bluuebunny/crossref_metadata_2025 huggingface dataset:
NOSOCOMIAL INFECTION WITH ECHO VIRUS TYPE 31 IN A NEONATAL INTENSIVE CARE UNIT
Authors: McDonald Louise L. , St. Geme Joseph W. , Arnold Barbara H.
Published: December 2021

During the summer of 1968 ECHO virus type 31 was isolated from four infants in a neonatal intensive care unit. The index case was admitted from home in a comatose state and harbored ECHO 31 in his throat. Necropsy findings were inconclusive, and no virus was recovered from neural tissues. After the admission of this patient, two infants in the unit developed apneic spells and ECHO 31 was isolated from their CSF, throat, and stool samples. The virus was also isolated from the stool of an asymptomatic infant. ECHO 31 had not been recovered in newborn infants prior to its isolation in these cases.

The isolation techniques currently used in many neonatal units may be inadequate to prevent viral dissemination. It is important to maintain a high index of suspicion of neonatal viral disease since careful virologic study will clarify the ecology of these nosocomial infections.
THE MICRO-VASCULAR CIRCULATION OF LYMPHANGIOMAS: A STUDY OF Xe133 CLEARANCE AND PATHOLOGY
Authors: Touloukian Robert J. , Rickert Robert R. , Lange Robert C. , Spencer Richard P.
Published: December 2021

An active lymphatico-venous circulation, comparable to cutaneous tissue, was demonstrated in five infants and children with superficial lymphangiomas of the neck, axilla, and foot. The study was conducted by monitoring washout curves of externally administered Xe133. Although the vascularity of these lesions, as determined by microscopic examination, was similar to one another, an inverse correlation between the lymphatico-venous circulation and the gross size of the lymphangioma was demonstrated. The study implies the existence of a functional abnormality of lymphatico-venous drainage contributing to the size of lymphangiomas.
MRS. LYDIA MARIA CHILD IN 1844 TELLS MOTHERS HOW TO DEVELOP THEIR CHILD'S CHARACTER
Authors: C. T. E.
Published: December 2021

Mrs. Lydia Maria Child (1802-1880), a prolific writer and humanitarian reformer, wrote the most widely read early 19th century book to guide mothers in the correct management of their children. Here is her advice on how to develop good affections or character in a child:

It is a common opinion that a spirit of revenge is natural to children. No doubt bad temper, as well as other evils, moral and physical, are often hereditary–and here is a fresh reason for being good ourselves, if we would have our children good. But allowing that evil propensities are hereditary, and therefore born with children, how are they excited, and called into action?

First, by the influences of the nursery–those early influences, which, beginning as they do with life itself, are easily mistaken for the operations of nature; and in the second place, by the temptations of the world.

Now, if a child has ever so bad propensities, if the influences of the nursery be pure and holy, his evils will never be excited, or roused into action, until his understanding is enlightened, and his principles formed, so that he has power to resist them. The temptations of the world will do him no harm; he will "overcome evil with good."

But if, on the other hand, the influences of the nursery are bad, the weak passions of the child are strengthened before his understanding is made strong; he gets into habits of evil before he is capable of perceiving that they are evil. Consequently, when he comes out into the world, he brings no armor against its temptations.
EXPERIMENTAL INFECTION OF THE SKIN IN THE HAMSTER SIMULATING HUMAN IMPETIGO
Authors: Dajani Adnan S. , Hill Patty Lee , Wannamaker Lewis W.
Published: December 2021

The efficacy of various therapeutic regimens for the treatment of impetigo was assessed in an experimental animal model. The topical application of gentamicin or bacitracin and removal of scabs were ineffectual. PHisoHex scrubbing delayed healing significantly and resulted in the development of satellite lesions. Healing was significantly promoted by the administration of penicillin, the benzathine variety being more effective than procaine penicillin. Benzathine penicillin was similarly effective in pure streptococcal lesions and in mixed lesions containing penicillin-sensitive or penicillin-resistant staphylococci in addition to streptococci. The development of skin lesions was markedly reduced following prophylactic administration of benzathine penicillin.
OBSERVATIONS ON HEROIN AND METHADONE WITHDRAWAL IN THE NEWBORN
Authors: Reddy A. Mahender , Harper Rita G. , Stern Gertrude
Published: December 2021

Retrospective analysis of 40 infants born to heroin addicted mothers revealed that 85% developed withdrawal symptoms consisting of central nervous system, gastrointestinal and respiratory disturbances, some within hours of their birth. Respiratory depression at time of delivery was not a prominent feature of these children, suggesting that even in utero, tolerance to chronic narcotic usage develops. A high incidence of low birth weight infants noted by previous authors is substantiated by our study. More than half of these infants were small for gestational age infants rather than true premature infants. Although the morbidity was high, the mortality was limited to two infants both below 1,000 gm birth weight. Serious congenital malformations were not noted in our study.

Withdrawal symptoms were also observed in infants born to methadone-maintained mothers. These infants exhibited a withdrawal pattern consisting of central nervous system, gastrointestinal and respiratory disturbances. Pediatricians should be aware that infants born to methadone maintained mothers may be seriously compromised in the newborn period.
Susceptibility of Medical Students to Mumps: Comparison of Serum Neutralizing Antibody and Skin Test
Authors: Brickman Anthony , Brunell Philip A.
Published: December 2021

Fifty-nine medical students without a history of parotitis were tested for mumps neutralizing antibody and 88.1% were found to be immune. The results of mumps skin tests showed poor correlation with the results of the serological testing whether or not the size of reactions to placebo antigen were subtracted from the skin test size.

