bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lumbar Puncture in Pediatric Bacterial Meningitis: Defining the Time Interval for Recovery of Cerebrospinal Fluid Pathogens After Parenteral Antibiotic Pretreatment
Authors: Kanegaye John T. , Soliemanzadeh Peyman , Bradley John S. 
Published: December 2021

Objective.
Despite the lack of evidence defining a time interval during which cerebrospinal fluid (CSF) culture yield will not be affected by previous antibiotic therapy, recent publications cite a “minimum window” of 2 to 3 hours for recovery of bacterial pathogens after parenteral antibiotic administration. We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures.

Methods.
The medical records of pediatric patients who were discharged from a tertiary children's hospital during a 5-year period with the final diagnosis of bacterial meningitis or suspected bacterial meningitis were reviewed. The decay in yield of CSF cultures over time was evaluated in patients with lumbar punctures (LP) delayed until after initiation of parenteral antibiotics and in patients with serial LPs before and after initiation of parenteral antibiotics.

Results.
The pathogens that infected the 128 study patients were Streptococcus pneumoniae (49),Neisseria meningitidis (37), group BStreptococcus (21), Haemophilus influenzae (8), other organisms (11), and undetermined (3). Thirty-nine patients (30%) had first LPs after initiation of parenteral antibiotics, and 55 (43%) had serial LPs before and after initiation of parenteral antibiotics. After ≥50 mg/kg of a third-generation cephalosporin, 3 of 9 LPs in meningococcal meningitis were sterile within 1 hour, occurring as early as 15 minutes, and all were sterile by 2 hours. With pneumococcal disease, the first negative CSF culture occurred at 4.3 hours, with 5 of 7 cultures negative from 4 to 10 hours after initiation of parenteral antibiotics. Reduced susceptibility to β-lactam antibiotics occurred in 11 of 46 pneumococcal isolates. Group B streptococcal cultures were positive through the first 8 hours after parenteral antibiotics. Blood cultures were positive in 74% of cases without pretreatment and in 57% to 68% of cases with negative CSF cultures.

Conclusions.
The temptation to initiate antimicrobial therapy may override the principle of obtaining adequate pretreatment culture material. The present study demonstrates that CSF sterilization may occur more rapidly after initiation of parenteral antibiotics than previously suggested, with complete sterilization of meningococcus within 2 hours and the beginning of sterilization of pneumococcus by 4 hours into therapy. Lack of adequate culture material may result in inability to tailor therapy to antimicrobial susceptibility or in unnecessarily prolonged treatment if the clinical presentation and laboratory data cannot exclude the possibility of bacterial meningitis.
Round Table Discussion
Authors: NETER ERWIN , LEPPER MARK H. , WEATHERMAN HAROLD , MCKEE WALTER C. 
Published: December 2021

Chairman Neter: The advances made in the treatment of infectious diseases since 1935, and more particularly during the last decade, have been nothing short of miraculous. Surveying these accomplishments briefly, it is clear that adequate chemotherapeutic and antibiotic agents are available for many bacterial and rickettsial infections and even for a few diseases caused by the larger viruses, closely related to the rickettsiae. Furthermore, the medical profession has had available for many years drugs which have proved effective in maladies caused by some protozoa, such as malaria, and substantial further advances have been made in this field during the following World War II.
At the same time, we are all painfully aware that in the daily practice of pediatrics we are still lacking chemotherapeutic and antibiotic agents which are curative in diseases caused by the true viruses and, to a larger extent, in illnesses due to fungi. Also for certain bacterial infections, such as those caused by mycobacteria, Proteus, Pseudomonas and others, the ideal antibiotic will yet have to be discovered. Indubitably, the research that is going on throughout the civilized world in the search for newer and better antibiotics will, in due time, solve these all-important problems.
The field of antibiotic therapy and prophylaxis has expanded at such an extraordinary rate that it has not yet been possible in all instances to determine with certainty the relative efficacy of various antibiotics in all infections and the optimal dosage schedule for each. It is quite likely that all of us, for example, use more penicillin in some patients than is needed.
Evaluation and Development of Potentially Better Practices to Prevent Neonatal Nosocomial Bacteremia
Authors: Kilbride Howard W. , Powers Richard , Wirtschafter David D. , Sheehan Michael B. , Charsha Dianne S. , LaCorte Meena , Finer Neil , Goldmann Donald A. 
Published: December 2021

