bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to the Editor
Authors: Smyth John A. , Levison Henry
Published: December 2021

While we agree with the hypothesis that techniques of ventilation may influence the development of broncho- pulmonary dysplasia (BPD), our study was not designed to answer this question. We selected children with unequivocal BPD and do not suggest that our findings represent the entire spectrum of the disease. Our findings of severe residual pulmonary changes are similar to those of Harrod et al.1

In the absence of comparable data on the long-term pulmonary function of infants with BPD whose treatment was managed by alternative techniques, we would not choose to incriminate a specific mode of ventilation in the pathogenesis of BPD.
Retrolental Fibroplasia Is Increasing in California
Authors: Akeson Nancy , Hatlen Philip
Published: December 2021

It occurs to us that your readers would be interested in an up-date of our population figures for retrolental fibroplasia (RLF).

Preschool-aged blind children in northern California are served by six home counselors from the Variety Club Blind Babies Foundation. Our combined case loads (350 legally blind preschoolers) include 50 children with the diagnosis of RLF. These children are distributed by birthdate as follows:

See Table in the PDF File

In 1976, there were statistics for the entire state of California.1
The Muddled Debate
Authors:   The Board of Directors
Published: December 2021

We sympathize with Ruedisueli's concern1 about the contradictory statements regarding the effect of distribution of free formula samples, as examined in the Montreal study. Our summary of the paper2,3 was correct, ie fewer women (78%) who received a sample were breast- feeding at one month than was the case for women not given a sample, 84% of whom were still breast-feeding. Although this difference does not reach statistical significance, statistically significant differences were found for the two vulnerable subgroups: mothers who had been ill (breast-feeding: 88% of those not given samples vs 67% of those given samples) and less educated mothers (less than or equal to 14 years of schooling; breast-feeding: 79% of those not given samples vs 67% of those given samples).
SMALLPOX VACCINATION WITH PROLONGED VACCINIA
Authors: BIGLER JOHN A. , SLOTKOWSKI EUGENE L.
Published: December 2021

Definite clinical, histologic and immunologic changes take place following smallpox vaccination. After its full development on the ninth or tenth day, the vaccinial lesion is followed by drying, crusting and scarring. Histologically, there are degenerative and irritative changes in the epidermis believed to be due to the direct action of the virus on the epithelial cells. Immunologically, humoral antibodies to vaccinia begin to appear at the end of the first week following cutaneous vaccination, increase in amount during the second and third weeks and reach a maximum at the end of the third week. The probable reason for the involution of the vaccinial lesion after the pustular stage is the appearance of specific antibodies in the blood which apparently neutralize the vaccinia virus. The presence of histologically active vaccinial lesions approximately four months after implantation of the vaccinia virus could only be explained on the inability of the child to develop immunity to the vaccinia virus. Because of this lack of immunity, degenerative action of the vaccinia virus continued unopposed.
Treatment Of Disseminated Histoplasmosis With Ethyl Vanillate
Authors: CHRISTIE AMOS , MIDDLETON JAMES G. , PETERSON J. CYRIL , MCVICKAR DAVID L.
Published: December 2021

Some of the physical and pharmacologic properties of ethyl vanillate, a new fungistatic or fungicidal agent, have been briefly stated.

The records of 12 patients with progressive disseminated histoplasmosis treated with ethyl vanillate have been reviewed. Five of these patients are alive and apparently well following treatment, an experience not previously encountered or reported in the literature.

The use of the drug in the treatment of histoplasmosis has been outlined and the toxic manifestations of overdosage have been described.
ENDOCARDIAL FIBROELASTOSIS
Authors: COLLIER FRED C. , ROSAHN PAUL D.
Published: December 2021

Eleven cases of fibroelastosis of the endocardium are reviewed and two new cases reported.

The microscopic evidence of hyperplasia of the fibrous and elastic tissue elements of the endocardium in the two new cases reported parallels the findings in the previously reported cases.

The pathogenesis of this lesion is at present not clear, although it is probable that the explanation lies in a developmental aberration in the fetus.
USE OF AUREOMYCIN AND PENICILLIN IN THE TREATMENT OF RUBEOLA IN THE PRE-ERUPTIVE AND EARLY ERUPTIVE PHASE
Authors: KARELITZ SAMUEL , KING HARRY , CURTIS BERNARD , WECHSEL M.
Published: December 2021

Neither aureomycin nor penicillin given to children with pre-eruptive rubeola or begun on the first day of rash seems to have any definite therapeutic effect on the course of the primary disease.

The temperature dropped earlier in the patients treated with aureomycin or penicillin than in the untreated control group.

Aureomycin and penicillin were effective against otitis media and pneumonia present on admission and on the complications which developed during the disease.

Aureomycin and penicillin are useful in the prevention and cure of secondary infection in rubeola.
BROCK PROCEDURE FOR THE RELIEF OF PULMONARY STENOSIS IN THE TETRALOGY OF FALLOT
Authors: DOWNING DANIEL F. , BAILEY CHARLES P. , GLOVER ROBERT P.
Published: December 2021

The surgical relief of pulmonary stenosis has been both direct and indirect. The indirect procedures have inherent dangers; the direct approach of Brock appears to be without these dangers and the circulation is allowed a more normal course. This approach entails an incision into the right ventricular chamber and the cutting of the stenosed pulmonary valve or the removal of obstructing tissue in the outflow tract of the right ventricle. Cyanosis is usually relieved immediately. The patient's exercise tolerance is significantly increased.

