bluuebunny/crossref_metadata_2025 huggingface dataset:
Caution on Overdiagnosis
Authors: Reinhart John B.
Published: December 2021

I am writing to comment on the article by Bugenstein and Phibbs, which appeared in the December 1975 issue of Pediatrics (page 1073). I do not question that such herniations do occur and may need surgical intervention on occasion. Whether they cause generalized abdominal pain or cause confusion in diagnosis to the pediatrician or surgeon who takes a careful history and does a careful physical examination is my question.

There is already the tendency to make a diagnosis on a "rule out" basis, and, in my opinion, there is excessive use of gastrointestinal x-ray and other laboratory procedures.
Respiratory Distress Syndrome: Echocardiographic Assessment of Cardiovascular Function and Pulmonary Vascular Resistance
Authors: Halliday Henry , Hirschfeld Stephen , Riggs Thomas , Liebman Jerome , Fanaroff Avroy , Bormuth Connie
Published: December 2021

Echocardiograms were performed for 82 preterm infants comprising 22 normal infants, 29 with mild respiratory distress syndrome (RDS), and 31 with severe RDS. Left ventricular systolic time intervals were measured from aortic valve echograms and right ventricular systolic time intervals from pulmonic valve echograms. Left ventricular performance seemed to be altered early in postnatal adaptation of preterm infants, but played no demonstrable role in the outcome of RDS. The right ventricular preejection period/right ventricular ejection time (RPEP/RVET) ratio was prolonged in 17 out of 31 patients with severe RDS, consistent with increased pulmonary vascular resistance or right ventricular dysfunction. Prolonged RPEP/RVET identified a subgroup with increased mortality and moribidity.
Decreased Mononuclear and Polymorphonuclear Chemotaxis in Human Newborns,Infants, and Young Children
Authors: Klein Robert B. , Fischer Thomas J. , Gard Sherrie E. , Biberstein Michael , Rich Kenneth C. , Stiehm E. Richard
Published: December 2021

A new method, chemotaxis under agarose gel, was used to assess the directed motility of polymorphonuclear (PMN) and mononuclear (MN) phagocytes of 21 newborns, 71 infants and children, and 50 adults. This assay requires only small quantities of cells and is rapid, easy, reproducible, and provides a permanent record. The chemotactic substance was zymosan-activated human serum.

Monocyte chemotaxis in the newborn was approximately 50% of adult control values, using the Boyden chamber (8.1 ± 2 cells per high-power field[HPF] [SE] in newborns compared to 17 ± 3 cells per HPF in adults), and 25% of adult control values, using the agarose method (50 ± 10 cells in newborns compared to 216 ± 15 cells in adults). Both are significant differences (P < .005). MN chemotaxis remains extremely low through age 5, and remains moderately reduced until age 10. PMN chemotaxis in the newborn was 82 ± 21 cells compared to adult controls of 300± 42 cells, also a significant difference (P < .05). PMN chemotaxis remains markedly depressed through age 2. Thereafter, PMN chemotaxis increases but remains significantly less than in adults until age 16.

These chemotactic defects may play an important role in depressed delayed hypersensitivity skin tests, diminished inflammatory reactions, and increased susceptibility to infection present in the newborn and young infant.
Nonoperative Management of Splenic Trauma in Children: A Report of Six Consecutive Cases
Authors: Aronson Daniel Z. , Scherz Arnold W. , Einhorn Arnold H. , Becker Jerrold M. , Schneider Keith M.
Published: December 2021

Postsplenectomy sepsis, although infrequent, is real and hazardous. We have taken a nonoperative approach to the child with a ruptured spleen who is in stable condition. Six consecutive patients with a diagnosis confirmed by angiography or scan were treated without surgery. The results suggest the usefulness of this approach in the child who is not bleeding massively.
Self-initiation and self-help: Promises and pitfalls
Authors: STARFIELD BARBARA
Published: December 2021

Self-help is in vogue. Stimulated at least partly by the purported inadequacies of our health care system, it promises better results if only people would take responsibility for their own destinies. The Lewises and their colleagues (p. 499), in their customary fashion, have added an innovative twist to the idea. Why not start the process in childhood?

In their article they describe a demonstration project in which children enrolled in an elementary school could initiate their own care from a school nurse. The nurse was trained to involve the children in the decisions required to cope with their problems. If
Nasoduodenal vs. Nasogastric Feeding
Authors: AVERY GORDON B.
Published: December 2021

To the Editor:

The article by Drs. Van Caillie and Powell entitled “Nasoduodenal Versus Nasogastric Feeding in the Very Low Birthweight Infant”(Pediatrics 56:1065, December 1975) represents a phenomenon all too common in the literature: investigation of an important question with inadequate numbers of patients and poor statistical control, resulting in conclusions based on insufficient data. The issue of how to feed the very small premature infant is indeed a significant one. A valid physiological
Old Answer Still Correct?
Authors: ARENA JAY M.
Published: December 2021

To the Editor:

I am writing in reply to the letter of Drs. Mofenson and Greensher(Pediatrics 59:788, May 1977), “The New Correct Answer to An Old Question on Kerosene Ingestion.” A correct quote from the third edition of my book, Poisoning: Toxicology-Symptoms, states that“treatment of kerosene ingestion without lavage or emesis is not only preferable, but actually the only logical course to follow.” I shall continue to use this statement in the fourth
Drs. Ivey and Kattwinkel Reply
Authors: IVEY HALLAM H. , KATTWINKEL JOHN
Published: December 2021

In reply to Drs. Grossman and Safir, we offer the following comments.

