bluuebunny/crossref_metadata_2025_split huggingface dataset:
FORMULA ROOMS FOR NEWBORN INFANTS IN LYING-IN HOSPITALS
Authors: WALLACE HELEN M. , ABRAMSON HAROLD , LOSTY MARGARET A. 
Published: December 2021

This report comprises a preliminary discussion of certain conditions under which formulas are prepared for newborn infants in lying-in hospitals. The general picture is one of lack of proper supervision of formula room procedures and of the unskilled personnel usually assigned to the important process of formula preparation. The conditions disclosed by this study are not peculiar to New York City alone, but merely reflect the pressing nature of the problem throughout the country.
Until recently the study of formula preparation was a neglected field of investigation. A review of the literature emphasizes the lack of attention that has been paid to the problem in the past. Investigators now state unanimously that the entire procedure of formula preparation in hospitals requires revision. But the methods by which this change should be achieved are still open to study. The general opinion is that some means of terminal steam sterilization is necessary. But opinion is, however, divided as to the type of steam sterilization that is desirable, the optimal temperature that should be employed, and the time of application required. Opinions are not always substantiated by adequate bacteriologic data.
Asking those with practical experience to answer certain questions on terminal processing of formula led to no consistent conclusion. Opinions were based mainly on clinical experience and judgment. There was general agreement that subjecting formulas to high temperatures would destroy such vitamins as thiamin and ascorbic acid, and would cause appreciable caramelization of the formulas. It was thought that such changes would not have deleterious effect on the baby. Vitamin replacement therapy could be readily introduced.
It is the responsibility of hospital administrators, pediatricians, obstetricians, nurses, dieticians, and public health workers to devise safe and practical methods for preparing infant formulas and to plan the layout of the formula room. The methods recommended should be based on sound scientific data and be sufficiently simple to be carried out effectively by any person assigned to formula room duty.
THREE YEARS' EXPERIENCE WITH AN AFFILIATED RURAL RESIDENT TRAINING PROGRAM
Authors: CARSON MERL J. , POOLE BELLE DALE 
Published: December 2021

FOR several years medical educators have given increasing consideration to the problem of extending medical teaching beyond the period of medical school and residency training, into the area of medical practice.
Dr. Edwards A. Park forcibly outlined this concept when he wrote, "Perhaps the greatest benefit which could be brought to pass in medical care in this country would result if the medical schools could be made to descend from their ivory towers—to use Dr. James Wilson's metaphor—and extend their educational facilities to the practicing physicians of the country and to assume the task of keeping them informed as a full part of their responsibilities."
A few months later a committee of the American Academy of Pediatrics reported, "In its report to the Executive Board at the Academy's Annual Meeting in Atlantic City, November 20-23, 1948, the Committee on the Improvement of Child Health gave due recognition to the great progress over the last half century in the medical care of children, but emphasized that the full benefits of modern medical care are not available to all children. The Committee's overall recommendations based on the findings are twofold:
"(1) To strengthen pediatric training in medical training in medical schools so that all doctors, not only specialists, may be thoroughly prepared to care for children, and
"(2) To develop systems of decentralized training and rural extension services so that better medical care for children may be available in outlying areas."
In view of the widespread interest in this concept and also in methods of developing a workable system of extending the services of a modern teaching center, it is felt that a description of the Children's Hospital-Imperial County Project might be of interest.
NUTRITIONAL RECOVERY SYNDROME
Authors: GÓMEZ FEDERICO , GALVÁN RAFAEL RAMOS , MUÑOZ JOAQUÍN CRAVIOTO 
Published: December 2021