Eight cases are presented.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: DUNHAM ETHEL C.
Published: December 2021

IT IS well known that prematurity plays an important role in causing infant deaths. Moreover, it is generally recognized that, to lower the high mortality rate from prematurity, concerted efforts are needed to lower the incidence of premature birth as well as to render proper care to these infants after birth.

The Second World Health Assembly directed the convening of an expert group on care of the premature infant, which met in Geneva from April 17-21, 1950. This report reviews the results of their deliberations, illustrates their suggestions and recommendations from material made available to them by the WHO staff and adds some personal comments.

Definitions

First, the expert group on prematurity recognized the necessity for uniform terminology for international usage. The primary goal—to lower foetal and neonatal mortality—can best be achieved by providing specialized care for infants of low birth weight. They suggested that a premature infant be defined as one whose birth weight is 2,500 gm. or less but recognized the limitations of this criterion since birth weight will not always be available. Other criteria of prematurity must then be used, for example, gestation period. They therefore recommended the adoption by all countries, for purposes of vital statistics, of the international definition of the World Health Assembly 1948, which states:
INTERNATIONAL NEWS
Authors: CRAIG JOHN
Published: December 2021

The North-Eastern Region of Scotland has had a culture of its own that extends back to prehistoric times. It is also circumscribed geographically and is well adapted for the regionalisation of the child health services. The Region is now one of the five into which Scotland is divided for the purposes of the National Health Service (Scotland) Act, 1947; and, as determined by the Secretary of State, the area in which the North-Eastern Regional Hospital Board "exercises functions with respect to the administration of the hospital and specialist services" consists of the City of Aberdeen; the Counties of Kincardine, Banff and Moray; and, in the far north, the island counties of Orkney and Shetland.
GASTROINTESTINAL LESIONS IN ACUTE BULBAR POLIOMYELITIS
Authors: COOK CHARLES D. , HARTMANN JOHN R. , SARNOFF STANLEY J. , BERENBERG WILLIAM
Published: December 2021

Five patients with severe bulbar poliomyelitis complicated by gastrointestinal perforation and/or hemorrhage are presented. A detailed case report is given in the one patient who recovered. The electrophrenic respirator was instrumental in maintaining this patient's respiration and massive blood transfusions in preventing shock from intestinal hemorrhage.

The gastrointestinal complications of bulbar poliomyelitis appear to be more frequent than previously realized. A relationship between midbrain damage and gastrointestinal lesions, as emphasized by Cushing, occurring during the course of acute bulbar poliomyelitis, is postulated.
EFFECT OF TETRAETHYLAMMONIUM CHLORIDE (ETAMON CHLORIDE) ON MUSCLE SPASM IN POLIOMYELITIS
Authors: WALCHER DWAIN N. , SCOTT JOHN R. , EKSTAM FRANCES C.
Published: December 2021

A series of 232 muscle functions were carefully evaluated on 17 patients, comparing the results obtained in the reduction of spasm using the intravenous administration of tetraethylammonium chloride (etamon chloride) with frequent stretching as opposed to the conventional hot packs with frequent stretching.

The results were not statistically significant in showing the virtues of one form of therapy as opposed to the other. The subjective impression of the personnel involved and the preference of the patients for the medication make it seem reasonable to enlarge the series studied to determine its true place in the current poliomyelitis therapy.
PNEUMATOSIS INTESTINALIS
Authors: MACKENZIE ELLEN P.
Published: December 2021

Thirteen cases of pneumatosis intestinalis are reported, 12 of them in infants between 12 days and 12 months of age, one in a boy of 6 years. Review of these cases and of 32 reported cases falling within the pediatric age range discloses that the disease occurs most frequently in patients whose general condition is poor, that it is very often associated with congenital or acquired disease of the intestine, and that respiratory disease, usually infectious, frequently co-exists. The presence of pneumatosis in pediatric patients has so far been discovered only at autopsy, but clinical diagnosis, with the aid of the typical roentgenologic findings, is feasible and may be accomplished when the disease is more widely known.

The clinical picture and roentgenographic findings in adults are reviewed. The most acceptable theories concerning the pathogenesis are discussed, with their possible relation to infantile diarrhea.
VOLUMETRIC AND MICROSCOPIC PATTERN OF BONE MARROW IN NORMAL INFANTS AND CHILDREN
Authors: STURGEON PHILLIP
Published: December 2021

The volumetric technic described is technically practical for the study of bone marrow in infants and children.

Tibial aspirations show in general a progressive increase in fat and decrease in myeloid-erythroid layer with advancing age; after approximately 2½ years of age, many of the specimens reflect a relatively fatty and hypoplastic marrow.

Iliac aspirations from individuals 18 months through 11 years of age yield volumetric values comparable to the values obtained from sternal aspirations.

Sternal aspirations from 5 years through 11 years yield values similar to those reported in the older age ranges.

