bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth Hormone in the Treatment of Children with Short Stature
Authors:   Ad Hoc Committee on Growth Hormone Usage, The Lawson Wilkins Pediatric Endocrine Society, and Committee on Drugs
Published: December 2021

Therapeutic use of growth hormone (GH) in the United States generally has been restricted to GH-deficient children who, with their families, agree to participate in research. The limited supply and the considerable expense of commercially prepared GH have restricted the number of children who have received such therapy. As the medical community and public become more aware of the therapeutic potential of GH, practicing physicians are faced with mounting pressure to prescribe GH for short children who are not GH deficient. Furthermore, the promise that abundant supplies of biosynthetic GH prepared by recombinant DNA methods will soon be available adds to the fever for uncontrolled experimentation.

Twenty-five years of experience indicate that therapeutic replacement of GH is safe for GH-deficient children. Nevertheless, using GH in the treatment of children who are not deficient in GH should not be engaged in lightly, as GH is a potent metabolic agent that might have significant side effects. Because there is so little experience with the therapeutic use of GH at the pharmacologic doses that may be required to accelerate growth in non-GH-deficient children, information on side effects is limited. It is appropriate, therefore, to review (1) the accepted indications for the therapeutic use of GH (GH-deficient children), (2) the disorders in which GH has been shown to lack beneficial effect, (3) the issues to be considered in selecting for therapy patients who do not appear to have classic GH deficiency, and (4) the side effects that might occur when GH is administered as a pharmacologic agent.

TREATMENT OF GROWTH HORMONE DEFICIENT CHILDREN

Growth failure due to GH deficiency is the only universally accepted therapeutic indication for GH treatment.
Urinary Tract Abnormalities in Children with Supernumerary Nipples
Authors: VARSANO IZHAK B. , JABER LUTFI , GARTY BEN-ZION , MUKAMEL MASZA M. , GRÜNEBAUM MICHAEL
Published: December 2021

Supernumerary nipples (accessory nipples or polythelia) are classified as minor developmental anomalies. Their incidence, as reported in different ethnic groups, varies from 0.22% to 5%.1,2 Various malformations associated with supernumerary nipples have been described in individual cases.2,3 Recently, attention was drawn to a high incidence of renal abnormalities in children with supernumerary nipples. Mehes1,4 initially evaluated 20 Hungarian children and then an additional 37 Hungarian children with supernumerary nipples and discovered urinary tract abnormalities in 15 (40%) and nine children (27%), respectively. On the other hand, Rahbar,5 using clinical criteria and urine findings, was not able to identify renal or other malformations in 22 American black neonates with supernumerary nipples.
Biostatistics in Pediatrics
Authors: KLESH KENNETH W.
Published: December 2021

To the Editor.—

I read with great interest the recent article by Hayden1 concerning the expanding use (and misuse) of biostatistics. in the medical literature. Having little background in statistics, I indeed have found it increasingly difficult to critically evaluate research presentations—the "auto-cerebrectomy" of which Feinstein2 spoke is both familiar and personally troubling.

While a series of instructional articles on statistical topics as has appeared in the New England Journal of Medicine, is most welcome, I suspect that an approach more intimately associated with a well-established continuing medical education effort would reach the greatest number of practicing pediatricians and could be more directly tailored to their needs.
Hearing Screening of High-Risk Newborns with Brainstem Auditory Evoked Potentials: A Follow-up Study
Authors: Shannon Dorothy A. , Felix Jacob K. , Krumholz Allan , Goldstein Phillip J. , Harris Kenneth C.
Published: December 2021

Numerous techniques have been used in attempts to find a reliable and efficient screening method for determining auditory function in the newborn. The brainstem auditory evoked potential (BAEP) is the latest method advocated for that purpose. The BAEP was evaluated as a hearing screening test in 168 high-risk newborns between 35 and 45 weeks of conceptual age. Follow-up data were obtained after 1 year (mean 17.3 months) on 134 of the infants (80%). Normal hearing was defined as a reproducible response in both ears to a 25 dB normal hearing level (nHL) click stimulus; 21 infants (12.5%) failed the initial screening test. Follow-up on 19/21 infants revealed 18 infants with normal hearing and one infant with an 80 dB nHL bilateral hearing loss substantiated. One infant with an abnormal screening test died before retesting, and the other infant was lost to follow-up but had only a unilaterally abnormal BAEP. None of the infants with a normal BAEP screening study had evidence of hearing loss on retesting. Sensitivity of the BAEP was 100%, specificity was 86%, predictive value of a positive test was 5.26%, and the predictive value of a negative test was 100%. The incidence of significant hearing loss in our population was between 0.75% (1/134 infants) confirmed, and 2.24% (3/134 infants) including infants who failed screening but were lost to follow-up. The BAEP is a sensitive procedure for the early identification of hearing-impaired newborns. However, the yield of significant hearing abnormalities was less than predicted in other studies using BAEP for newborn hearing screening.
Rapid Diagnosis of Group B Streptococcal Infection Utilizing a Commercially Available Latex Agglutination Assay
Authors: Friedman Charles A. , Wender David F. , Rawson John E.
Published: December 2021

