bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of the Pediatrician in Adoption with Reference to ‘The Right to Know’: An Update
Authors: Sherry S. Norman , Baum Richard , Lattimer Agnes D. , Rieke William C. , Sokoloff Burton , Sterne George G. , Wagner Virginia , Davis Joseph , Lewis Donald , Seidel Henry , Felitto Helen , Schwartz Elaine 
Published: December 2021

The adoption process in our country traditionally has been designed to safeguard the rights of the adoptive parents, ensure the solidarity of the adoptive family, and preserve the anonymity of the birth parents. When adoption is finalized, the original birth certificate is "sealed" and a new certificate is issued in the name of the adoptive parents. Once sealed, the laws of most states specify that the original record can be opened only by court order and for "just cause." A few states have provisions for opening of the records on demand of the adoptees when they become adults. This provision frequently is true in theory but not in practice, and the definition of "just cause" has varied considerably from court to court.
Most adoptive parents have warm and loving relationships with their adoptive children. Most try to pass on to them, at appropriate times, as much of the birth information as they know and are able to provide. Most adoptees have a warm and loving and truly bonded relationship with their adoptive parents. In spite of this, and regardless of their attachment to the adoptive parents, some adoptees have a compelling desire and/or need to learn of their birth parent or parents.
Many adult adoptees and adoption specialists see this search as essential to the establishment of a sense of identity. Most reports of reunions indicate that adoptees have been pleased with the meeting and that their ties to their adoptive parents have been strengthened thereby. In addition, there is the growing body of law that has spoken to the right of people to know the content of various personal records.
Henoch-Schönlein Purpura and (γ)-Benzene Hexachloride
Authors: Fagan Joel E. 
Published: December 2021

Many drugs have been cited as possible etiologic agents in Henoch-Schönlein (anaphylactoid) purpura. I have recently seen a case of Henoch-Schönlein purpura occurring shortly after an exposure to (γ)-benzene hexachloride, an occurrence not previously documented.
A 9-year-old boy was admitted to Foothills Hospital on March 12, 1979 for investigation of a skin rash of four days' duration and severe vomiting of 40 hours' duration. Six days before admission, several classmates were found to have head lice and an inspection of the patient's scalp was thought to show two nits.
Mercury in Incubators: Detecting ‘Safe’ Levels
Authors: Greene R Joel 
Published: December 2021

The article, entitled "Mercury Vapor Contamination of Infant Incubators: A Potential Hazard" (Pediatrics 64:640, 1979) provided some information that is critical for clinicians, administrators, and others concerned with patient safety and medical liability issues in the health-care environment. Considering the lack of information on acute infant exposure to mercury vapor, it is clear that, " . . . the prudent course would be to avoid all contact with this toxic substance."1
Instrumentation commonly available today, such as that used in the survey, has an accuracy of 0.01 mg/cu m.
Is Exercise Testing Worth It?
Authors: Boiko Patricia 
Published: December 2021

On the basis of the conclusions of the article "Exercise Performance of Hypertensive Adolescents" by Dov B. Nudel et al (Pediatrics 65:1073, 1980), I would not feel comfortable exercise testing any of my adolescent patients with hypertension. In addition, their study failed to show me any reason to exercise test a hypertensive adolescent.
The conclusion that "... maximal exercise performance in hypertensive adolescents is safe," is based on a study of only ten essential hypertensive adolescents.
Letters to the Editor
Authors: Nudel Dov B. 
Published: December 2021

Our study included 18 patients: ten with sustained and eight with labile hypertension and our conclusions are based on this sample. Whether larger studies will confirm our results remains to be seen.
Dr Boiko states that the patients with essential hypertension "were not sex, weight, race, or activity matched to the normal control subjects." In each of the two groups there are nine boys and one girl. The patients with sustained hypertension included eight whites and two blacks, and the mean weight was 72.3 (± 3.6 SE) kg.
Water Intoxication
Authors: Silber David L. 
Published: December 2021

The recent communication by Schulman,1 which reminds us that water intoxication is not always iatrogenic and may occur out of the hospital, appeared just as we were combing the literature for a better understanding of a similar problem; namely, heat illness. The similarities between Schulman's patients and some patients with heat exhaustion are noteworthy.
In an exhaustive review of the subject of heat illness, Knochel2 describes two forms of heat exhaustion: one resulting from predominant water depletion; the other, from predominant salt depletion.
Unnecessary Biopsy?
Authors: Berliner Benjamin C. 
Published: December 2021

The clinical description of the little girl's disease which is provided in the article by Manzella et al1 is certainly sufficient for a diagnosis, and biopsy rather than being "essential" is an unnecessary and unwarranted intervention.
I am puzzled by the diagnostic term "toxic epidermal necrolysis" as used here. What is described is a typical instance of erythema multiforme bullosa (Stevens-Johnson syndrome), a disorder which involves the mucous membranes as well as the skin. This entity is readily distinguishable from the staphylococcal scalded skin syndrome (toxic epidermal necrolysis, staphylococcal scarlet fever, Ritter's disease of the newborn) by the fact that the latter patients exhibit neither bullae nor mucous membrane involvement.
Letters to the Editor
Authors: Manzella John P. 
Published: December 2021