With use of the technics described, the iliac site is technically superior to the sternum for the study of bone marrow of children from 18 months through 11 years; for those individuals less than 18 months of age, the tibia offers a practical site.
COMPARISON OF PULMONARY HYALINE MEMBRANES IN VAGOTOMIZED RABBITS WITH THOSE IN NEWBORN INFANTS
Authors: MILLER HERBERT C. , BEHRLE FRANKLIN C. , GIBSON DAVID M.
Published: December 2021

Pulmonary hyaline membranes similar in appearance to those seen in newborn infants were found in 13 of 20 rabbits vagotomized bilaterally in the midcervical region. The time of appearance of these membranes in relation to the operative procedure in the rabbits approximated closely the time of appearance of the membranes seen in the lungs of newborn infants in respect to the time of birth. In both species a polysaccharide aldehyde was regularly identified in the hyaline membranes. The similarity of the pulmonary lesion seen in vagotomized rabbits to that seen in newborn infants suggests that there may be factors common to both which are responsible for these pulmonary changes.
OMPHALOCELE
Authors: BURGESS C. M. , PALMA JOSEPH , MYERS W. A.
Published: December 2021

A case is presented which demonstrates many of the problems encountered in treating this rare surgical emergency. The credit for a successful outcome must go mainly to the pediatricians whose close supervision and prompt therapeutic efforts were rewarded by a healthy normal infant. In the presence of a seriously damaged bowel and general peritonitis, it is difficult to imagine recovery without the streptomycin and penicillin administered. Infants are notorious for their inability to withstand any surgical procedure that allows even minor peritoneal contamination such as that occurring in bowel resection or ileostomy. According to the literature available to the authors, this is the third infant that has recovered when the omphalocele was founded ruptured at birth. All these recoveries occurred during the past few years and with the aid of large doses of antibiotics. This case also demonstrates the often life-saving value of the polyethylene venous cannula which will stay patent for days and allow continuous adequate doses of fluids, both electrolytes and blood. Demonstrated, also, is the lesson all surgeons should know—to give every case all possible aid even in the face of a seemingly hopeless pathologic state.
GALACTOSEMIA IN INFANCY
Authors: DUSHANE JAMES W. , HARTMAN EVELYN E.
Published: December 2021

GALACTOSEMIA is an uncommon disorder of carbohydrate metabolism characterized by the inability of the body to utilize ingested galactose. The symptoms and signs of this disease in infancy are: failure to gain weight, retardation of development, enlargement of the liver and spleen, melituria, excretion of albumin in the urine, often osteoporosis and cataract formation. Recognized instances of galactosemia are uncommon; only nine substantiated cases have been reported in medical literature. A review of these cases emphasizes the importance of accurate diagnosis, since proper treatment, that is, elimination of galactose from the diet, results in clinical improvement, gain of weight, decrease in the size of the liver and spleen, and elimination of albumin and reducing substance from the urine. Evidence indicates that this clinical improvement is not associated with any alteration in the intolerance to ingested galactose, although follow-up studies over a long period have not been reported.

An infant with galactose intolerance has recently been observed for 24 months after the diagnosis was established.

Report of Case

A white male infant aged 4½ mo. was admitted to the hospital with the complaints of poor gain of weight, retarded development, pallor, vomiting and diarrhea since birth.

He was the fifth child of apparently healthy parents. The oldest sibling was 9½ yr. old and in good health; the second child had died at the age of 2½ mo. with symptoms of diarrhea and a diagnosis of cystic fibrosis of the pancreas; the third child had died at the age of 3 wk. of unknown causes; the fourth child was 2½ yr. of age and had nephrosis.
NEPHROTIC SYNDROME IN RATS
Authors: HEYMANN WALTER , LUND HERBERT Z.
Published: December 2021

1. Chronic renal disease was produced in 235 4 to 5 week-old rats of the Long-Evans strain by the intravenous injection of nephrotoxic sera obtained from rabbits.

2. Massive proteinuria, largely without hematuria, was noted without delay. Severe edema and ascites was observed in 35% of the animals within the first 2 to 3 weeks. Thirty-two per cent died within the first two weeks. A spontaneous cure of the disease occurred in 30% and chronic renal disease that lasted in some instances as long as 13 months, was observed in the remaining animals.

3. From 125 sick rats, 74% remained normotensive. A fluctuating and moderately severe hypertension was noted in the remaining 26%.

4. The blood chemistry revealed marked hypoproteinemia and hyperlipemia in the earliest phase. This subsided slowly as the disease progressed but did not reach normal values as long as the disease persisted. With a few exceptions the creatinine concentration remained normal during all phases of the disease. Marked azotemia was frequently obtained in severe disease at onset. It subsided regularly within the first two months and slight degrees of azotemia in late stages of the disease were noted in approximately 50% of the rats.

