome of the Academy's discussions with DHHS has major implications, not just for pediatricians and the infants and children we care for but for people of all ages. It's possible, if not probable, that the same rules will apply to the care of the elderly, especially in regard to the withdrawal of life support treatment, if the Baby Doe rule goes into effect.
The Silent Patent Ductus Arteriosus
Authors: KASHANI IRAJ A. , SWENSSON RICHARD E. , MERRITT T. ALLEN
Published: December 2021

To the Editor.—

We read with interest the article by Ellison et al1 on evaluation of preterm infants for patent ductus arteriosus. While commending the study for its elaborate design, we believe that in the modern neonatal intensive care unit there is a need for a less cumbersome and more practical approach to this common problem.

The criteria for detecting patent ductus arteriosus (PDA) in the presence of a continuous or systolic murmur presented in this paper are well founded, and the figures on the incidence of PDA are in agreement with some studies that have primarily relied on the murmur as the key feature.2,3
How Intensive Is Newborn Intensive Care? An Environmental Analysis
Authors: GOTTFRIED ALLEN W. , HODGMAN JOAN E. , BROWN KATHLEEN W.
Published: December 2021

Each year, approximately 200,000 to 250,000 newborn infants in the United States require intensive care. The length of hospitalization for the premature newborn usually ranges from 15 to 50 days and occasionally longer.1 Although follow-up studies have shown normal development in most of these infants, evidence continues to indicate sensory and cognitive deficits in very small premature newborns. It has been suggested that contemporary management of newborns receiving intensive care may be responsible for newly recognized iatrogenic complications and may contribute to developmental deficits associated with prematurity.2-5 Both clinicians and researchers have begun to question the potential adverse medical and developmental consequences of environmental stimulation for newborns in special care units.6