bluuebunny/crossref_metadata_2025 huggingface dataset:
On Benzoate Therapy for Ammonia Toxicity
Authors: Tremblay George C. , Wendler Philip A.
Published: December 2021

The conjugation of benzoic acid with glycine to form hippuric acid can be useful in ammonia detoxification only if glycine is replenished from endogenous pools of waste nitrogen at a rate sufficient to combat hyperammonemia.1,2 We have examined this requirement with suspensions of isolated hepatocytes from the rat.3 Consistent with previous studies with intact animals, the conversion of benzoate to hippurate was stimulated by glycine (4x) or glyoxylate (2.6x), the α-keto analogue of glycine. Thus, glycine is clearly limiting in hippurate synthesis.
High-Frequency Ventilation in Premature Infants with Lung Disease: Adequate Gas Exchange at Low Tracheal Pressure
Authors: Frantz Ivan D. , Werthammer Joseph , Stark Ann R.
Published: December 2021

The technique of high-frequency ventilation (HFV) was used in ten infants with severe respiratory distress syndrome and five infants with pulmonary interstitial emphysema (PIE). The mean frequency used was 12 Hz (720/min). Peak tracheal pressure for the infants with respiratory distress syndrome was 28 ± 4 (SD) cm H2O on conventional ventilation, and 22 ± 4 cm H2O on HFV (P < .05). For the infants with PIE, peak tracheal pressure decreased from 38 ± 11 to 24 ± 5 cm H2O (P < .05). Mean tracheal pressure was the same for the two types of ventilation. No adverse clinical or pathologic side effects were seen. Clinical and radiologic improvements were seen in the infants with PIE after initiation of HFV. It is believed that these improvements in the patients with PIE were secondary to the decrease in tracheal pressure and that HFV may have a role in treatment of preexisting barotrauma and its prevention. These studies contribute to the preliminary data necessary before controlled trials of HFV in infants with respiratory distress syndrome and PIE can be carried out.
Sulfisoxazole Chemoprophylaxis for Frequent Otitis Media
Authors: Liston Thomas E. , Foshee Col William S. , Pierson Maj Wayne D.
Published: December 2021

Sulfisoxazole, 75 mg/kg/d in two divided doses for 3 months, was administered in a double-blind placebo crossover study to 35 children aged 6 months to 5 years who had frequent recurring episodes of otitis media. There was a 40% reduction in the rate of otitis media among patients receiving sulfisoxazole compared with those receiving placebo (0.25 v 0.42 episode per patient-month) which did not depend on age, sex, season, or several other factors. Using a randomized order, among patients who received placebo first, there was a 64% reduction on sulfisoxazole therapy compared with placebo (0.20 v 0.56 episode per patient-month). In this subgroup, there was significant improvement in eustachian tube function according to serial tympanograms. In the patients who received sulfisoxazole first, the rate of acute otitis remained low on placebo (0.28 v 0.30 episode per patient-month), and tympanogram patterns continued to improve after discontinuation of the active drug. These differences suggest a carry-over effect from the benefits of chemoprophylaxis. There was no significant difference in the species or sensitivity patterns of bacteria isolated from patients receiving sulfisoxazole or placebo. Sulfisoxazole chemoprophylaxis appears to be safe and effective in significantly reducing episodes of otitis media and improving tympanogram patterns.
Nonketotic Hyperglycinemia: Treatment with Diazepam—A Competitor for Glycine Receptors
Authors: Matalon Reuben , Naidu Sakkubai , Hughes John R. , Michals Kimberlee
Published: December 2021

Two female infants with nonketotic hyperglycinemia (NKH) were treated with diazepam for the control of seizures. The first infant had seizures, lethargy, and respiratory distress in the first 24 hours of life. The diagnosis of NKH was made at 3 weeks of age and she was then placed on a regimen of strychnine and a lowprotein diet. Strychnine therapy was discontinued after three months of treatment because there was no improvement in the seizure control or in the patient's condition. At 5 months of age the patient was referred to our clinic for further work-up. The second infant had seizures, hypotonia, and respiratory distress shortly after birth. She was treated with phenobarbital and diphenylhydantion, which had no effect on her seizures. The baby was referred to our clinic at 8 months of age and diagnostic studies revealed NKH. All previous medications were stopped and both infants were placed on diazepam, a competitor for glycine receptors in the CNS. Choline and folic acid were added for one-carbon unit transfer and sodium benzoate to bind excessive glycine. Both infants responded to this treatment with cessation of seizures; they became more responsive and alert, and their EEGs showed remarkable improvement despite the persistence of elevated glycine levels in plasma, CSF, and urine. Diazepam as a competitor for the receptors of glycine may prove helpful in controlling the intractable seizures associated with NKH.
Daytime Television Viewing by Hospitalized Children: The Effect of Alternative Programming
Authors: Guttentag Deborah N. Waldner , Albritton William L. , Kettner Ruth B.
Published: December 2021