5. A histologic analysis was obtained in 119 sick, 12 recovered and 31 control rats. By correlating the chronologic order of clinical evidence with the pathologic picture, the following conclusions were drawn: (a) The nephrotoxin produces primarily a degenerative lesion with changes in glomeruli and tubules; (b) There may be recovery from the degenerative phase or it may be followed at variable intervals by a variable degree of fibrous proliferation in the glomerular tufts and capsules.
ROLE OF HYALINE MEMBRANES, BLOOD, EXUDATE, EDEMA FLUID AND AMNIOTIC SAC CONTENTS IN PREVENTING EXPANSION OF THE LUNGS OF NEWBORN INFANTS
Authors: BEHRLE FRANKLIN C. , GIBSON DAVID M. , MILLER HERBERT C.
Published: December 2021

The lungs of 43 infants were removed at autopsy and expanded with measured amounts of negative pressure. The amounts of pressure required to initiate expansion and to bring about apparent complete expansion of the gross specimens could not be correlated with the final degree of expansion that was obtained as measured by the thickness of the alveolar walls. Expansibility of the lungs was impeded in two groups: those with a birth weight less than 1200 gm. and those who had extensive hyaline membranes in the lungs. The presence of amniotic sac contents, blood, exudate and edema fluid in the alveoli and air passages, even in large amounts, did not mechanically prevent what appeared to be satisfactory expansion of the lungs.
Retinopathy of Prematurity: Incidence and Risk Factors
Authors: Shohat Mordechai , Reisner Salomon H. , Krikler R. , Nissenkorn Ilana , Yassur Yuval , Ben-Sira Isac
Published: December 2021

A high incidence of retinopathy of prematurity (ROP) was found in the very low-birth-weight infants discharged from the neonatal intensive care unit during the years 1977 to 1980, in spite of frequent monitoring of oxygen use. Although the yearly incidence of ROP in infants weighing <1,500 g varied between 35% to 36%, none were blind. The medical records of 65 infants with a birth weight between 501 and 1,250 g, surviving in 1979 to 1980, were reviewed in order to find risk factors for ROP. There were no significant differences between the 34 infants with ROP and the 31 infants who did not have ROP in mean birth weight or mean gestational age. Of 32 possible risk factors examined, the factors significantly associated with ROP were: apnea with mask and bag ventilation; prolonged parenteral nutrition; number of blood transfusions; and episodes of hypoxemia, hypercarbia, and hypocarbia. A highly significant association between hypocarbia and the development of severe ROP was found.
Hypercalcemia in Children with Disorders of Calcium and Phosphate Metabolism During Long-Term Treatment with 1,25-Dihydroxyvitamin-D3
Authors: Chan James C. M. , Young Reuben B. , Alon Uri , Mamunes Peter
Published: December 2021

Forty-two children received 1,25-dihydroxy-vitamin-D3 for treatment of disorders in calcium and phosphate metabolism secondary to chronic renal insufficiency (n = 29), sex-linked dominant hypophosphatemic rickets (n = 9), hypoparathyroidism (n = 2), and pseudohypoparathyroidism (n = 2). Serum calcium, phosphate, and creatinine concentrations were measured monthly for a mean of 26 months and a total of 1,079.5 patient-months. Patients with renal osteodystrophy manifested hypercalcemia (>11 mg/dL) once in every 13 months of treatment on the average. Of three children with hypophosphatemic rickets who experienced hypercalcemia, two proved to have tertiary hyperparathyroidism. Among children with hypoparathyroidism and pseudohypoparathyroidism, three episodes of hypercalcemia were observed during 124.5 patient-months, an incidence of one hypercalcemic episode per 39 treatment months. Renal function, as represented by reciprocals of serum creatinine determined retrospectively for a mean of 22 months before and prospectively for a mean of 26 months after initiation of 1,25-dihydroxyvitamin-D3 treatment, underwent no significant changes except in seven of 29 children with chronic renal insufficiency, six of whose rate of renal function deterioration increased on the treatment and one whose rate decreased. With one exception, hypercalcemia was associated in all cases with accelerated renal function deterioration. Before and after initiation of treatment with 1,25-dihydroxyvitamin-D3 the mean calcium x phosphate solubility products were 42.9 and 47.2, respectively. Values less than 60 are accepted as normal. Hypercalcemia is an occasional concomitant of such treatment and a more rapid deterioration of renal function may occur in some of the patients treated with 1,25-dihydroxyvitamin-D3. Thus, careful monitoring of concentrations of serum calcium, phosphate, and creatinine must accompany 1,25-dihydroxy-vitamin-D3 therapy.
A New ‘Gravity-Flow’ Nipple for Feeding Infants with Congenital Cleft Palate
Authors: Martin Lester W.
Published: December 2021

Infants with congenital cleft palate are generally unable to suck a regular nipple because the free flow of air through the cleft via the nose immediately decompresses the negative pressure of sucking. For many years, infants with cleft palate have usually been fed by depositing formula directly into the pharynx with a short rubber tube attached to the end of a bulb syringe, or with a medicine dropper, or with some makeshift modification of a nipple.

A nipple has been designed which when attached to a squeezable plastic bottle (Figure) uses the same "gravity-flow" principle as the bulb syringe method, yet is more aesthetically appealing, is more readily accepted by the mother, and is so similar in appearance to the usual nipple and bottle that the feeding technique is easily understood and mastered.
‘Look-alikes’
Authors:   Committee on Drugs
Published: December 2021

Pediatricians should be aware that adolescents and young adults are abusing medication that is regarded as sufficiently benign to be available without prescription. Obtained through legitimate over-the-counter channels or the purchase of "look-alikes" and used in place of controlled substances, these drugs can cause serious problems.