A significant difference between two lots of skin test antigen was detected.
Streptococcal Wound Infection with Evidence of Widespread Tissue Involvement
Authors: Haddow J. E. , Sher N. , Gall D. G. , Green D.
Published: December 2021

A 5-year-old boy is presented who, in association with a severe streptococcal wound infection, developed evidence of widespread tissue insult. Symptoms included prolonged delirium, confusion, and gastrointestinal dysfunction. Biochemical abnormalities included elevated BUN, LDH, SGOT, CPK, and amylase. Urinary sediment was found to be markedly abnormal. Symptoms and laboratory measurements improved slowly on therapy.

Reports of clinical material with some common features are reviewed as well as autopsy findings in fatal streptococcal infections. Also mentioned is a summary of the biochemical and pathologic effects of streptococcal exotoxins in animals. It is hypothesized that streptococcal extracellular products may be responsible for many of the symptoms and biochemical alterations occurring with streptococcal infections.
VITAMIN K SUPPLEMENTATION FOR INFANTS RECEIVING MILK SUBSTITUTE INFANT FORMULAS AND FOR THOSE WITH FAT MALABSORPTION
Authors: Filer Lloyd J. , Barness Lewis A. , Goldbloom Richard B. , Holliday Malcolm A. , Miller Robert , O'Brien Donough , Pearson Howard A. , Scriver Charles R. , Weil William B. , Whitten Charles F. , Cravioto Joaquin , Kline O. L.
Published: December 2021

Certain milk substitute infant formulas, particularly meat-based and casein hydrolysate based formulas, may be low in vitamin K content in relation to the needs of the infants receiving them. Studies are reviewed of a few infants in which inadequate dietary supply of vitamin K from such sources may have been one factor in the development of hypoprothrombinemia, though this could not be established with certainty.

On theoretical grounds it seems reasonable to increase the level of vitamin K1 in milk substitute formulas to 100 µg/l, particularly because these products are often used in treatment of clinical conditions which are associated with diminished absorption of this vitamin. Vitamin K1 (phylloquinone) would seem the most appropriate form to be used for supplementation of formulas.

In clinical situations associated with malabsorption of fat, e.g., cystic fibrosis of the pancreas or biliary atresia, and prolonged diarrhea or starvation, vitamin K supplementation of feedings or periodic parenteral administration of vitamin K is recommended.

When parenteral vitamin K is necessary, intravenous administration is rarely indicated. Subcutaneous or intramuscular injection is preferred.
Estimation of the Rate of Congenital Malformations
Authors: Selvin Steve , Garfinkel Joseph
Published: December 2021

In view of the article by A. Khalili, and coauthors,1 we thought it might be interesting to present an alternative way of looking at the estimation of the rate of malformation from multiple sources. Also, we will present some new data on the rates of congenital malformation in New York State.

When death certificates are matched to birth certificates, three possible outcomes exist with respect to congenital malformations. The malformation will be noted on both the death and birth certificates, it will be included on the birth certificate only, or on the death certificate only.
Another Danger from Cats to Sleeping Children
Authors: Rosenthal Robert
Published: December 2021

I greatly enjoy reading the historical items published in Pediatrics under the by-line, "Noted by T.E.C., Jr., M.D." For me, these short pieces are a welcome addition to the pages of Pediatrics.

In a recent contribution (Pediatrics, 47: 515, 1971), attention is called to a 1905 report of a child who was thought to have been suffocated while sleeping by the weight of a cat lying on the child's chest.

Another widespread superstition is that "the cat steals the sleeping infant's breath" as noted in this quotation from a book written in 1898 for the use of mothers in rearing their children.
THE GROWTH AND DEVELOPMENT OF FOUR XYY INFANTS
Authors: Valentine G. H. , McClelland Marilyn A. , Sergovich F. R.
Published: December 2021

Four XYY infants ascertained from 1,066 unselected newborn infants have been followed for 2½ to 3½ years. None of them show any distinctive physical characteristics, though three of the four lack a C triradius in the palmar dermatoglyphics. All four are of normal stature. Three appear of normal intellect and personality. One is of borderline intelligence and by 2 years was exhibiting aggressive, defiant, and destructive behavior.

There are great problems of what, if anything, to divulge to the parents when an XYY chromomosome complement has been discovered.
THE CRITICALLY ILL CHILD: SICKLE CELL DISEASE CRISES AND THEIR MANAGEMENT
Authors: Pearson Howard A. , Diamond Louis K.
Published: December 2021

This brief review, being limited in scope to the recognition and management of the life-threatening and painful crises in infants and children with sickle-cell disease, has not even touched on the intriguing mystery of the molecular basis for the sickling phenomenon–how one amino-acid substitution (gene controlled) in the beta chain sequence of 146 amino acids can cause such serious disruption in form and function; or how this mutation occurred in the first place and why it has persisted in contrast to the rapid disappearance of many other deleterious mutants. Nor has there been even mention of the many milder symptoms, signs, and complications due to the presence of Hb. S., either in the homozygous (disease-producing) state or heterozygous form when found in combination with other hereditary hemoglobin defects. The accumulated knowledge about this mutant gene, its biochemical effects, and geographic distribution is enormous. From a fundamental scientific standpoint, sickle cell disease is one of the best understood of human afflictions.