Objective. Six neonatal intensive care units (NICUs) that are members of the Vermont Oxford National Evidence-Based Quality Improvement Collaborative for Neonatology collaborated to reduce infection rates. There were 7 centers in the original focus group, but 1 center left the collaborative after 1 year. The objective of this study was to develop strategies to decrease nosocomial infection rates in NICUs.Methods. The process included a comprehensive literature review, internal practice analyses, benchmark studies, and development of practical experience through rapid-cycle changes, subsequent analysis, and feedback. This process led to 3 summary statements on potentially better practices in handwashing, approach to nosocomial sepsis evaluations, and central venous catheter management.Results. These statements provide a basis for an evidence-based approach to lowering neonatal intensive care unit nosocomial infection rates.Conclusions. The 2-year process also led to changes in the culture and habits of the institutions involved, which should in turn have long-term effects on other aspects of quality improvement.
SERUM MUCOPROTEINS IN PATIENTS WITH RHEUMATIC FEVER
Authors: KELLEY VINCENT C. , ADAMS FORREST H. , GOOD ROBERT A. 
Published: December 2021

Serum mucoprotein concentrations during various stages of rheumatic fever are compared to those of normal children and children suffering from a variety of diseases.
In untreated rheumatic fever as in rheumatic fever treated with bed rest and salicylates the concentration of mucoproteins in the serum appears to be useful index of rheumatic activity.
Treatment of rheumatic fever with ACTH or cortisone causes deviation of the elevated serum mucoprotein concentration toward normal but hormonal treatment has less effect on this "acute phase reactant" than on other objective indices of rheumatic activity.
A tendency of the mucoprotein concentration to "plateau" at elevated levels in spite of hormone treatment is described. The possibility that maintenance of elevated mucoprotein levels during hormone therapy indicates persisting disease activity is suggested.
The tendency to develop recurrent rheumatic symptomatology following cessation of hormone treatment is correlated with concentration of mucoproteins in the serum and with the total duration of treatment.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: CUNNICK DOROTHY GILDEA , FINBERG LAURENCE 
Published: December 2021

A situation in which responsibility for care of foster children fell to a teaching pediatric service, provided an opportunity for extending a pediatric house officer's activities into a sociologic sphere. Every house officer has had some contact with social problems discovered as part of outpatient care, but in the instance to be described these problems were so concentrated that active participation by the pediatric house staff seemed a logical and necessary step.
The Baltimore City Hospitals' Pediatric Division supplies the medical care for the wards of the Children's Division of the Department of Public Welfare. This agency supervises about 2,300 children in foster homes in the city of Baltimore. As these children were brought to the outpatient department for one or another reason, we were constantly confronted with the special Problem of the adolescent girl in a foster home.
The manifest special problems of the age group were concerned with sexual relations-Promiscuity, prostitution, illegitimate pregnancy amid its consequences, and venereal disease. Particularly trying to the clinic physicians in their attempts to develop a satisfactory physician-patient relationship with these girls were their attitudes of resentment, their lack of even minimal information on matters of basic hygiene, and their unawareness of "accepted" social conduct.
ANORECTAL RINGS IN INFANCY: INCIDENCE AND SIGNIFICANCE
Authors: HARRIS LLOYD E. , CORBIN H. PENUEL F. , HILL JOHN R. 
Published: December 2021

