bluuebunny/crossref_metadata_2025 huggingface dataset:
Language Development and Emotional Expression
Authors: Bloom Lois
Published: December 2021

The relation of language and emotion in development is most often thought about in terms of how language describes emotional experiences with words that name different feelings. However, children typically do not begin to use these words until language development is well underway, at approximately 2 years of age. Given the relatively small number of words for naming feelings and emotions, and the redundancy between emotion words and the expressions they name, understanding how emotion and language are related in early development requires looking beyond just acquisition of specific emotion words.
Early Interventions for Infants of Depressed Mothers
Authors: Field Tiffany
Published: December 2021

Infants of mothers who remain depressed for 1 year after birth have a distinct profile of behavioral, physiologic, and biochemical dysregulation. Their mothers also have a distinct profile that can be used to target those in need of intervention. These interventions may include mood induction, massage therapy, interaction coaching, and natural buffers such as nondepressed fathers and caregivers.
Influences on the Receipt of Well-child Visits in the First Two Years of Life
Authors: Freed Gary L. , Clark Sarah J. , Pathman Donald E. , Schectman Robin
Published: December 2021

Objective.

To determine demographic and health care system factors associated with children receiving an adequate number of well-child visits (WCVs).

Methods.

Information on 4385 children and their families was obtained via birth certificates, parent interviews, chart review of outpatient sites of care, and insurance records.

Results.

Only 77% of children received at least five WCVs by age 2. In regression analysis, the factors most strongly associated with children's total number of WCVs were delay in the initiation of prenatal care (odds ratio = 0.6) and receipt of all outpatient care in private physician offices (odds ratio = 4.2 to 5.6). Having an adequate number of WCVs was associated with being up to date for immunizations.

Conclusions.

Children of mothers who delay prenatal care are at high risk for not receiving adequate numbers of WCVs. Recognition of this marker can allow for targeted interventions that aim to ensure that children receive appropriate preventive care.
Children of Substance Abusers: Overview of Research Findings
Authors: Johnson Jeannette L. , Leff Michelle
Published: December 2021

A relationship between parental substance abuse and subsequent alcohol problems in their children has been documented extensively. Children of alcoholics (COAs) are considered to be at high risk because there is a greater likelihood that they will develop alcoholism compared with a randomly selected child from the same community. COAs and children of other drug-abusing parents are especially vulnerable to the risk for maladaptive behavior because they have combinations of many risk factors present in their lives. The single most potent risk factor is their parent's substance-abusing behavior. This single risk factor can place children of substance abusers at biologic, psychologic, and environmental risk.

Since the turn of the century, many reports have described the deleterious influence of parental alcoholism on their children. A series of studies measured mortality, physiology, and general health in the offspring of alcoholic parents and concluded that when mothers stopped drinking during gestation, their children were healthier. Today, research on COAs can be classified into studies of fetal alcohol syndrome, the transmission of alcoholism, psychobiologic markers of vulnerability, and psychosocial characteristics. Each of these studies hypothesizes that differences between COAs and children of nonalcoholics influence maladaptive behaviors later in life, such as academic failure or alcoholism. This research supports the belief that COAs are at risk for a variety of problems that may include behavioral, psychologic, cognitive, or neuropsychologic deficits.

The vast literature on COAs far outweighs the literature on children of other drug abusers. Relatively little is known about children of heroin addicts, cocaine abusers, or polydrug abusers. Nonetheless, many researchers suggest that the children of addicted parents are at greater risk for later dysfunctional behaviors and that they, too, deserve significant attention to prevent intergenerational transmission of drug abuse. Most research on children of other drug abusers examines fetal exposure to maternal drug abuse.

The overview of the research on children of substance abusers points toward the need for better, longitudinal research in this area. Most studies on COAs or other drug abusers are not longitudinal; they examine behavior at one point in time. Given the studies reviewed in this article, it is unclear whether we see true deficits or developmental delay. Longitudinal studies will allow us to predict when early disorders and behavioral deviations will be transient or when they will be precursors to more severe types of maladaptive behavior. Longitudinal research also will enable us to explain specific childhood outcomes. Differences in outcome could be studied simultaneously to understand whether antecedents discovered for one are specific to it or are general antecedents leading to a broad variety of outcomes.
The Principles and Practice of Evidence-Based Neonatology
Authors: Soll Roger F. , Andruscavage Lisa
Published: December 2021

Significant strides toward improving the outcome of newborn infants have been observed during the modern era of neonatal-perinatal medicine. One of the challenges that neonatologists and pediatricians face is deciding when to change current practices. New literature is abundant, but it must be critically reviewed and evaluated before changes in practice are made. The evidence-based medicine process can be used to help in changing practices or adopting new practices. It is based on five steps: 1) forming answerable questions; 2) searching for the best evidence; 3) critically appraising the evidence; 4) applying the evidence in practice; and 5) evaluating one's performance.

This article reviews the five steps of the evidence-based medicine process. The various levels of evidence, including randomized, controlled trials and systematic reviews, are defined and discussed. An example of a critically appraised topic, a practical tool that can be used as an aid in addressing the first three questions of the evidence-based medicine process, is included. Once the evidence has been evaluated, the decision of whether or not to implement a change in individual practice or in institutional guidelines must be made. These decisions are difficult and require a variety of individual and societal factors to be taken into account.