The Wellcogen Strep B latex assay rapidly identifies all cases of culture-positive sepsis and meningitis and may be more sensitive than standard culture techniques for identifying group B Streptococcus disease and assessing the degree of severity. The quantitation of antigen concentration combined with the peripheral WBC count proves helpful in predicting poor outcome.
Five Cases of Near-Miss Sudden Infant Death Syndrome and Development of Obstructive Sleep Apnea Syndrome
Authors: Guilleminault Christian , Souquet Marianne , Ariagno R. L. , Korobkin Rowena , Simmons F. B.
Published: December 2021

Five full-term infants were referred for "near miss" sudden infant death syndrome events, which occurred between 3 and 12 weeks of age. After a complete pediatric evaluation and 24-hour polygraphic monitoring, each infant was monitored at home with a cardiorespiratory monitor. Each was followed regularly (with repeat polygraphic recordings) up to 4 years of age. All five infants developed heavy snoring at night and symptoms of obstrutive sleep apnea syndrome. The diagnosis of obstructive sleep apnea syndrome was confirmed by polygraphic recordings; surgery was recommended. Four of the five children underwent adenoidectomies between 3 and 4 years of age, and this significantly improved their condition. These five cases are the first polygraphically documented histories of the development of obstructive sleep apnea syndrome.
Use of Pneumococcal Polysaccharide Vaccine in Preventing Otitis Media in Infants: Different Results Between Racial Groups
Authors: Howie V. M. , Ploussard John , Sloyer John L. , Hill James C.
Published: December 2021

A total of 133 children between 6 and 11 months of age with at least one episode of otitis media were given one of two pneumococcal vaccines. One vaccine contained 25 µm of types 1, 3, 6, 7, 14, 18, 19, and 23 and the other vaccine (control) contained 25 µm of types 2, 4, 5, 8, 9, 12, and 25. Follow-up care of the 65 black infants revealed significantly more otitis media visits in those infants receiving the control vaccine. Among the 68 white infants there was no difference between control and vaccine groups after vaccination.
Mental Health Problems Among Children Seen in Pediatric Practice: Prevalence and Management
Authors: Goldberg Irving D. , Roghmann Klaus J. , Mclnerny Thomas K. , Burke Jack D.
Published: December 2021

An ambulatory care survey involving 40% of all pediatricians in Monroe County, NY, was conducted between January and December 1979 to obtain an estimate of the prevalence of mental health problems among children seen by pediatricians. If a child with such a problem was identified, the pediatrician described the problem in detail, its impact on the family and the patient, and the action taken to handle the problem. The weighted 40% probability sample was representative of all pediatric practices in the county. During the 2 months for which each of the 30 pediatricians reported on all visits, there were 21,575 visits made by 18,351 children. There were 935 children detected at their first visit as having a problem, and another 48 children at a repeat visit during the reporting period. This is equivalent to a point prevalence at time of first visit of 5.09%. There was considerable variation between pediatricians: group practitioners reported a point prevalence of 4.06%, solo practitioners reported 5.06%, and health center pediatricians reported 7.33%. High rates were reported among children 7 to 14 years old (8.0%), boys (6.2%) compared with girls (3.9%), those on Medicaid (8.3%), and those whose presenting complaint was a chronic physical disorder (13.1%). The slightly higher rate among blacks than whites appeared to be related to the generally lower socioeconomic status among blacks. The rate among children in one-parent families was twice as high as in two-parent families. With regard to the mental health problem, most frequent diagnoses (primary or secondary) were adaptation reaction (31.5% of "problem" children), speech and language disorder (18.4%), other specific learning disorder (17.1%), hyperkinetic disorder (16.8%), and conduct disorder (14.7%). Functional impairment was moderate or severe in more than half the affected children; most frequent treatment provided by the pediatricians was supportive therapy or counseling (81.4%); drugs were prescribed for 11.3% of the affected children, amphetamines fro 4.7%.
Results of Controlled Double-Blind Study of Thyroid Replacement in Very Low-Birth-Weight Premature Infants with Hypothyroxinemia
Authors: Chowdhry Parveen , Scanlon John W. , Auerbach Richard , Abbassi Val
Published: December 2021

The nature of hypothyroxinemia in sick very low-birth-weight (VLBW) infants was evaluated by assessment of the hypothalamic-pituitary axis and by the clinical response to thyroxine (T4) therapy. Twenty-three very low-birth-weight infants of gestational age 26 to 28 weeks, whose serum T4 concentrations were 4 µg/dL on two occasions, and thyrotropin < 20 µU/mL, were included in a double-blind study. Following a thyrotropin-releasing hormone stimulation test, babies were given either T4 or placebo. Nine babies were thyrotropin-releasing hormone tested prior to therapy; four babies, two from each group, were tested 1 to 2 weeks after therapy. In 11 untreated babies, mean base line serum thyrotropin of 7.0 ± 1.4 rose to 23.7 ± 4.1 µU/mL in 30 minutes. This response was not significantly greater than the observed response in full-term babies, 23.7 ± 4.1 v 16.6 ± 0.97 µU/mL, respectively, P > .05. In two babies treated with T4 the thyrotropin response to thyrotropin-releasing hormone was completely suppressed. Serial serum T4 determinations showed normalization in both groups after a similar time interval. There was no beneficial effect of T4 therapy on growth of head circumference, length, or weight. Developmental data revealed no significant differences in the mental, motor, or gross neurologic outcome in the treated and nontreated infants after 1 year of follow-up. These observations imply that hypothyroxinemia in sick preterm infants is not a direct consequence of hypothyroidism. Despite the lack of demonstrable short-term beneficial effects of T4 therapy, follow-up studies are necessary to resolve the question of long-term benefits.
Maxillary Sinus Radiographs in Children with Nonrespiratory Complaints
Authors: Kovatch Anthony L. , Wald Ellen R. , Ledesma-Medina Jocyline , Chiponis Darleen M. , Bedingfield Bruce
Published: December 2021