The purpose of our original communication was not to debate the advisability of suppressing cough (by itself a highly controversial area), but rather to point out the “potentially dangerous recommendations concerning the dosage of Actifed-C.” Nelson's Textbook of Pediatrics recommends a codeine dosage range of 1 to 1.5 mg/kg/24 hr (not “per dose”). It seems clear that the recommended dose for cough in
Dr. Thaler Replies
Authors: THALER M. MICHAEL
Published: December 2021

Dr. Glasgow's updating of developments since my article was submitted is much appreciated. It may serve to stimulate further exploration of the possibility that aberrant ammonia metabolism is involved in the pathogenesis of Reye's syndrome. This, after all, was my aim in proposing a“working” hypothesis.

The points raised by Dr. Glasgow deserve serious attention. Certainly, once various defects which manifest clinically as Reye's syndrome are recognized,each may require a specific form of therapy.
Fragmentation of Care and the Medical Home
Authors: HUGHES JAMES R. , GRAYSON ROBERT , STILES FRANK C.
Published: December 2021

To the Editor:

In stating that its goal shall be “the attainment by all children of the Americas of their full potential for physical, emotional and social health,” the Constitution of the American Academy of Pediatrics provides that the Academy shall seek to “foster measures and conduct activities directed toward establishing and maintaining the highest possible standards of quality and acceptability in the delivery of health care to children.”Implicit in these standards is a
Do What You Can Do
Authors: SHAW EDWARD B.
Published: December 2021

To the Editor:

No one can disagree with the report by Weber et al. (Pediatrics57:152, January 1976), which agrees with a similar article by Battaglia and Lockhart1 and the comments of Sydney Gellis in the 1976 Yearbook and which demonstrates that in ideal surroundingsthe use of endotracheal intubation is the appropriate emergency room method for affording an airway for the child with epiglottitis, replacing an older statement by Berenberg and Kery,2 i.e., “in
One Chairman's View
Authors: VAN LEEUWEN GERALD J.
Published: December 2021

To the Editor:

I read Dr. Haggerty's commentary entitled “Departments of Pediatrics” (Pediatrics 57:303, March 1976) with intense interest,having recently resigned after seven years as chairman of the Department of Pediatrics at the University of Nebraska. As always, Dr. Haggerty's comments are concise and accurate. He is essentially correct in all areas; I should like to emphasize, too, that academic pediatricians do look upon teaching as an opportunity rather than a “load,” and that
The case for day-care surgery
Authors: Brownlee Robert C.
Published: December 2021

In a very interesting article elsewhere in this issue (p. 600), El-Shafie and Shapiro have outlined their experience with outpatient or "day-care" surgery in a developing country (Jamaica). It is important to remember that in 1909 Nicoll1 of Glasgow, Scotland, was the first in the era of "modern medicine" to record experience with outpatient surgery on children. While one's definition of a developing country might not apply equally to Jamaica in 1973 and Scotland in 1909, it is possible that the medical conditions might have been more primitive in Scotland at that time.

It is unfortunate that Nicoll's recommendations were not followed.
Nonhyperoxic Retrolental Fibroplasia
Authors: Adamkin David H. , Shott Roger J. , Cook Larry N. , Andrews Billy F.
Published: December 2021

Retrolental fibroplasia (RLF) has most often been observed in preterm infants exposed to high ambient oxygen concentrations. This case report describes an infant near term who was never exposed to supplemental oxygen but in whom stage 4 RLF developed. The etiologic role of exchange transfusion is discussed.
Acute and Chronic Theophylline Therapy in Exercise-Induced Bronchospasm
Authors: Bierman C. Warren , Shapiro Gail G. , Pierson William E. , Dorsett Carol S.
Published: December 2021

This study examined the effectiveness of theophylline therapy in modifying exercise-induced bronchospasm (EIB) in children with perennial asthma and evaluated whether tolerance to theophylline developed with prolonged use.

Twenty-one children between 7 and 16 years of age were studied by a standardized treadmill exercise test carried out before administration of theophylline, 90 minutes after administration of theophylline, and again after three weeks of round-the-clock theophylline treatment. Changes in forced expiratory volume at one second, forced expiratory flow between 25% and 75% of vital capacity, and peak expiratory flow rate were measured before and after each exercise test.

Theophylline inhibited EIB in 20 of 21 subjects. There was considerable intersubject variation in the response to theophylline, however, ranging from complete inhibition in five subjects to no inhibition at all in one subject, even though theophylline controlled perennial asthma in all subjects, and all but one had theophylline levels between 10 and 22 µg/ml when tested. On repeated testing after three weeks of therapy, no tolerance developed to theophylline.