Examples of evidence-based medicine in neonatal and perinatal medicine include the use of antenatal corticosteroids for promotion of lung maturity, the use of surfactant replacement therapy for the treatment and prevention of respiratory distress syndrome, and prophylactic indomethacin for the prevention of intraventricular hemorrhage. Review of these examples provides insight into the strengths and weaknesses of evidence-based medicine.
Characteristics of Families Who Attend Free Vaccine Fairs
Authors: Hambidge Simon J. , Easter Sally A. , Martin Sharon , Melinkovich Paul , Brown Jeffrey , Siegel Carol D.
Published: December 2021

Objective.

To determine the health care resources and perceived barriers to care of families attending free vaccine fairs.

Design.

A cross-sectional survey.

Setting.

Twelve free vaccine fairs in Denver, Colorado, in 1994.

Participants.

A total of 533 consecutive parents or guardians of children receiving vaccine at the fairs.

Interventions.

None.

Measurements/Results.

Survey respondents reported that their children received regular health care through a private physician or health maintenance organization (HMO) (47%), a public clinic (20%), or a hospital-based clinic (14%); 18% had no regular site for health care. Twenty-seven percent of the families carried private insurance, although less than half of these plans covered children's vaccines: 9% were enrolled in an HMO or a preferred provider organization and 13% had Medicaid, whereas 50% had no health insurance. Families who received primary care at a private physician's office (OR: 1.7; 95% CI: 1.01–2.7) and those with no regular site for health care (OR: 2.0; 95% CI: 1.01–4.0) were more likely than those who went to a public clinic or hospital clinic to report free vaccine as the most important reason for attending a vaccine fair. Conversely, families who received well-child care at a hospital clinic were more likely to identify no appointment needed as the most important reason (OR: 2.7; 95% CI: 1.4–5.1). Families with private health insurance (OR: 2.3; 95% CI: 1.05–4.0) or no health insurance (OR: 2.3; 95% CI: 1.1–4.6) were more likely to identify free vaccine as the most important reason for attending a vaccine fair, whereas those enrolled in an HMO or preferred provider organization identified convenient time as the most important reason (OR: 3.2; 95% CI: 1.2–8.3). Families with Medicaid (OR: 3.2; 95% CI: 1.3–8.3) or with no insurance (OR: 2.1; 95% CI: 1.02–4.6) were more likely than were those with private insurance to identify no appointment needed as the most important reason for attending a vaccine fair.

Conclusions.

Most families attending free vaccine fairs have a regular source of health care. For families with private health insurance or with no health insurance, the availability of free vaccine is the major reason to bring their children to a vaccine fair, whereas for families whose insurance routinely covers the cost of childhood vaccine (HMO, Medicaid), convenience is the major determinant.
Structured Clinical Observations: A Method to Teach Clinical Skills With Limited Time and Financial Resources
Authors: Lane J. Lindsey , Gottlieb Ruth P.
Published: December 2021

Objective.

To develop and implement a methodology to teach clinical skills to medical students in busy clinical settings.

Methods.

The Structured Clinical Observation (SCO) program with guidelines and observation sheets for history-taking, physical examination, and information-giving skills was created. Faculty development preceded SCO implementation for pediatric clerkship students at Jefferson Children's Health Center. SCO observation sheets were tabulated and faculty and student questionnaires were administered.

Results.

The mean number of observations per student was 6, with 368 observations done for 63 students. SCOs were highly rated as an educational tool by faculty and students. The impact of the SCO program on faculty ability to perform clinical duties was initially minimal, but increased over the year. Observations were used primarily for feedback, but did influence outpatient clinical faculty's evaluation of two thirds of the students. Only 50% of students reported being observed in other rotations.

Conclusions.

SCOs are a feasible, inexpensive, qualitatively effective method of teaching clinical skills. The quantitative effect of SCOs on performance needs to be evaluated.
COMPARATIVE STUDY OF CANINE DISTEMPER AND A RESPIRATORY DISEASE OF MAN
Authors: ADAMS JOHN M.
Published: December 2021

Clinical, epidemiologic, pathologic and serologic evidence has been presented which indicates a possible relationship of canine distemper and a respiratory disease of human beings.

Neutralization of distemper viral infection in ferrets has been accomplished experimentally; infection caused by this virus in living chick-embryos has been neutralized by human sera and by human gamma globulin. Both in vivo and in vitro methods were employed in these experiments.

Inclusion bodies are shown with the same morphologic and staining characteristics as well as similar tissue reactions to infection. The striking features of these changes are the proliferation and destruction of pulmonary lining epithelium, giant cell formation, and a predominant mononuclear reaction in the animal and human sections.

A review of the literature on a possible relationship between canine distemper and human illness has been presented. The former disease is now proved to be due to a specific virus.
PATTERN OF GROWTH OF SELECTED GROUPS OF BREAST-FED INFANTS IN IOWA CITY
Authors: PAIVA SILVIO L.
Published: December 2021

The data of measurements of 21 male and 24 female breast-fed infants from birth to 6 to 7 months of age are presented. The infants were born of well fed mothers, coming from families of better than average income and intelligence.