This paper presents clinical and laboratory data which indicate the development of a syndrome heretofore undescribed and still incompletely studied which appears in children during recovery from severe malnutrition.
The principal clinical findings are portal-intrahepatic hypertension beginning 20 to 40 days after treatment is instituted and lasting about a month.
Hepatomegaly, which is the first sign, is marked and progressive, affects particularly the left lobe and is inversely proportional to the degree of fatty infiltration of the liver, as is demonstrated by liver biopsies.
Along with the hepatomegaly there is distention of the abdomen, a thoraco-abdominal venous network and ascites.
Later phenomena (occurring after about 60 days of treatment) are hypertrichosis of the forehead, back and thighs, as well as a more or less marked eosinophilia not explained by intestinal parasites or allergy.
The most important chemical finding is the hyper-gamma globulinemia, the highest level of which coincides with the appearance of the portal hypertension; this is definitely statistically significant. At the same time a considerable elevation of total plasma proteins takes place and thymol turbidity tests become progressively more abnormal.
PSYCHIATRIC ASPECTS OF CHANGES IN INFANT AND CHILD CARE
Authors: BRUCH HILDE 
Published: December 2021

DURING the last 2 or 3 decades child care has concerned itself with the question of how to raise children who would be emotionally secure and well-adjusted as well as physically healthy. A flood of advice has been directed toward parents as to the "best" psychologic methods of handling children.
I wish to draw attention to the problems involved in deliberately changing child-rearing customs, particularly when the advice goes from one extreme to the other. In contrast to the relative ease of teaching better physical care, parent education in the field of psychologic care has often resulted in dismal confusion. Such failure of the wonderful promise of better mental health due to better psychologic insight seems to be related to the contradictions inherent in different psychologic theories, their simultaneous and often mechanical application, and the neglect of some of the underlying problems.
Deliberately oversimplifying, I shall sketch the background of the various recommendations. Two main schools of thought can be recognized. According to one, children are more or less like blank pieces of paper and it is up to the parents to make the correct entries, or to "condition" a child to the correct way of life. The academic source is the psychologic teaching of behaviorism.
Translated into practice it implies child care in which everything is prescribed in exact terms. This trend was congenial to the thinking of scientific pediatrics. The combination resulted in a system of child care characterized by rigid schedules for feeding, toilet training and every other activity, that is, an over-all atmosphere of emotional sterility. This rigid school was the vogue from 20 to 30 years ago.
The opposed psychologic approach has its main source in psychoanalytic theories. It starts with the assumption that an infant is a bundle of intense emotions and instincts and that he "knows" in a mysterious way everything that is good for his future development. Hence the chief task is to satisfy to the fullest the child's instinctual demands and not to interfere with the unfolding of his drives.
Impact of Appointment Reminders on Vaccination Coverage at an Urban Clinic
Authors: Irigoyen Matilde M. , Findley Sally , Earle Beryl , Stambaugh Kevin , Vaughan Roger 
Published: December 2021

Objective.To test if appointment reminders blinded to immunization status improve kept-appointment and vaccination coverage rates.Design.Controlled trial.Setting.Pediatric clinic serving a low-income community in New York City.Intervention.Children ages 4 through 18 months (n = 1273) scheduled sequentially for clinic appointments were systematically assigned to 1 of 4 study groups: control (n = 346); postcard (n= 314); telephone call (n = 307); and postcard and telephone call (n = 306).Outcome Measures.Kept-appointment and vaccination coverage rates.Results.Children assigned to the postcard and telephone group were 1.75 times more likely to keep their appointments than controls (95% confidence interval [CI] = 1.2, 2.5). Children who actually received the postcard and telephone reminders were 2.3 times more likely to keep an appointment than controls (95% CI = 1.4, 3.7). Children who kept appointments were 2.3 times more likely to be up-to-date with their immunizations (95% CI = 1.7, 3.2). The reminders selectively increased vaccination coverage for the subgroup of children who were not up-to-date before the appointment (χ2 = 11.2). The cost of the reminders was $.67 for the postcard and $1.58 for the postcard and telephone. Assuming 5000 visits per year and $100 reimbursement per visit, the return on each dollar invested was $10 for the postcard and $7.28 for the postcard and telephone reminder.Conclusions.Appointment reminders blind to immunization status are a practical and cost-effective strategy to increase kept-appointment rates for all children, and, through this mechanism, reach and vaccinate children who are not up-to-date.appointment reminder, vaccination coverage.
Evidence-Based Approach to Change in Clinical Practice: Introduction of Expanded Nasal Continuous Positive Airway Pressure Use in an Intensive Care Nursery
Authors: Jackson Jodi K. , Vellucci Judy , Johnson Patrice , Kilbride Howard W. 
Published: December 2021

