bluuebunny/crossref_metadata_2025_split huggingface dataset:
HYPERBILIRUBINEMIA OF PREMATURITY
Authors: Lucey Jerold F. 
Published: December 2021

The general subject of hyperbilirubinemia of prematurity has been reviewed. Several factors which are now known to affect the concentration of bilirubin in the serum in the neonatal period have been discussed. These are divided into pre- and postnatal factors.
It is suggested that the term hyperbilirubinemia should be used in preference to "physiologic jaundice" when referring to infants with concentrations of serum bilirubin of over 10 to 15 mg/100 ml. This roughly separates a group of infants who are potentially endangered and for whose jaundice some specific etiology can frequently be found.
Data have been presented which indicate that the incidence of hyperbilirubinemia and kernicterus may vary considerably from one premature nursery to another and within the same unit from time to time. The hypothesis has been offered that this variation may be due to iatrogenic factors. It seems justified to suggest that any premature unit encountering a high incidence of hyperbilirubinemia or kernicterus should carefully examine some of its routine policies.
The results of a survey by the author indicate that there is a wide divergence of opinion as to whether hyperbilirubinemia of prematurity should be treated. Considerable variation in the criteria used to select infants for treatment also exist. The only proven effective means of therapy at the present time is exchange transfusion. This has been demonstrated not to be excessively dangerous for premature infants, and available evidence suggests that it is effective in preventing brain damage. Fully realizing the many deficiencies inherent in the concept of a "critical level" of serum bilirubin, the author recommends choosing a concentration of serum bilirubin between 18 and 25 mg/100 ml as the main criterion for the selection of patients for treatment. Some of the newer methods aimed at controlling hyperbilirubinemia are reviewed. These are still in the highly experimental stage and cannot as yet be adequately evaluated.
Calculation of Surface Area of the Body
Authors: KROVETZ L. JEROME 
Published: December 2021

Several recent commentaries have been concerned primarily with the use of surface area of the body as a means of computing parenteral fluid dosages. Since there is, fortunately, a reasonably wide latitude of bodily homeostatic mechanisms, it becomes largely a matter of personal preference whether one utilizes surface area to estimate initial dosages or some other scheme to apply a corrective factor to weight-age relationships.
There exists another more profound facet to this issue, namely the relationship, if any, of surface area of the body to such physiologic variables as cardiac output, oxygen consumption, renal functioin, etc. It seems logical to separate three areas for discussion.
THE NEPHROTIC SYNDROME IN THE FIRST YEAR OF LIFE
Authors: Parker R. A. , Piel Carolyn F. 
Published: December 2021

The clinical course of nephrosis in five infants with onset of disease before 7 months of age is presented, together with evaluation of renal lesions seen at necropsy.
The problems of the management of nephrosis susceptibility to infection and water and electrolyte imbalance were found to be exaggerated by the young age of the patients.
The renal pathology observed in these five infants consisted of persistence of immature glomeruli and dilatation of the tubules in the cortical area. Later, the immature glomeruli and associated tubules appear to atrophy and the remaining glomeruli to hypertrophy.
Long-term adrenocorticosteroid therapy seems to be contraindicated, not only on the basis of the pathologic changes, but because it greatly exaggerates the problems of management and does not effect a remission of the disease.
SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Cook Charles D. , Wedgwood Ralph J. P. , Craig John M. , Hartmann John R. , Janeway Charles A. 
Published: December 2021

An analysis of 37 cases of systemic lupus erythematosus in children is reported in order to demonstrate the course of this disease and its pathology. In this series 92% of the children were girls.
Necropsies of 14 cases of the present series revealed characteristic renal findings in all, even when clinical evidence of renal disease had been absent. Generalized arteriolitis as well as evidence of cardiac involvement was usually present. Renal failure was the most frequent cause of death.
Of the 37 children, 10 were alive at the time of this report; 8 of these surviving patients have been followed for more than 2 years. Steroid therapy was associated with partial or complete disappearance of urinary abnormalities in six children. Endocrine therapy was used in 32 of the children with symptomatic improvement in most cases.
Until more specific drugs are available, an intensive and prolonged course of therapy with adrenal corticosteroids offers the best, though limited, chance of slowing or halting this disease process.
A PEDIATRIC VIEW OF GENERAL EDUCATION
Authors: Richmond Julius B. 
Published: December 2021