However, from a practical point of view treatment of the patient himself is often only symptomatic and palliative. Nevertheless, prompt and effective therapy of the myriad manifestations of sickle cell disease can effectively reduce morbidity and mortality. The pediatrician who cares for black children in his practice should be familiar with the cardinal diagnostic and clinical aspects of sickle cell disease and its crises.
CONTROLLED TRIAL OF INTENSIVE CARE FOR VERY LOW BIRTH WEIGHT INFANTS
Authors: Kitchen W. H. , Campbell D. G.
Published: December 2021

Two controlled clinical trials were carried out in infants with a birth weight between 1,000 and 1,500 gm. Careful control of arterial oxygen and the infusion of 10% glucose for the first 3 days of life failed to reduce the mortality rate in a group of 118 infants. In the second clinical trial involving 120 patients, the mortality rate was reduced, especially in infants with clinical evidence of respiratory distress syndrome, by the addition to the regime of early vigorous efforts to correct acidosis.

The mortality in comparable infants before the introduction of intensive care in 1965 was 49%. In the era of intensive care, 35% of patients given only routine care died, whereas infants receiving vigorous intensive care had a mortality rate of only 18%. The patients with respiratory distress syndrome showed the most noticeable improvement in survival.
DR. JOB LEWIS SMITH (1827-1897) WRITES ABOUT MATERNAL EMOTIONS AS A CAUSE OF CONGENITAL DEFORMITY
Authors: C. T. E.
Published: December 2021

The best known American pediatrician of his time with the single exception of Abraham Jacobi was Job Lewis Smith.1 In continuous practice of pediatrics in New York City for nearly 50 years, as well as the clinical professor of pediatrics at Bellevue Hospital Medical College for a large part of these years, Dr. Smith exerted an enormous influence on American pediatrics. His textbook of the diseases of children, based entirely on his own clinical experience, is still esteemed as a solid reliable work. In the second edition of this book, Smith wrote:

It is the popular belief, and the belief of many physicians, that vivid mental impressions sometimes have a direct effect on the development of the foetus (sic). Many cases are on record in which infants were born with marks or deformities, corresponding in character with the objects which had been seen and had made a strong impression on the maternal mind at some period of gestation. . . . The multitude of facts which have accumulated justify the belief that deformity . . . is due to the emotions of the mother. . . . I have met the following cases. An Irish woman of strong emotions and superstitions was passing along a street in the first months of her gestation, when she was accosted by a beggar, who raised her hand, destitute of thumb and fingers, and in "God's name" asked for alms. The woman passed on: but reflecting in whose name money was asked, felt that she had committed a great sin in refusing assistance.
Low Voltage Skin Burns
Authors: Jarvis Charles W. , Voita Donald A.
Published: December 2021

The hazards accompanying the increasing use of line-operated electrical devices for diagnosis and therapy as well as the more common hospital appliances such as electrically operated beds, television sets, radio sets, and so forth have been recently reemphasized.1 Most physicians are aware of the dangers of alternating current (60 Hz AC) or of high voltage direct current (DC) , especially in relation to cardiac function. However, few physicians seem to be aware of the hazards of low voltage direct current. A standard text2 on laboratory safety fails to mention the subject. Low voltage direct current is used with many different types of miniature electronic devices and iontophoresis.
Pulmonary Mycobacterium scrofulaceum Infection in a Child
Authors: Cooper Austin R. , Martin Ronald S.
Published: December 2021

Pulmonary infections due to atypical mycobacteria are very rare in children, in whom they closely simulate infections associated with Mycobacterium tuberculosis.

The present case report presents a possible pulmonary infection due to Mycobacterium scrofulaceum (Runyon group II) in a 2-year-old girl. The results of bacteriologic isolation of this organism have to be interpreted with caution, however, since the organism may exist in commensal form in man.
STABILITY OF ANTIBIOTICS IN PARENTERAL SOLUTIONS
Authors: Wyatt Richard G. , Okamoto Gary A. , Feigin Ralph D.
Published: December 2021

Stability of ampicillin, carbenicillin, clindamycin, kanamycin, cephalothin, methicillin, and penicillin was tested in each of seven parenteral solutions (Isolyte M and Isolyte P, Ringer's lactate, 5% dextrose in water, 10% dextrose in water, dextrose in normal saline and normal saline) at three temperatures (4°C, 25°C, and 37°C). Each antibiotic was reconstituted to a predetermined concentration with bacteriostatic water and immediately added (zero time) to each solution at each temperature. Aliquots were obtained at 30 minutes and at 1, 2, 4, 6, and 12 hours and tested for antibacterial activity. Ampicillin activity fell in most solutions reaching nondetectable levels in Ringer's lactate at 24 hours at 37°C. Minimal loss of activity was demonstrable in Isolyte M and Isolyte P solutions at 24 hours. Carbenicillin, clindamycin, kanamycin, methicillin, and penicillin generally retained 90% of their initial activity at 24 hours in all solutions and at all temperatures. Cephalothin activity was retained for 24 hours in all solutions at 4°C and 25°C and at 37°C until 6 hours; thereafter, antimicrobial activity decreased in solutions at 37°C. The stability of ampicillin in multiple electrolyte solutions containing acetate contrasted sharply with loss of activity in solutions containing lactate.
HYDROCEPHALUS IN ACHONDROPLASIA STUDIED BY CISTERNOGRAPHY
Authors: James A. Everette , Dorst John P. , Mathews Ernest S. , McKusick Victor A.
Published: December 2021