Anorectal rings were found in 13.8% of 1,716 consecutive newborn infants. The anorectal ring was detected in four times as many females as males.
Anorectal rings of the grades discovered in this study dilated spontaneously and did not require treatment.
The incidence of constipation, colic, blood in the stool, excessive straining, distention, tear of the anal skin, and crying with defecation was the same in a group of 168 infants with anorectal rings as it was in a group of 160 infants in whom the anorectal ring was absent.
A thick, fibrous anorectal ring which does not dilate spontaneously may cause obstructive symptoms and require treatment. This type of anorectal ring did not occur in this group of 1,716 infants.
AN EPIDEMIC OF DIARRHEA OF THE NEWBORN CAUSED BY ESCHERICHIA COLI O-111, B4
Authors: STULBERG CYRIL S. , ZUELZER WOLF W. , NOLKE ANTHONY C. 
Published: December 2021

An outbreak of diarrhea of the newborn in a premature nursery has been described. The results of bacteriologic, epidemiologic, and therapeutic studies identified the etiologic agent as a specific type of coliform organism, Escherichia coli O-111, B4.
This organism was isolated in virtually pure culture from the stools of 24 premature infants who developed diarrhea. It was not found in premature infants who were effectively isolated and who remained clinically well. E. coli O-111, B4 was not present in the stools of patients before their illness started but was isolated, again in practically pure culture, almost simultaneously with the onset of symptoms.
Neomycin proved to be an effective chemotherapeutic agent, both in eliminating the organism from the stools and causing the cessation of symptoms within a short time of each other.
Three patients died. Their case histories and post-mortem findings with relation to the pathogenesis of the disease are discussed.
REVIEW ARTICLE
Authors: MAY CHARLES D. 
Published: December 2021

WITHIN the past year a dramatic outbreak of a singular type of convulsive seizures in babies has provided convincing evidence of an essential role for Vitamin B6 in human nutrition under natural circumstances. This is a general review of the circumstances surrounding this outbreak and of the present state of our knowledge of vitamin B6.
But it is also important that this episode be considered as a reminder of the complex interrelationships which permeate studies of nutritional factors and as a warning against hasty conclusions. It also serves as an illustration of the hazard in premature or uncontrolled application to human nutrition of isolated fragments of knowledge concerning nutritional factors.
The existence of Vitamin B6 was discovered in 1934 by experiments with rats. Symptoms of deficiency of this vitamin were soon described in several species of animals but not in man. Within a few years the chemistry of the vitamin was determined and the synthesis achieved. Considerable information as to the metabolic reactions affected by a deficiency of Vitamin B6 was rapidly accumulated. Only recently, 16 years after the discovery of Vitamin B6, the Council on Pharmacy and Chemistry of the American Medical Association reviewing the status of our knowledge of the role of Vitamin B6 in human nutrition reached only a cautious acceptance of an essential dietary requirement for Vitamin B6 in the human.
The original observations which called attention to the problem of unusual convulsions in infants and pointed the way to its solution were made by a doctor in practice, just as were similar observations which led a few years ago to an appreciation of the circumstances producing a deficiency of folic acid in infancy.
OXYGEN ADMINISTRATION AND RETROLENTAL FIBROPLASIA
Authors: GORDON HARRY H. 
Published: December 2021

THE ORIGINAL description by the Owens of the clinical evolution of the lesions of retrolental fibroplasia stimulated a wide search for a postnatal cause. Conclusive evidence that the administration of oxygen is the major cause has been reviewed. This editorial comment is prompted by the confusion about translating the evidence into Practice.
The data proving the importance of administration of oxygen consist of both clinical and laboratory observations. In 1952 Patz, Hoeck and de la Cruz reported a series of careful, controlled clinical observations from the District of Columbia General Hospital. Alternate infants weighing less than 3.5 pounds at birth were assigned to high or low oxygen and followed with careful ophthalmoscopic examinations for at least 6 months. Oxygen concentrations were measured 3 times daily and flows adjusted to maintain the desired concentrations. In a group of 28 infants kept in 65 to 70% oxygen for 4 to 7 weeks, seven or 25% showed permanent residua which included detachment of the retina. In 37 infants who received minimal oxygen, never more than 40%, from 1 day to 2 weeks, none developed residual changes. During a second year of alternation, these results were confirmed: of a total of 60 infants in high oxygen, 12 showed residua as compared with 1 in low oxygen. These clinical studies have been supported by independent uncontrolled studies from Australia, England, Switzerland, Denver, and Montreal, a more recent controlled study from New York, and an epidemiologic survey in Maryland; they bear out the original suggestion of Kinsey and Zacharias, that increased use of oxygen was one of the changes in care of premature infants which might be responsible for retrolental fibroplasia.
PROLONGED INTERMITTENT ACTH AND CORTISONE THERAPY IN THE NEPHROTIC SYNDROME; IMMUNOLOGIC BASIS AND RESULTS
Authors: Lange Kurt , Slobody Lawrence , Strang Ruth 
Published: December 2021