Pediatricians, because of their interest ". . . in all aspects of the work for the welfare of children,"° have reason to be concerned with the current controversy concerning education in general. Although it is evident that there is no simple solution, it is important that as a professional group concerned with child development, we keep informed on the problems facing us in education in order that we may lend support to constructive efforts as these develop. It is in this spirit that this communication is offered.
While the launching of Sputnik I by the Russians set off public anxiety concerning education in this country, it is well to note that educators and thoughtful citizens generally were concerned about the quality of our educational programs for a considerably longer period of time.1,2
CONFLICTS AND REBELLION DURING ADOLESCENCE
Authors: Glaser Kurt 
Published: December 2021

During the years from 10 to 18 the youngster is confronted with a series of problems for which he has to find solutions suitable and acceptable to himself, to his parents, and to society. He can find the solutions and adjust his life pattern either in a gradual, smooth and comfortable way or in stormy forward bouts and retreats: this will determine his life during adolescence. The nature and suitability of the solutions and his acceptance of them as his way of life will determine his integration into adult society.
Advancement to high school requires adjustment from one teacher to several, from a prearranged curriculum to some choice of subject, from day to day assignments to projects extending over weeks, requiring responsibility for planning that are now to be assumed by the student rather than the teacher. The youngster becomes concerned about his career and begins to understand the connection between his present schooling and future life plans.
His thoughts about his choice of profession still vacillate between an immature wish for gratification of immediate desires (he wants to be a taxi driver because he likes to ride in cars) and a more mature ability to postpone gratification and engage in long-range planning. He learns to consider his interests, abilities, opportunities, and ultimate returns from his work and begins to favor them over the immediate returns. His plans and his ability to carry them out will depend upon his emotional maturity. He is in need of guidance to assist him with his decisions, and to supplement his partially matured conscience, self-control and super-ego.
ABNORMALITIES OF SEX DIFFERENTIATION
Authors: Wilkins Lawson 
Published: December 2021

There are many discordances between the anatomic development of the external and internal sex organs, the chromosomal patterns, the gonadal morphology and the secondary sexual development. The psychosexual orientation is not predetermined by any of these, but depends largely upon the gender role assigned to a child in early life. It is, therefore, most important to select in early life the sex to which the child can best adapt.
The abnormalities of sex differentiation are: 1) Gonadal dysgenesis, in which there are various widely differing defects in the embryonic development of the gonads. These conditions are often due to chromosomal aberrations. There is a low familial incidence. 2) Male pseudohermaphroditism, in which testes are morphologically fairly well developed, but have defective secretion of "male organizing substance." 3) Female pseudohermaphroditism, in which masculinization of the external genitalia of females is due to androgens of the fetal adrenals or transmitted from the mothers during pregnancy.
Ambiguity of the external genitalia is usually the finding which arouses a suspicion of an abnormality of sex differentiation. However, the finding of firm masses in the groins or labia of apparent females or the absence of gonads in apparent males are also indications for more extensive diagnostic studies.
The study of the nuclear chromatin pattern of cells in smears of the buccal mucosa is the most important diagnostic screening test. A chromatin-positive pattern indicates that the patient is either a female pseudohermaphrodite, a true hermaphrodite or a case of "testicular dysgenesis." In chromatin-positive cases the urinary excretion of 17-ketosteroids should be measured to determine whether or not the patient has virilizing adrenal hyperplasia. Patients with a chromatin-negative pattern have either male pseudohermaphroditism, true hermaphroditism or some form of gonadal dysgenesis. Exploratory laparotomy with gonadal biopsies is necessary to establish the diagnosis. When the diagnosis is made in early infancy, all types of female pseudohermaphrodites should be reared as females. In male pseudohermaphroditism the assignment of the gender role depends largely upon the degree of phallic development. In true hermaphroditism one must take into consideration both the anatomy of the external genitalia and the type of development of the gonads. The explanations to be given to the parents and the hazards of changing the gender role in later life are discussed.
The relative incidence of the various types of abnormalities of sex differentiation are shown. It is pointed out that among 242 patients of all types, there were only 20 cases in which the assignment of a male role would have been preferred.
Pathogenesis of Hyposthenuria in Sickle Cell Anemia
Authors: Morgan Clarence L. 
Published: December 2021