An attempt was made to determine the frequency of abnormal maxillary sinus radiographs in a group of unselected children having diagnostic skull radiographs performed for indications unrelated to respiratory infection. An occipitomental, or Water's, view was obtained in every case in order to evaluate the maxillary sinuses. Prior to performance of the radiographs, a history of recent respiratory symptoms was obtained and a physical examination of the ears, nose, and throat was performed. An abnormal maxillary sinus radiograph was defined as one that revealed an air-fluid level, partial or complete opacification, or mucous membrane thickening of 4 mm or greater. Fifty-nine (53%) of 112 presumably "normal" children had evidence of recent respiratory inflammation by history or at physical examination. In 50 subjects less than 1 year of age, abnormal maxillary sinus radiographs were common, irrespective of respiratory symptoms and signs. In contrast, eight of 14 children (57%) aged 1 to 16 years with both symptoms and signs of respiratory inflammation had abnormal maxillary radiographs, compared with only two of 31 children (7%) with neither symptoms nor signs (P < .005). Crying alone was not associated with abnormal radiographs in the older age group. In children more than 1 year of age, abnormal maxillary sinus radiographs are infrequent and are generally related to inflammation of the upper respiratory tract.
Child Abuse, Cardiopulmonary Resuscitation, and Rib Fractures
Authors: Feldman Kenneth W. , Brewer David K.
Published: December 2021

Rib fractures have occasionally been described in children receiving cardiopulmonary resuscitation (CPR). Because child abuse is sometimes suspected in these cases, it is both medically and legally important to establish whether the rib fractures are secondary to abuse or CPR. One hundred thirteen children, including 41 victims of child abuse, 50 patients who had CPR, and 22 patients who had rib fractures, were studied. Twenty-nine patients had rib fractures; 14/29 (48%) were abusive. Other causes of fracture were: motor vehicle accidents (four), rickets/osteoporosis (five), surgery (five), and osteogenesis imperfecta (one). In spite of prolonged resuscitation performed with variable degrees of skill, no fractures could be attributed to CPR. On the other hand, rib fractures occurred frequently in abused children (6/41 or 15%). Abusive fractures were often multiple, of different ages, and affected multiple adjacent ribs. Patients with abusive rib fracture also had other physical and radiologic signs of abuse or neglect.
Necrotizing Fasciitis of the Parapharyngeal Space with Carotid Artery Occlusion and Acute Hemiplegia
Authors: Bush Janice K. , Givner Laurence B. , Whitaker Stephen H. , Anderson Donald C. , Percy Alan K.
Published: December 2021

Necrotizing fasciitis is characterized by necrosis with extension over fascial planes and mixed aerobic-anaerobic etiologies. Necrotizing fasciitis is uncommon in children and seldom involves the head and neck area. An infant who developed necrotizing fasciitis involving the parapharyngeal space is described. Chronic dental pathology was probably the initial focus of infection. The patient had a left hemiparesis due to a right middle cerebral artery infarct. Carotid angiography demonstrated complete occlusion of the right internal carotid artery, probably secondary to inflammatory arteritis or direct compression along its course through the parapharyngeal space. Mixed aerobic-anaerobic etiologies predominate in infections of the potential spaces of the head and neck as was demonstrated in this patient. The patient recovered, but had neurologic sequelae. Prompt and aggressive therapy is necessary in patients with necrotizing fasciitis syndromes in order to avoid such severe complications.
Ethanol in Liquid Preparations Intended for Children
Authors:   Committee on Drugs
Published: December 2021

Ethanol is present in more than 700 pharmaceutical liquid preparations, ostensibly as an "inert" solvent on diluent.1 Despite recent voluntary efforts by several pharmaceutical companies to replace alcohol or reduce its content, there remain on the market an excessive number of liquid medications containing alcohol in concentrations ranging from 0.3% to 68%, eg, teething preparations, decongestants, and cough medicines. The presence of ethanol in children's medication is of major toxicologic interest with respect to both acute ingestion and passive exposure that occurs during therapy with ethanol-containing products. This commentary focuses upon the toxicology of ethanol in children and the determination of acceptable alcohol concentrations in children's medication.