A decade ago, tightening of drug laws restricted production and availability of popularly abused stimulants, setting the stage for an increased use of nonprescription, sympathomimetic drugs. Amyl nitrite was restricted to availability by prescription in 1969, and the Controlled Substance Act of 1972 may have reduced the manufacture of amphetamine 95% from the levels of the 1960s. In 1974, methaqualone, a hypnotic, was added to the list of substances covered by the 1972 Act. These changes and the upsurge of cocaine use during the 1970s fostered the production of a legion of new drugs popularly known as look-alikes. Most often, look-alikes closely resemble amphetamine tablets or capsules in size, color, numbering, and trademarking; they also exist as cunning counterfeits of well known medications. Adolescents and young adults who abuse look-alikes usually locate sources of supply in magazine advertisements that emphasize the "-amine" or "-caine" component of the drug. They receive more than a placebo, but not what they expect. Some look-alikes contain the stimulants phenylpropanolamine (deleted from some new look-alike formulations), ephedrine, and caffeine; others have lidocaine (to cover some advertising claims) or a hodge-podge of other substances—all of which are commonly found in over-the-counter preparations marketed for the treatment of allergic symptoms, upper respiratory infections, or obesity, or as "pick-me-ups."
Screening for Hypothyroidism
Authors: Kilbride Howard W. , Lull Robert J. , Lehman Heinz G.
Published: December 2021

Although the New England Regional Screening Program report1 indicates that human error is the most likely cause of failure to detect congenital hypothyroidism in infants, our experience suggests that compensated hypothyroidism might be missed in some newborns unless screening includes a thyroid-stimulating hormone (TSH) assay and a thyroxine (T4) concentration. In the past 2 years, we have diagnosed congenital hypothyroidism in three infants. In at least one of these infants, the disease would not have been identified by T4 concentration screening alone.
Letter to the Editor
Authors: Chin James
Published: December 2021

Rosenthal agrees that the prevention or modification of hepatitis B viral infections in infants is important, but is concerned about the safety of the hepatitis B vaccine, particularly regarding the possibility that this vaccine might transmit whatever may eventually be identified as an acquired immune deficiency syndrome (AIDS) agent. I welcome this opportunity to respond to his letter because the AIDS issue was just starting to emerge as a major concern at the time that I submitted my commentary.1
Odor Perception in Children in Relation to Nasal Obstruction
Authors: Ghorbanian S. Nasrin , Paradise Jack L. , Doty Richard L.
Published: December 2021

To determine whether nasal obstruction in children results in impaired nasal function, olfactory sensitivity was assessed in 65 children with various degrees of nasal obstruction and in 13 children without nasal obstruction. Overall, olfactory detection thresholds were directly related to clinical ratings of degree of nasal obstruction. Of the subjects with nasal obstruction attributable to adenoid hypertrophy, 28 received adenoidectomy; when retested 2 to 28 months later, 20 of the 28 subjects showed generally commensurate reductions in nasal obstruction ratings and olfactory detection thresholds. In a comparison subgroup of 16 subjects retested after intervals of 5 to 13 months without having received intervening adenoidectomy, both the nasal obstruction ratings and the olfactory detection thresholds remained relatively unchanged. These results suggest that, in children, nasal obstruction of varied degree is associated with commensurate impairment of the ability to smell, and that reduction in the degree of nasal obstruction results in commensurate recovery of the ability to smell. Olfactory function, although hitherto accorded little pediatric attention, deserves consideration both in weighing the importance of nasal obstruction in children and in deciding about therapeutic intervention.
Medical Treatment of Intestinal Agangliosis
Authors: POTTS S. R. , BROWN S. , SMYTH B. T.
Published: December 2021

To the Editor.—

We wish to report our recent experience with the use of the decapeptide caerulein in managing a case of total intestinal aganglionosis. The child, a male born at term, had had multiple intestinal biopsies and had had two previous laparotomies (one for obstruction mistakenly thought to have been mechanical and the other for enterocolitis at which a double-barrelled enterostomy was fashioned) when a diagnosis of intestinal agangliosis was made at 31 days of age. Prior to the third intervention, Hirschsprung's disease was suspected but preoperative rectal suction biopsies although aganglionic did not show acetylcholinesterase staining.
Adolescent Medicine: Attitudes and Skills of Pediatric and Medical Residents
Authors: Slap Gail B.
Published: December 2021

Adolescents receive care from different specialists whose training may affect the quality of care. To measure possible effects, all 80 level 1 and level 3 pediatric and medical residents at one institution completed a questionnaire that asked if they planned to care for adolescents and determined their attitudes and skills for 30 relevant tasks. The mean age chosen for transfer of care from a pediatrician to an internist was 18.7 years by the pediatric residents and 16.6 years by the medical residents (P = .00001). Skill in obtaining histories; staging puberty; screening for scoliosis; performing pelvic examinations; diagnosing delayed puberty, psychiatric disorders, or learning disabilities; immunizing; and treating knee and hip pain more often were thought to be important by pediatric residents (88% to 100%) than by medical residents (40% to 75%) (P < .02). More than 70% of PL-3 but fewer than 50% of ML-3 residents rated themselves skilled for these tasks (P < .05). Fewer than 60% of each resident group rated themselves skilled in contraception. Both groups rated themselves underskilled in adolescent history-taking; counseling; evaluation of psychopathology; and treatment of dysmenorrhea and hypertension. In both groups, the decision to care for an adolescent was negatively influenced by the presence of a psychosocial disorder. In conclusion, both pediatric and medical residents plan to care for adolescents, and both recognize deficiencies in their training. Pediatric residents, however, are more confident of their skills in adolescent care than are medical residents.
Alveolar Macrophages in Perinatal Infants
Authors: Alenghat Elizabeth , Esterly John R.
Published: December 2021