Schlitt and Keitel report (Pediatrics, 26: 249, 1960) complete reversibility of hyposthenuria in a 6-month-old subject with sickle cell disease following transfusion over a 4-day period of 290 ml of blood with a rise in maximal urine osmolality from 700 to 1100 mosmol/l. They cite this as evidence against an independent genetic defect being causal in the etiology of hyposthenuria in sickle cell disease.
It is well known that the concentrating capacity of the normal kidney increases as the ratio of urea to other solutes in the urine approaches 0.35, and the approximate range of improvement may be from 650 to 1100 mosmol/l.1
A TRIBUTE TO JAMES L. GAMBLE, M.D
Authors: Gamble James L. 
Published: December 2021

The first six articles in this issue of Pediatrics are new contributions from from the laboratories of former associates of James L. Gamble and are dedicated to his memory. At the request of the Editor two friends of Dr. Gamble and members of the Editorial Board, Dr. Charles Janeway and Dr. William Waallace, located papers ready for publication and persuaded the authors to submit them to Pediatrics a collection in honor of their great teacher. This sort of enterprise requires more thought and effort than is generally realized and so constitutes a substantial and fitting tribute. The Editor wishes to express appreciation to all who have aided our purpose, especially to William Wallace, who was the guiding hand.
Pediatrics is proud to sponsor this tribute, not only to a unique and distinguished pediatric investigator, but also in recognition of the continuing vigor of basic research in pediatric laboratories. The aim of this tribute is to commemorate the man by reviewing his deeds and offering a sample of the work stimulated by his immortal influence.
A brief chronology of pivotal points in Dr. Gamble's career may serve to place the ensuing accounts of his timeless thoughts and work in familiar temporal perspective. He was born in Millersburg, Kentucky on July 18, 1883. Dr. Gamble's early education was accomplished in private schools in that small town. In 1901 the family moved to Pasadena, California, and he entered Stanford University and enrolled in the premedical course, graduating in 1906. In 1910 he received his M.D. degree, cum laude, from Harvard.
A COMPARATIVE STUDY OF BACTERIAL CULTURES AND COLONY COUNTS IN PAIRED SPECIMENS OF URINE OBTAINED BY CATHETER VERSUS VOIDING FROM NORMAL INFANTS AND INFANTS WITH URINARY TRACT INFECTION
Authors: Pryles Charles V. , Lüders Dieter , Alkan Mustafa K. 
Published: December 2021

Bacteriologic studies, including cultures and colony counts, of catheterized and voided specimens of urine from infants (all under 2 years of age) were carried out in three groups: Group I, paired specimens (catheter and clean-voided); Group II, random non-clean-voided specimens; Group III, clean-voided and catheter specimens in a group of infants with clinical evidence of urinary tract infection.
In 70% of the Group I patients there was complete "diagnostic" correlation between catheter and clean-voided specimens if one accepts the figure of 1,000 colonies/ml of urine as the dividing line between a true bacteriuria and contamination, as established in this clinic for those over 2 years of age. While a 96% "diagnostic" correlation between clean-voided and catheter specimens is observed if the line between "contamination" and "infection" is placed at 10,000 colonies/ml, and this figure corresponds to the 98% correlation figure found in the group over 2 years of age, it is our feeling that the critical count should remain at 1,000 colonies/ml of urine for both infants and children. Repeat examination of clean-voided or catheter specimens should resolve all equivocal findings.
Proper "strapping" of boy and girl infants after careful cleansing of perineum, vulva or prepuce and glans will provide satisfactory samples of urine for bacteriologic study. Where doubtful results are obtained, the study of more than one specimen of urine is absolutely necessary. Catheterization, under certain circumstances, may be necessary to clarify doubtful findings, but this should be carried out with the full realization of the risk of introducing infection.
EVIDENCE FOR FAMILIAL ALLERGY
Authors: Critz George T. 
Published: December 2021