In response to an earlier survey indicating that hospitalized children were indiscriminately watching excessive amounts of commercial television, a closedcircuit television station was instituted at the Children's Hospital of Winnipeg. The station offered patients commercial-free children's programming between 9 AM and 5 PM, including a daily one-hour live broadcast. In order to evaluate the effect of this station on children's television-viewing patterns, a second survey of the quantity and quality of daytime television viewing was carried out. This evaluative survey demonstrated an overall increase in television viewing, but a decrease in exposure to the potentially harmful effects of commercial television inasmuch as an average of nearly half of the children's viewing time was devoted to the hospital station. A dramatic increase in the viewing of children's programs (mean 43 v 147 minutes daily for the first and second surveys, respectively) along with additional viewing pattern data suggest that the closed-circuit station successfully filled a void for the patients. Overall the data indicated that alternative programming for pediatric patients has an enormous potential for alleviating the boredom and anxiety of hospitalized children.
Bilirubin 20 mg/dL = Vigintiphobia
Authors: WATCHKO JON F. , OSKI FRANK A.
Published: December 2021

VIGINTIPHOBIA: A ONE-ACT PLAY Cast: A third-year pediatric resident A 40-year-old neonatologist A 50-year-old practicing pediatrician Scene: The hallway outside of the normal newborn nursery at almost any hospital Time: Any time in 1983 Resident:—(addressing the neonatologist) We just admitted an apparently healthy 4-day-old term infant for evaluation and treatment of jaundice. The baby was the product of a normal pregnancy and delivery and weighed 3,200 g when born at this hospital. The baby went home at 48 hours of age and was being fed a commercial formula. The infant now weighs 3,250 g. Physical examination is entirely normal and the baby is vigorous.
Testosterone Need Questioned
Authors: ROSENFELD RON G. , HINTZ RAYMOND L.
Published: December 2021

In Reply.—

We thank Dannenhoffer and Crawford for their thoughtful comments on our recent study of testosterone treatment of constitutional delay. We agree that the size of the study population was relatively small, and that subject randomization resulted in a significant difference in mean height at the time of entry into the study. Nevertheless, we believe the data still support the conclusion that short-term testosterone treatment can result in significant growth acceleration in this population. In general, linear growth in children correlates better with bone age than with chronologic age, and the skeletal ages of the two groups in this study were not significantly different.
Circumcision Continues
Authors: BRENNEMAN GEORGE
Published: December 2021

To the Editor.—

The conclusions made in "The Role of Parental Information in the Incidence of Circumcision"1 do not agree with my experience. Parental information prenatally is important, but it must compete with routines and attitudes of all personnel who work in the postpartum and nursery areas. The authors apparently did not evaluate these important sources of influence.
Focal Ischemic Cerebral Injury in the Newborn: Diagnosis by Ultrasound and Correlation with Computed Tomographic Scan
Authors: Hill Alan , Martin David J. , Daneman Alan , Fitz Charles R.
Published: December 2021

Ischemic brain injury in the newborn is a common cause of subsequent neurologic deficits seen in older children. Clearly, determination of severity and location of such injury is important for management and prognosis. Although ultrasound scanning of the brain has been used extensively in the premature infant for diagnosis of hemorrhagic lesions, its use in the term infant for recognition of isehemic cerebral lesions has not been reported. Four cases are described in which focal echodense areas were identified on ultrasound scan of the brain. These echodense areas on ultrasound corresponded to the appearance on computed tomographic (CT) scan of areas of decreased density which are known to represent ischemic cerebral injury. In three of the four cases there were focal neurologic findings and/or focal abnormalities on EEG. In two cases, real-time ultrasound scanning demonstrated changes in arterial pulsations in cerebral vessels in the area of the lesions. Thus in both, there was diminution in pulsations within the echodense areas and in one case, an increase in pulsations was observed at the periphery of the echodense lesion. Our data demonstrate the value of ultrasound scanning for assessment of the extent and location of focal cerebral ischemic lesions in the newborn. Such assessment permite assessment of prognosis.
A Population Study of the VACTERL Association: Evidence for Its Etiologic Heterogeneity
Authors: Khoury Muin J. , Cordero Jose F. , Greenberg Frank , James Levy M. , Erickson J. David
Published: December 2021

Using the population-based data from the Metropolitan Atlanta Congenital Defects Program, the interrelation of the six defects that are components of the VACTERL association were investigated. There were 400 cases with two or more of these defects, whereas only 29 cases would be expected if the defects had occurred together randomly. There were 76 cases with three or more defects, whereas less than one case was expected. Of these 76 cases, seven had recognized causes (five chromosomal anomalies, two single-gene disorders); another 19 had recognized clinical phenotypes or syndromes of unknown etiology. In the remaining 50 cases, ventricular septal defect was the most common cardiovascular defect (30.0%), and renal agenesis was the most common renal anomaly (30%). Their most common limb defects were reduction deformities (34%) and polydactyly (20%). This study confirms the clinically recognized nonrandom occurrence of the VACTERL association. It also shows that the association is a spectrum of various combinations of its components, which can be a manifestation of several recognized disorders, rather than a distinct anatomic or etiologic entity. A common denominator of the VACTERL association is suggested to be a defective mesodermal development during embryogenesis, due to a variety of causes and leading to overlapping manifestations.
Sibling Visiting in a Neonatal Intensive Care Unit
Authors: Schwab Fred , Tolbert Brenda , Bagnato Stephen , Maisels M. Jeffrey
Published: December 2021

The effect of sibling visiting in a neonatal intensive care unit was studied. Sixteen siblings of 13 infants were randomly assigned to a visiting or nonvisiting group. Behavioral patterns were measured by questionnaires administered to the parents and by direct observation and interviews with the children. There were no significant changes in the behavior of the children following the birth of their sibling, and there was no significant difference between the behavior scores of the two groups 1 week after the experimental (or control) intervention. The visiting children did not show signs of fear or anxiety during the visit. These data suggest that sibling visiting to a neonatal intensive care unit is not likely to be harmful and might be beneficial to the siblings and their families.
Excretion of Technetium in Human Milk
Authors: MAISELS M. JEFFREY , GILCHER RONALD O.
Published: December 2021

The radioisotope technetium-99m(99mTc) is widely used in nuclear medicine for a variety of scanning procedures. On occasion, it may be necessary to perform such studies on a nursing mother, and it is important to know what dose of radioactive material a nursing infant might receive and how soon after the isotope administration the mother may resume breast-feeding.