These findings suggest that EIB and perennial asthma may result from different causes and that theophylline's ability to control asthma will not predict its effect on EIB. Subjects who have severe EIB should be retested after theophylline pretreatment to evaluate the effectiveness of therapy.
Leigh's Encephalomyelopathy in a Patient With Cytochrome c Oxidase Deficiency in Muscle Tissue
Authors: Willems J. L. , Monnens L. A. H. , Trijbels J. M. F. , Veerkamp J. H. , Meyer A. E. F. H. , van Dam K. , van Haelst U.
Published: December 2021

A patient is described with subacute necrotizing encephalomyelopathy proven by autopsy. A slight increase of blood pyruvate and lactate levels with an increased lactate/pyruvate ratio and frequently increased β-hydroxybutyrate/acetoacetate ratio suggested a disorder of mitochondrial oxidation.

A cytochrome c oxidase deficiency was shown in peripheral muscle tissue with some residual cytochrome c oxidase activity in heart muscle. Normal cytochrome c oxidase activity was present in liver tissue. Because of the markedly higher levels of pyruvate and lactate in CSF compared with blood and an increased lactate/pyruvate ratio in CSF, there may also have been defective activity of cytochrome c oxidase in brain tissue. After a period of apparently normal development, the child's clinical condition gradually deteriorated and she died at age 6 years due to respiratory insufficiency. This study illustrates the fact that Leigh's disease is not linked to a single inherited molecular defect.
Hospital-Based Group Practice and Comprehensive Care for Children of Indigent Families
Authors: Ullman Ralph , Kotok David , Tobin James R.
Published: December 2021

The replacement of a community hospital's pediatric outpatient clinics with a physicians' group practice is described, and the effects of this development on the receipt of services by children of indigent families are analyzed. An expanded patient population, frequent telephone utilization, decreased emergency room use, and satisfactory parental perceptions are found. A comparative measure of effectiveness is obtained from a record review of the preventive care received by infants delivered by the hospital's staff obstetricians. The latter data show the group practice to be more successful than the clinics in initiating and maintaining well-child care in its facility, and in achieving the timed completion of immunizations and screening procedures.

The experience indicates an acceptance by low-income families of an outpatient service that emphasizes the physician-patient relationship with limited use of outreach services and nonphysician providers. It also indicates that such a system of care can be provided to a heterogeneous patient population within the same facility.
Complement Activation and Group B Streptococcal Infection in the Newborn: Similarities to Endotoxin Shock
Authors: Fenton Lawrence J. , Strunk Robert C.
Published: December 2021

Serial measurements of CH50, C3, C4, and factor B were performed on three newborn infants with group B streptococcal sepsis. Two of the septic infants had a colonized but noninfected identical twin. All three infants with group B streptococcal sepsis had hypotension, prolonged coagulation times, neutropenia, and respiratory failure. During the course of the sepsis, factor B was depressed 30% to 35%, C3 was depressed 40% to 60%, and CH50 was depressed by 100% when compared to their cord blood levels. Two of the infants also had a 50% to 70% depression of C4. In contrast, no significant decrease in complement levels occurred in the siblings of the twins or in two additional control infants.

These data are characteristic of older patients with Gramnegative sepsis and strongly suggest that the group B Streptococcus has endotoxin-like properties.
Childhood Cancer and the Jehovah's Witness Faith
Authors: Frankel Lawrence S. , Damme Catherine J. , Van Eys Jan
Published: December 2021

The argument here, however, is not that these patients prove that transfusions need be given less frequently, because that would constitute a post hoc justification on medical grounds of what was an ethical decision.

The final decision to abide by or try to override a patient's wishes must rest with the physician, who alone can perceive the unique needs and sensitivities (both medical and emotional) of his patient. The tendency often is to downplay the emotional needs and excessively magnify the medical needs. This group of patients constitutes a challenge to bring the issues into sharp focus and into true perspective.
Anatomy of a trial
Authors: Holtzman Neil A.
Published: December 2021

Efficacy and safety of new treatments can seldom be predicted with certainty. Even when it addresses biochemical alterations, a therapy may not improve the clinical situation. The low-phenylalanine diet for phenylketonuria (PKU), for instance, followed logically from the discovery of an enzyme deficiency, but the diet's effectiveness in preventing retardation in asymptomatic infants was still in doubt a decade after it was introduced. Studies in which some subjects are not treated can often establish the benefits and risks of therapy. Many obstacles, however, lie in the way of controlled clinical trials despite the advantage they offer. The PKU story exemplifies the issues.
Drs. Conway and Grossman Reply
Authors: Conway James , Grossman Herman
Published: December 2021

I have performed a comprehensive review of the use of radionucides for Meckel's diverticulum detection and this was reported to the Society of Nuclear Medicine at their 23rd annual meeting in June 1976. An abstract of that presentation has been published in the Journal of Nuclear Medicine. Currently, there are approximately 35 articles in the world literature which generally attest to the efficacy of this procedure, particularly when compared to roentgenographic techniques. In our report, which was collated from those surgically proven cases reported in the literature and approximately ten pediatric institutions, there was an accuracy of 78%.
Hyperkinesis and Food Additives: Testing the Feingold Hypothesis
Authors: Harley J. Preston , Ray Roberta S. , Tomasi Lawrence , Eichman Peter L. , Matthews Charles G. , Chun Raymond , Cleeland Charles S. , Traisman Edwin
Published: December 2021