Cerebrospinal fluid (CSF) images were obtained in two patients with achondroplasia. Communicating hydrocephalus was present without ventricular stasis of the radiopharmaceutical. CSF diversionary shunts may not be indicated in the usual patient with achondroplasia and hydrocephalus. This diagnostic study offers future promise in predicting those patients who may benefit from a CSF diversionary shunt.
DIFFICULTIES IN THE DIAGNOSIS OF THE ADRENOGENITAL SYNDROME IN INFANCY
Authors: Shackleton C. H. , Mitchell F. L. , Farquhar J. W.
Published: December 2021

Pregnanetriol was not excreted by an infant (7 days old) who was later shown to have a defect in steroid 21-hydroxylase. However, the excretion of this compound increased during the following days (1.2 mg on the thirteenth day of life). A high excretion of 3β-hydroxy-Δ steroids was the most noticeable abnormality in steroid excretion noted on the seventh day of life (e.g., 3β, 16α-dihydroxy-5-pregnen-20-one, 15 mg; 3β, 21-dihydroxy-5-pregnen-20-one, 1.4 mg and 3β, 16α-dihydroxy-5-androsten-17-one, 7.4 mg). This high 3β-hydroxy-Δ steroid excretion results in difficulties in distinguishing a defect in 3β-hydroxy steroid dehydrogenase from a 21-hydroxylase deficiency.

At the age of 14 months the principal steroids excreted were those predominant in other cases of 21-hydroxylase deficiency, viz. pregnanetriol and 5β-pregnane-3α, 17α, 20α-triol-11-one (11-oxo-pregnanetriol).
PSYCHOLOGICAL SEQUELAE TO BACTERIAL MENINGITIS: TWO CONTROLLED STUDIES
Authors: Sell Sarah H. W. , Webb Warren W. , Pate John E. , Doyne Emanuel O.
Published: December 2021

Two controlled studies concern the results of standardized psychological test assessment of long-term sequelae of bacterial meningitis in school age children who were ill before age 3.

In the first group, each survivor was matched with a near-age, nonmeningitic sibling. Results of the Wechsler Intelligence Scale for Children indicated that the mean IQ of the post-meningitic children was 86; control children, 97 (p = < .05). Comparison of each subject with his control revealed that six (29%) were 15 IQ points (1 standard deviation) below the control. In two (10%) the difference exceeded 30 IQ points (2 standard deviations). There were six subjects with IQ scores higher than controls but none by 15 points.

The second investigation compared survivors who were considered to be entirely normal with matched peers in the same classroom. Results of the dependent measures-Illinois Test of Psycholinguistic Abilities, the Frostig Developmental Test of Visual Perception, and the Peabody Picture Vocabulary Test-all indicated that the post-meningitic children functioned at significantly lower levels than their nonmeningitic peers.

It was concluded that both groups of survivors were damaged by the disease. The evidence supports the need for prevention rather than reliance upon cure of meningitis.
THE NEPHROTIC SYNDROME IN CONGENITAL SYPHILIS: AN IMMUNOPATHY
Authors: Hill L. Leighton , Singer Don B. , Falletta John , Stasney Richard
Published: December 2021

This report describes the renal morphology in an infant, 2½ months of age, who had the nephrotic syndrome secondary to congenital syphilis. A specimen of the kidney obtained by needle biopsy was studied by light, electron, and fluorescent microscopy.

Periarterial cellular infiltrates composed of lymphocytes and plasma cells were prominent in the interstitial tissues. Glomerular visceral and parietal epithelial cells were swollen and increased in number. The axial matrix in many glomeruli was expanded by partially collagenized axial matrix mateial.

Nodular electron dense deposits were numerous in the epithelial aspect of the glomerular basement membrane.

The areas corresponding to the electrondense deposits were strongly stained with fluorescein tagged antisera to IgG, IgM, and fibrinogen. Less intense but still positive staining was obtained with antisera to IgA and β1c globulin.

The nephropathy in congenital syphilis appears to have its basis in the deposition of immune complexes within the glomerular basement membrane. The very young infant, therefore, appears capable of manifesting with an immune deposit disease. The presence of all classes of immunoglobulins in the membranous deposits suggests that the infant has precocious capabilities for producing each of these immunoglobulins.
TEEN-AGE PREGNANCY AND THE PROBLEM OF ABORTION
Authors: Hazard Sprague W. , Allen V. Robert , Eisner Victor , Garell Dale C. , Hammar S. L. , Shaffer Thomas E. , Shen Jerome T. Y. , Tanner Natalia M. , Welty John Allen
Published: December 2021

In a previous statement approved by the Executive Board of the American Academy of Pediatrics, and subsequently by the House of Delegates of the American Medical Association, the American College of Obstetricians and Gynecologists emphasized the magnitude of the problem of teenage pregnancy and the responsibilities of professionals involved in the care of these young people. Rapid changes in contemporary attitudes and in legislation have caused many physicians and their patients to consider abortion as an acceptable solution to an unwanted pregnancy in adolescent girls. These changes place a heavy responsibility on pediatricians and other physicians caring for adolescents, particularly in regard to their special need for compassionate and considerate understanding.