The presence of alveolar macrophages in the neonatal lung at the time of autopsy is correlated with the presence of pulmonary lesions and with the duration of postnatal life. Alveolar macrophages were noted at 20 weeks of gestation in infants with congenital pneumonia, but were not present in most full-term infants who were stillborn. They were found in nearly all infants who survived for 48 hours irrespective of pulmonary lesions or gestational age.
Intellectual Function of Girls with Precocious Puberty
Authors: Galatzer Avinoam , Beth-Halachmi Nessia , Kauli Rivka , Laron Zvi
Published: December 2021

The IQ of 52 girls with precocious puberty (mean age 9.5 ± 2.8 years) was compared with that of 51 normal matched control subjects (mean age 9.7 ± 2.8 years) and with that of eight girls with fast puberty (onset at normal age but accelerated advancement). Girls with precocious puberty had a significantly higher verbal IQ score than the control subjects but no difference was found in the performance score. The distribution of the verbal IQ score in the girls with precocious puberty was skewed toward the upper side of the theoretical distribution curve. The distribution was two or more times the expected theoretical percentile in the above average area (> 110, 56.9% v 25%), and five times more in the very superior area (> 130, 10.1% v 2.2%). The girls with fast puberty had the same behavior as the population with normal development. The results are interpreted as possible evidence of an effect of sex hormones on brain development, especially on the left hemisphere, during the prepubertal period.
Revision of Recommendation for Use of Rifampin Prophylaxis of Contacts of Patients with Haemophilus influenzae Infection
Authors:   Committee on Infectious Diseases
Published: December 2021

A review of the data from a trial sponsored by the Centers for Disease Control to evaluate the effectiveness of rifampin for the prevention of secondary cases of invasive Haemophilus influenzae type b disease and the recognition of failure of rifampin prophylaxis in some day care centers and families prompted the changed recommendations listed below. An increased risk of invasive H influenzae type b disease in household contacts, particularly in those less than 49 months of age had been demonstrated. Although nursery school and day care center contacts may also be at increased risk of secondary disease, the magnitude of this is uncertain at this time. Preliminary data from ongoing studies suggest that the risk of secondary disease among nursery school contacts may vary widely between centers. Asymptomatic colonization with H influenzae type b is frequent in household contacts of all ages. Rifampin, 20 mg/kg (600 mg maximum dose) given once daily for four days, eradicates H influenzae type b in approximately 95% of carriers.

In the trial conducted by the Centers for Disease Control, household and day care center contacts were randomized to receive rifampin prophylaxis or placebo. There was a significant diminution in secondary cases among rifampin recipients if the treated household and day care centers were combined. Four secondary cases occurred among the 800 placebo-treated contacts in contrast to no cases among the 1,166 rifampin-treated contacts (P = .03). Analysis of attack rates among children less than 48 months of age showed a trend toward efficacy in household contacts (3/131 placebo recipients V 0/162 rifampin recipients, P = .08).
Buttock Bruises = Mongolian Spot
Authors: ASNES RUSSELL S.
Published: December 2021

To the Editor.—

Pediatricians have come to recognize the classic skin lesions of inflicted trauma such as strap or cord marks, hand prints, cigarette burns, and other unusual appearing burns. Occasionally, a child may be suspected of having been abused when, in fact, the dermatologic findings are the result of an acute disease process or a "folk medicine" treatment. Examples include the cutaneous lesions seen in hypersensitivity vasculitis1 and the ecchymotic markings resulting from Cao gio (coin rubbing)2 and cupping.3 Adler and Kane-Nussen4 recently described three children who had erythema multiforme and who were mistakenly considered to have been abused.
Twin Transfusion Syndrome Causing Cutaneous Erythropoiesis
Authors: Schwartz Joel L. , Maniscalco William M. , Lane Alfred T. , Currao William J.
Published: December 2021

Two cases of twin transfusion syndrome are described in which the donor twin exhibited blueberry muffin-like macules and papules associated with ctuaneous erythropoiesis. No evidence was found in either case for intrauterine viral infection, the most common cause of cutaneous erythropoiesis. Cutaneous erythropoiesis is these two cases is considered to be due to persistence or reactivation of fetal dermal erythropoiesis secondary to prolonged, severe intrauterine anemia.
Radiologic Manifestations of Malabsorption: A Nonspecific Finding
Authors: Weizman Zvi , Stringer David A. , Dunrie Peter R.
Published: December 2021