The pattern of growth of these infants is compared with that of a larger group, the majority of whom were artificially fed infants of the same socio-economic status.

It is concluded that the pattern of growth of the breast-fed infants does not differ significantly from that of artificially fed infants of the same socio-economic group.
COMPARATIVE EFFECTS OF PENICILLIN, AUREOMYCIN AND TERRAMYCIN ON STREPTOCOCCAL TONSILLITIS AND PHARYNGITIS
Authors: DENNY FLOYD W. , WANNAMAKER LEWIS W. , HAHN EDWARD O.
Published: December 2021

The effects of penicillin, aureomycin and terramycin on the clinical course of streptococcal tonsillitis and pharyngitis were compared in a controlled study. Under therapy with these agents most of the symptoms and signs subsided somewhat more rapidly than in control patients, leucocytosis was reduced and antibody formation was diminished; but in the dosage used no one drug was consistently most beneficial. Penicillin was the most effective drug in eradicating streptococci from the throat. Nausea and vomiting occurred frequently among the patients receiving aureomycin, and diarrhea was common in both the aureomycin and terramycin treated groups. Final determination of the drug of choice should await comparison of the effects on suppurative and nonsuppurative complications in larger groups of patients.
Round Table Discussion
Authors: MCARTHUR JANET W. , JOY FREDERICK B. , GLASSCOCK ERNEST L.
Published: December 2021

Chairman McArthur: The first consideration of this discussion is: "Who shall take care of the menstrual problems of the adolescent girl?" Shall it be the gynecologist, the internist, or the pediatrician? My own feeling is that the pediatrician is probably the best qualified of all these specialists to handle adolescent problems. In the first place, he has usually known both the parent and the child for many years, and has gained a rapport of inestimable value in allaying the embarrassment of the patient and the anxiety of the parent. In the second place, the pediatrician has the developmental point of view. It is essential to treat adolescent menstrual disorders with patience and restraint—attitudes which come naturally to a specialist thoroughly accustomed to the vagaries of an evolving organism.

If we examine the following list, which enumerates the various sexual characteristics in the order in which they appear, we see the relevance of the developmental point of view to problems of sexual maturation. It becomes evident that adolescence is a process—not an event. Because the first menstrual period is such a dramatic occurrence one is apt to think that it is synonymous with sexual maturity, the ability to reproduce one's kind. Actually, this is not the case, as we know from several lines of evidence. Thus, anthropologists studying the inhabitants of the Trobiand Islands have found pregnancy to be rare in young girls until one to 2 years have elapsed following the first menstrual period. In these islands, it is customary for sexual congress to take place freely from childhood on.
Symposium
Authors: BYERS RANDOLPH K. , GIBBS FREDERIC A. , ALEXANDER HATTIE E. , CROTHERS BRONSON , MATSON DONALD D.
Published: December 2021

In our discussion this morning we will deal with certain neurologic conditions of childhood. Such conditions differ from those in adults in that they affect a more or less rapidly developing complex organ. You need only be reminded of the rapid increase in brain weight and of the functional maturation attending and continuing after this weight gain to realize this fact. Our various developmental and intellectual examinations are attempts at measuring the latter.

The results of disease processes may show themselves by disturbing in various ways tissues already functionally active, as for instance by suppressing respiration in the newborn, or they may injure tissue not yet mature in which case they tend to distort or suppress development. As Dr. Crothers has long maintained, recovery from acute cerebral insults in infancy and childhood differs from recovery in adult life. In the latter, approximate return to the status quo ante is a satisfactory result. If, however, a 3 year old regains his attributes as a 3 year old and then fails to continue to develop he will be feebleminded at 6. Neurologic recovery in childhood therefore requires the resumption of orderly development, and can often not be determined for a period of years after an insult.

This is not the place to attempt an etiologic catalogue of cerebral disease in childhood. Suffice it to remind you that prenatal, natal and postnatal periods of life each has its own special developmental hazards. Because these affect the developing nervous system they tend in many instances to produce rather widespread changes resulting in the functional disabilities which we label mental retardation, cerebral palsy and epilepsy.
A HITHERTO UNRECOGNIZED BIOCHEMICAL DIFFERENCE BETWEEN HUMAN MILK AND COW'S MILK
Authors: GYÖRGY PAUL
Published: December 2021

A specific mutant of L. bifidus (var. Penn) isolated from the feces of a breast-fed infant has shown no growth in the usual medium satisfactory for most strains of L. bifidus. It required for its propagation the addition of a specific "growth factor" present in human milk. Cow's milk had only 1/30 to 1/100 of the activity of human milk. The average relative activity was highest for the human colostrum, closely followed by rat colostrum, then by human milk, rat milk and cow's colostrum (taken on the first day). All the other milks tested, in particular the milk from ruminants such as sheep and goats in addition to cow's milk, have shown only very low activity. Sow's and mare's milk are slightly more active, guinea pig milk is inactive. This microbiologic growth factor is different from all known vitamins and growth factors. Very slight activity was exhibited by liver compounds, and practically none by yeast or meat. Meconium is highly active. Human semen, uterine (cervical) mucus, gastric juice (even in a case of pernicious anemia), saliva, amniotic fluid, and tears are also very active. The growth factor occurs in low and higher molecular form in human milk. In meconium it is present in undialyzable form. Purified blood group substance A and B are highly active. From human milk levorotatory active products were obtained containing N-acetyl glucosamine, fucose and galactose, but no amino acids. N-acetyl glucosamine and N-acetyl galactosamine were only slightly active.