Technetium is one of the halide elements and is handled, biologically, much like iodine.1 Like iodide,2,3 the pertechnetate ion (99mTcO4-) is concentrated in the thyroid gland1,4 and stomach5,6 and in the breast milk of nursing mothers4-6 and women with the amenorrhea-galactorrhea syndrome.7 In this report we present studies on 99mTcO4- in breast milk, including its binding to milk protein, biologic half-life, and calculations of radioactivity that might be ingested by a nursing infant.
Acute Worsening of Congenital Lobar Emphysema with Subsequent Spontaneous Improvement
Authors: MORGAN WAYNE J. , LEMEN RICHARD J. , ROJAS RODRIGO
Published: December 2021

The degree of respiratory dysfunction and subsequent morbidity of patients with congenital lobar emphysema (CLE) are related to the degree of hyperinflation of the involved lobe.1 Whereas neonates with severe CLE may have marked respiratory distress requiring surgical resection of the hyperinflated lobe, children with mild forms of CLE seldom have a sudden increase in size of the involved lobe leading to respiratory failure.2,3 We report two infants with mild CLE who were clinically stable and developed respiratory distress with increased hyperinflation of the involved lobe associated with an acute respiratory tract infection. Both infants returned to their base line clinical status with conservative therapy alone following resolution of their respiratory illness.
Bad Effects of Patterning
Authors: BOLTON JOHN C.
Published: December 2021

To the Editor.—

I would like to commend the American Academy of Pediatrics for its updated and strong statement against the "patterning" treatment of neurologically handicapped children.1

Certainly one of the problems with the promoters of this type of treatment has been their insistence that the therapy be carried out 365 days a year and as much as 22 h/day. In the best of circumstances, this will totally disrupt family life and divert attention from other children in the family, while at the same time, providing no benefits to the patient in question.
Flaws in Study of Management of Children with Febrile Illness
Authors: CLUB JOURNAL
Published: December 2021

To the Editor.—

Our residency's journal club recently reviewed your October issue and the article on management of febrile illness.1 We found it to be misleading and inconclusive for the following reasons.

First, the study presented itself as a comparison of the management of fever in children by pediatricians and "general practitioners." Based on introductory statements the term "general practitioner" implies family physician, but this is not clearly stated. As the article progresses, we find the data collected are based on experience in emergency rooms at a children's hospital v a "general" hospital, each staffed by residents or interns.
The Pediatric Early Elementary Examination: Studies of a Neurodevelopmental Examination for 7- to 9-Year-Old Children
Authors: Levine Melvin D. , Meltzer Lynn J. , Busch Betsy , Palfrey Judith , Sullivan Maureen
Published: December 2021

The Pediatric Early Elementary Examination (PEEX) is a neurodevelopmental assessment designed to evaluate children with learning problems between the ages of 7 and 9. The current study of this procedure focused on a sample of youngsters from two middle-class communities and a group of children referred for learning problems to the School Function Program, a specialty clinic at The Children's Hospital in Boston. During prior pilot testing, diagnostic criteria had been established for specific areas of development assessed on the Pediatric Early Elementary Examination. Findings were expressed as "areas of concern" or developmental weaknesses suggesting the need for further monitoring or referral. It was found that nearly half of the children in the community had at least one such finding. These areas of concern were spread fairly evenly over the seven developmental areas of concern correlated with results of the revised Wechsler Intelligence Scale for Children (WISC-R) and the California Achievement Test in the community. Youngsters referred to the School Function Program with learning problems also were more likely to have multiple areas of developmental concern. Results suggest that the Pediatric Early Elementary Examination shows promise as a reliable and valid system of observation for use by health care professionals.
Current Status of Behavioral Pediatric Training for General Pediatric Residents: A Study of 11 Funded Programs
Authors: Friedman Stanford B. , Phillips Sheridan , Parrish John M.
Published: December 2021

The W. T. Grant Foundation has funded training in behavioral pediatrics for pediatric residents at 11 medical centers. The approaches toward training taken by the 11 funded programs, based on information systematically collected by interviews conducted with departmental chairmen, faculty, and residents during a program visit to each medical center, are described. No single training site emerged as optimal for teaching behavioral pediatrics, although linking such teaching to a "low priority" setting was an educational obstacle. A serious problem in many programs was the lack of ongoing research in behavioral pediatrics. Success in teaching behavorial pediatrics was dependent upon faculty support and a mandatory experience in behavioral pediatrics for all residents.
Digital Deformity: An Effect of Frostbite in Children
Authors: Brown Forst E. , Spiegel Peter K. , Boyle William E.
Published: December 2021