INTERACTION WITH OTHER DRUGS

When taken in conjunction with other drugs, medicines containing alcohol may produce undesirable interactions. Acute ethanol administration may alter drug absorption2 or impair the degradation of other drugs.3 When taken with sedating drugs, it may result in enhanced psychomotor impairment.4,5 Chronic ethanol administration, which induces drug-metabolizing enzymes (such as P-450), may be of clinical importance by altering the clearance of several drugs (phenobarbital, phenytoin, meprobamate, and warfarin).3 Disulfiram (Antabuse) reactions, symptoms of which include flushing, tachycardia, nausea, vomiting, and, in severe forms, cardiac arrythmias, cardiovascular collapse, respiratory depression, and convulsions, may also be induced by alcohol-containing medicines. Of more direct importance to pediatricians are recent reports of disulfiram-like reactions that occur in some individuals after the simultaneous use of antibacterial drugs such as moxalactam, metronidazole, sulfonamides, chloramphenicol on cefamandole, and alcoholic beverages or medicinal elixirs.6-9

ESTABLISHING CRITERIA FOR ALCOHOL CONTENT IN CHILDREN'S MEDICATION
Prostaglandins as Mediators of Vasotonia in the Immature Retina
Authors: Flower Robert W. , McLeod D. Scott , Wajer Stephen D. , Sendi Gregory S. , Egner Patricia G. , Dubin Norman H.
Published: December 2021

In vivo observations of the immature beagle puppy retina indicates that in general 02-breathing induces vasoconstriction whereas CO2 or CO2 combined with O2 induces vasodilation. It was the goal of this study to determine whether a specific correlation could be found between this pattern of vascular response to changes in blood gas content and production of prostaglandins in the eye. Prostaglandin production by puppy choroidal and retinal tissues and platelets exposed in vitro to these gas combinations was such that it appears platelet-derived thromboxane could have a significant influence in determining retinal vasotonia.
Pathogenesis of the Prune-Belly Syndrome: A Functional Urethral Obstruction Caused by Prostatic Hypoplasia
Authors: Moerman Philippe , Fryns Jean-Pierre , Goddeeris Paul , Lauweryns Joseph M
Published: December 2021

Abdominal muscle deficiency, urinary tract abnormalities, and cryptorchidism are the three major features of the prune-belly syndrome, also referred to as triad syndrome or Eagle-Barrett syndrome. The etiology is unclear and the pathogenesis a subject of continuing debate. Clinical and pathologic experience with seven cases of prune-belly syndrome is reviewed. Findings indicate that the urogenital anomalies can be attributed to a functional urethral obstruction which in turn is the result of prostatic hypoplasia. The histology of the abdominal wall is that of atrophy—ie, the degeneration of already formed muscle—and not of primitive muscle. This observation supports the theory that the abdominal muscle hypoplasia is a nonspecific lesion, resulting from fetal abdominal distension of various causes. Transient fetal ascites may be an important feature of the prunebelly syndrome.
Necrotizing Enterocolitis in the First 24 Hours of Life
Authors: Thilo Elizabeth H. , Lazarte Raul A. , Hernandez Jacinto A.
Published: December 2021

Necrotizing enterocolitis (NEC) is commonly thought of as occuring in the sick premature infant, usually in the first one to two weeks of life. A review of NEC at the Children's Hospital of Denver over a 5-year period, found that 13 of 79 infants (16.1%) had onset of NEC during the first day of life. These infants were larger (mean birth weight 2,624 ± 849 g), more mature (mean gestational age 37.9 ± 2.5 weeks), and less asphyxiated as judged by Apgar scores (mean five-minute score 8.15 ± 1.07) than infants with onset of NEC after the first day of life (mean birth weight 1,519 ± 586 g, mean gestational age 32.0 ± 3.5 weeks, P < .001, and mean five-minute Apgar score 6.81 ± 1.84, P < .05). Despite their large size and degree of maturity, eight of these infants (62%) showed signs of respiratory distress; four (31%) were polycythemic; four (31%) had either a partial or double-volume exchange transfusion performed; and 11 (85%) were fed prior to developing NEC. Presenting signs of disease, occurrence of sepsis (31%), requirement for surgical intervention (62%), and mortality (30%) were similar for the two groups of infants. It is suggested that term and near-term infants who have significant illness after delivery be treated more like their premature counterparts with cautious introduction of feedings after an adequate period of stabilization.
Chronic Sinus Disease with Associated Reactive Airway Disease in Children
Authors: RachelefSky Gary S. , Katz Roger M. , Siegel Sheldon C.
Published: December 2021

Sinus disease has been described as one of several aggravating factors for chronic adult-onset asthma. Forty-eight children whose reactive airway disease (asthma) was significantly improved with treatment of their sinusitis have been observed. All of the subjects were seen in the office with chronic (more than 3 months) respiratory symptoms; all had daytime and nighttime cough and/or wheeze. The 48 children (32 male and 16 female) had a mean age of 8.2 ± 1.2 (SD) years (range 4 to 13 years). Fourteen (35%) were nonatopic as determined by family history, personal history, and skin test reactivity to inhalant and pollen antigens. Eighteen of the patients were receiving or had recently received oral corticosteroids. All had been taking bronchodilators daily for at least 3 months without adequate control of the asthma. Sinus radiographs (Waters view) revealed the following abnormalities of the maxillary sinuses: greater than 6 mm of mucosal thickening (ten children [21%]), one opacified (12 children [25%]), bilateral opacification (18 children [38%]) and air fluid level(s) (eight children [17%]). All children were treated with antimicrobial agents for 2 to 5 weeks. Thirty-nine responded both clinically and radiologically. Antral lavage was performed in nine children. Of the 48 subjects, 38 (79%) were able to discontinue taking the bronchodilators with resolution of their sinusitis. It is concluded that sinus disease in children may be an aggravating factor for chronic reactive airway disease and that proper, aggressive treatment of the former will notably improve the latter.
Vitamin D Metabolism in Osteogenesis Imperfecta During Calcitonin Therapy
Authors: Nishi Yoshikazu , Hyodo Sumio , Yoshimitsu Kazunori , Sawano Kunihiko , Yamaoka Kanji , Seino Yoshiki , Usui Tomofusa
Published: December 2021