A study of parents of 50 allergic children has been presented. A history of personal or family allergy was elicited in 20 mothers and 23 fathers, but bilateral histories were found in only 11. Scratch tests were performed on these parents and on a group of 44 adults free of allergy.
The children themselves were scratch-positive in 46 (92%) of the cases. The parents were scratch-positive in 70% (mothers) and 72% (fathers) of the cases. The presumably nonallergic comparison group of adults was positive in one (2.2%) case.
Of the parents as individuals, both history and scratch test indicated allergy in 56 (56%) of the cases (36 allergic subjects were positive and 20 "nonallergic" subjects were negative). Disagreement occurred in 44 cases, of which 37 were scratch-positive although clinically "nonallergic." In the remaining seven, verification of clinical allergy was lacking. This 7% compares favorably with the 8% of children known to be allergic in whom verification by scratch test was not demonstrated.
Using history and scratch tests as criteria for the presence of allergy, the results indicate that in 50 allergic children, 66% possessed evidence for familial allergy in both parents, 28% in one parent, and 6% in neither parent.
THE FLUORESCENT ANTITOXIN TEST FOR THE IMMEDIATE DIAGNOSIS OF DIPHTHERIA
Authors: Whitaker Jo Anne , Nelson John D. , Fink Chester W. 
Published: December 2021

The recent increase in the incidence of diphtheria in our area stimulated the search for a reliable laboratory test for the immediate differential diagnosis of diphtheritic and non-diphtheritic membranous tonsillitis. Fluorescein-conjugated diphtheria antitoxin proved to be highly specific for staining toxigenic C. diphtheriae. Eight of nine patients with proved diphtheria had fluorescent organisms on a smear of exudate. The failure in the one case is attributed to the poor quality of the specimen obtained. An early case of diphtheria was detected by examination of family contacts of one of the patients in this series.
The conjugated antitoxin does not result in fluorescent staining of nontoxigenic diphtheria bacilli on of other bacteria commonly found in the nasopharyngeal tract. Fluorescent staining of cultures suggests that only a small proportion of the potentially toxigenic diphtheria organisms are actually producing toxin at a given moment.
The fluorescent antitoxin test can be performed within 1 hour. A positive result of the test is an absolute indication for antitoxin therapy. With a negative result the physician must still rely on his clinical judgment and cultural and virulence tests.
THE PASSIVE TRANSFER OF ANTIBODIES TO ESCHERICHIA COLI 0111:B4 FROM MOTHER TO OFFSPRING
Authors: Sussman Sidney 
Published: December 2021

Esch. coli antibody titers in 27 mothers and their respective offspring were studied by the trypsinated and nontrypsinated hemagglutination technic.
All of the maternal sera and colostra contained Esch. coli 0111-B4 antibody. In 19 cases the antibody titer in the specimens of colostrum on the first day was higher than that of the corresponding sera. The antibody titer in the colstrum fell rapidly during the next 3 to 4 days.
Five cord sera had a low antibody titer to Esch. coli 0111:B4 when tested by the trypsinated hemagglutination method. By contrast, only two cord sera were positive for Esch. coli 0111:B4 antibody when tested by the untrypsinated hemagglutination technic.
With the trypsinated method, two infants showed a 2-tube rise and one infant had a 1-tube rise in titer at the end of the third colostrum day; one infant demonstrated a 1-tube rise in titer when tested by the untrypsinated hemagglutination technic.
In general, there was a 1-to-3-tube difference between the trypsinated and untrypsinated hemagglutination procedures.
Human Toxoplasmosis: Proceedings of the Conference on Clinical Aspects and Diagnostic Problems of Toxoplamosis in Pediatrics at the VIII International Congress of Paediatrics, Copenhagen
Authors: FELDMAN HARRY A. 
Published: December 2021

