bluuebunny/crossref_metadata_2025_split huggingface dataset:
NEPHROTIC SYNDROME
Authors: RILEY CONRAD M. 
Published: December 2021

The effects of short term ACTH treatment (4 to 6 days) in 14 patients with the nephrotic syndrome are presented. Five patients given eight courses showed complete clearing of edema in seven instances, one failing to show any response to a second course. Four patients given six courses showed significant but incomplete clearing of edema each time. Five patients showed no clinically significant response to seven courses.[See Table 5 in Source Pdf]
The type of diuresis with regard to salt and water excretion was similar to that seen with spontaneous diuresis. In all but one instance the patients who failed to have a clinically significant response did, nevertheless, show a slight sodium diuresis after with drawal of the drug. There were no consistent changes in the significant chemical findings in the blood, except that in most cases, regardless of clinical results, a drop in the level of total cholesterol was observed after treatment. Several patients who received sodium lactate by mouth following diuresis did not accumulate edema and had a pronounced increase in the urinary sodium. This suggests that at least temporarily their kidneys were capable of dealing with sodium in normal fashion.
The period of post-treatment studies on these patients varies from 7 to 15 months. Some of the patients have remained symptom-free, others have relapsed several times but responded to subsequent periods of treatment, still others after early successes have failed to respond to later ACTH administration. Only one of the group has shown clearing of the urine suggesting a permanent remission. Thus the use of this hormone at best offers only a means of controlling edema of the nephrotic syndrome. Whether its repeated use may alter the over-all prognosis can only be determined after a much longer period of observation. It should, however, prove useful in the study of the mechanism of diuresis.
STUDIES IN STEATORRHEA
Authors: CHUNG ARTHUR W. , MORALES SOLEDAD , SNYDERMAN SELMA E. , LEWIS J. M. , HOLT L. EMMETT 
Published: December 2021

Metabolic observations were carried out in three patients with "idiopathic" celiac disease and three patients with cystic fibrosis of the pancreas at different levels of fat intake.
It was found that fat absorption remained proportional to fat intake even at high levels. Increasing the intake thus led to improved absorption.
Deleterious clinical or metabolic effects were not encountered with one possible minor exception.
The implications of these observations are discussed.
The Role of the Pediatrician in Substance Abuse Counseling
Authors:   Committee on Adolescence
Published: December 2021

The past two decades have been marked by both an increasing recognition of the pediatrician's responsibilities toward the adolescent and the emergence of substance abuse as a critical concern for those who care for children and youth. The use and abuse of psychoactive substances have become common even among young adolescents, and the pediatrician must be prepared to address this issue as part of routine health care. In addition, the counsel of the pediatrician regarding substance abuse is often sought by families, schools, and community agencies. Familiarity with the extent and nature of adolescent drug use, as well as the health consequences of such use, has become a necessary part of the body of pediatric knowledge. The pediatrician must possess the skills necessary to determine which young patients are at risk from substance abuse and be able to offer appropriate counseling to the adolescent and his or her family so as to minimize the risk of future illness and dysfunction.
The pattern of substance abuse among teenagers has undergone rapid change during the past 15 years. During the late 1960s the abuse of psychoactive drugs, previously a predominantly adult phenomenon, became widespread among adolescents. Opiates, amphetamines, barbiturates, hallucinogens, and inhalants were all used and abused by large numbers of teenagers.1 The use of tobacco in this age group represents a significant health threat, and during the past decade the use of cocaine and other intoxicants, in particular alcohol and marijuana, has increased dramatically among adolescents. These drugs now cause major concern to those who provide health care for teenagers.
Letter to the Editor
Authors: Mitchell Marvin L. 
Published: December 2021