The effect of calcitonin on plasma concentrations of 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D [1,25-(OH)2D] was studied in six patients with osteogenesis imperfecta. The mean pretreatment value of plasma 1,25-(OH)2D was significantly higher than the mean value of age-matched control subjects (P < .05). High or normal plasma levels of 1,25-(OH)2D before calcitonin therapy were decreased after 1 month of therapy and remained normal thereafter in all six patients. Plasma 25-hydroxyvitamin D concentrations, which were normal before calcitonin injection, remained normal during calcitonin administration. These results indicate that there may be acute and chronic effects of calcitonin on vitamin D metabolism.
Onset of Hearing Loss in Children with Bacterial Meningitis
Authors: Kaplan Sheldon L. , Catlin Francis I. , Weaver Toni , Feigin Ralph D.
Published: December 2021

Auditory brainstem responses were evaluated in 37 children with bacterial meningitis within 48 hours of admission. Four children (two with Haemophilus influenzae type b, and two with Streptococcus pneumoniae) had definite abnormalities of hearing detected at admission. Two of these children had severe-to-profound hearing losses which have persisted. Hearing losses were greatly reduced in the other two children (one child also was ataxic) when repeat testing was performed. Auditory brainstem responses in two additional children suggested brainstem dysfunction at admission (one child died and the other has had severe sequelae). Hearing losses occur early in the course of bacterial meningitis in some children. Further studies are required to confirm the use of auditory brainstem responses in detecting hearing losses early in high-risk children with bacterial meningitis.
Early Diagnosis and Evolution of Deafness in Childhood Bacterial Meningitis: A Study Using Brainstem Auditory Evoked Potentials
Authors: Vienny H. , Despland P. A. , Lütschg J. , Deonna T. , Dutoit-Marco M. L. , Gander C.
Published: December 2021

Fifty-one children with bacterial meningitis were studied prospectively using serial recordings of brainstem auditory evoked potential (BAEP) from the earliest phase of the disease, according to a standardized protocol. The objectives were to make an early diagnosis and follow the evolution of deafness in the course of meningitis and evaluate the prognostic value of BAEP. Thirty-five children (68.6%) always had normal recordings; 11 children (21.6%) had transient BAEP abnormalities (prolonged wave V latency or elevated threshold for wave I), and five children (9.8%) had persistent pathologic BAEP recordings from the first examination at 48 hours until discharge from the hospital and have a persistent deafness. All recordings that were normal or pathologic at discharge were confirmed by behavioral audiometry 3 months later. These results show the early occurrence of deafness in the course of meningitis with a crucial phase of possible recovery or worsening occurring during the first 2 weeks. There were no cases of "late" deafness or "late" recovery (there was sometimes slight improvement) occurring after discharge; thus BAEPs have a prognostic value. However, observation of a child with clinically proven selective high-frequency postmeningitic deficit but without a hearing handicap, a disorder that was diagnosed early with BAEP (which tests only the high frequencies), is a warning that this method alone is insufficient and that clinical auditory surveillance and conventional audiometry remain necessary.
Empyema in Children: Clinical Course and Long-Term Follow-up
Authors: McLaughlin F. John , Goldmann D. A. , Rosenbaum D. M. , Harris G. B. C. , Schuster S. R. , Strieder D. J.
Published: December 2021

Sixteen patients, aged 1 month to 15 years, were studied to determine the clinical course and longterm outcome of empyema in previously healthy children. The pathogens responsible were Haemophilus influenzae type b (seven patients), Staphylococcus aureus (five patients), Streptococcus pneumoniae (three patients), and viridans group Streptococcus (one patient). All patients had loculated fluid showing on chest roentgenographs. Chest tube drainage yielded 20 to 1,495 mL (mean 293 mL) during the first three days, accounting for 83% of total drainage. Chest tubes were removed after three to 17 days (mean ten days). Only slight roentgenographic improvement showed during chest tube drainage. Three patients required an open thoracotomy because of an unsatisfactory clinical response. Hospitalization ranged from eight to 77 days (mean 25 days). All patients had residual pleural thickening shown on chest roentgenographs taken at discharge. Thirteen patients were seen 5 to 140 months (mean 66 months) after discharge. Findings from physical examination were normal in 12 of the 13 patients. Pulmonary function tests in ten of the 13 patients revealed (mean percent predicted ± 1 SD): vital capacity 92 ± 12, residual volume 85 ± 31, total lung capacity 92 ± 13, peak flow rate 96 ± 17, forced expiratory volume in 1 second 90 ± 13, and maximal mid-expiratory flow rate 93 ± 25. In all but one patient, findings on chest roentgenograms were normal or showed slight pleural thickening. Children with loculated empyema can be treated successfully with antibiotics and chest tube drainage. Few patients require open drainage, and further surgery is rarely required. The long-term outcome is excellent.
Fever Therapy: An Educational Intervention for Parents
Authors: Casey Rosemary , McMahon Francis , McCormick Marie C. , Pasquariello Patrick S. , Zavod William , King Frank H.
Published: December 2021