Objective. Recent studies provide evidence that nasal intermittent positive pressure ventilation (NIPPV) may stabilize the airway of extremely low birth weight infants after endotracheal extubation. The objective of this project was to introduce the use of NIPPV into a busy level 3 intensive care nursery.Methods. This report describes the process of NIPPV introduction using a series of rapid-cycle improvement projects, as proposed by the Vermont Oxford Network.Results. In the first cycle, 7 (88%) of 8 infants were successfully extubated with NIPPV after meeting criteria for reintubation on nasal continuous positive airway pressure alone. Proper positioning of the prongs in the nasopharynx was found to be an important determinant of success. In a second cycle, shorter 2.5-cm nasopharyngeal prongs were more effective than standard 4-cm prongs in 12 recently extubated infants as assessed by objective measurements and subjective nursing reports. A third cycle confirmed the acceptance of this technique in our unit and demonstrated an associated decrease in markers of chronic lung disease in extremely low birth weight infants during the 22 months after its introduction.Conclusion. This experience supports the role for the rapid-cycle change model in achieving effective evidence-based medical practices in a neonatal intensive care setting.
RADIOIODINE UPTAKE IN THE STUDY OF DIFFERENT TYPES OF HYPOTHYROIDISM IN CHILDHOOD
Authors: SILVERMAN SAMUEL H. , WILKINS LAWSON 
Published: December 2021

A method for demonstrating small uptakes of radioiodine by the thyroid gland has been described. The study suggests that in some cases of cretinism iodine-accumulating thyroid tissue may be completely absent while in others a small amount may be present. In cretins in whom a small amount of thyroid tissue can be demonstrated, the symptoms, even though appearing during the first year of life develop more insidiously. In cases of hypothyroidism developing later in childhood, small amounts of thyroid tissue capable of taking up iodine usually can be demonstrated.
In addition to the cases of hypothyroidism in which there is absence of the gland or marked diminution in the amount of thyroid tissue, two patients (Nos. 13 and 14) with definite hypothyroidism showed a normal uptake of I131. One of those patients had a thyroid gland of normal size, the other a moderately enlarged gland. They lived in regions in which there was no likelihood of deficient iodine intake (see Addendum).
One patient (No. 15) with acquired hypothyroidism took up no iodine when first studied but after injection of thyrotropic hormone showed a normal uptake. The problem of whether acquired hypothyroidism may be due to deficiency of thyrotropic hormone is discussed.
MAXIMUM BREATHING CAPACITY AND VITAL CAPACITY IN FEMALE CHILDREN AND ADOLESCENTS
Authors: FERRIS B. G. , SMITH C. W. 
Published: December 2021

Expected mean values and a range of normal values (plus or minus twice the standard deviation) are presented for the vital capacity and the maximum breathing capacity of female children and adolescents.
Although multiple correlation does not demonstrate a particularly higher degree of predictability it is recommended that the above values be based upon the four attributes (age, height, weight, and body surface area) rather than upon a single attribute. This is especially important in the abnormally shaped individual.
DIABETES INSIPIDUS IN INFANCY RESISTANT TO PITRESSIN
Authors: KAO MARY YUN-CHEN , STEINER MATTHEW M. 
Published: December 2021

The present authors have presented the report of a 6½ month old Negro male who, shortly after birth, developed polyuria, polydipsia, fever, vomiting, dehydration, constipation and failure to gain weight.
Investigations ruled out systemic infections as well as the common inflammatory and congenital renal diseases.
Under "control" conditions (average fluid intake) there was a persistence of the fever, vomiting and constipation; the values for nonprotein nitrogen, serum sodium and chloride were elevated above normal. The polyuria, which was characterized by low specific gravity, rose to a value of 1.011 during periods of marked dehydration.
During the "hydration test," a progressive increase of fluid intake above 2000 cc. daily resulted in normal temperature, absence of vomiting, increase of weight, and normal values for nonprotein nitrogen, serum sodium and chloride.
There was no antidiuretic response either to intravenous infusion of hypertonic saline (Carter-Robbins' test) or to 0.1 unit pitressin intravenously. A normal control showed prompt antidiuresis during and following the infusion of hypertonic saline.
Intramuscular administration of pitressin to the point of toxicity (4 units) had no effect on the volume or specific gravity of the urine.
It is postulated that this syndrome of diabetes insipidus in infancy, resistant to pitressin, is the result of a failure of end-organ response in the kidney.
SURGICAL EMERGENCIES OF THE NEWBORN
Authors: Clatworthy H. Wm. , Ingalls Theodore Hunt , White Harvey , Smith Lowell D. 
Published: December 2021