The authors are indeed fortunate that they have (1) a small case load, (2) serum specimens and not dried blood on filter paper, and (3) the opportunity to measure both thyroxine (T4) and thyroid-stimulating hormone (TSH) in all samples. Unfortunately, in the current economic climate most mass screening programs must limit their laboratory approach to T4 supplemented by TSH measurements or forego the T4 procedure and rely on TSH as the sole marker.
In the latter instance, infants with hypothyroidism secondary to hypothalamic or pituitary disease will be missed and even those with mild primary thyroid insufficiency could be overlooked because of the large coefficient of variation in the assay at TSH concentrations between 20-25 µU/ml in dried blood on filter paper.
The Death Setting
Authors: Ziegler John M. 
Published: December 2021

I laud the spirit of concern behind Silverman's commentary on neonatal death.1 However, I take issue with the assumption that a "natural death" cannot take place in a hospital. Furthermore, I believe that physicians and nurses, along with clergy, can and should care for the needs of a terminally ill neonate and his family.
Physicians and nurses are not limited to doing "something to prolong earthly existence," as Silverman suggests. On the contrary, medicine historically has served the dying: "I esteem it to be clearly the office of a physician, not only to restore health but also to mitigate the pains and torments of diseases and not only when [a cure is expected] but also when all hope of recovery being gone, it serves only to make a fair and easy passage from life."2
Joint Reply to `Maternal-Infant Bonding: A Joint Rebuttal'
Authors: LAMB MICHAEL E. , CAMPOS JOSEPH J. , HWANG CARL-PHILIP , LEIDERMAN P. HERBERT , SAGI ABRAHAM , SVEJDA MARILYN 
Published: December 2021

To the Editor.—
It is clear that there is some disagreement about the effects of early skin-to-skin contact, and these issues are discussed below. We want to underscore, however, that there is no disagreement about the laudable humanization of birthing practices that Klaus and Kennell helped bring about. All are agreed that the maintenance and extension of these practices is desirable, and that we owe a great deal to Klaus and Kennell for their role in promoting them.
Use of Microcomputer for Self-Evaluation in Pediatric Practice
Authors: GOUYON J. B. , ALISON M. , NIVELON J. L. , DUSSERRE L. 
Published: December 2021

To the Editor.—
We have been very interested in the various uses of microcomputers in pediatric units as proposed by Schwartz and Hammer.1 Following our experience in a neonatal unit, we have found another utilization.2 Microcomputers can be used for self-evaluation of the quality of care treatment in a pediatric unit. According to the number of variables studied, a microcomputer or minicomputer could be used.
For example, using a minicomputer (Hewlett-Packard 9045 B), we store 400 variables for each newborn.
Sulfisoxazole Prophylaxis for Otitis Questioned
Authors: PARADISE JACK L. 
Published: December 2021

To the Editor.—
Sulfisoxazole prophylaxis may be effective in reducing the occurrence of otitis media, but the report by Liston et al1 provides no supporting evidence. As reported, the study embodied a number of key flaws in design and methodology, any one of which would have been sufficient to invalidate the study's conclusions. I will focus on those that seem most important.
First, it appears that not all the patients entering the trial were comparable from an otologic standpoint.
Current Outlook for Children Around the World
Authors: SCHMIDT BENJAMIN JOSE 
Published: December 2021

The most tragic impact of the deep economic recession of the 1980s is falling on the 1.8 billion children less than 15 years of age who represent 40% of the 4.5 billion inhabitants of this earth. Two fifths of the world population still lacks the comfort of even minimally adequate housing and one third of the world's work force is unemployed or underemployed.
The result is that 100 million children stay hungry every day. Most of the nutritional education programs of the World Health Organization have turned out to be useless in improving protein diet. Sixty percent of the mothers of malnourished children are unaware of the fact that their children are underdeveloped and suffering from inadequate nourishment; due to a high rate of illiteracy, infantile malnutrition passes unobserved in one fourth of the population of developing countries.
A Pediatrician's Program for the Prevention of Dental Caries in the First Years of Life
Authors: HAGLER SUMNER 
Published: December 2021