Fever in children is a common problem, but one which often alarms parents. Parental misconceptions often lead them to unnecessarily aggressive and inappropriate management of fever in their children. A prospective controlled trial of an educational intervention to improve parental understanding and management of fever, involving the parents of 108 children, aged 6 months to 4 years, was performed in a private group practice. Although the majority of these patients were well educated, most were found to be misinformed about many aspects of the seriousness of fever and its management. Parents in the intervention group received a standardized interview in which the management of fever was discussed, demonstrated, and practiced. In addition, they received a printed information sheet for reinforcement 2 months after the initial interview. Parents in both the control group and intervention group revealed an increase in knowledge about fever over time, but only in the intervention group were inappropriate physician contacts and medication errors reduced. The effectiveness of an active learning approach to anticipatory guidance for the management of transient febrile illness was documented and it is suggested that extension of this approach to other common problems in the private practice setting be examined.
Response to Acute Hypercapnia in the Parents of Victims of Sudden Infant Death Syndrome
Authors: Couriel Jonathan M. , Olinsky Anthony
Published: December 2021

The ventilatory response to acute hypercapnia was studied in 68 parents of victims of sudden infant death syndrome and 56 control subjects. Tidal volume, inspiratory time, and total respiratory cycle time were measured before and immediately after a vital capacity breath of 13% CO2 in oxygen. Instantaneous minute ventilation, mean inspiratory flow (tidal volume/inspiratory time), and respiratory timing (inspiratory time/total respiratory cycle time) were calculated. Both groups of subjects showed a marked increase in tidal volume (48.4% ± 26.5%), instantaneous minute ventilation (56% ± 35%), and tidal volume/inspiratory time (56.8% ± 33.5%) after inhalation of the test gas, with little change in inspiratory time/total respiratory cycle time. There were no significant differences between the two groups for ventilation before or after inhalation of the test gas. The ventilatory response to acute hypercapnia is mediated by the peripheral chemoreceptors. These results suggest that an inherited abnormality of peripheral chemoreceptor function is unlikely to be a factor leading to sudden infant death syndrome.
Neonatal Screening for Phenylketonuria
Authors: BERLOW STANLEY
Published: December 2021

To the Editor.—

Publication of the article by McCabe et al1 in September 1983 marks the twentieth anniversary of Guthrie and Susi's description of newborn screening for phenylketonuria (PKU), also published in these pages.2 The bacterial inhibition assay (BIA), which was reported in the latter article became the basis of a system of preventive pediatric care which has expanded during the past two decades.

In 1974, Holtzman et al3 were the first to examine extensively the issue of false-negative tests or missed PKU, and this problem has become a major concern.
Effects of Diarrhea Associated with Specific Enteropathogens on the Growth of Children in Rural Bangladesh
Authors: Black Robert E. , Brown Kenneth H. , Becker Stan
Published: December 2021

Village-based surveillance data from longitudinal studies in rural Bangladesh have been used to evaluate the nutritional consequences of infectious diseases, including diarrhea due to specific pathogens. The prevalences of specific illnesses were related to the ponderal and linear growth of young children for 2-month and 1-year periods. Of the common illnesses, only diarrhea had a significant inverse relationship with increments of weight during 2-month periods and of length during 1 year. Diarrhea accounted for 20% of the difference in linear growth between the study children and the international reference population during the first 5 years of life. Diarrhea associated with enterotoxigenic Escherichia coli had a significant negative effect on the bimonthly weight gain of children in this community and shigellosis had the strongest negative effect on bimonthly and annual linear growth. Control of diarrhea due to enterotoxigenic E coli and Shigella would not only substantially diminish diarrheal morbidity but would also improve the growth of children and thereby reduce the prevalence of protein-energy malnutrition.
Use of Visual Training for Reading Disabilities: A Review
Authors: Metzger Richard L. , Werner David B.
Published: December 2021

Visual training continues to be used as a remediation technique for reading disabilities despite consistent evidence that it does not provide effective treatment. A review of the ophthalmologic, optometric, and psychological literature relating to the assumption that a relationship exists between reading failure and perceptual ability has found no evidence to support this assumption.
Breast-Feeding Behavioral Patterns Among La Leche League Mothers: A Descriptive Survey
Authors: Cable Thomas A. , Rothenberger Lee A.
Published: December 2021