Teacher ratings, objective classroom and laboratory observational data, attention-concentration, and other psychological measures obtained on 36 school-age, hyperactive boys under experimental and control diet conditions yielded no support for the Feingold hypothesis. Parental ratings revealed positive behavioral changes for the experimental diet; however, they seemed primarily attributable to one diet sequence. Parents' behavioral ratings on ten hyperactive, preschool boys indicated a positive response to the experimental diet; again, laboratory observations showed no diet effect.
Ophthalmoplegic Migraine in Infancy
Authors: Robertson William C. , Schnitzler Eugene R.
Published: December 2021

Isolated oculomotor nerve palsy is an unusual finding in the pediatric patient. Third nerve weakness is a rare complication of vascular headaches, and there are few reported cases of so-called ophthalmoplegic migraine (OM) in young children. Recently we have seen a 12-month-old girl with OM that appeared to respond to treatment with propranolol.
Triglyceride Levels After Intralipid Infusion in Children With Cystic Fibrosis
Authors: Allué Xavier , Sanjurjo Pablo
Published: December 2021

Infusions of soybean oil emulsion (Intralipid) have been reported to correct essential fatty acid (EFA) deficiency in patients with cystic fibrosis of the pancreas (CF).1 The Intralipid dosage used by Elliot1 was 2 gm/kg of body weight given over a period of four hours. This article reports the immediate effects of Intralipid infusion in patients with CF in an attempt to ascertain through biochemical data whether the use of Intralipid at the reported dose is free of untoward effects.

MATERIALS AND METHODS

Six patients with CF were placed in a protocol that called for periodic infusions with soybean oil emulsion containing EFAs.
Blood pressure of children in the United States
Authors: Adams Forrest H.
Published: December 2021

Recently a Task Force of the National Heart, Lung and Blood Institute published a report in Pediatrics on blood pressure control in children.1 The report was good in many respects in that it presented in summary form a critique of what we currently know and do not know about blood pressure in children. Particularly good for pediatricians were the sections on methodology for measurement of blood pressure; mechanisms and causes of hypertension; evaluation of the hypertensive patient; and treatment of the hypertensive patient. The Task Force stressed the importance of further research in the field of blood pressure control in children and specifically recommended that physicians incorporate the measurement of blood pressure in the annual physical examination after 3 years of age.
Food additives and hyperkinesis: Are there nuts among the berries?
Authors: Bierman C. Warren , Furukawa Clifton T.
Published: December 2021

In this issue of Pediatrics, two studies focus on the subject of food additives and hyperkinesis. They represent a scientific approach to a current pediatric dilemma: Do food additives cause children to be hyperactive? Unfortunately, concerns about additives and hyperkinesis developed as a result of feelings, beliefs, fads, and emotions and had little to do with science.

At the annual meeting of the American Medical Association in June 1973, Dr. Benjamin F. Feingold presented a paper correlating children's hyperactivity with their consumption of food additives such as artificial flavors, colors, and preservatives, as well as natural salicylates. He claimed that 30% to 50% of children that he treated with special additive-free diets had striking behavioral improvement.
Granulocyte Transfusions in Neonates with Bacterial Infection, Neutropenia, and Depletion of Mature Marrow Neutrophils
Authors: Christensen Robert D. , Rothstein Gerald , Anstall Harold B. , Bybee Blair
Published: December 2021

During a three-year period, 26 neonates with bacterial infection and neutropenia were studied. In order to assess the marrow neutrophil reserves, bone marrow aspirates were obtained from each of these patients. The neutrophil storage pool (percent polymorphonuclear + band neutrophils + metamyelocytes in 1,000 nucleated marrow cells) was significantly greater in those who survived their infection (X= 20.1%, range 3.2% to 60.8%) than in those who died (X = 1.9%, range 0.4% to 5.2%, P < .002). In an attempt to improve survival in this group, seven neutrophil-depleted patients with sepsis were given granulocyte transfusions and all survived. In contrast only one of nine nontransfused, neutrophil-depleted infants with sepsis survived (P <.01). The seven granulocyte recipients were examined for possible adverse effects of the transfusions and none were detected. It is suggested that infected, neutropenic neonates with depletion of mature marrow neutrophils are at high risk for death from sepsis, and that these infants may benefit from granulocyte transfusion therapy.
Injuries Related to Baby Walkers
Authors: Holroyd H. James
Published: December 2021

The Consumer Products Safety Commission issued a report on baby-walker related injuries at approximately the same time that an article on the same subject was accepted for publication in Pediatrics.1 The latter study of the risks and problems of baby walkers as seen in a private practice accurately expresses the problem as most practicing pediatricians see it. However, only a portion of users who are sufficiently injured to require treatment will be observed or treated by pediatricians. Thus, the CPSC report of 23,900 walker injuries requiring treatment in one year, 1980, indicates a much greater problem than might be inferred from the experience of a single pediatric practice.
Pericarditis in Juvenile Rheumatoid Arthritis
Authors: Pearl William
Published: December 2021

I read with interest the excellent article by Yancey et all1 reviewing their experience with pericarditis in juvenile rheumatoid arthritis. I have a patient who has been followed up much longer than their patients, and unlike their patients, did develop constrictive pericarditis as a late complication of juvenile rheumatoid arthritis.