L. bifiidus var. Penn contains a specific enzyme which inactivates the microbiologic growth factor required by the same strain. The enzymatic inactivation of meconium or purified blood group substance as growth factor is accompanied by the reduction of its serologic titer as specific blood group and by the liberation of dialyzable reducing substances, chiefly acetyl-glucosamine.
ACUTE NICOTINE POISONING
Authors: OBERST BYRON B. , MCINTYRE ROSS A.
Published: December 2021

A case of acute nicotine poisoning due to a tobacco infusion given per enema is described. The importance of maintaining adequate respiration and restoration of blood pressure is stressed. The nature, action, fate and toxicity of nicotine is presented.
PLEUROPNEUMONIA ORGANISM MENINGITIS COMPLICATING RUPTURED MENINGOCELE
Authors: DAVIS JOSEPH H. , ARNSTELN LAWRENCE H.
Published: December 2021

A case of meningitis due to the pleuropneumonia-type organism occurred in a newborn infant with a spinal meningocele. The source of infection is believed to have been from the maternal birth canal through the dural membrane which ruptured at birth. The infection became apparent after 25 days of penicillin and streptomycin therapy, but responded promptly to terramycin, and the baby made a complete recovery from the infection.
Round Table Discussion
Authors: KANNER LEO , McKAY ROBERT J. , MOODY E. EARL
Published: December 2021

Chairman Kanner: Probably everybody in this audience has heard the old quip about the difference between a general practitioner and a specialist. The former, according to the jesters. knows a little about many things; as time goes on, he knows less and less about more and more, until he reaches a point when he knows nothing about everything. The specialist, in reverse, is said to know much about a circumscribed area of medicine; eventually, he knows more and more about less and less, until in the end he knows everything about nothing.

The pediatrician is the only medical man to whom this jocularly exaggerated pseudo-definition cannot possibly apply. His specialty is based not on a specific organ system or methodology but on an age group with all of its structural, functional, environmental, prophylactic and therapeutic concerns. He has thus the unique distinction of being a specialist and a general practitioner at the same time. His field is limited only to the extent that he courteously dismisses his patients when they reach the threshold of adulthood; it is broad enough to encompass every conceivable aspect of his patients' lives during infancy, childhood and adolescence.

The resulting multiplicity of interests, which is truly remarkable, has its rewards and its complications. The pediatrician has been widely accepted as a key figure to whom people turn with their puzzlements about their children's physical health, developmental pace, and mode of behavior. If a poll were taken as to whom the man-in-the-street regards as the logical adviser of parents, the overwhelming majority would undoubtedly name the pediatrician.
A CLINICIAN'S GUIDE TO CHILDHOOD PSYCHOSIS
Authors: Aug Robert G. , Ables Billie S.
Published: December 2021

This paper attempts to resolve some of the prevailing confusion about psychosis in childhood by defining it as a heterogeneous group of clinical syndromes which share certain key symptoms. A crucial distinction is made between pathognomonic symptoms and those which are not pathognomonic but which may dominate the symptom-picture when present. Within this framework, differential diagnostic observations are made concerning (1) mental retardation, (2) the behavior syndrome of minimal brain damage, (3) various conditions with delayed or absent speech, (4) other conditions with hyperactivity and impulsivity, and (5) other conditions with odd or deviant behavior. A comparison is made among differing current formulations of the psychopathology and the etiology of childhood psychosis.
STIFF SKIN SYNDROME
Authors: Esterly Nancy B. , McKusick Victor A.
Published: December 2021

Four patients are described with localized areas of stony-hard skin, mild hirsutism, and limitation of joint mobility. In three of these individuals the disorder was congenital and, in the fourth, it was first noticed in early childhood. No other abnormalities have been observed on repeated physical examination. Biopsies of affected skin show abnormal amounts of hyaluronidase-digestible acid mucopolysaccharide in the dermis. Fibroblast cultures from one individual demonstrated marked increase in intracellular metachromatic material. None of the patients had increased excretion of mucopolysaccharide in the urine.

The occurrence of this disorder in a mother and two children suggests an autosomal dominant mode of inheritance. It is postulated that these patients manifest a connective tissue disorder possibly resulting from an abnormality of mucopolysaccharide metabolism.
NITROGEN DIOXIDE AND LOWER RESPIRATORY ILLNESS
Authors: Pearlman Martin E. , Finklea John F. , Creason John P. , Shy Carl M. , Young Marion M. , Horton Robert J. M.
Published: December 2021

Significantly increased bronchitis morbidity was reported among elementary school children exposed for 2 and 3 years and infant cohorts exposed for 3 years to elevated levels of nitrogen dioxide in the ambient air. Both the relative proportion of children affected and the frequency of attacks in these cases were higher in the polluted areas. Morbidity associated with croup, pneumonia, and hospitalizations did not significantly differ among the three exposure areas studied– high, intermediate, and low. Retrospective questionnaire responses were validated by physician and hospital records. Question sensitivity exceeded 67% and specificity 70% for each clinical diagnosis.