Although the American Academy of Pediatrics prefers neither to sanction nor to forbid the use of abortion to terminate an unwanted pregnancy in the teen-age girl, it does have the responsibility to insist that physicians considering this recourse provide for appropriate counseling and support for these adolescent girls and other involved persons, including the young fathers. In circumstances where the pediatrician is unable to provide adequate counseling support, he should act as the pivotal person in arranging for a social worker, pastor, or other experienced counselor to conduct this essential of care, both before and after the procedure.

Consistent with his accredited role in preventive medicine, the pediatrician must make certain that adequate information and sex counseling are available to his teenage patients. Contraceptive advice and prescription for the sexually active teenage girl should be accompanied by investigation and alteration of contributing issues wherever possible.
Mood-Altering Drugs and Hyperkinetic Children
Authors: Erenberg Gerald
Published: December 2021

Dr. Ralph Olsen's recent letter to the Editor,1 questioning the validity of prescribing medication for all children with school behavior problems, is more acceptable to me than the opinions stated in the response of Dr. L. Eugene Arnold.2

As a pediatric neurologist, I have first-hand knowledge of the frequency with which this request is made and have had many opportunities to evaluate the results of pharmacotherapy. The initial problem is that of identifying the child whose hyperactive behavior is due to minimal brain dysfunction (by definition an "organic" process).
Corticosteroids and Group: Comments from a Grass Rooted Ivory Tower
Authors: Shaw Edward B.
Published: December 2021

Dorland defines croup as "a condition resulting from acute obstruction of the larynx caused by allergy, foreign body, infection or new growth, occurring chiefly in infants and children and characterized by resonant barking cough, hoarseness and persistent stridor." Life was simpler when we distinguished false (spasmodic) from true (diphtheritic) croup! Now, we recognize many etiologies, often viral in origin.

In some lofty quarters, accepted opinion might hold that controlled studies have failed to show any value of steroid medication; however, my opinion is based more on 37 years of pediatric practice than on my 13 years in the "tower." A number of laryngologists and anesthesiologists recommend corticosteroids, especially dexamethasone, for treatment of laryngeal edema, even though it is less acceptable to many pediatric faculties and house staffs.
Susceptibility of Medical Students to Mumps: Dubious Value of Currently Available Skin Test Antigens
Authors: St. Geme Joseph W.
Published: December 2021

We wish to commend Doctors Brickman and Brunell for their interesting study of the "Susceptibility of Medical Students to Mumps."1 They detected mumps virus neutralizing antibody in 88.1% of 59 students without a history of parotid swelling.

During the summer of 1965 Doctor Eric Eisenklam and I studied 66 residents, interns, medical students, and nurses at the University of Minnesota Hospitals. Using a protocol of bleed, mumps skin test, then rebleed in 4 weeks, we discerned that 95% of these young adults had humoral immunity (neutralizing antibody titer of at least 4) to mumps virus.
Prenatal Infections (International Symposium of Vienna, September 2nd and 3rd, 1970), edited by Otto Thalhammer. New York: Grune & Stratton, Inc., 1971, 84 pp., $6.00
Authors: Eichenwald Heinz F.
Published: December 2021

This little booklet, edited by a recognized expert in the field, consists entirely of papers presented at a 2-day international symposium. Not included is any discussion which might have followed these presentations. Little editing of the various papers is evident since there is a lack of uniformity and some duplication.

The inherent weaknesses of such an approach are, of course, obvious. In the allotted time and space, it was not possible to discuss or even sketch the vast body of information in the area of prenatal infections.
A FILTER PAPER SAMPLING METHOD FOR THE URIC ACID:CREATININE RATIO IN URINE
Authors: Mclnnes Roderick , Lamm Peter , Clow Carol L. , Scriver Charles R.
Published: December 2021

In the article: A Filter Paper Sampling Method for the Uric Acid-Creatinine Ratio in Urine: Normal Values in the Newborn, Pediatrics, 49:80 (January) 1972, the last sentence of the Results section should read:

We were unable to obtain and test urine samples which had been collected during the first week of life from known patients with the Lesch-Nyhan Syndrome.
STUDIES ON ORGAN MATURATION: "SKIN AGE" AS AN INDICATOR OF "LUNG AGE" IN FETAL RABBITS
Authors: Taeusch H. William , Wang N. S. , Avery Mary Ellen
Published: December 2021

A skin score was constructed from the study of histological specimens from 38 rabbit litters removed during the last third of gestation. The score increased predictably with increasing gestational age. Changes in body weight occurring within litters of the same gestational age did not affect the score. This pattern of development is similar to that previously described for fetal rabbit lung. In 16 fetuses, 1 mg of hydrocortisone was injected 2 days before delivery on day 28 of gestation. Although lung age is known to be accelerated by steroid injection, the skin score was not advanced. Therefore, maturational indices of lung and skin while normally parallel and independent of body weight variation, are affected differently by an altered steroid environment.
DRUG INTERACTIONS—PART I
Authors: Yaffe Sumner J.
Published: December 2021

The past several decades have witnessed a remarkable growth in our understanding of drug action and disposition within the intact organism. Awareness of the significant role which hepatic drug metabolizing enzymes play ill determining the duration and intensity of action of many drugs expanded prodigiously as a result of the fundamental research by Bernard B. Brodie and his co-workers at the National Institutes of Health. This achievement spurred the training of a new breed of pharmacologists devoted to the extension of these findings to man. Their insights, plus surveillance of prescribing habits, have generated concern over the frequency with which patients receive multiple medications concurrently. The possibility of interaction among these therapeutic agents increases in proportion to the number administered. In addition to prescribed drugs, the individual is also exposed to a host of environmental chemicals and over-the-counter preparations. All may alter drug action.