The patient is a 19-year-old white man who is known to have had juvenile rheumatoid arthritis since 12 years of age. Although acute pericarditis was never diagnosed, at 17 years of age he came to the hospital complaining of shortness of breath, increasing abdominal girth, and a weight gain of 15 lb (6.8 kg) in one week.
Propranolol in Children: Safety-Toxicity
Authors: Artman Michael , Grayson Mitch , Boerth Robert C.
Published: December 2021

Four hours after acute ingestion of 400 to 1,200 mg of propranolol by a healthy, 3-year-old boy, his plasma concentration of propranolol was 2,289 ng/ml. The only pharmacologic effect observed was a diminished heart rate response to crying and activity. In a second case, a 4-year-old boy on chronic propranolol therapy for renovascular hypertension had a hypoglycemic seizure when solid food was refused for three days because of an oral wound. The hypoglycemia was easily managed with intravenous glucose, and there were no sequelae. The first case alludes to the safety of propranolol in a healthy child even with very high plasma concentrations. The second case suggests the necessity of anticipating and avoiding hypoglycemia that can develop in children on chronic propranolol therapy when caloric intake is impaired.
Periodic Apnea in the Full-Term Infant: Individual Consistency, Sex Differences, and State Specificity
Authors: Waite Stephen P. , Thoman Evelyn B.
Published: December 2021

The occurrence of periodic apnea (apnea during periodic breathing) was studied in 27 normal, full-term infants during the first five weeks of life. The rate and mean length of apnea were analyzed both with respect to sleep state and with respect to respiratory pattern, ie, periodic vs nonperiodic breathing. The rate of apnea was found to vary according to sleep state and the pattern of breathing. The highest apnea rates were non-periodic apneas in active sleep. Periodic apnea rates were relatively low in both active and quiet sleep; however, this type of apnea was consistently observed from weeks 2 through 5. The proportion of apneas that are periodic is much higher in quiet sleep than in active sleep. Rates of periodic and nonperiodic apnea were more consistently correlated in active sleep than in quiet sleep. The mean length of periodic apnea was found to be significantly greater than the mean length of nonperiodic apnea in both sleep states, a difference that reflected a greater positive skew in the distribution of the nonperiodic apnea lengths. This variation in length between periodic and nonperiodic apnea explains, in part, the increased mean length in quiet sleep compared with active sleep. There were significant individual differences over weeks in both forms of apnea in active sleep and in quiet sleep. Female infants were observed to have higher rates of nonperiodic apnea than male infants in active sleep, although no significant differences in the distribution of lengths were obtained.
Pediatricians and General Practitioners: A Comparison of the Management of Children with Febrile Illness
Authors: Leduc D. G. , Pless I. B.
Published: December 2021

To assess the relative competence of pediatricians and general practitioners in managing febrile illnesses in childhood, a prospective study was undertaken of 259 children less than 10 years of age seen consecutively at the emergency room of a children's hospital and a general hospital. Both groups of patients were similar in demographic characteristics, age, sex, presenting complaints, and height and duration of fever. Of the 148 patients entered in the study at children's hospital and the 111 at general hospital, 90% and 94%, respectively, were interviewed by telephone within two weeks of their emergency room visit to determine outcomes based on duration of the acute illness episode and further physician contacts or admissions to hospital. Although no significant differences in the measured outcomes of febrile illnesses seen by pediatricians or general practitioners were found, a trend in favor of those cared for by pediatricians was discernible with respect to two key measures: unresolved symptoms at one week (8.3% vs 12.5%) and subsequent hospitalization (0.8% vs 3.0%). The overall frequency of laboratory use and antibiotic prescriptions was the same in both groups; however, significant differences were noted in the type of laboratory test used: general practitioners ordered three times more roentgenograms than pediatricians and one fifth the number of microbiologic tests. Larger prospective studies are needed to test how these findings may be generalized in view of their importance for quality assurance in the primary care of children.
Infantile Water Intoxication After a Swimming Lesson
Authors: Goldberg Gerald N. , Lightner Elmer S. , Morgan Wayne , Kemberling Sid
Published: December 2021

This report emphasizes a danger inherent in early infant swimming programs, ie, the need to observe the infant closely for ingestion of excessive amounts of water. A physician faced with a history compatible with near-drowning or possible aspiration of water must consider the diagnosis of acute water intoxication. Accidental ingestion of water can produce hyponatremia with resulting signs and symptoms of acute water intoxication, ie, lethargy, vomiting, seizures, and increased intracranial pressure.
Spontaneous Perforation of the Extrahepatic Bile Ducts in an Infant
Authors: Andersson Dan , Helin Ingemar , Nettelblad Sven-Caspar , Cederlund Clas-Göran
Published: December 2021

Spontaneous perforation of the extrapepatic bile ducts, with an accumulation of bile in the peritoneal cavity, is a rare condition. Nevertheless, it is second in frequency to biliary atresia as the cause of obstructive jaundice during the first year of life.1 Although approximately 60 cases of this condition have been described in the literature, it is only occasionally listed in pediatric textbooks. Nevertheless, it is important that the condition be recognized in time to perform lifesaving surgical intervention. We therefore consider it instructive to present a patient with the classic features of this condition who was cured by surgical treatment on the 29th day of life.
THE FIRST ENGLISH ACCOUNT OF APNEIC ATTACKS IN THE NEWBORN INFANT (1799)
Authors: C. T. E.
Published: December 2021

Michael Underwood (1737-1820), the most advanced writer on diseases of children in the eighteenth century, gave the first English account of apneic attacks in the newborn infant in the fourth edition of his Treatise on the Diseases of Children (1799).