To the Editor.—
Inasmuch as infants and children usually do not visit a pedodontist or a dentist in the first few years of life, I have recently undertaken a dental prophylactic program.
The program consists of three approaches: (1) Fluoride supplementation is started in the first 2 weeks of life whenever the infant is ready to use formulas, or when well water with inadequate fluoride content is used. This consists of 0.25 mg of fluoride with the usual vitamin drops and later vitamin tablets with fluoride until the infant is seen by the family dentist.
Treatment of Disabled Infants
Authors: HARRISON HELEN 
Published: December 2021

To the Editor.—
As the mother of a severely handicapped child, I was disappointed by the recent AAP Joint Policy Statement on the care of disabled infants.1 The Academy, whose members once argued so eloquently against the Baby Doe rule, now seems to have accepted one of its worst provisions—the insistence upon medical treatment "regardless of the nature and severity of the disability." Apparently this was done to placate the Reagan administration, an administration that shows it's true concern for the handicapped by constantly attempting to cut support programs for the disabled and their families.
Review of Research on the Factors Associated with Choice and Duration of Infant Feeding in Less-Developed Countries
Authors: Forman Michele R. 
Published: December 2021

Research on factors associated with infant-feeding choice and duration has the following objectives: to describe the associated factors; to determine the degree of association; and to determine factors that are amenable to intervention in order to plan and implement infant nutrition programs. Underlying these objectives are a series of questions including: (1) What are the factors associated with the decision to breast-feed and/or bottle-feed at birth? (2) Among less-developed groups, in particular, what are the factors associated with use of prelacteal feeds before or in combination with breast-feeding or feeding by breast and bottle? (3) What are the factors associated with duration of exclusive breast-feeding, time of introduction of liquid breast milk substitutes, time of introduction of solids, and duration of partial breast-feeding? These questions are addressed in this review.
This review encompasses research from a variety of disciplines—anthropology, epidemiology, nutrition, economics, and demography, for example. This is because infant feeding can be considered a behavior, a perception, a nutritional pattern, and a risk factor in infant growth and development. When infant feeding is classified as a behavior, the objective is to describe the infant's actions as he/she feeds at the breast or from the container for the breast milk substitute. The focus is on measuring the sucking action; the ability of the infant to latch onto the breast; and the frequency of, interval between, and duration of feeds.
To examine a mother's perception of her infant-feeding practice requires answers to the following: Does the mother consider herself an exclusive breast-feeder, a breast-feeder and bottle-feeder, or an exclusive bottle-feeder? Does she feed on demand or on schedule? The focus of this research is on the mother's perception of her infant-feeding status rather than on the actual practice of infant feeding; the correlation between perception and practice may be examined but is commonly assumed.
Breast-Feeding, Birth Interval, and Infant Health
Authors: Anderson John E. , Marks James S. , Park Tai-Keun 
Published: December 2021

In this section we consider the indirect effects of breast-feeding on infant health through its effect on birth intervals. First, we examine the evidence that breast-feeding is associated with longer intervals between births. Then we discuss studies that have attempted to show that short birth intervals are related to poorer infant health.
EFFECT OF BREAST-FEEDING ON INTERVALS BETWEEN BIRTHS
Breast-feeding is associated with a delay in the return of ovulation after a birth, with longer intervals between births, and with lower fertility rates occurring in populations where this practice is prolonged. In a recent issue of Population Reports,13 numerous studies that evaluate the contraceptive effect of breast-feeding were reviewed. Studies that link breast-feeding and fertility include clinical reports based on small numbers of women, larger prospective studies, and single-round demographic surveys which may be representative of national populations.
Clinical Studies
Because ovulation is difficult to measure, studies linking breast-feeding with ovulation have been limited to small numbers of clinic-based subjects.4,14,17 These studies have shown that women who breast-feed—and those who breast-feed for longer periods—tend to ovulate later following a birth than other women. This effect is believed to be related to the hormone prolactin, which is released through the stimulus caused by the infant's sucking. Prolactin promotes the production of breast milk and is believed to be related to the inhibition of ovulation. Levels of prolactin and the anovulatory effect are related to the frequency and intensity of nursing. Thus, women who breast-feed partially on infrequently, while giving supplementary food, are more likely to ovulate than those who breast-feed fully.
Personal Experience
Authors: MILMAN DORIS H. , BENNETT ANGELA A. 
Published: December 2021