Two young children, aged 2½ and 3½, were briefly exposed to temperatures of -20°F (-29°C) without adequate hand protection. Hand contact with snow and metal doorknobs also occurred. Second and third degree frostbite of the cold injured digits ensued. Within six months, and progressing thereafter, the fingers developed a stubby appearance and demonstrated distal angulation and weak extension. Roentgenograms revealed undermineralization of the phalanges and coarsening of the trabecular pattern. The epiphyses of the middle and distal epiphyses were absent or atrophic. The metaphyses were irregularly convoluted. The pathogenesis of this deformity appears to be the direct effect of freezing and of ischemia on the most metabolically active site in the digit—the growth plate.
Nephrocalcinosis: Detection by Ultrasonography
Authors: ALON URI , BREWER WILLIAM H. , CHAN JAMES C. M.
Published: December 2021

Abdominal plain radiography has long been regarded as an excellent noninvasive method for the diagnosis of nephrocalcinosis.1 However, to be detected by radiography, the calcium deposition in the kidneys must be quite large. Thus, in the early stages of renal calcification, radiography often fails to detect nephrocalcinosis.2,3 In most cases treatment can arrest the pathologic process and prevent further damage to the kidneys; therefore, early detection is of crucial importance4,5 and diagnostic methods that are more sensitive than abdominal plain radiography are needed.

We hearby describe our experience in two children in whom plain abdominal radiographs failed to document nephrocalcinosis. In constrast, ultrasonography clearly demonstrated the nephrocalcinosis, which was subsequently confirmed histologically by percutaneous needle biopsy.
Sudden Infant Death Syndrome and Phenothiazines
Authors: STANTON A. N.
Published: December 2021

To the Editor.—

Kahn and Blum1 discuss the relationship between phenothiazines and the sudden infant death syndrome (SIDS) but do not mention the potentially important anticholinergic side effects of this group of drugs. Phenothiazines impair temperature regulation, including the ability to sweat, and are implicated in many reports of heatstroke2,3 and hypothermia. Any temperature rise tends to occur early in treatment4 and may bee provoked by standard dosage.5 Studies in mice given a single 1-mg/kg dose of chlorpromazine show that younger animals become hyperthermic, whereas older ones becomes hypothermic.6
Cytomegalovirus Infection of Breast Milk and Transmission in Infancy
Authors: Dworsky Meyer , Yow Martha , Stagno Sergio , Pass Robert F. , Alford Charles
Published: December 2021

Of unselected postpartum women, 39% reactivated cytomegalovirus in breast milk, vaginal secretions, urine, and/or saliva. Consumption of infected breast milk led to infection of 69% of the infants. Although there was some milk secretory immune response to this virus, it prevented neither viral shedding nor viral transmission. All infected infants chronically shed cytomegalovirus. However, no infants have yet demonstrated chronic sequelae. Two preterm infants did develop a significantly acute problem, pneumonitis, which did resolve. The possibility that an unnecessary and perhaps more severe illness might occur in low-birth-weight seronegative infants fed banked human milk from sources other than the mother is disturbing and needs resolution.
Development and Differences of Intestinal Flora in the Neonatal Period in Breast-Fed and Bottle-Fed Infants
Authors: Yoshioka Hajime , Iseki Ken-ichi , Fujita Kozo
Published: December 2021

The development of stool bacterial flora was studied in breast-fed and bottle-fed infants. In both groups of infants, the intestine was first colonized with enterobacteria and their number attained 109 per gram of feces. On day 6, bifidobacteria were the predominant organisms in the stool of breast-fed infants, exceeding enterobacteria by a ratio of 1,000:1, whereas enterobacteria were the predominant organisms in formula-fed infants, exceeding bifidobacteria by approximately 10:1. At 1 month of age, bifidobacteria were the most prevalent organisms in both groups but the number of these organisms in the stool of bottle-fed infants was approximately one tenth that of breast-fed infants. The properties of breast milk that promote the growth of bifidobacteria and suppress the growth of coliform and other potentially pathogenic organisms, theoretically, would help to minimize the incidence of neonatal diseases caused by these organisms. The results would support the advantages of breast-feeding for optimal care of newborn infants.
Alae Nasi Activation (Nasal Flaring) Decreases Nasal Resistance in Preterm Infants
Authors: Carlo Waldemar A. , Martin Richard J. , Bruce Eugene N. , Strohl Kingman P. , Fanaroff Avroy A.
Published: December 2021

The effect of alae nasi activation on nasal resistance in a group of healthy preterm infants was measured. Alae nasi activity was determined via the alae nasi electromyogram obtained from skin surface electrodes during both active and quiet sleep. Nasal resistance was calculated from airflow measured with a mask pneumotachograph and transnasal pressure drop obtained by simultaneous measurement of nasal pressure via a catheter inserted in one nostril and mask pressure. The percentage of breaths accompanied by phasic alae nasi activity was higher during active sleep than during quiet sleep (43% ± 10% v 14% ± 6%; P < .005), and hypercapnic stimulation (4% CO2 inhalation) significantly increased the incidence of phasic alae nasi activity to comparable levels in both sleep states (82% ± 8% in active sleep and 82% ± 9% in quiet sleep). Elevation of tonic alae nasi activity also occurred more frequently during active sleep (P < .05). The presence of either phasic or elevated tonic alae nasi activity decreased nasal resistance by 23% ± 4% during active sleep and 21% ± 3% during quiet sleep. This reduction in nasal resistance resulted in either a lower transnasal pressure during inspiration, a higher peak inspiratory airflow, or a combination of the two. Alae nasi activity may be an important mechanism that facilitates ventilation by reducing nasal resistance, and it may help stabilize the upper airway by preventing the development of large negative pharyngeal pressure during inspiration.
A Neonatologist Looks at the Baby Doe Rule: Ethical Decisions by Edict
Authors: BERSETH CAROL LYNN
Published: December 2021