He wrote:

Mr. Hey, senior surgeon to the Infirmary at Leeds, ... reports that an infant born at the full time lay moaning and languid for four or five hours, and was then seized with a fainting fit: in which it continued for half an hour. In this state Mr. Hey found it. It had ceased to breathe except now and then giving a gasp, or sob, and was as pale as a corpse. There was however a sensible pulsation of the heart though feeble and slow, but whether the circulation had been kept up all the time previous to his visit could not be ascertained. As soon as Mr. Hey had time to consider the case he directed the infant's nostrils and temples to be stimulated with the volatile alkali, and when it became capable of swallowing, a few drops of the tinctura valerian. volat. were administered in a teaspoonful of water and repeated at proper intervals; it likewise took a teaspoonsful of the ol. ricini [castor oil].

The child had three other similar attacks in the course of the day, though it had slept composedly between whiles and sucked at the breast. It had seven more fainting fits in the night, two of which were severe ones; but Mr. Hey was not called again till the next morning.
PEDIATRIC PSYCHOPHARMACOLOGY
Authors: Haggerty R. J.
Published: December 2021

In this issue the editors conclude a two-part special section. Of the five papers in the second part, four center on conduct disturbances. Conduct disturbances have not received the attention that their high prevalence rate and poor prognosis merit, despite the fact that they are probably also the most common reason that psychotropic drugs are prescribed for children and adolescents.

The first paper is a useful review which concludes with a pilot study that is of interest because it adds to our knowledge of the place of lithium in child psychiatry.

The second paper reports an interesting serendipitous observation arising out of a study of depressed children. While in some cases depression may present as conduct disorder, and therefore respond to antidepressant medication, this study suggests the possibility of an independent role for antidepressant drugs in conduct disorder.

The next paper is a short report on the use of a new drug (or a new use for an old drug) propranolol in rage reactions in brain-damaged patients. All three of these studies, however, are uncontrolled or otherwise methodologically flawed. This is justifiable only in pilot studies such as these, which must be taken only as signposts to future possibilities of the use of pharmacologic agents in behavior disturbances.
Letter to the Editor
Authors: Fulginiti Vincent A.
Published: December 2021

In response to your thoughtful comment and criticism of the statement by Committee on Infectious Diseases, "Aspirin and Reye Syndrome" (Pediatrics 69:810, 1982), the Committee deliberated at two committee meetings and by two conference calls concerning this issue before we issued our statement. Further, we had the statement reviewed by the Committee on Drugs and the Executive Committee of the Academy, both of which forwarded comments to us. The statement was extensively edited in the process.
Does Carbon Dioxide Play a Role in Retrolental Fibroplasia?
Authors: Bauer Charles R.
Published: December 2021

The role of carbon dioxide tensions in the evolution of acute and/or chronic retrolental fibroplasia (RLF) is a subject of much current interest. Flower and Blake1 have produced cicatricial disease for the first time in an animal model by inhibiting prostaglandin-mediated retinal vasoconstriction. Similar vascular alterations were induced in this puppy model by either aspirin pretreatment or by hypercarbia exposure—both resulting in vasodilator predominance and scarring disease. This suggests that "vasodilation" may be a pathologic process, rather than the oxygen-induced "vasoconstriction," which has previously been incriminated in the pathogenesis of this disease.
Validation of an Early Language Milestone Scale in a High-Risk Population
Authors: Coplan James , Gleason John R. , Ryan Rita , Burke Michael G. , Williams Margaret L.
Published: December 2021

Detailed language evaluations were obtained by interviewing the parents of 191 healthy children aged 0 to 3 years, and by testing the children themselves. From these data, normative values were derived for 41 language milestones in the first 36 months of life. These values were used to construct the Early Language Milestone Scale (ELM Scale), a brief language assessment tool suitable for use by general pediatricians. Physician use of the ELM Scale in a population of 119 children considered at high risk for the presence of developmental disability yielded 97% sensitivity and 93% specificity for the ELM Scale as a detector of developmentally delayed children, when compared with more formal developmental measures as applied by a clinical psychologist or speech pathologist. Early language milestones are a sensitive indicator of developmental integrity; delayed achievement of early language milestones strongly suggests the presence of a significant underlying developmental disability. The ELM Scale may be adopted as a valid measure of developmental status among children considered at high risk for the presence of developmental disabilities.
Recurrent Pneumonia in Children and Its Relationship to Bronchial Hyperreactivity
Authors: Eigen Howard , Laughlin James J. , Homrighausen Jean
Published: December 2021