NATAL day mortality has not changed in the past 40 years and today neonatal deaths represent over half of all infant deaths. Pre-existing malformations, ofttimes surgically remediable, cause 15 per cent of neonatal deaths.
In newborn infants, respiratory distress (tachypnea over 60 per minute, dyspnea, or cyanosis) is produced by medical lesions such as atelectasis, pulmonary hyaline membranes, brain damage, cardiac malformations, and oversedation. Dr. Clatworthy explained that similar symptoms result from surgically correctable defects such as "air block," lung cysts, endobronchial plugs, intrathoracic tumors, and diaphragmatic hernia.
When presented with a newborn infant in respiratory distress, clear his upper airway of mucus, give oxygen if indicated, and after a physical examination, obtain roentgenograms of the chest. Dr. White stressed the importance of good radiographic examination, best achieved by obtaining upright lateral and AP chest films.
"Air block" may occur in resuscitated babies with atelectasis or aspiration pneumonia. The trapped air in the perivascular and interstitial tissues prevents adequate aeration of the lungs and this air may dissect along the great vessels and cause mediastinal emphysema or tension pneumothorax. While the former is treated expectantly, tension pneumothorax frequently requires judicious aspiration and occasionally closed thoracotomy.
Congenital lung cysts are frequently single, large ovoid defects with thickened walls and occasionally fluid levels. They require surgical removal. By contrast, treat postpneumonic pulmonary pneumatocele (usually secondary to staphylococcal infections) expectantly.
Do not confuse obstructive lobar or pulmonary emphysema of endobronchial origin with compensatory emphysema. Obstructive emphysema is manifested by a mediastinal shift to the normal side and spreading of the intercostal spaces with a depressed, immobile diaphragm on the affected side and is treated by immediate lobectomy or pneumonectomy.
NEPHROGENIC DIABETES INSIPIDUS
Authors: West James R. , Kramer James G. 
Published: December 2021

1. Two cases of congenital diabetes insipidus resistant to pitressin, or diabetes insipidus of the nephrogenic type, occurring in male cousins during infancy have been described in which the most striking manifestations were recurrent pyrexia, polyuria, polydipsia, poor weight gain and development and hyperelectrolytemia.
2. The basic defect in these patients appears to be renal; in the nature of an endorgan failure to respond to the antidiuretic hormone of the posterior pituitary body.
3. The demonstration of the trait in the mothers of the patients and probably an uncle and maternal grandmother suggests genetic transmission by means other than the previously postulated sex-linked recessive pattern.
4. The literature pertinent to this condition is reviewed and some of the clinical features and diagnostic problems are discussed.
ESOPHAGEAL ATRESIA
Authors: Clatworthy H. William 
Published: December 2021

Congenital atresia of the esophagus is not a medical oddity but a relatively common cause of neonatal infant morbidity and mortality. This lesion is susceptible to a single curative surgical procedure in at least 90 per cent of the patients, providing the diagnosis is made within the first or second day of life. Any newborn infant who (1) is delivered of a mother with polyhydramnios, or (2) suffers from excessive mucus or intermittent cyanosis, or (3) develops acute abdominal distention should be suspected of having esophageal atresia and have a catheter intubation of the esophagus performed immediately. If the catheter cannot be passed into the stomach, the newborn may be considered to have esophageal atresia until proved otherwise.
The outlook for infants with this isolated anomaly is good. One should expect that, if a well-integrated effort is made to save these patients, 65 to 75 per cent will survive.
HEMOPHILUS INFLUENZAE TYPE b PNEUMONIA
Authors: Nyhan William L. , Rectanus Daniel R. , Fousek Mildred D. 
Published: December 2021