Controversy and public attention has swirled around the recent Jane Doe case and the recent "Baby Doe" Rule issued by Secretary of Human Services Margaret Heckler.1 Jane Doe was an infant born with congenital esophageal atresia and Down's syndrome. The child's parents and physician chose to defer surgical repair of the child's esophageal anomaly. The child's anomaly precluded provision of enteral nutrition. No parenteral nutrition was provided, and the child died 6 days later. Several months later, Secretary Heckler of the Department of Health and Human Services issued a directive stating that hospitals receiving federal funding must display on a sign a telephone number by which anonymous observers could report parents or physicians who were witholding medical treatment or food from defective newborns.
BCG Vaccine and Isoniazid Prophylaxis
Authors: LE CHINH T.
Published: December 2021

To the Editor.—

The 1982 edition of the Report of the Committee on Infectious Diseases (Red Book) contains the specific statement that "BCG vaccine should not be given during INH administration because INH inhibits the multiplication of BCG organisms." This statement is apparently made in reference to the study by Narain et al1 (P. A. Brunnell, personal communication, Jan 19, 1983). It is estimated that isoniazid (INH) kills 90% of the bacilli in bacillus Calmette-Guerin (BCG) vaccines. However, the clinical implication of this observation is controversial.
Concerns of Mothers Seeking Care in Private Pediatric Offices: Opportunities for Expanding Services
Authors: Hickson Gerald B. , Altemeier William A. , O'Connor Susan
Published: December 2021

A surplus of general pediatricians has been predicted for 1990. This surplus could provide both opportunity and need for practitioners to identify areas of maternal concern that might guide expansion of marketable physician services. For this purpose, maternal concerns were assessed by interviewing 207 mothers seeking care in private pediatric offices. Only 30% of mothers were most worried about their child's physical health. The remaining 70% were most concerned about problems falling into six categories of parenting, behavior, and development (psychosocial concerns): personality/social development, discipline, mental development, motherchild interaction time, adjustment to divorce and other life changes, and adolescent transition. Although the majority of these concerns conceivably could be handled in private offices, only 28% of these mothers had discussed their greater psychosocial concern with their pediatrician. A search for explanations of this failure to communicate indicated mothers often were not aware that their pediatrician could help, or they questioned his ability or interest in assisting them. Characteristics that correlated significantly with communication were higher family socioeconomic levels, and greater physician self-perceived ability and interest in these psychosocial problems. Parenting, behavior, and development concerns represent an opportunity for expanding services if some of these obstacles can be overcome.
Detection of Late-Onset 21-Hydroxylase Deficiency Congenital Adrenal Hyperplasia in Adolescents
Authors: Emans S. J. , Grace E. , Fleischnick E. , Mansfield M. J. , Crigler J. F.
Published: December 2021

Because severe hirsutism is difficult to reverse, the evaluation of the adolescent girl with progressive hirsutism should aim at the pathophysiology of androgen excess in order to select appropriate therapies. A prospective study was undertaken to determine the occurrence of late-onset 21-hydroxylase deficiency among adolescents with androgen excess. Twenty-two young women (mean age 17.3 ± 2.6 years) with androgen excess had serum 17-hydroxyprogesterone measured before and after bolus intravenous infusion of synthetic ACTH (Cortrosyn), 0.25 mg. Two patients, aged 13 and 19 years old, had elevated base line 17-hydroxyprogesterone and 30- and 60-minute responses to Cortrosyn consistent with 21-hydroxylase deficiency. Chromosome 6p haplotypes provided supportive evidence of 21-hydroxylase deficiency. The base line androgen levels, clinical presentation, and a four-day dexamethasone test did not distinguish patients with 21-hydroxylase deficiency from other hirsute adolescents. The Cortrosyn test identifies a population of adolescents who need long-term corticosteroid therapy. The use of major histocompatibility complex haplotypes could be of help in identifying affected siblings prior to the development of significant hirsutism.
Venipuncture Fits: A Form of Reflex Anoxic Seizure
Authors: RODDY SARAH M. , ASHWAL STEPHEN , SCHNEIDER SANFORD
Published: December 2021

Blood banks and hospital laboratories all too often observe the phenomenon of a syncopal episode associated with bloodletting in an otherwise healthy patient. However, during the syncopal episode it is unusual for these patients to develop a generalized seizure. We recently studied a child who had a history of seizures following venipuncture. Utilizing ECG and EEG monitoring during venipuncture, we determined that these episodes were not true epileptic seizures but rather anoxic convulsions secondary to vagal asystole.