To determine what conditions are most likely to cause persistent or recurrent pneumonia (PRP) in children, the records of 81 children referred to James Whitcomb Riley Hospital for Children for evaluation of PRP were reviewed. Twenty patients had an apparent underlying cause that predisposed them to PRP. Of the 61 remaining patients (mean age 3.8 years) without any apparent cause for PRP, 49% had a history of allergy or family history of asthma, 31% patients had a history of wheezing and 18% were wheezing during their initial visit. No patient had an elevated sweat chloride determination or immunoglobulin deficiency. Of the 12 patients who were able to be recalled for pulmonary function testing, three had airflow obstruction that responded to an inhaled bronchodilator (isoproterenol). Of the nine patients with normal function, eight responded to methacholine with a decrease from base line in the one-second forced expiratory volume of greater than 20%. In all, 92% of those tested had bronchial hyperreactivity. These results indicate that asthma is a common cause of PRP in children and that PRP may occur as the initial symptom even in the absence of wheezing.
Evaluation of Infants with Bronchopulmonary Dysplasia Using Cardiac Catheterization
Authors: Berman William , Yabek Steven M. , Dillon Terrence , Burstein Rochelle , Corlew Sue
Published: December 2021

Nine infants with bronchopulmonary dysplasia underwent cardiac catheterization to define their circulatory status. In room air, the mean cardiac index was normal (3.4 liters/mm/sq m), but pulmonary arterial pressure (39 mm Hg, mean) and pulmonary vascular resistance (8.6 Wood units · sq m) were elevated. Preejection period/right ventricular ejection time ratios determined echocardiographically correlated well with values obtained at catheterization, but did not correlate well with hemodynamic values. Administration of 40% and 88% oxygen caused variable responses in hemodynamic measurements. Studies of left ventricular function were normal in all patients. These findings raise questions about the long-term prognosis of infants with bronchopulmonary dysplasia.
The Irresponsible Expert Witness: A Failure of Biomedical Graduate Education and Professional Accountability
Authors: Brent Robert L.
Published: December 2021

Many forces have created the epidemic of negligence and malpractice litigation. One of the contributing factors to the rising rate of nonmeritorious litigation is the increasing number of unqualified and irresponsible expert witnesses. The high remuneration has attracted physican-scientists who are unaware of the proper role of an expert witness. They are frequently manipulated by the attorneys and function as partisans rather than scholars. The role of the expert witness should be taught in medical and graduate school. Testimony should be treated as a scholarly endeavor and experts should be encouraged to seek peer review of their opinions and not to testify secretly and in isolation. It is suggested that greater visibility of experts and their testimony (light of day phenomenon) should raise the quality of expert witness testimony and encourage more qualified experts to participate as expert witnesses, thus removing the stigmata usually associated with unqualified expert witnesses.
PRAGMATIC ATTITUDES IN THERAPEUTIC TRIALS
Authors:   Student
Published: December 2021

. . . most therapeutic trials are inadequately formulated, and this from the earliest stages of their conception. Their inadequacy is basic, in that the trials may be aimed at the solution of one or other of two radically different kinds of problem: the resulting ambiguity affects the definition of the treatments, the assessment of the results, the choice of subjects and the way in which the treatments are compared . . . .

Consider a trial of anti-cancer treatments in which radiotherapy alone is to be compared with radiotherapy preceded by the administration of a drug which has no effect by itself but which may sensitise the patient to the effects of radiation. Suppose the drug is to be administered over a 30-day period. The "radiotherapy alone" group may then be handled in two different ways: (a) radiotherapy may be preceded by a blank period of 30 days, so that it is instituted at the same time in each group; (b) radiotherapy may be instituted at once, thereby carrying it out at what is most probably the optimal time.

Neither procedure can be said to be "better" than the other. The first allows us to compare two groups which are alike from the radiotherapy point of view and which differ solely in the presence or absence of the drug. It therefore provides an assessment of the sensitising effect of the drug and gives valuable information at a biological level. The second procedure enables us to compare two treatments under the conditions in which they would be applied in practice.
‘Red Book’ Update
Authors: Fulginiti Vincent A. , Brunell Philip A. , Cherry James D. , Ector Walton L. , Gershon Anne A. , Gotoff Samuel P. , Hughes Walter T. , Mortimer Edward A. , Peter Georges , Plotkin Stanley A.
Published: December 2021

UPDATE

The Red Book Committee met on May 10, 1982 and considered a number of issues, including:

1. The 1982 edition (19th) of the Red Book has been distributed beginning on June 4, 1982. We welcome comments and suggestions for the 20th edition.

2. IMPORTANT REVISION IN RED BOOK RECOMMENDATIONS: After the Committee meeting it came to our attention that three children who had anaphylactoid reactions to egg ingestion experienced immediate allergic reactions to chick-embryo-grown live measles virus vaccine; two had difficulty breathing and one had hypotension. Persons who are egg-allergic but do not have a history of anaphylactoid reactions appear to be at little or no risk from live measles virus (LMV) vaccine (See Morbidity Mortality Weekly Rep 31:217-231, May 7, 1982). Because previous experience indicated no adverse reactions in egg-allergic children given vaccine prepared in chick embryo tissue culture, the 1982 Red Book contains the following statement:

The vaccine currently used in the United States is prepared in chick embryo tissue culture by inoculation with a further attenuated passage of the Edmonston B strain of measles virus. This preparation is virtually devoid of allergenic substances derived from the chick embryo cell cultures used for growth of the live vaccine viruses. However, there is a remote potential risk of hypersensitivity reactions in patients allergic to eggs, chicken, or chicken feathers; large scale use of the vaccine for more than a decade has resulted in only rare, isolated reports of minor allergic reactions. In a study in which children known to be allergic to eggs, chicken, or chicken feathers were vaccinated with a chick embryo cell culture-derived vaccine, no allergic reactions were observed.
Letter to the Editor
Authors: Block Stanley Hoyt
Published: December 2021

Bourgeois, Dodson, and Ferrendelli appropriately list additional reported interactions between isoniazid and primidone; isoniazid and certain barbiturates; nicotinamide and primidone; and nicounamide and carbamazephine. These are in addition to the interaction mentioned in my recent report in Pediatrics (69:494, 1982) between isoniazid and carbamazepine. These reports should serve as warning that the levels of several anticonvulsant drugs can be altered when other medications (such as isoniazid) are added to the regimen.