Lower respiratory tract infection appeared to be a sensitive host response indicator of air pollution. Increased bronchitis in childhood may augur increased morbidity and mortality in adulthood.
HUMAN MILK BANKING PRACTICES
Authors: Silverman William A.
Published: December 2021

On June 13, 1970, an informal meeting was held in San Francisco sponsored by the Mothers' Milk Bank to review current methods for collection, decontamination, and storage of human milk, in the light of evidence which has accumulated in the past few years. A number of problems were identified and several recommendations were made.

Chemical contamination of human milk was discussed at length and it was concluded that adulteration by ingested drugs is preventable by thorough screening of the donor's history and the advisement that all drugs (including unusual amounts of alcohol, aspirin, and coffee) be avoided by the donor.

Environmental contaminants, especially chlorinated hydrocarbons, are now ubiquitous and it is unrealistic to expect that all traces of these compounds will disappear (or can be removed easily) from human milk. It appears unlikely that avoidance of human milk significantly reduces the total amount of DDT in the body beyond early infancy, since human milk is not the primary source of this material; it is transmitted to the fetus across the placenta and is soon available to the child in other ingested foods (especially meat). No physiologic effects attributable to DDT have been described in infants fed human milk (e.g., amounts are considerably lower than needed for hepatic microsomal enzyme induction) and "tolerances" have not been established; nonetheless it is cheering to find that sporadic reports of measurements of DDT in human milk since 1951 give no evidence that there has been an increase in recent years (Table I).1-5 It was concluded that it is not necessary to monitor DDT concentration in the milk of individual donors (especially since day to day variations are quite small); however it was recommended that measurements be made of pooled samples at regular intervals to detect long-term trends.
BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

The consequences to children involved in worrying dogs were dreaded even more in the 1820's than today. Rabies prophylaxis and pediatric surgery were still unknown.

Medical and lay writers of the early 1800's often warned parents about the perils of dog bites. These writers tended to juxtapose the adjectival "wicked" whenever they wrote "boy," as though the two were inseparable.1
Poverty, Illness, and the Negro Child: A Dissenting Voice
Authors: Eschenburg C. G.
Published: December 2021

Ordinarily, I am not an avid "Letters to the Editor" correspondent, but the article, "Poverty, Illness, and the Negro Child" (Pediatrics, 46:305) by Dr. Seham was the final straw.

How long must we be constantly bombarded by the press–including "scientific" journals–with such sociologic clap-trap? Are there so many guilt-ridden people who have to join the bandwagon that no other voices are heard?

Surely, physicians should realize that biologic organisms will group in a variable bellshaped curve. Why must we join the sociologists, politicians, and communists in trying to "flatten out" normal variability; producing (which is impossible) a nation of mediocre nebbishes.
Letters to the Editor
Authors: Fischer Carl C.
Published: December 2021

We asked Dr. Carl Fischer, as the most appropriate representative of the Academy, to comment. He did so, as follows:

On reading Doctor Schulman's letter of October 13, 1970, I note that his concerns are the same as those felt by the Executive Board when it directed the Council on Pediatric Practice to make a 2-year study of the status of the delivery of health care to children and prepare a report with the best possible recommendations for the future.
Pica—Symptom, Vestigial Instinct, or What?
Authors: Palmeri R.
Published: December 2021

Dr. H. H. Neumann's paper on "Pica–Symptom or Vestigial Instinct?" (Pediatrics, 46:441) raised two separate questions. I subscribe to the first question and hypothesis: (1) Chewing on hard material may be a deterrent against cavities. This discovery alone may turn out to be the answer to one of the oldest health problems and a great contribution to preventive medicine.

On the second question I strongly disagree with Dr. Neumann: (2) Can pica be explained solely and/or primarily on the basis of vestigial instinct? I believe that Dr. Neumann does not distinguish deviant behavior such as pica (not necessarily a chewing activity but rather the ingestion of a variety of always unedible materials) from the healthy habit of "chewing" on hard material (with or without ingestion but I suspect more without than with).
THE ADRENAL CORTEX, STEROIDS, AND HYALINE MEMBRANE DISEASE
Authors: Reynolds John W.
Published: December 2021

The paper by Naeye, et al.,1 in this issue reports a very interesting relation between adrenal gland size and the presence of hyaline membrane disease in newborn infants. Those infants with hyaline membrane disease had smaller adrenal glands than weight matched control infants, due to a decreased number of cells in both the permanent and fetal zones of the adrenal cortex. More direct evidence of possible relation between adrenal cortical size and the capacity of the lung to produce surfactant is brought out by their finding of a correlation between adrenal cortical size in anencephalic infants and the osmiophilic granule content of so-called type II alveolar lining cells.
Neonatal Addiction to Methadone
Authors: Annunziato David
Published: December 2021

In a recent effort to alert the members of our chapter to the increasing incidence of infants born manifesting withdrawal symptoms due to their mother's heroin addiction, we became aware of another area of concern. Members of our committee have seen infants with methadone withdrawal symptoms.