CASE REPORT

D.D., an 11-year-old girl, had her first generalized seizure following blood drawing at age 3 years. At least ten similar episodes have occurred with the seizure beginning one to two minutes after venipuncture.
Gypsies and Acute Medical Intervention
Authors: Wetzel Randall C. , Dean J. Michael , Rogers Mark C.
Published: December 2021

Recently, a 7-month-old, terminally ill Gypsy infant was admitted to a pediatric intensive care unit. Treating this child and her extended family was a challenging experience during which numerous culture-related problems were encountered. The Gypsy approach to acute medical care consisted of the presence of a large extended family unit, the lack of decision making by the patient's parents, and several different Gypsy traditions. There were diverse, and often derogatory, reactions and prejudices from the hospital staff. After interviewing family members, this family's needs were easier to understand, and interaction with them in culturally relevant terms was possible. When dealing with Gypsy families, identification of the responsible elder male members of the family, establishment of firm lines of communication with essential family members and the parents, and education of the medical staff concerning Gypsies are recommended.
Rape and the Adolescent
Authors:   Committee on Adolescence
Published: December 2021

In recent years the problem of rape and sexual abuse of young persons has begun to receive appropriate medical attention. Nearly 50% of reported rape victims are adolescents1,2 Whereas the vast majority of offenses involve girls, the incidence of sexual assaults on young males also appears to be increasing.

Although community resources may vary considerably, most metropolitan areas now have special programs or facilities to assist the victims of sexual assault. Such assistance usually includes advice as to the management of the acute crisis as well as guidelines for the collection of evidence and the preparation for trial should legal action follow. Because so many of the victims are adolescents, they are being seen with increasing frequency in pediatric emergency rooms.

The adolescent who is forcibly assaulted may display a wide range of behaviors, such as hysterical crying or giggling, agitation, feelings of degradation, anger and rage, helplessness, nervousness, and rapid mood swings. Alternatively, the adolescent may appear calm and controlled, masking internal turmoil. She is often angry, confused, and filled with self-blame. In cases of forcible assault, longterm sequelae such as fears, nightmares, and sleep disturbances, disturbed peer and sexual relationships, and psychosomatic complaints may develop. Some fear retaliation from their attacker and develop ritualistic behavior as a defense. Some believe their bodies to be permanently damaged, and may even fear death as a consequence of the violent act they have experienced.

For the victim, the circumstances of the initial medical evaluation may be frightening and stressful. Police interrogation, repeated questioning by health professionals, and the physical examination itself all have the potential to add to the trauma of the sexual assault.
Use of Erythromycin in Pertussis Outbreaks
Authors: BASS JAMES W.
Published: December 2021

To the Editor.—

With two outbreaks of pertussis recently observed and soon to be reported in Maryland (41 cases) and Hawaii (24 cases), it is appropriate that all means to curb spread of infection from individuals involved in these outbreaks be properly utilized. In this regard, I would like to take issue with a recommendation in the current Red Book.1 Certainly, erythromycin is presently the drug of choice for pertussis but the recommended duration of treatment of seven to ten days is inadequate.
Bonding, Humanism, and Science
Authors: LAMB MICHAEL E.
Published: December 2021

In Reply.—

I have consistently emphasized1-3 that the changes in birthing practices that Klaus and Kennell helped bring about are laudable, and that the failure to demonstrate clear, enduring, universal, and clinically significant effects attributable to early contact should in no way justify a return to dehumanizing birthing practices. In this respect, I am entirely in agreement with Emde and Osofsky, as well as Klaus and Kennell.4.5 As Emde and Osofsky suggest, it is unfortunate that policy-relevant research and reviews of it lend themselves to misuse by those whose agenda is set regardless of the scientific evidence.
Nasal Obstruction in the Pediatric Patient
Authors: Myer Charles M. , Cotton Robin T.
Published: December 2021

Early signals of pathologic causes of nasal obstruction in childhood may pass unnoticed by the unsuspecting physician because these signals mimic innocuous problems such as the common cold, sinusitis, and allergic rhinitis. The hope for early recognition of the more serious causes of nasal obstruction in children depends upon a high degree of suspicion. Some of the common and uncommon causes of nasal obstruction are enumerated by categorizing the possible etiologies into congenital, traumatic, iatrogenic, inflammatory, and neoplastic classifications. With a systematic approach that utilizes history, physical examination, and special diagnostic studies, misdiagnosis can be avoided and treatment initiated more rapidly and effectively.
Neonatal Herpes Simplex Virus Infection: Follow-up Evaluation of Vidarabine Therapy
Authors: Whitley Richard J. , Yeager Anne , Kartus Paula , Bryson Yvonne , Connor James D. , Alford Charles A. , Nahmias Andre , Soong Seng-Jaw ,   National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group
Published: December 2021

An open study of vidarabine (adenine arabinoside) therapy was performed to verify the mortality from neonatal herpes simplex virus infection and to define further long-term morbidity. A total of 39 babies not previously reported were treated with either 15 mg/kg/d (16 newborns) or 30 mg/kg/d (23 newborns) of vidarabine administered intravenously for ten to 14 days. Outcome was compared with that from 56 newborns evaluated in a prior trial. Irrespective of the dose of medication, therapy decreased the mortality in babies with disseminated and CNS disease to 40%. The extent of organ involvement and, in particular, pulmonary herpes simplex infection were predictive of mortality (P = .001, for both). For these babies, 32% achieved normal developmental milestones 2 years after therapy. Disease localized to the skin, eye, and/or mouth was not associated with death. However, neurologic impairment occurred in 12% of this treated group of newborns. These findings underscore the value of vidarabine therapy of neonatal herpes simplex virus infection. However, an increase in dosage did not appear to result in significant improvement in either mortality or morbidity. Further improvement in the mode of therapy and the utilization of more potent antiviral drugs are currently being tested.
Amiodarone Therapy in Children: A Cautionary Comment
Authors: HESSLEIN PETER S.
Published: December 2021