Historically, drug interaction involves the prescribing of mixtures of ingredients, an approach which has deep-seated roots in medical tradition and psychological appeal for patient and physician. The appeal for the physician to prescribe not just one, but a combination of pharmacologically active ingredients, has been, and continues to be difficult to resist because of the inference that more drugs are necessarily better than few—a concept far from the truth.

A widely accepted current definition of the word "drug" is "any biologically active substance." This encompasses both synthetic and natural substances. They may be administered or naturally occurring. Drug interaction may result not only among administered compounds but between an administered drug and endogenous substances.
The Lecithin-Sphingomyelin Ratio of Amniotic Fluid: An Index of Fetal Lung Maturity?
Authors: Roux Jacques F. , Nakamura Junichi , Brown Edwin , Sweet Avron Y.
Published: December 2021

The proportion of lecithin (L) to sphingomyelin (S) measured in amniotic fluid has been proposed as an index of fetal lung maturity.1 A ratio of L to S of 1.5 or less has been correlated with hyaline membrane disease in the postnatal period. Therefore, prevention or delay of immediate delivery has been advocated in such circumstances.

In our laboratory, the L to S ratio (L/S) was determined immediately before birth in 88 amniotic fluid samples obtained by amniocentesis between the 8th and 46th week of gestation.
Treatment of Idiopathic Respiratory Distress with Large Doses of Corticoids
Authors: Ewerbeck H. , Helwig H.
Published: December 2021

The investigations of Reynolds1 and of Naeye, Harcke, and Blanc2 published recently should be considered with great interest. So far, all therapy proposed for idiopathic respiratory distress (RDS) did not prove effective enough to survive a 10-year period. Before we knew the above mentioned studies, we started treating severe RDS in final stages of the disease with extremely high doses of prednisolone intravenously (20 to 40 mg/kg/day) with an encouraging success. Five of 10 infants sumvived; of the five who died, three had fatal cerebral bleeding, in two, post-mortem examination could not be performed.
Simon Yudkin
Authors: Barnett Henry L. , Fraad Lewis M. , Kretchmer Norman
Published: December 2021

We believe that the many friends of the late Dr. Simon Yudkin among our readers would be interested in knowing that a Memorial Trust has been set up in his memory as described in the following letter to the Editor of "The Times" of London.

"Dr. Simon Yudkin, consultant paediatrician to University College Hospital and to the Whittington Hospital, died in April (1968) aged 54. His death brought to an untimely end a brilliant clinical career.
IS THE WEARING OF OVERSHOES DETRIMENTAL TO A CHILD'S HEALTH?
Authors: C. T. E.
Published: December 2021

The author of the letter below, published in 1831, vehemently proscribed the use of overshoes as an article of clothing for children. He wrote:

Overshoes For Children

To the Editor of the Boston Med. and Surg. Journal

Sir,—It is a subject of regret that there is so great a demand, in this part of the country, for children's India-rubbers; and as your Journal is probably taken by every physician in New England of any distinction, I am desirous of enlisting, through its pages, their influence against so pernicious a custom. Are not parents sensible that they cannot well do their children a greater unkindness, than thus cautiously to protect their feet from external dampness, and parboil them in perspiration? The feet of children should be well bathed in the coldest water every morning throughout the year, and they should then be protected by nothing thicker, warmer, or more impervious to water, than leather shoes. If, in wet weather, the soles of these shoes are soaked through, no injury can come of it, if the child have never been made tender and susceptible of cold by practice I feel it is a duty to discourage. On the contrary, he will run and sport about more briskly, and lay the foundation of a firmer constitution, and more vigorous and uniform good health.

I have noticed several families of children whose feet are thus habitually guarded, and find them looking puny and pale, kept at home from school oftener by colds, than other children by bad walking, and in sickness offering much less resistance to disease than those whose systems have been fortified by more hardy management.
Darvon Poisoning with Delayed Salicylism: A Case Report
Authors: Kaufman Felix L. , Dubansky A. Stephen
Published: December 2021

A case of combined Darvon and aspirin poisoning is presented. A phenomenon of delayed salicylism (as opposed to acute or chronic) as a result of an enteric coated preparation is described. The case illustrates the need for knowledge of not only the time of the ingestion and dose ingested, but also the type of preparation involved, before good judgements can be made.
Puerperal Bacteremia and Neonatal Sepsis Due to Hemophilus Parainfluenzae: Report of a Case with Antibody Titers
Authors: Zinner Stephen H. , McCormack William M. , Lee Yhu-Hsiung , Zuckerstatter Marguerite H. , Daly A. Kathleen
Published: December 2021

Puerperal bacteremia and neonatal sepsis due to Haemophilus parainfluenzae is described in a mother and her infant. Indirect fluorescent antibody studies for specific IgM antibody directed against the H. parainfluenzae were performed on maternal and infant sera. The rise in infant IgM antibody titers suggested that the infant acquired the infecting organism during labor or delivery. H. parainfluenzae has not previously been implicated as a pathogen in either puerperal or neonatal sepsis.
Sodium, Potassium, Calcium, and Magnesium in Hair from Neonates with Cystic Fibrosis and in Amniotic Fluid from Mothers of Such Children
Authors: Kopito L. , Elian E. , Shwachman H. , Rossen E.
Published: December 2021