1) Serum complement levels were always low in 40 cases with acute and subacute glomerulonephritis.
2) Serum complement levels were low in 27 of 29 cases with the nephrotic syndrome whether or not underlying glomerulonephritis could be demonstrated.
3) The low complement levels were not due to loss of complement into the urine, lack of formation or anticomplementary factors.
4) Spontaneous remissions of the nephrotic syndrome were preceded in 11 of 13 instances by high fever. Depression of the eosinophil count (4 patients) and a rise in urinary 17-ketosteroids (1 patient) were observed.
5) Complement rose prior to the diuresis in spontaneous remissions, and fell prior to relapses.
6) Rise in serum complement and diuresis occurred independent of changes in plasma protein levels and changes in plasma oncotic pressure.
7) In the nephrotic syndrome large doses of ACTH and oral cortisone led to a rise in complement levels followed by diuresis. Relapses were preceded by a fall in complement.
8) ACTH given for 3 to 8 weeks on 3 successive days of each week after an initial 7 to 10 day course of ACTH was accompanied by long-lasting remissions in 3 out of 6 patients.
9) Oral cortisone given in high doses in a similar schedule after an initial 7 to 10 day course of ACTH was accompanied by long remissions in 16 out of 18 patients when given for 6 to 30 courses.
10) Cortisone maintenance therapy led to a rapid return to normal in the levels of plasma protein and cholesterol and a reduction of proteinuria.
11) Cortisone maintenance therapy did not produce diuresis in 4 patients but prevented relapses in a high percentage of patients.
12) There was no fatality in 29 patients with the nephrotic syndrome observed for from 3 to 40 months during or after maintenance therapy.
REPORT OF THE LIAISON REPRESENTATIVE TO THE CHILDREN'S BUREAU
Authors: Webb Clarence H. 
Published: December 2021

DURING the past year the Children's Bureau has given special attention outside of its regular activities, to three problems which should be of some interest to Academy members because of their nationwide significance and almost universal applicability. These activities have been directed at mentally retarded children, children of migrant families, and juvenile delinquency.
1. Mentally Retarded Children. The past few years have seen an upsurge in attention on to and planning for the medical care and educational needs of "exceptional" children, and particularly the mentally retarded child, since this is by fart the largest segment. Part of the Children's Bureau's special work in this field has been in fostering studies of this problem as well as in giving assistance to state groups in meeting their particular problems. It is hoped that during the coming year the Bureau can give assistance and advice where it is desired, to Academy members in states where the problem of caring for the mentally retarded is urgent. State Chairmen can call to the attention of Academy members the opportunities which pediatricians have to give guidance and assistance to parent groups and other bay organizations which are attempting to meet the needs of retarded children and other exceptional children.
2. Children of Migrant Families. The Children's Bureau has engaged in a study of migrant families along the Eastern seaboard. The Bureau hopes to extend these studies to the two larger migrant streams, one which passes through Texas to Colorado and the Midwest and the other along the Pacific Coast. Difficult problems are offered which involve the coordination of medical, educational, and welfare services through the various agencies concerned. The rapid transit of these people from state to state creates special problems.
REVIEW ARTICLE
Authors: Najjar Victor A. 
Published: December 2021