After reviewing the few published articles and after some direct communication with those in the field, the impression was that no symptoms occurred in the infants of mothers on methadone.
AN UNIQUE PRESENTATION OF SICKLE CELL DISEASE:PYOGENIC HEPATIC ABSCESS
Authors: Shulman Stanford T. , Beem Marc O.
Published: December 2021

A laparotomy-proved pyogenic hepatic abscess was the initial clinical manifestation of sickle cell disease in a 4-year-old black boy. Although this complication has been reported in an adult patient with sickle cell disease, it has not been reported previously in children nor as the presenting manifestation of this state. Peptococcus species, a strictly anaerobic staphylococcus never previously reported implicated in a liver abscess, was isolated from two blood cultures. Inadequate anaerobic bacteriologic techniques may explain the failure to identify the causative organism in up to 60% of pyogenic hepatic abscesses. That this abscess represents a secondarily-infected hepatic sickle cell infarction seems probable.
GUIDELINES ON SHORT-TERM CONTINUING EDUCATION PROGRAMS FOR PEDIATRIC NURSE ASSOCIATES
Authors: Burnett Robert D. , Frank Donald J. , Goldstein Paul S. , Haverty John Rhodes , Silver Henry K. , Skinner Alfred L. , Teate H. Luten , Connelly John P. , Connelly John P. , Burnett Robert D. , Frank Donald J. , Harrison Stanley L. , Hoekelman Robert A. , Chaney Patricia , Popiel Elda S. , Duiker Wesley J. , Burroughs Arlene K. , Dunkley Pearl H. , Church Gertrude , Di Maggio Gellestrina , Furnas E. Jane , Shannon Iris R. , Spector Audrey F. , Sorensen Gladys , Wittmann M. Elaine
Published: December 2021

I. INTRODUCTION

The American Nurses' Association and American Academy of Pediatrics recognize collaborative efforts are essential to increase the quality, availability, and accessibility of child health care in the U.S.A. In order to meet the health care needs of children, it is essential that the skills inherent in the nursing and medical professions be utilized more efficiently in the delivery of child health care.

Innovative methods are needed to utilize these professional skills more fully. One such innovative approach is the development of the Pediatric Nurse Associate* program. This program will enable nurses, both in practice and reentering practice, to update and expand their knowledge and skills. It is essential that physicians become more aware of the skills and abilities of the nursing profession and that such skills be expanded in the area of ambulatory child health to enable both the nurse and the physician to devote their efforts in the delivery of child health care to the areas of their respective professional expertise.

The expansion of the nurse's responsibilities would encompass some of the areas that have traditionally been performed by physicians. Proficiency and competence in performing these new technical skills associated with the expanded responsibility should be viewed as increasing the sources from which the nurse gathers data for making nursing assessment as a basis for diagnoses and action and thus contributing directly to comprehensive nursing. Nurses must therefore be prepared to accept responsibility and accountability for the performance of these acts and must have the opportunity to be engaged in independent as well as cooperative decision making.
AUTOMATED BLOOD ANALYSIS: SUCCESS OR EXCESS?
Authors: Cook Charles D.
Published: December 2021

As the abnormalities and complications of prematurity and especially the idiopathic respiratory distress syndrome have become better understood, it has become appropriate to treat any potentially viable infant much more aggressively than 20 or even 10 years ago. Once it was believed that an incubator served, among other things, as a barrier to protect a premature infant from the meddling and disturbing manipulations of physicians; now we have warming devices without walls so that the infants are more accessible and the physical barriers are minimized.

Much of the increased knowledge about normal and abnormal neonatal adjustments has been based on physiologic and/or biochemical investigations and these, in turn, have been possible because of the development of microtechniques, especially those for the determination of serum electrolytes, blood gases, and pH.
Pseudomonas Osteomyelitis (Continued)
Authors: McAlister William H. , Minnefor Anthony B. , Olson Mary I. , Carver David H.
Published: December 2021

In the article on pseudomonas osteomyelitis, which appeared in Pediatrics for March, 1971,1 Figure 2 shows a lytic lesion at the base of the fourth metatarsal taken 2 days prior to admission. Figure 3 is stated to be taken 4 days later and this showed obvious diffuse demineralization with frank destruction of the fourth and fifth proximal metatarsals. It is a littie difficult for me to believe that this destruction occurred in 4 days. I wonder if the radiograph shown in Figure 3 was actually taken between the fourteenth to twentieth days.
LIVER SCANS IN CHRONIC GRANULOMATOUS DISEASE OF CHILDHOOD
Authors: Samuels L. D.
Published: December 2021

The biochemical defect of oxidase deficiency present in chronic granulomnatous disease of childhood is manifest clinically by recurrent infections, especially focal abscesses. In the liver these may be bacterial abscesses or characteriastic miliary, sterile granulomas. Either of these can be well-visualized and usefully followed with radioisotope liver scans.