Children demonstrating a radiologic malabsorption pattern on small bowel follow-through study performed for other reasons are frequently subjected to intensive gastrointestinal investigations, even in the absence of clinical manifestations of malabsorption. To determine the usefulness of this radiologic finding, the clinical findings of all patients with the typical malabsorption pattern on small bowel follow-through examination were reviewed retrospectively. The presence of a malabsorption pattern was based on three radiologic criteria: flocculation and segmentation of barium, thickening of mucosal folds, and dilation of intestinal loops. Thirteen patients fulfilled the criteria for radiologic malabsorption pattern, but six (46%) had no clinical evidence of malabsorption, according to 3- to 5-day fecal fat analysis. In addition, five of these patients had normal mucosal histologic findings on duodenal biopsy. It was concluded that radiologic malabsorption pattern is a nonspecific finding, and in the absence of other clinical features suggestive of malabsorption or growth failure further investigations may not be justified.
Effects of Hyperoxia and Hypoxia on Vascular Prostacyclin Formation in Vitro
Authors: Stuart Marie J. , Setty B. N. Yamaja , Walenga Ronald W. , Graeber Janet E. , Ganley Carolyn
Published: December 2021

Exposure to high oxygen (O2) concentrations, especially in the neonate, is associated with the development of pathologic syndromes characterized by vascular involvement including the retinopathy of prematurity. Some of the initial vascular changes observed appear consistent with a reduction in prostacyclin formation. Exposure of human umbilical arteries to oxygen resulted in more than 30% inhibition in the ability of the vessels to produce prostacyclin either from endogenous stores of arachidonic acid or from exogenously provided substrate. In contrast, hypoxia (which more closely approximates the fetal environment) resulted in more than 30% stimulation in the production of prostacyclin from either endogenous or exogenous arachidonic acid. When microsomes were prepared from treated arterial segments, these effects persisted. In vitro results suggest that neonates exposed to O2 after delivery may experience a marked decrease in vascular prostacyclin formation. Inhibition of the production of this potent vasodilator and antithrombotic metabolite could play an important role in the acute exudative phase of O2 toxicity.
Bacterial Flora of Breast-Fed Infants
Authors: YOSHIOKA H. , FUJITA K. , ISEKI K.
Published: December 2021

In Reply.—

We read Rose's comments with much interest. As he mentioned, some English researchers reported that the predominant fecal organisms in infants were coliforms and Bacteroides but not bifidobacteria even if the infants were exclusively breast-fed. It is a mystery why the breast milk of English women does not stimulate growth of bifidobacteria in the intestine of their babies, but a possible explanation is, as Simhon et al1 have pointed out, that the chance of a baby's acquiring bifidobacterial flora from the mother has diminished because of recent changes in obstetric techniques, which are continually becoming more aseptic.
Problems with Human Milk and Infant Formulas
Authors: Miller Sanford A. , Chopra Joginder G.
Published: December 2021

EXAMPLES OF PROBLEMS WITH HUMAN MILK

Nutritional Problems

The adequacy of breast milk as the sole food for the baby is related to the mother's diet during pregnancy and lactation, to maternal calorie reserves in the form of subcutaneous fat, to fetal stores (mainly hepatic), and to birth weight.

Although human milk is commonly believed to be a complete, perfect food for infants, deficiencies of vitamin K, vitamin D, and iron may develop in normal, full-term infants breast-fed by apparently healthy women consuming conventional diets. Other nutrient deficiencies may occur in breast-fed infants as a consequence of special conditions existing in the infant, the mother, or both.

Normal infants consuming human milk or commercially prepared formulas will receive adequate vitamin K, except in the immediate neonatal period. Because this initial vitamin K deficiency does not become manifest until two or three days after birth, all full-term infants should receive 0.5 to 1 mg of water-soluble vitamin K preparation at delivery.31

Because human milk provides less vitamin K than fortified formulas do, and because breast-fed infants consume relatively small amounts of milk during the first few days of life, vitamin K deficiency in the newborn period is more common is breast-fed than in formula-fed infants.43,69 Thus, parenteral administration of a water-soluble vitamin K preparation to the newborn soon after birth is particularly desirable for breast-fed infants.

A report42 that human milk contains appreciable but variable amounts of a water-soluble vitamin D sulfate suggests that the vitamin D content of human milk may be greater than was previously recognized.
Trends in Infant Feeding in Developing Countries
Authors: Notzon Francis
Published: December 2021

In recent years, interest in breast-feeding and infant-supplementation practices in the developing world has been growing. Numerous community, regional, and national studies have described the patterns of breast-feeding and, to a lesser extent, of supplementation in a wide range of low-income countries. Nevertheless, adequate documentation of national trends in breast-feeding is available for only a small number of developing countries, and trends in supplementation remain to be described.

The apparent decline in breast-feeding in the developing world has been the subject of numerous articles describing the impact of this trend on infant morbidity and mortality, fertility levels, and family finances. Frequently, the examples used to illustrate the decrease in breast-feeding are methedologically flawed; they use nonrepresentative or noncomparable samples, for example, or make implicit assumptions about past breast-feeding practices. In spite of such shortcomings, the consistent reports of important declines appear to indicate that some basic changes are taking place in breast-feeding practices in certain areas of the developing world. The fact that these changes seem to be following the general pattern of breast-feeding decline that occurred at earlier times in developed countries adds to their plausibility.