To the Editor.—
The pediatric community is indebted to Dr Schwartz1 for sharing his personal experience with his own marijuana-using son and for using this experience to alert practitioners once again to the hazards of this drug. His remarkable personal restraint, combined with his thorough scientific documentation, underscore the pain that a family must endure as they witness the inexorable deterioration of their child, a pain made all the worse by the realization that the course of events might have been preventable.
Clinical Estimation of Liver Size in Newborn Infants
Authors: BRION LUC , AVNI FREDDY E. 
Published: December 2021

To the Editor.—
Measurement of liver size in the newborn frequently has been obtained only by palpation of the projection below the costal margin.1 It has been suggested2 that the measurement of the liver span obtained by percussion/palpation could be a more reliable estimation of the liver size. A study was designed to evaluate both methods.
A total of 317 newborns were examined: 287 were appropriate (in size) for gestational and 30 were small for gestational age, on the first and/or the fifth days of life.
Introduction to the Workshop on Current Issues in Feeding the Normal Infant
Authors: Gaull Gerald E. 
Published: December 2021

Gestation and lactation form a biologic continuum during which nutrients, protective factors, and growth modulators are transferred from mother to offspring. Because placental transfer ceases at birth, these placental functions must be maintained by feeding. It has become accepted as axiomatic that breast-feeding by a healthy mother for some time after birth is the biologic norm for the healthy term infant. However, the apparent success of modern commercially prepared formulas in the Western world has raised questions in the minds of some pediatricians and infant nutritionists about this axiom. Certainly, it cannot be argued on teleological grounds alone that because a particular constituent is present in human milk that it is, therefore, needed by the infant. Scientific questions about human milk can be formulated, and the evidence should be subjected to the same scrutiny as any other such question.
During this first year of postnatal life, many biochemical adaptations are taking place. Those in the gastrointestinal tract and the immune system are especially important in bridging the transition between gestation and lactation, on the one hand, and independent postnatal life, on the other. In early infancy we must consider the role of human milk v formula and of whey-predominant v caseinpredominant formulas in the light of our newer knowledge of these adaptations. Both in the human and in animals, biochemical adaptations during the fetal and perinatal periods have been more extensively studied than those during the weaning period. Indeed, the data on which to make nutritional judgments during the later periods of infancy are scant.
Summary-Gastrointestinal and Immunologic Development
Authors: Kretchmer Norman 
Published: December 2021

CARBOHYDRATE DIGESTION AND ABSORPTION
Whereas the first session of this meeting was concerned primarily with the nutritional content of infant feeds, the second focused on development of the organs that digest those feeds. Dr Richard Grand began the session with a review of various aspects of the development of the intestine from biochemical and physiologic standpoints, indicating that the absorption of various elements of food is dependent upon enzymatic activity and absorptive capability. He showed that, for unknown reasons, glucose from sucrose is absorbed at a much faster rate than glucose alone. In addition, in contrast to general opinion, the scientific data show that diand tripeptides are absorbed faster and by different mechanisms than the individual amino acids. Grand's talk then focused on the enzymes of the brush border, with particular emphasis on five enzyme groups that are involved in carbohydrate metabolism: (1) glucoamylase; (2) sucrase-isomaltase; (3) maltase; (4) lactase; and (5) trehalase. (The last enzyme is probably of minor importance in present day nutrition.) Grand also indicated that at one week of life, there is a decreased amount of digestibility derived from pancreatic enzymes, particularly amylase.
The relationship of these enzymes to nutrition was made quite evident by some studies conducted with the perfused fetal lamb, in which lactose was shown not to be a limiting substrate as there was a sufficient amount of lactase present in the intestine. In contrast, sucrose and maltose contributed little glucose to the general circulation of the lamb because sucrase and maltase were deficient in the intestine.
Neonatal Intensive Care: Cost-Benefit Analysis
Authors: BLACK LEHMAN E. , DAVID RICHARD J. , MCLONE DAVID G. 
Published: December 2021