In this issue of Pediatrics, Shahar and associates have added yet another testimonial on the efficacy of amiodarone in the treatment of the tachydysrhythmias associated with the Wolff-Parkinson-White syndrome.1 Besides the drug's excellent therapeutic success rate,2-5 it appears to have other advantages over standard antidysrhythmic agents. Because its half-life is measured in days or weeks, a single daily dose is sufficient, and occasional missed doses are inconsequential. Unlike most standard agents, amiodarone does not significantly depress ventricular function,6 which may be an important consideration in patients with congestive heart failure or reduced ventricular function. Last, and most appealing, is the seeming safety of this agent.
Syndrome of Cutis Laxa Ligamentous Laxity and Delayed Development
Authors: Sakati Nadia O. , Nyhan William L. , Shear Carol S. , Kattan Hoda , Akhtar Mohamed , Bay Carolyn , Jones Kenneth Lyons , Schackner Lawrence
Published: December 2021

Congential cutis laxa with ligamentous laxity and delayed development appears to be a distinct syndrome. Experience with six patients brings the total number of cases described to 13. Characteristics of the syndrome include congenital dislocation of the hips, wide patency and delayed closure of the anterior fontanel, and delayed intrauterine growth and extrauterine growth and development. Each of the 13 patients has been female. Inheritance may be as an autosomal recessive or an X-linked dominant lethal in the male.
Use of Extracorporeal Membrane Oxygenation for Respiratory Failure in Term Infants
Authors: Kirkpatrick Barry V. , Krummel Thomas M. , Mueller Dawn G. , Ormazabal Miguel A. , Greenfield Lazar J. , Salzberg Arnold M. , Crute Stephen L. , Boswell Peter A.
Published: December 2021

Eight infants with intractable respiratory failure were treated with extracorporeal membrane oxygenation. Intractable respiratory failure was defined as alveolar-arterial oxygen gradient of more than 620 torr for six to 12 hours that did not respond to hyperventilation and the use of tolazoline. Infants with overt sepsis, CNS damage, or other debilitating conditions were not considered for extracorporeal membrane oxygenation. Six of the eight infants survived after a mean extracorporeal membrane oxygenation time of 164 hours. Five of the six survivors were normal neurologically and developmentally when examined at 1 year of age.
Neonatal Drug Withdrawal
Authors:   Committee on Drugs
Published: December 2021

Symptoms of neonatal drug withdrawal consist of: W = wakefulness; I = irritability; T = tremulousness, temperature variation, tachypnea; H = hyeractivity, high-pitched persistent cry, hyperacusia, hyperreflexia, hypertonus; D = diarrhea, diaphoresis, disorganized suck; R = rub marks, respiratory distress, rhinorrhea; A = apneic attacks, autonomic dysfunction; W = weight loss or failure to gain weight; A = alkalosis (respiratory); L = lacrimation (Fig 1); also, hiccups, vomiting, stuffy nose, sneezing, yawning, photophobia, twitching, myoclonic jerks, opisthotonos, or seizures.

When these symptoms are seen in a newborn infant, the physician should consider a diagnosis of withdrawal from maternal drugs. Narcotics reported to cause these symptoms in the neonate are heroin,1 methadone,2 meperidine,3 morphine, codeine,4 pentazocine,5,6 and propoxyphene.7 A glossary of drugs is provided in Fig. 2.

The onset of symptoms may be present at birth or may begin within four days of delivery. In some instances, symptoms may not become obvious until 10 days of age. This depends upon the drug the infant was exposed to in utero and the pharmaco-kinetic excretion of the drug. Subacute symptoms of narcotic drug withdrawal may last for 4 to 6 months.8

Rosen and Pippenger9 have demonstrated that infants born to mothers maintained on methadone do not begin to manifest withdrawal symptoms until the plasma level is less than 0.06 µg/mL. In utero exposure to multiple drugs may cause a biphasic pattern of withdrawal symptomatology in the neonate.10 Polydrug abusers frequently use as many as two to five drugs in combination; these might include phenobarbital, diazepam, marijuana, pentazocine, tripelennamine, phencyclidine, and codeine.11 A physician who is unaware of a mother's drug ingestion may initially make an erroneous diagnosis of colic in the infant; therefore, a detailed maternal drug history should be obtained, including prescription and nonprescription drugs received, social habits of the parents, and whether the mother is breast-feeding.
What Is the Best Test for Iron Deficiency?
Authors: OSKI FRANK A.
Published: December 2021

In Reply.—

Dine raises a very important question which is continuously posed by the pediatrician in practice-what is the best (simple, inexpensive, and sensitive) test to determine whether an infant or child has iron deficiency?