This Conference, organized by the editor and participated in by representatives from 12 countries, was the largest meeting ever to be concerned with this subject. Although the Conference was held in 1956, the material presented was revised by the contributors in 1959. Thus, the monograph probably represents the greatest amount of information available on the subject of toxoplasmosis in a single volume.
Following some prefatory remarks by Prof. P. Plum, there is an introductory discussion, by Dr. Albert B. Sabin, of the status of problems posed by toxoplasmosis in pediatrics. There then follow six sections, each made up of contributions by participants from various countries.
STUDIES OF CARBOHYDRATE METABOLISM IN THE NEWBORN INFANT
Authors: Cornblath Marvin , Ganzon Angelita F. , Nicolopoulos Demetrios , Baens Gloria S. , Hollander Richard J. , Gordon Mordecai H. , Gordon Harry H. 
Published: December 2021

Sugars in capillary blood were measured during the first hours of life in full-term infants delivered vaginally and by cesarean section. Pretreatment with dextrose solution for mothers delivered vaginally did not affect the course of the sugar in blood significantly Pretreatment with dextrose or saline solution for mothers delivered by cesarean section produced significant differences in the course of the infants' sugar in blood when compared to each other.
Full-term infants delivered vaginally who were more than 6 hours old had a greater hyperglycemic response to glucagon, 30 µg/kg, than infants less than 3 hours of age.
Full-term infants delivered by elective cesarean section without previous labor responded to 30 µg/kg of glucagon with a diminished hyperglycemia as compared to infants delivered vaginally.
An exposure to labor influenced the neonates' response to glucagon, whereas neither pretreatment of the mother nor the course of sugar in blood were associated with this response.
With large doses of glucagon, 300 µg/kg, the response differences associated with mode of delivery and maturity were not found to be significant.
PEDIATRICIANS' APPRAISALS OF PATIENTS' INTELLIGENCE
Authors: Korsch Barbara , Cobb Katharine , Ashe Barbara 
Published: December 2021

Four hundred seventy-seven estimates by pediatricians of developmental level and intelligence of 242 patients from 1 through 9 years of age were compared with results of standard psychologic tests. Approximately a half of the pediatricians' appraisals were accurate within 10 points of the psychologic test results, and about a third deviated more than 15 points.
None of the attributes of the pediatricians or the conditions under which they made their appraisals were related to accuracy. However, not all estimates were made equally well. The greatest accuracy was shown in the estimates for children within the normal range of intelligence. The two groups most consistently misjudged by the pediatricians were the physically ill and the mentally retarded. Levels of development were most frequently underestimated in physically ill children and grossly overestimated in mentally retarded children.
Implications of the findings for pediatric practice and education are presented.
Letters to the Editor
Authors: STEIGMAN ALEX J. 
Published: December 2021

In response to Doctor Kozinn's thoughtful letter, may I say at once that his latter point is entirely well taken; nystatin is considered specific rather than "nonspecific," a typographical error which should be rectified in future editions.
As to the source of Candida, the Report states that p. 55) "yeastlike fungi are frequently found in intestinal tract, vagina, and skin of normal individuals." The skin ought not be singled out. In any of these three anatomic sites Candida may result in symptoms and signs. It was not intended to dismiss C. albicans as a common saprophyte.
The Committee appreciates comments and criticism of its brief Report.
Letters to the Editor
Authors: FINKEL K. C. 
Published: December 2021

I am grateful to Dr. Cannon Eley for his criticisms on my paper, because I would not wish anyone to feel that the problem of varicella in patients receiving adrenocorticosteroids can be dismissed lightly.
In the cases referred to by Dr. Eley, adrenocorticosteroids were being administered in full therapeutic doses not only during the period of viremia, but also when clinical disease was apparent.
I would stress that my recommendations concern patients exposed to varicella and not individuals who have received steroids in full dosage throughout the incubation period.