Many studies have documented the behavioral patterns of unrestricted breast-feeding among Third World mothers, but knowledge of this behavior among Western women is lacking. La Leche League International is a strong advocate of unrestricted breast-feeding, a feeding behavior more characteristic of women in developing countries than in Western society. To investigate the breast-feeding patterns of La Leche League mothers, a pilot study of 24 active members was undertaken. Utilizing a home diary, a 2-month record of suckling frequency, vaginal bleeding, sexual intercourse, solid food supplements, and six-hour intervals without a suckling episode was maintained. The results show the La Leche League mother in this sample to be an average of 29 years old, white, and well-educated. She fed an infant an average of 15 times per day and frequently slept with her child. Frequency of mother and child sleeping together was inversely related to the frequency of marital intercourse. Prolonged lactational amenorrhea was also found, as 92% of the mothers nursing infants 5 to 16 months old had not regained their normal menstrual flow. La Leche League mothers represent a subset of nursing mothers who have a life-style of which the primary care physician must be aware in order to provide optimal maternal-infant care.
The Mother Working Outside the Home
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: December 2021

Sixty percent of women (35% of mothers of children less than 18 years of age and 45% of mothers with preschool-aged children) in the United States work outside the home either of necessity or by choice. The pediatrician, who has an important role in helping such women find the best way of dealing with their multiple and demanding roles as workers, wives, and mothers, is often asked to address some of the questions posed below.

1. Is my working harmful to my child? The answer to this question depends upon (a) the provision of a safe, caring environment for the child; and (b) the mother's satisfaction in her outside work, the support and help of her family, and her vitality at the end of the day to nurture her children.

2. How do I evaluate a substitute care-giving situation? In addition to safety, sanitation, and the provision of proper nutrition, the kind of care giver to whom a young infant or young child is entrusted is the overriding consideration. This person must be warm, caring, responsible, and able to provide the child the stimulation of new learning experiences. In all cases, parents should talk frequently with the care giver about the child-rearing practices they desire, especially if the substitute mother is inexperienced or comes from a different sociocultural background. Although the needs of each child in a group setting vary with his or her age and personality, a ratio of one adult to three infants less than 2 years of age is advised, with the desired ratio increasing to 1 to 4 or 1 to 5 for older children.
Percutaneous Absorption of Iodochlorhydroxyquin in Humans and Dogs
Authors: STOHS S. J. , EZZEDEEN F. W.
Published: December 2021

To the Editor.—

Iodochlorhydroxyquin (Clioquinol, Vioform) has been widely used for the prophylaxis of traveler's diarrhea, treatment of amoebic dysentery, and the management of fungal infections, although its medical value has been questioned.1 However, its oral use has been severely restricted in recent years due to its potential for neurotoxicity,2,3 hepatoxicity and nephrotoxicity.3,4 Iodochlorhydroxyquin, is still used widely in the treatment of diaper rash and other skin disorders, and it is presumed to undergo little percutaneous absorption.
Formula Composition
Authors: MACLEAN WILLIAM C.
Published: December 2021

To the Editor.—

In their recent article on chronic protracted diarrhea of infancy, Lo and Walker1 refer to some of the formulas that have been used in the management of this condition.

Carbohydrate malabsorption and intolerance are frequently the factors limiting intake during rehabilitation of these infants.2 Consequently, the type of carbohydrate is an important consideration in the choice of formula. The source of carbohydrate was inaccurately listed for most of the hydrolysate, low-lactose, and lactose-free formulas in their table 3.
The Cough and the Bedsheet
Authors: Cohlan Sidney Q. , Stone Shirley M.
Published: December 2021

Of 33 patients with psychogenic cough tic, 31 were successfully treated using an unusual reinforced suggestion technique. The cough usually follows an incidental upper respiratory tract infection and persists as a loud paroxysmal barking or honking sound for weeks to months. Paroxysms occur all day but cease with sleep. The diagnosis is often delayed for weeks to months while the patient is exposed to an increasing intensity of diagnostic procedures and therapy. Thirty percent of some 20 patients previously reported in the literature had been hospitalized. The reinforced suggestion technique depends upon the physician's convincing the patient that the persistent cough has weakened the chest muscles, which are now unable to contain the cough, and that a bedsheet tightly wrapped around the chest will provide the necessary support to stop the cough within 24 to 48 hours. The typical patient can produce the cough on command, has an ambivalent response to the prospect of care, is unconcerned about his symptoms, submits willingly to the examination and procedures, and is kept out of school for the duration of the cough. Findings on physical examination are normal except for abnormal gag and corneal reflexes. The gag reflex was depressed in six and absent in 20 of the 31 patients. The corneal reflex was depressed in 16 and absent in 5 of the 31 patients. These abnormal responses help to corroborate the psychogenic etiology. Early recognition of the nonorganic nature of this syndrome will reduce parental anxiety, loss of school time, risk of iatrogenic complications, and unnecessary medical and hospital expense.
Infectious Diseases and Child Day Care
Authors: Goodman Richard A. , Osterholm Michael T. , Granoff Dan M. , Pickering Larry K.
Published: December 2021

The number of day care centers and home care facilities has steadily increased in the United States. Recent interest has focused on the possible relationship between attendance at child day care facilities and the occurrence of certain infectious diseases. A variety of infectious agents have been reported as causes of illness among children and staff in day care programs. In general, however, concurrent risks for these infections among children attending and those not attending day care programs have not been established by prospective studies. A review is made of the pathogens that have been associated with infections in day care settings, patterns of occurrence of infectious diseases in day care facilities, aspects of control and prevention of these diseases, and controversies related to infectious diseases in child day care facilities. Aspects of this problem that warrant further research are outlined.
Role of Coagulopathy in Newborn Intracranial Hemorrhage
Authors: McDonald Marilyn M. , Johnson Michael L. , Rumack Carol M. , Koops Beverly L. , Guggenheim Mary Anne , Babb Cynthia , Hathaway William E.
Published: December 2021