Follow-up scans of the liver have shown that chronic changes of the disease may severely distort the gross liver morphology. Cases are presented of two surviving teen-age cousins and two young sisters, subsequently deceased, whose third sibling has just presented with the disease.
NEONATAL NECROTIZING ENTEROCOLITIS—OLD PIT-FALL OR NEW PROBLEM?
Authors: Fetterman George H.
Published: December 2021

No pediatrician with responsibility for the care of newborn infants, premature or full term, can fail to be interested in the syndrome of neonatal necrotizing enterocolitis. The recent outpouring of reports concerning the disease attests not only to the growing recognition of the problem but also the immediacy of the challenge which it presents. The challenge is twofold, demanding clinical diagnosis of the disease at an early stage as well as study directed toward the elucidation of its etiology and pathogenesis.

The most quoted articles from the European literature are Genersich's1 original case report in 1891, the series of 62 cases described by Willi2 in 1944, and the series reported by Rossier, et al.3 in 1959.
A BIZARRE METHOD TO TREAT INTUSSUSCEPTION
Authors: C. T. E.
Published: December 2021

In the mid-nineteenth century, intussusception was an almost universally fatal disease, save for the occasional child who responded to inflation of the bowel or to enemas.1 Of all the nonoperative forms of treatment (the first successful operation for intussusception in a child was performed by Hutchinson2 in 1871), none is more outlandish than this published in 1857:

Intussusception

In which one portion of the bowel falls down into another, like as when a stocking is turned half way inside out, effectually prevents any passage from the bowels, and death is inevitable, unless relief is given. Our intimation previously, that a pint of molasses drank while quite warm, had been known to give immediate relief, has caused a suggestion from W. H. Stanton, of Knoxville, that his father's sheep were invariably cured of a similar ailment, by being taken by the hind legs and swung around several times. As ludicrous as this "operation" might seem in its application to a human being, we would not hesitate to try it, in case other things failed. To us there is a kind of grandeur in all that is true and practical.

The most violent case of hysterics may be instantly arrested, if a great indignity is offered to the patient, such as slapping in the face with your slipper; and yet that is a better remedy than a plug of the intolerable Asafoetida.3
RISK OF LOCAL AND SYSTEMIC INFECTIONS ASSOCIATED WITH UMBILICAL VEIN CATHETERIZATION: A PROSPECTIVE STUDY IN 86 NEWBORN PATIENTS
Authors: Balagtas Rolando C. , Bell Charles E. , Edwards Lawrence D. , Levin Stuart
Published: December 2021

Umbilical vein catheterizations (UVC) (for fluid administration) in 86 infants were studied to determine the risk of infections associated with the procedure. Fifty-two percent of the catheters were colonized upon removal. The rate of catheter colonization was not dependent on duration of catheterization. Six infants (8%) were found to be bacteremic while the catheter was in place. In each of these patients an identical organism was isolated from the catheter. Systemic penicillin and kanamycin significantly reduced the rate of catheter colonization, particularly with pathogenic organisms, and the rate of bacteremia. Thus, the risk of local and systemic infections associated with UVC is significant and possible preventive measures are discussed.
PHENOBARBITONE PROPHYLAXIS FOR NEONATAL HYPERBILIRUBINEMIA
Authors: Yeung C. Y. , Tam L. S. , Chan Angeline , Lee K. H.
Published: December 2021

In a controlled study of phenobarbitone prophylaxis for neonatal hyperbilirubinemia, 133 term infants born of group O mothers were divided into three study groups. The first consisted of 45 control infants receiving no medication, the second of 44 infants born of mothers who received 30 mg of the drug every night for an average of 2 weeks before delivery, and the third of 44 infants given phenobarbitone 5 mg 8-hourly for an average of 3½ days beginning 6 to 8 hours after birth. The serum bilirubin of all infants was assessed daily for 6 days. Treated infants showed significant reduction of incidence of neonatal hyperbilirubinemia and of mean bilirubin levels as compared to the controls. Infants born of treated mothers showed similar beneficial effects, though such effects were much diminished in those with ABO incompatibility. Treatment of infants was more effective in lowering the bilirubin level than treatment of their mothers, perhaps because of the low dosage and short course used. Beneficial effects of phenobarbitone were attributed to enhancement of the impaired liver functions of the newborn.
EXTERNAL MONITORING AND PLASMA DISAPPEARANCE FOR THE DETERMINATION OF RENAL FUNCTION: COMPARISON OF EFFECTIVE RENAL PLASMA FLOW AND GLOMERULAR FILTRATION RATE
Authors: Cohen Melvin L. , Patel Jivan K. , Baxter David L.
Published: December 2021

In 40 patients effective renal plasma flow (ERPF) was measured by analyzing mathematically the plasma disappearance curve and the precordial external monitor disappearance curve of Na hippuran I131 simultaneously after a single injection of 30 µCu. The monitor curve is variably more shallow than the actual plasma curve. A mathematical interpolation is described using two plasma samples to correct the external monitor curve to approximate the entire plasma curve. ERPF determined by using the corrected monitor curve correlates well (r = .998) with the ERPF determined from the actual plasma curve and gives a small scatter (S.E. of estimate 11.1). The terminal exponential slope of plasma disappearance of Na hippuran I131 is apparent before 30 minutes and ERPF can then be obtained in a 40-minute study.