The concentration of Na, K, Ca, and Mg in amniotic fluid from mothers who have borne children with cystic fibrosis, is similar to that of normal women. Scalp hair of neonates with cystic fibrosis contains significantly elevated concentrations of sodium and potassium. Nearly all of the calcium and 80% of the magnesium in the hair of these patients may be extracted by washing or boiling the hair in water, whereas only a small fraction of the calcium and magnesium of the hair of healthy infants is water soluble. The increased or decreased solubilities of calcium complexes have been previously observed in various tissues of patients with CF. The inability of hair from patients with CF to bind calcium and magnesium may be related to the basic defect in this disease.
HEXACHLOROPHENE AND SKIN CARE OF NEWBORN INFANTS
Authors: James L. Stanley , Cornblath Marvin , Drorbaugh James E. , Graven Stanley N. , Kay Jacob L. , Korones Sheldon B. , Meyer H. Belton , Oliver Thomas K. , Segal Sydney , Shinefield Henry , Sutherland James M. , Tooley William H. , Hasselmeyer Eileen , Talner Norman L. , Carrington Elsie R.
Published: December 2021

The question of safety has been raised by the recent evidence that levels of hexachlorophene in the blood of newborn infants receiving daily baths with a 3% solution are close to levels which are neurotoxic for adult rats. Hexachlorophene is widely used in newborn nurseries, but techniques vary considerably; they range from meticulous, double, early bathing followed by daily baths, to alternate day washing with a diluted solution followed by rinsing off.

Blood levels associated with leg weakness progressing to paralysis in the adult rat with chronic oral administration have ranged from 0.985 to 1.48 p.p.m. Toxic manifestations have not been observed nor recognized in newborn infants with "meticulous" daily washing. The chemical is readily absorbed from the skin, resulting in blood levels of 0.009 to 0.646 p.p.m. The compound is excreted as a monoglucuronide in the bile and feces. Convulsions have been reported in an infant 4 days after repeated application of the 3% emulsion to the skin without subsequent rinsing; and, toxic manifestations have been observed in burn patients, but at relatively high serum levels (29 µg/ml), after denuded areas of the skin have been washed with hexachlorophene.

It is not known whether or not this substance as currently used on infants is toxic. Although the symptoms observed in adult man and adult rats are similar, the actual blood levels at which symptoms are produced in man appear to be much higher. Symptomatology in the rat with chronic oral administration was accompanied by brain lesions, cerebral edema, and cystic spaces in the white matter of the brain; these lesions were reversible over a period of 6 weeks when hexachlorophene was discontinued.
PHENYLKETONURIA AND THE PHENYLALANINEMIAS OF INFANCY
Authors: Kugel Robert B. , Bartran John Bowman , Bost Roger B. , Cavanaugh James J. A. , Hanson Virgil , Kennell John H. , McMahon Jean , Pearson Paul H. , Scott Roland B. , Scurletis Theodore D. , Browder J. Albert , Halpern Daniel , Martin Edwin W.
Published: December 2021

In 1965 this Committee issued a statement outlining the responsibilities of the physician to the child with phenylketonuria, an inherited abnormality of amino acid metabolism.

A lack of knowledge about the disorder and about the results of treatment placed constraints on the 1965 statement. The Committee therefore feels that, with recent advances in knowledge about the disorder, a new statement is needed.

An increased level of phenylalanine in the blood can occur under sporadic and transient conditions in the absence of disease, with or without a concomitant elevation of serum tyrosine; it is always present in the disorder now called phenylketonuria. Because of incomplete information, simple classification of a specific case of phenylalaninemia is often not possible.

Screening programs allow for the detection of infants with elevated blood levels of phenylalanine. Screening programs should be encouraged and supported because they are the best available means for identifying all infants with abnormalities of protein metabolism resulting in serum phenylalanine elevations.

Two important, unresolved issues need clarification: (1) the effect of a persistently elevated blood level of phenylalanine on the intellectual growth of the child when there are no other indications of disease, and (2) the possibility of harmful effects of a diet low in phenylalanine.

The basic treatment of phenylketonuria is to reduce circulating phenylalanine by dietary restriction; and, because a spectrum of disorders causes an elevation of that amino acid, differing approaches in management seem indicated.

The relative rarity of phenylketonuria precludes the opportunity for individual physicians to gain widespread experience and expertise in management outside of a hospital specialty clinic setting.
BETA-METHYLCROTONYL-CoA CARBOXYLASE DEFICIENCY: A NEW METABOLIC ERROR IN LEUCINE DEGRADATION
Authors: Stokke Oddvar , Eldjarn Lorentz , Jellum Egil , Pande Helene , Waaler Per Erik
Published: December 2021

A new inborn error of metabolism, characterized by urinary excretion of substantial amounts of β-hydroxyisovaleric acid and β-methylcrotonylglycine, is described. The disorder is most likely due to a defect in the biotin-dependent enzyme β-methylcrotonyl-CoA carboxylase in the leucine degradation pathway. The patient, a 4½-month-old girl, suffered from neurological symptoms similar to those of Werdnig-Hoffmann's disease. No episodes of acidosis could be detected. In periods the urine had a peculiar odor, like that of cat's urine. Relatively large doses of biotin (0.25 mg/day) did not influence the condition. On a diet containing the minimum requirement of leucine, the daily excretion of β-hydroxyisovaleric acid dropped from 400 mg to about 50 mg and β-methylcrotonylglycine from 100 mg to 50 mg. However, the clinical course was unaltered and the patient died at 9 months of age from bronchopneumonia. Biochemically, as well as clinically, the findings are distinctly different from previously described errors in the leucine metabolism.
PARENTERAL FEEDING—A NOTE OF CAUTION
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