If there were an easy answer, this question would not be repeatedly asked. No single laboratory test is sufficiently sensitive and specific to detect all patients with iron deficiency or even iron deficiency anemia.1 For example, it has been demonstrated that close to one third of infants with hemoglobin in the low-normal range (11.0 to 11.4 g/dL) will display a significant increase in hemoglobin following a therapeutic trial of iron.2
Gastroesophageal Reflux and Apnea
Authors: ROSEN CAROL LYNN , FROST JAMES D. , HARRISON GUNYON M.
Published: December 2021

In Reply.—

In our study of polygraphic recordings in infants with unexplained apnea, esophageal pH was monitored continuously uously and all infants were fed standard infant formula approximately every four hours during the polygraphic studies. Orenstein has questioned the absence of gastroesophageal reflux (GER) in 36% of the pH recordings, and has suggested that nonacid feedings may have masked some episodes of GER. Other studies utilizing nonacid feedings during extended esophageal pH monitoring have shown that some normal children do not reflux and that nonacid feeds do not necessarily mask GER.
Adolescent Chest Pain
Authors: PANTELL ROBERT H. , GOODMAN BENJAMIN W.
Published: December 2021

In Reply.—

We did not conduct urine testing for cannabinoids but did inquire about the use of marijuana. Adolescents were questioned about use of all street drugs, including manjuana. Patients with chest pain did not admit to using drugs (5%) any more frequently than patients in our control groups with abdominal pain (8%) or without pain (4%).

The above letters highlight the importance of considering the importance of psychologic, situational and environmental conditions when evaluating an adolescent with chest pain.
Congenital Leukemia: Two Transient Regressions Without Treatment in One Patient
Authors: WARRIER R. P. , RAVINDRANATH Y. , INOUE S. , KAPLAN J. , EMAMI A.
Published: December 2021

To the Editor.—

The article by Chu et al1 has prompted us to report briefly our experience with cytochemical, chromosomal, and immunologic marker studies in four patients with congenital leukemia. The clinical and laboratory findings for the four cases are summarized in Tables 1 and 2.

Congenital leukemia is extremely rare. 2-4 In our experience, only four cases have been reported during the last 15 years; at the same time approximately 500 cases of acute leukemia were seen at Children's Hospital of Michigan. Although the number is small, half the patients in these series had acute lymphatic leukemia, suggesting that even in this age group, acute lymphatic leukemia may be more common than previously appreciated when "transient leukemia" 56 associated with Down's syndrome is excluded.
Cold-Induced Urticaria in Infancy
Authors: TING STANISLAUS
Published: December 2021

The following account describes one case of cold-induced urticaria.

CASE REPORT

C.S., a 3.5-kg baby girl, was born after an uneventful pregnancy. She is one of three siblings, born to unrelated parents, with no familial history of cold-related medical disorders. At 3 months of age, generalized urticarial lesions developed after immersion for a few minutes in an outdoor swimming pool. She was immediately removed from the water. The hives disappeared completely within 30 minutes. There was no evidence of joint swelling, fever, or irritability. Similar urticarial lesions occurred at 6 months of age, once again associated with exposure to cold water in a swimming pool.
Postmortem Protocol
Authors: WHELAN DONALD T.
Published: December 2021

To the Editor.—

The article by Knonick et al1 illustrates the advantage of having a "penimortem protocol" that includes an assembled kit to obtain appropriate diagnostic specimens from the dying infant or just after death has occurred.

I agree with the philosophical and practical approach taken by the authors. However, I would like to comment further on techniques we have found helpful under similar circumstances. At McMaster University Medical Centre, a total body radiograph is added to the protocol in all stillborn infants when unusual clinical signs are observed.
Short Children and Growth Hormone
Authors: JOHANSON ANN J. , BRIGHT GEORGE M. , ROGOL ALAN D. , BLIZZARD ROBERT M.
Published: December 2021

In Reply.—

Copeland raises some interesting questions and speculation regarding the treatment of "normal short" children with growth hormone that many, if not all, of the pediatric endocrinologists who treat short children are currently considering.

Regarding the ethical question of who should or should not receive growth hormone, who should give it, who should pay for it, and what are the side effects: information is being gathered and will be forthcoming in stages. A statement prepared by the Ad Hoc Committee on Growth Hormone Usage of The Lawson Wilkins Pediatric Endocrine Society, chaired by Dr Louis E. Underwood, has recently been published.1
Immunologic Response to Early and Routine DTP Immunization in Infants
Authors: Baraff Larry J. , Leake Rosemary D. , Burstyn Don G. , Payne Terrance , Cody Christopher L. , Manclark Charles R. , Geme Joseph W. St.
Published: December 2021

The effect of early immunization, prior to discharge from the newborn nursery, on subsequent immunity as determined by enzyme-linked immunosorbent assay (ELISA) immunoglobulion (Ig) M and IgG antibody titers to filamentous hemagglutinin and lymphocytosis-promoting toxin (LPT) of Bordetella pertussis and by standard pertussis agglutinin titers was investigated. Eighteen infants received routine diphtheria-tetanus-pertussis (DTP) immunization at 2, 4,and 6 months of age; 17 other infants received routine immunization and an additional DTP immunization in the newborn nursery. Antibody was determined on samples of cord blood and whole blood obtained at 4,6, and 9 months of age. IgM anti-filamentus hemagglutinin was significantly higher at 4 and 6 months of age in the group that received early immunization (P < .05). There was no significant difference in IgM anti-LPT, IgG anti-filamentus hemagglutinin, IgG anti-LPT, or pertussis agglutinin antibodies Six control infants had high cord IgG anti-LPT titers. These six infants had significantly lower antibody titers to LPT at 6 and 9 months of age when compared with control with control infants with lower cord titers. Thirteen infants in the early immunization group with lower cord IgG anti-LPT titers achieved significantly lower titers at 9 months of age than the 12 comparable infants in the control group.