Although a general awareness of changes in lactation in the developing world now prevails, the documentation of this trend is far from complete. Even for those countries in which trends have been appropriately measured, the amount and pattern of change may vary widely from country to country. In most of the countries with information on breast-feeding trends, recent declines have occurred, although the decreases range from sharp to moderate.
Candida Antigen Detection in Two Premature Neonates with Disseminated Candidiasis
Authors: Schreiber John R. , Maynard Edward , Lew Michael A.
Published: December 2021

Two premature neonates with birth weight less than 1,200 g developed systemic candidiasis during treatment with multiple antibiotics and parenteral hyperalimentation. Clinical findings included signs of necrotizing enterocolitis in one patient and multiple fungal renal cortical abscesses in the other. The Candida antigen, mannan, was present in the sera of both patients at the time of clinical deterioration. Multiple blood cultures and urine and stool samples from both patients grew Candida albicans. Systemic antifungal therapy was given for a 6-week period and was associated with prolonged antigenemia despite negative findings on follow-up cultures. Antifungal therapy was stopped soon after antigen was no longer detected. Both patients recovered without evidence of further fungal infection. Candida antigen detection may be useful in the diagnosis and follow-up of premature infants with disseminated candidiasis.
Causal Thinking in Practice: Strengths and Weaknesses of the Clinical Vantage Point
Authors: Susser Mervyn
Published: December 2021

The place of causal inference in clinical practice is considered. One function relates to the validation of existing knowledge, as in the evaluation of the medical literature, and is exemplified by the process of editorial selection. A second function relates to the validation of potential knowledge, as in the testing of hypotheses, and is exemplified by the pursuit of a nutritional cause of retarded mental development. Features of clinical practice that contribute strengths or weaknesses to causal inference are then examined. These include the diagnostic process, the effect of cumulative clinical experience, continuity of observation and follow-up, and the focus on disease.
Evaluation of Group Well-Child Care for Improving Burn Prevention Practices in the Home
Authors: Thomas Katherine A. , Hassanein Ruth S. , Christophersen Edward R.
Published: December 2021

The inclusion of counseling on home safety procedures has been recommended by the American Academy of Pediatrics as a routine part of well-child care. However, few, if any, data exist to give direction to the pediatrician interested in advising parents about home safety. In the present study, 58 couples were randomly assigned, prospectively, to an experimental group and a control group. Both were enrolled in a single group well-child care class that lasted 90 minutes. The control group was provided with information and discussion on nutrition, dental care, safety in the car and home, child development, child rearing, illness management, and immunizations. The experimental group received information and discussion on the same topics, and they also received specific information on burn prevention: hot water heater settings and smoke detectors. On a subsequent home visit, 65% of the couples in the experimental group had their hot water temperature measured at 54.4°C (130°F) or less, whereas all of the couples in the control group had hot water temperatures of more than 54.4°C (130°F) (a significant difference). Although only one couple in the experimental group did not have an operational smoke detector, enough of the couples in the control group had operational smoke detectors that results were not significant. These results suggest that the pediatrician may now be in a position to include effective safety counseling procedures for burn prevention in the home as a part of well-child care.
Improved Survival of Newborns Receiving Leukocyte Transfusions for Sepsis
Authors: Cairo Mitchell S. , Rucker Ralph , Bennetts Geni A. , Hicks David , Worcester Carrie , Amlie Ragnar , Johnson Stephen , Katz Jacob
Published: December 2021

To determine the role of polymorphonuclear (PMN) leukocyte transfusions in neonates with sepsis, 23 consecutive newborns were prospectively randomly selected during an 18-month period in a treatment Plan to receive polymorphonuclear leukocyte transfusions with supportive care or supportive care alone. Thirteen neonates received transfusions every 12 hours for a total of five transfusions. Each transfusion consisting of 15 mL/kg of polymorphonuclear leukocytes was subjected to 1,500 rads of radiation. The polymorphonuclear leukocytes were obtained by continuous-flow centrifugation leukapheresis and contained 0.5 to 1.0 x 109 granulocytes per 15 mL with less than 10% lymphocytes. Pretreatment demographic, clinical, and laboratory variables that were found to be insignificant in prognosis between newborns who received transfusions and newborns who did not receive transfusions included weight, gestational and postnatal age, hypoxia, acidosis, hypotension, initial absolute granulocyte count (AGC), initial levels of immunoglobulins (IgA, IgG, and IgM), and total hemolytic complement. Positive findings on blood cultures were obtained in 14/23 patients and even were randomly selected for each treatment group. Absolute granulocyte counts were <1,500/µL in 13 patients but tibial bone marrow examinations revealed that the neutrophil supply pool was depleted in only three patients. The survival was significantly greater in the treatment group (13/13, 100%) compared with the group that did not receive transfusions (6/10, 60%, P < .02). There were no unto-ward effects attributable to the polymorphonuclear leukocyte transfusions during the study or on subsequent follow-up clinic visits. These preliminary data suggest that the use of adult donor polymorphonuclear leukocytes in the early treatment of proven or clinically suspected newborns with sepsis lowers mortality of neonatal sepsis.
Abdominal Pain
Authors: Farrell Michael K.
Published: December 2021

Chronic abdominal pain affects 10% to 12% of school-aged children. In 90% to 95% of such patients, no organic cause can be elicited. Certain behavioral and personality characteristics are frequently evident in these children. Significant stress is usually present in the families. The goal of the evaluation is education of the child and family about the abdominal pain. The reality of the pain is acknowledged, but the stress is dealt with as the primary issue.