Fifty newborn infants of less than 33 weeks' gestation were followed prospectively from birth with serial coagulation and real-time ultrasound studies. A significant association of hypocoagulability in the first four hours of life with subsequent onset or progression of intraventricular or other clinical hemorrhages was documented. Abnormalities included lower values for fibrinogen, platelet count, antithrombin III, and factor VIII with higher values for fibrin monomer and longer Laidlaw whole blood clotting times. These abnormalities tended to correct spontaneously in surviving infants. An association between gestational complications and incidence of hypocoagulability and intracranial hemorrhage (ICH) was noted. Babies of preeclamptic mothers had fewer abnormalities and babies born to mothers with premature rupture of membranes and suspected amnionitis manifested more hypocoagulability and more severe intracranial hemorrhages.
Effect of Oral Diuretics on Pulmonary Mechanics in Infants with Chronic Bronchopulmonary Dysplasia: Results of a Double-Blind Crossover Sequential Trial
Authors: Kao Lily C. , Warburton David , Cheng Mary H. , Cedeño Cecilia , Platzker Arnold C. G. , Keens Thomas G.
Published: December 2021

In a randomized double-blind crossover trial with sequential analysis, the effects of oral diuretics were compared with the effects of placebo on pulmonary mechanics in ten infants with bronchopulmonary dysplasia (BPD). Pulmonary mechanics were measured before and at the end of a week of treatment with oral diuretics (chlorothiazide, 20 mg/kg/dose and spironolactone, 1.5 mg/kg/dose) given twice daily, or placebo. Mean airway resistance decreased 35.3 cm H2O/L/s, mean specific airway conductance increased 0.095 1/L/s/cm H2O, and mean dynamic pulmonary compliance increased 1.74 mL/cm H2O during treatment with diuretics (all P <.001), but not during treatment with placebo. The infants' rate of weight gain decreased on the first three days of diuretic treatment, but was thereafter comparable with weight gain during treatment with placebo. Fluid intake was similar in infants receiving diuretics and placebo. But, infants receiving diuretics not only had significantly increased urine output, osmolal clearance, and potassium and phosphorus excretion, but these infants also retained less fluid, and, in addition, excreted less calcium than infants receiving placebo. It is concluded that oral diuretics improve lung function in infants with chronic bronchopulmonary dysplasia; however, potassium and phosphorus depletion are potential complications of treatment.
Incidence of Invasive Bacterial Disease in Children with Fever and Petechiae
Authors: Van Nguyen Quoc , Nguyen Elizabeth A. , Weiner Leonard B.
Published: December 2021

The records of 129 patients admitted to the hospital with the findings of fever and petechiae were reviewed to determine the incidence of invasive bacterial disease in patients with this symptom complex. Twenty-six patients (20.2%) had culture-proven bacterial infections; 13 (11.1%) of the group had Neisseria meningitidis, eight had Haemophilus influenzae type B. No single laboratory test was sufficiently sensitive to detect all patients with life-threatening bacterial infections, but a combination of normal laboratory findings was highly specific for those without significant disease.
Effect of Early Immunization on Antibody Response to Reimmunization with Measles Vaccine as Demonstrated by Enzyme-Linked Immunosorbent Assay (ELISA)
Authors: Murphy M. Dianne , Brunell Philip A. , Lievens Alan W. , Shehab Ziad M.
Published: December 2021

A measles epidemic in San Antonio, Texas provided a population of children who were immunized at ≤10 months of age and reimmunized at ≥15 months of age. Of these children, 302 were evaluated for measles antibody by the sensitive enzyme-linked immunosorbent assay (ELISA), and their responses were compared with those of 300 children who had been immunized at the customary time (≥15 months) with a single immunization. There were only five seronegative findings in each group. The children immunized at the customary time did have significantly higher (P < .001) antibody titers than the children immunized at ≤10 months and reimmunized at ≥15 months. These results indicate that early immunization followed by reimmunization may be indicated when young infants are at significant risk of measles exposure. This approach should not create an increased number of serologically nonresponsive children when reimmunized at ≥15 months.
Gastroschisis in a Case of Dizygotic Twins: The Possible Role of Maternal Alcohol Consumption
Authors: SARDA P. , BARD H.
Published: December 2021

Gastroschisis is a congenital defect which is characterized by evisceration of the intestine through a paraumbilical defect of the abdominal wall. Little is known of the etiology of gastroschisis. During the last two decades a significant increase in the incidence of gastroschisis has been documented. Between 1960 and 1969, an incidence of 1/150,000 was reported, whereas during the 5-year-period from 1970 to 1974 the incidence increased to 1/6,000.1 However, not all studies have noted a recent increase in the incidence of gastroschisis.2 Most cases have been reported to appear in the first pregnancy of young mothers (average age 19.5 years). Hereditary factors have rarely been suspected although there are reports of recurrence in families.3,4