Glomerular filtration rates (GFR) were performed in 34 patients using 10 µsCu of Na iothalamate I125, comparing values derived by blood and urine sampling with those derived by plasma disappearance.

The latter method gave consistently falsely high values. The terminal exponential slope of the plasma disappearance curve for this isotope was not apparent before 80 or 90 minutes. Determination of GFR by plasma disappearance alone using Na iothalamate I125 is invalid in studies lasting up to 100 minutes after a single injection.
MENTAL RETARDATION IN FOUR OFFSPRING OF A HYPERPHENYLALANINEMIC MOTHER
Authors: Brown Eleanor S. , Waisman Harry A.
Published: December 2021

Four educable mentally retarded nonphenylketonuric children were born to a mentally normal hyperphenylalaninemic female whose plasma phenylalanine levels averaged 16 mg/100 ml. Growth was not retarded in three of the children. All were born with head circumferences below two standard deviations from the normal, but these approached normal during their subsequent growth. The children did not appear to differ significantly from other educable retarded children in height or learning ability. No unusual personality pattern was seen in the children, and although each child had minor congenital anomalies, these were not the same in all the children. It is suggested that maternal phenylalanine levels as low as 16 mg/100 ml can cause mental retardation in offspring.
A COMPARISON OF AMPICILLIN AND CHLORAMPHENICOL THERAPY IN HEMOPHILUS INFLUENZAE MENINGITIS
Authors: Schulkind Martin L. , Altemeier William A. , Ayoub Elia M.
Published: December 2021

A comparison was made of the clinical courses of 37 patients treated for H. influenzae meningitis with either ampicillin or chloramphenicol. The only significant difference noted in the courses of the two groups of patients was a prolonged duration of fever in the ampicillin-treated patients. The prolonged febrile course was not accompanied by any evidence that the antibiotic had failed to eradicate the infection. Neither could the fever be explained on the basis of subdural effusion, intercurrent infections, phlebitis, or drug fever.

In all other respects, the H. influenzae meningitis patients treated with either ampicillin or chloramphenicol had similar responses to therapy. The mortality rate and the incidence of neurological sequelae were the same for both groups of patients.

These findings indicate that a prolonged febrile course may be expected during the effective treatment of H. influenzae meningitis with ampicillin. This persistent fever is, in itself, no indication for the replacement of ampicillin therapy as long as other criteria show evidence of a favorable response to therapy.
SCHOOL PHOBIA—THE GREAT IMITATOR: A PEDIATRICIAN'S VIEWPOINT
Authors: Schmitt Barton D.
Published: December 2021

School phobia will be diagnosed if the physician asks about school attendance in his patients with vague complaints but normal physical and laboratory findings. The immediate goal of treatment is to return the child to full school attendance. The long range goal is to improve the dependency problem. School phobia can often be prevented by proper anticipatory guidance regarding independence during well child exams.
The Effect of Repeated Mumps Skin Tests on the Induction of Antibody
Authors: St. Geme Joseph W. , Wankner John J. , Arce Miriam A. , Van Pelt Lloyd F.
Published: December 2021

Repeated intracutaneous inoculation of inactivated mumps virus skin test antigen failed to induce a primary neutralizing antibody response in five fully susceptible, seronegative rhesus monkeys. Eight equally susceptible pregnant monkeys developed a primary antibody response and delayed hypersensitivity following inoculation with live mumps virus. Six of the eight monkeys also demonstrated an anamnestic rise in antibody following the application of the mumps virus skin test.

One may conclude that the mumps virus skin test reagent contains sufficient antigenic mass to evoke only a secondary immunologic response.
Hypertension Associated with Crossed Renal Ectopia in an Infant
Authors: Mininberg David T. , Roze Stephanie , Yoon H. J. , Pearl Marylin
Published: December 2021

Hypertension is not found commonly in infants under 1 year of age. Renovascular type of hypertension is extremely rare in this age group. A 3-month-old male infant is presented who developed hypertension secondary to the unilateral anomaly of crossed renal ectopia. This was associated with two other developmental anomalies, imperforate anus Type III-B and rectourethral fistula. The hypertension was treated successfully by surgery.

Case Report

A male infant, the full-term product of a 34-year-old G6P4A1 mother, was born by normal spontaneous delivery, weighing 5 pounds 8½ ounces. Physical examination was entirely normal except for the presence of an imperforate anus which subsequently proved to be Type III-B.
LIPID CONCENTRATION AND COMPOSITION IN HUMAN FETAL TISSUE DURING DEVELOPMENT
Authors: Roux Jacques F. , Takeda Y. , Grigorian A.
Published: December 2021

The concentration and fatty acid composition of lipids from the sixth to thirty-second week of gestation has been measured in human fetal tissues.

The data found show that the lipid concentration and fatty acid composition does not vary significantly during these stages of development. However, more palmitic acid and less linoleic acid is detected in fetal adipose tissue than in that of the mother and this relationship does not change in the immediate postpartum period. The results suggest that fetal lipid metabolism is well established early in gestation and that the concentration of lipids increases in proportion to the rate of growth of the fetal organs and cell structure.