My report and the letter of Bourgeois et al emphasize that this can be a clinical as well as theoretical problem.
Care for Foster Children on the Move
Authors: Neff John M.
Published: December 2021

Schor is to be congratulated on his excellent article on foster care and health1 and his emphasis on the major deficiencies that exist for foster children in our current health-care system. I am also pleased to see that there was such a strong commentary on this issue by Sokoloff.2 I would, however, like to differ with one of Sokoloff's conclusions, and that is that "Foster families should be encouraged to incorporate the foster child into their own health care system." In fact, this is what most foster families have done in the past and this practice has helped accentuate the current problem.
Bilirubin Toxicity Model Questioned
Authors: Poland Ronald L.
Published: December 2021

Levine and associates1 have produced data that confirm two well-accepted concepts. First, acutely injured tissues swell, releasing increased quantities of serum albumin into extravascular, extracellular spaces. Second, bilirubin is transported in the body extensively bound to serum albumin. These two concepts account for all of their observations. They have speculated on a "blood-brain barrier" which, in the context of their experiments seems to be nothing more complex than a semipermeable membrane.

These authors have not, however, produced evidence that supports their speculations concerning the neurotoxicity of bilirubin.
In Reply: Digoxin and Low-Birth-Weight Infants
Authors: JOHNSON GREGORY L.
Published: December 2021

We appreciate the interest shown in our report by Olander and Maurer. In response to their query as to why we elected to report our experience, the following comments must be made. First, when the work by Berman et al was published, we reevaluated the methods of digoxin administration in our nursery and set a rigid protocol for such administration. In cases in which loading dosages of digoxin were felt to be required, the recommendations of Berman et al were adhered to (ie, 25 to 30 µg/kg loading and 10 µg/kg/day maintenance).
Ultrasonography in Subcapsular Hematomas of the Liver in the Newborn
Authors: MOUZARD ALAIN , COHEN JEAN YVES , HUAULT GILBERT
Published: December 2021

French and Waldstein determined the clinical parameters associated with subcapsular hematomas of the liver in the newborn. The authors describe two cases with diagnosis made during life, but they are not precise about clinical findings. Hemoperitoneum may be due to other bleeding sites.

We have observed 19 cases of hemoperitoneum in the newborn, 16 with subcapsular hematoma of the liver and three with splenic rupture. The different etiologic factors are birth injury, prematurity with neonatal rescuscitation, particularly external cardiac massage, and epileptic mothers treated with phenobarbitone.
A New, Treatable Source of Recurrent Meningitis: Basioccipital Meningocele
Authors: Hemphill Michael , Freeman John M. , Martinez Carlos R. , Nager George T. , Long Donlin M. , Crumrine Pat
Published: December 2021

A 19-month-old boy suffered eight episodes of bacterial meningitis. During the ninth episode a meningocele of the basioccipital clivus communicating with the nasopharynx was discovered. Identification of the organism causing the episodes of meningitis was not helpful in pointing to the site of this congenital anatomic defect. Surgical closure of the defect has prevented further recurrences.
Autosomal Dominant Polycystic Kidney Disease in the Neonatal Period: Association with a Cerebral Arteriovenous Malformation
Authors: Proesmans Willem , Van Damme Boudewijn , Casaer Paul , Marchal Guy
Published: December 2021

Two brothers with the neonatal presentation of dominant polycystic kidney disease are reported. The first infant died shortly after birth; autopsy revealed polycystic kidneys. The second infant had two markedly enlarged kidneys at birth. Intravenous pyelography at the age of 10 days showed typical images as observed in the recessive form of polycystic kidney disease. Kidney biopsy showed cystic dilation involving all parts of the nephron; the liver biopsy did not show any abnormality. Severe arterial hypertension was a major problem in the first six months of life. At the age of 3 and 5 years, respectively, the patient developed intracerebral hemorrhage, which was due to a complex intracerebral arteriovenous malformation. At the age of 8 years the boy had chronic renal failure and spastic quadriplegia. Previously unsuspected polycystic kidneys were found in the father during the family study.
Acquired Postganglionic Cholinergic Dysautonomia: Case Report and Review of the Literature
Authors: Inamdar Sarla , Easton Lon B. , Lester Georgina
Published: December 2021

An 8-year-old girl with acute abdominal pain had cholinergic autonomic dysfunction. There have been only four patients with acquired postganglionic cholinergic dysautonomia described in the literature. The characteristic clinical features are atony of the bowel and bladder, lack of tears, saliva, and sweat, internal ophthalmoplegia, and normal adrenergic functions. Special studies for autonomic nervous function help in confirming this diagnosis. The exact pathogenesis of the disorder is still not clear. This case demonstrates successful treatment with bethanechol chloride.