To the Editor.—
The article by Walker et al1 supports an idea that is becoming commonplace in the medical literature: preserving the lives of certain segments of the population (in this case very low-birth-weight babies) may not be worthwhile, not because we are inflicting pain and suffering on them by our treatments, but because they may constitute a net fiscal burden on society. These authors are even more explicit than most, using a cost-benefit analysis that compares the costs of neonatal intensive care and future medical and educational services to an infant's "expected lifetime earnings" to determine a baby's net worth.
Neonatal Intensive Care: Cost-Benefit Analysis
Authors: WALKER DONNA-JEAN B. , FELDMAN ALLAN , VOHR BETTY R. , OH WILLIAM 
Published: December 2021

In Reply.—
In response to the comments on our paper1 dealing with the issue of cost-benefit analysis of health care delivery to the very low-birth-weight infants.
1. Neuspiel raised two issues. The first issue refers to placing a dollar value on human life. The final sentence of the abstract of our paper may be read by some to infer that care of infants weighing less than 900 g at birth is not economically beneficial; therefore, these infants should be restricted from receiving this care.
Nutritional Needs of Low-Birth-Weight Infants
Authors:   Committee on Nutrition
Published: December 2021

Optimal nutrition is critical in the management of the ever-increasing number of surviving small premature infants. Although the most appropriate goal of nutrition of the low-birth-weight (LBW) infant is not definitively known, achieving a postnatal growth that approximates the in utero growth of a normal fetus at the same postconception age appears to be the most logical approach at present.1 In uncomplicated cases, growth will usually begin by the second week after birth, after the initial changes in body water distribution have taken place, and after the infant has accommodated in a nonstressful way to the provision of enteral feeds and parenteral supplements. The fetal standards of growth that will be considered here include not only weight and length, but also values for rate of retention of individual nutrients and minerals (Table 1).2 The quality of postnatal growth may differ from the quality of fetal growth, depending on the type of milk consumed, eg, ex utero weight gain of a premature infant given formula includes more fat gain than that of a fetus of the same maturity.3
CALORIC REQUIREMENT
Energy expenditure for maintenance and growth determines the caloric requirements of the infant. The energy expenditure for growth includes both the energy value of the new tissue and the energy cost of the tissue synthesis. The estimated "basal" or maintenance metabolic rate of LBW infants, including an irreducible amount of physical activity, is lower in the first week after birth than later, and in a thermoneutral environment is approximately 50 kcal/kg/d by 2 to 3 weeks of age.4,5
Blood Transfusions and Safety
Authors: MATTSON PHILIP D. 
Published: December 2021

To the Editor.—
Transfusion practices in the neonate have become increasingly controversial with the recent reporting of AIDS (acquired immune deficiency syndrome). Many parents have requested the opportunity to provide directed donations with marginal success due to lack of storage apparatus and or staff refusal. The question of increased safety has been contested, especially when the infant requires multiple donors.
In some facilities, the Walking Donor Program has been resurrected. However, with heparinized syringes there is limited shelflife and inability to pack and irradiate (as done in some centers), and there are also contraints of donor availability.
Asthma and Pneumomediastinum
Authors: STURTZ GEORGE S. 
Published: December 2021

In Reply.—
Zwerdling and Hen correctly point out the well-known association of pneumomediastinum and asthma. In most patients, pneumomediastinum occurs as a complication of asthma; in fact, a child reported by Knott in 1850 had been wheezing for 3 weeks!
My paper was intended to emphasize that severe anterior chest pain, precordial crunching, and the presence of subcutaneous air in the neck of a previously healthy adolescent should lead to the clinical diagnosis of spontaneous mediastinal emphysema. Thus, on clinical grounds alone, one can rapidly identify a benign illness in a seemingly critically ill patient.