THE ASTONISHING success of chemotherapeutic agents in the treatment of infectious diseases has rendered the management of such cases relatively simple and rewarding thereby shifting emphasis to less common clinical problems in pediatrics. A decade ago, metabolic diseases constituted a mere fraction of the clinical problems encountered; but now make up a large segment of those cases that call for unusual skill and wide knowledge of disease. A clear understanding of metabolic processes has therefore become necessary for the study and management of such cases.
The main factors concerned with the normal function of an organ are its constituent enzymes and the forces that influence enzyme function. The latter are chiefly hormonal and nutritional influences. In recent years, there has been a very rapid advance in our knowledge of the enzyme systems involved in carbohydrate and fat metabolism and the factors that affect the function of those systems.
These advances have placed before the student of metabolism a pattern of stepwise processes that determine the direction and efficiency of metabolism in synthesis or degredation. These orderly processes make it possible to predict more or less accurately, the metabolic picture that may result from a defect in any one particular step. It was with this in mind that a few metabolic diseases were studied and precise biochemical lesions discovered. In some instances these defects were enzymatic and in others essentionally hormonal. This is truly a reversal of the course of events more commonly encountered, because it is often the metabolic disease that furnishes the stimulus for the advances in the physiology of metabolism.
Knowledge for knowledge's sake has characterized this era of rapid physiological advances. The more advanced and orderly this process is, the easier it shall be for the clinician to understand and treat disease.
EPIDEMIC DIARRHEA AMONG INFANTS ASSOCIATED WITH THE ISOLATION OF A NEW SEROTYPE OF ESCHERICHIA COLI: E. COLI 0127:B8
Authors: Cooper Merlin L. , Walters Edward W. , Keller Helen M. , Sutherland James M. , Wiseman Hollis J. 
Published: December 2021

During an outbreak of epidemic diarrhea a new serotype of Escherichia coli: E. coli 0127:B8, was isolated from 44 of 145 infants and from 1 nurse among 82 adult personnel in attendance. Among the 44 infants whose rectal swab cultures were positive, 20 were in the first month of life, 16 were 2 to 6 months of age, and 6 were 7 to 12 months of age, a total of 42 being in the first year of life.
Severe epidemic diarrhea associated with the presence of E. coli 0127:B8 was characterized by the sudden development of extreme abdominal distention among some of the infants; explosive onset of diarrhea and the presence of a pungent, musty, objectionable odor not noticed around other patients with diarrhea.
E. coli 0127: B8 was isolated more frequently while the patients were having diarrhea.
Neomycin® was used orally for the specific treatment of patients with diarrhea. The early dosage was small due to our caution in using a new antibiotic. Over the 4 months period of this study the dosage was gradually increased. The average dose was 40 mg./kg./day for the patients with positive cultures and 46 mg./kg./day for those with negative cultures.
Of 22 patients with positive cultures, 12 who were treated with Neomycin® alone or in addition to other antibiotics continued to show the presence of E. coli 0127:B8 after Neomycin® therapy had been terminated; however, only 2 of these patients had recurrence of diarrhea, both having had negative cultures while receiving Neomycin®.
The administration of Neomycin® to every infant on the 2 wards, regardless of clinical condition, was followed by a decreasing incidence of diarrhea and decreasing detection of E. coli 0127:B8. The dose of Neomycin® was 40 to 50 mg./kg./day. It is our feeling that Neomycin® administered orally was of definite clinical value therapeutically and prophylactically but in the dosage used was inadequate bacteriologically.
Four deaths occurred among the 44 infants whose rectal swab cultures were positive for E. coli 0127:B8 and necropsy studies were made on each. A hemorrhagic enteritis was present in 3 infants and in the fourth infant the cause of death was a congenital heart condition. Death of 1 patient with negative rectal swab cultures may very likely be attributed to severe diarrhea.
Sera from patients and personnel failed to show the presence of agglutinins for E. coli 0127:B8.
in vitro sensitivity tests showed that the order of decreasing bactericidal effectiveness of 5 antibiotics for E. coli 027:B8 was polymyxin, Neomycin®, chloramphenicol, Achromycin®, and Terramycin®. All strains were resistant to dihydrostreptomycin and sodium sulfadiazine. Only the last strains isolated from 2 patients showed increased resistance to Neomycin®, four-and sixteenfold when compared with the first strains isolated from the same patients.