Five cases of pneumonia due to H. influenzae Type b are reported. Three were in infants, 1 in a 5-year-old boy and the fifth in a 62-year-old man. The consolidations in all were lobar or segmental in distribution, and pleural effusions occurred in 3 patients. Diagnosis was by growth of the organism in pure culture from the blood in 4 and from the lung at autopsy in 1. In 2 cases favorable therapeutic response was obtained with penicillin therapy, but in both streptomycin was added to the regimen following specific bacteriologic diagnosis.
The nature of this infection is discussed, and the value of routine admission blood cultures in its diagnosis emphasized. In treatment of H. influenzae Type b infections it is recommended that a combination of 2 antibacterial agents to which the organism isolated is found susceptible be used and that one of these be chloramphenicol or streptomycin.
IRON STORAGE IN THE FIRST FIVE YEARS OF LIFE
Authors: Smith Nathan J. , Rosello Salvador , Say M. Burhan , Yeya Kazuko 
Published: December 2021

Iron storage in the first 5 years of life has been evaluated by chemical determination of "hemosiderin" iron concentration of samples of liver from 58 selected autopsies; histological preparations of the liver of these patients have been stained by the Prussian blue reaction.
Similarly prepared histological sections of particles from 109 bone marrow aspirates have been studied. It was not possible to identify normal variations in the content of iron in the bone marrow by the study of such histologic preparations, nor could iron deficiency states he differentiated from the normal by the bone marrow findings using this technique.
The normal fall in hemoglobin concentration during the first 2 months of life is associated with a high concentration of storage iron in the liver.
Iron deficiency anemia, most commonly encountered during the second year of life, occurs during that period in which the hemosiderin concentration of liver is lowest and storage iron reserves are minimal.
EDUCATION
Authors: Davison W. C. 
Published: December 2021

THE CARE of chronically in children differs from that of adults in at least 3 ways. First, except for mental retardation and leukemia, and now even for leukemia, it is expected that the chronically ill child will recover. Hence the attitude of pediatricians and other general practitioners is more hopeful than that of internists, surgeons, psychiatrists and psychologists. Second children do not understand the reason for being ill, and sometimes are bewildered and rebellious. Third, in addition to all of the problems of chronically ill adults, children need tender loving care, education and provision for growth and development.
The goal of the pediatrician and family physician is to help children recover rapidly, happily and hopefully without invalidism and maladjustment, and team work obviously is essential.
ABNORMALITIES OF SEXUAL DEVELOPMENT
Authors: Gross Robert E. , Meeker Irving A. 
Published: December 2021

A series of 75 patients with abnormalities of sexual development is presented and summarized. Twenty-eight of these patients had manifestations based on a hormonal disturbance, the adreno-genital syndrome. In the remaining 47, there was no evidence of a hormonal imbalance.
A classification is given which we have found useful. While the various abnormalities might seem to present a wide variety of deformities, we have felt that placing subjects into rather well-defined groups gives a clearer picture of the methods of therapy which are available for each of them.
Of the 75 children, 6 were true hermaphrodites and were proved to have gonads of both sexes. The remaining 69 have been called "pseudohermaphrodites" to indicate that while some parts of the sexual apparatus simulated those of the opposite sex in reality the gonads in each individual were of only 1 sex.
From the experience gained in dealing with these 75 children, it has become quite clear that cases of sexual abnormality are handled with the greatest facility and with least disturbance to child and family if the investigations are made in infancy. Then the best plan for handling the case thereafter can be formulated promptly and most intelligently. Adequate study of sexual abnormalities, excepting those in which there is a definite and readily identifiable adrenogenital syndrome, requires pelvic laparotomy to acquire the necessary information. Exploration under general anesthesia can be carried out even in the early days of life with safety and satisfaction.
Methods for treating and managing cases in the various groups are briefly outlined.