Parenteral feeding in which all nutrients are given intravenously was shown by Wilmore and Dudrick1 to have sustained growth at a near-normal rate in an infant. Height, head circumference, and development progressed at normal rates for 44 days. Normal weight gain and skeletal growth also has occurred in puppies fed intravenously for 10 months.2 A number of studies3-7 have shown that nutritional needs sufficient to promote wound healing, improve general status, cause a gain in body weight, and support positive nitrogen balance can be met for periods in excess of 1 year entirely by parenteral alimentation. The mean daily weight gain in a recent report3 was 18 gm for infants in the first 2 months of life. This rate of gain is at the 5th percentile for normal breast-fed infants during the first 2 months of life.8

The preferred method of infusion has been the insertion of a silastic catheter through either a subclavian or jugular vein into the superior vena cava, with scrupulous attention paid to the prevention of sepsis from skin bacteria.2,5 Insertion into other veins has been associated with a much higher complication rate.9,10 The infused solution2 has provided about 80% of the needed calories as glucose and 20% as either Amigen (a hydrolysate of casein) or Aminosol (a hydrolysate of beef fibrin),* Minerals and vitamins have been added to these solutions. Plasma has been infused in some, but not all, patients 1 to 2 times weekly in an effort to provide essential fatty acids and trace minerals.
Evaluating Effectiveness of Care: Some Questions
Authors: Austin Glenn
Published: December 2021

Gordis and Markowitz (Pediatrics, 48:766, 1971) reported an "evaluation" of "controlled studies" on episodic versus what they optimistically call continuous pediatric care. They were unable "to demonstrate that comprehensive and continuous care was more effective than conventional ambulatory care for children." This study deserves challenge as its method indicates lack of experience with many significant factors and represents a simplistic statistical view. The results could be unfortunately accepted by government planners who financed the study and are even further from the realities of practice.
Improvement of the Incubator-Respirator
Authors: Chernick V. , Karlowsky R.
Published: December 2021

The article by Somerwill, Brown, and Sweet in this issue1 is timely for several reasons. It is quite clear that the incubator-respirator was not adequately tested by the manufacturer before being placed on the market.

Several years before converting to continous negative pressure (CNP) use, we found it necessary to make certain modifications in order to prevent equipment failure and the manufacturer was notified about our problems and solutions. The triac semi-conductor was changed from an SC45B to an SC45D which has a maximum breakover voltage of 400 V.
IgA in Meconium, and Cystic Fibrosis
Authors: Newcomb Richard W.
Published: December 2021

It is hard to accept the conclusion of Rule, et al.1 regarding the presence of γA in meconium from infants with cystic fibrosis without further information about their antisera, Nonimmunologic precipitates between gut juices and goat, sheep, or bovine antisera have caused some confusion in the past. These reactions depend on nonimmunoglobulin protein reacting with proteolytic enzymes, and can be avoided by the simple expedient of using only the γ-globulin fractions of antisera.2 A description of the specificity of the antiserum preparations to exocrine ("secretory") γA and "Secretory Component" is also in order to assure that they did not react with other antigens common to exocrine fluids, especially lactoferrin.3
In Reply: Erythromycin in the Middle Ear: Further Information
Authors: Bass James W.
Published: December 2021

Thank you for the opportunity to respond to Dr. Meland's comments regarding our article "Erythromycin Concentrations in Middle Ear Exudates," which was published recently in the Journal.

We are aware that the various esters of erythromycin are absorbed in their bacteriologically inactive form and must be hydrolyzed to active erythromycin base in the body, a process which may take considerable periods of time with certain esters of the drug. This delay in hydrolysis of erythromycin esters to the active base observed in vivo may explain why viable Hemophilus influenzae organisms were isolated from exudates with relatively high total concentrations of erythromycin as determined by the in vitro method of bioassy utilized.
ART AS THERAPY WITH CHILDREN, by Edith Kramer. New York: Schocken Books, 1972, 234 pp., $10.00
Authors: DiLeo Joseph
Published: December 2021

In their drawings and paintings, children often express what they cannot or will not verbalize. The value of their graphic expressions has been clearly established and has given rise to a voluminous literature. Among the writers on children's art are gifted artists and sculptors, as well as those directly involved in the behavioral sciences: psychologists, psychiatrists, educators, and pediatricians.

A survey aimed at determining the most widely used test items in psychological assessment revealed human figure drawings to be second only to the Rorschach.
INFANT FEEDING AND BLOOD ACID-BASE STATUS
Authors: Kildeberg Poul , Winters Robert
Published: December 2021

The anecdotal experience reported by Healy in this issue of Pediatrics includes the observation of low concentrations of bicarbonate in the serum of five nonthriving full-term infants receiving Nutramigen during recovery from "serious illness." The data reported offer few clues as to the mechanism of the apparent acidosis; they should, however, serve to refocus the attention of clinicians upon the general relationship between formula composition and acid-base metabolism of young infants. Of major interest is the amply documented association of acidosis and growth failure in this age group.

The total acid load resulting from feeding a given quantity of any specified diet to a particular individual is a complex function of a large number of variables and cannot be derived from dietary analysis alone; rather, it must be evaluated experimentally by bioassay techniques.