Dr Berliner raises two points. He questions both the need for the biopsy in the evaluation of patients with desquamating skin disorders and the use of the term "toxic epidermal necrolysis."
While it is true that severe mucosal involvement does not occur in the staphylococcal scalded skin syndrome (SSSS), the initial desquamating process may involve the lips. In turn, during the early stages of toxic epidermal necrolysis (TEN) mucous membrane involvement may be minimal. Contrary to Dr Berliner's statement that bullae do not occur in the SSSS, a prominent part of this syndrome is the appearance of flaccid bullae within 24 to 48 hours of the beginning of the disease process.1
School Health Examinations
Authors: Cook Donald E. , Andringa Conrad L. , Hess Karl L. , Kishner Leonard L. , Leavitt Samuel R. , Novak Stanley F. , Rogers Kenneth D. , Stackpole J. Ward , Wiggins Casper E. , Carlyon William , De Angelis Catherine , Kolb Weldon G. , Mcginnis Betty , Newton Jerome , Weiss Charles 
Published: December 2021

School health examinations were begun years ago because parents, educators, and physicians all realized that healthy children learned more effectively than children with health problems. Earlier in this century, many children in the United States entered school without having had a health evaluation. Most children in this country today receive health care during their preschool years. Therefore, reevaluation of the concept of routine health exammations is now indicated because of changing health patterns in the United States and children's different health needs.
PHYSICAL EXAMINATION
Ideally, every school child should have a complete physical examination and health evaluation every one to two years from his or her personal physician or source of ongoing medical care. Several things should be accomplished during this examination:
(1) interval health history; (2) head-to-toe health appraisal; (3) assessment of growth, development, and school progress; (4) mental health evaluation of the child and family; (5) assessment of immunization status; (6) health education and counseling for both parent and child; (7) evaluation for participation in athletics; (8) recommendations about the child's health needs.
Physicians may not be available for comprehensive health supervision in some rural and urban areas. Therefore, the Committee makes the following recommendations for health examinations required by schools.
1. Schools should require a complete physical examination for all children at least every three years.
2. Ideally, this physical examination should be done by the child's pediatrician or primary care physician. A school nurse, with physician backup, if trained in physical assessment skills, can do an assessment if no physician is available to conduct the examinations.
Hyperammonemia and Perinatal Asphyxia
Authors: Procianoy Renato S. 
Published: December 2021

In a recent article Goldberg et al1 presented data on 12 asphyxiated newborn infants with high ammonia levels concomitant with abnormal liver function tests. They pointed out that the liver dysfunction, probably secondary to the ischemic-hypoxic injury, might have contributed to ammonia elevation by decreasing urea biosynthesis.
I have recently seen two asphyxiated newborn infants who had elevated ammonia levels without any liver dysfunction. Both were meconium-stained postterm neonates with Apgar scores of 1 and 4 at one and five minutes, respectively, who developed seizures, coma, and apnea on the first day of life and required mechanical ventilation for apnea and phenobarbital for seizures.
Fever and Convulsions— Indications for Laboratory Investigations
Authors: Jaffe M. , Bar-Joseph G. , Tirosh E. 
Published: December 2021

The routine laboratory investigations performed on 562 children seen with their first episode of convulsions and fever were retrospectively analyzed. By dividing the cohort into SFC and nonSFC groups, it was found that the yield of abnormal laboratory results was significantly more prevalent in the latter group.
In almost all of the cohort cases, clinically significant laboratory abnormalities in blood chemistry could have been anticipated from the history and physical examination.
It is therefore concluded that the only routine investigation indicated, even in the absence of clinical suspicion, is a lumbar puncture. In ideal situations even this procedure may be omitted. Other investigations should be performed only if the clinical features of the case warrant them.
Does Lumbar CSF Pressure Accurately Reflect Intracranial Pressure?
Authors: Rockoff Mark A. 
Published: December 2021

In a recent article Horbar and colleagues1 claim that the Ladd fiberoptic sensor used to record intracranial pressure (ICP) is affected by the force with which the device is attached to the anterior fontanel. They have clearly shown that as this force increases, pressure recorded by the sensor also increases. The question is whether this increase occurs only at the sensing device, or truly reflects an increase in ICP.
The authors believe that, based upon simultaneous recording of lumbar CSF pressure and fontanel pressure in one infant, the former is the case.
Another Aspect of the SIDS Problem
Authors: Young Paul C. 
Published: December 2021

Dr Valdeś-Dapena's well-organized review article, "Sudden Infant Death Syndrome: A Review of the Medical Literature 1974-1979" in the October issue (Pediatrics 66:597, 1980) was an excellent analysis of the current literature of this confusing and complex entity. The extensive bibliography will be most helpful to any individual interested in the subject.
The clinician providing primary care for children is likely to be confronted with the sudden infant death syndrome (SIDS) phenomenon in one of three ways: First, there is the necessity of dealing with a family who has just lost a baby.
Etiology of Pertussis Syndrome
Authors: Garty Ben Zion , Drucker Moshe M. , Nitzan Menachem 
Published: December 2021

Keller et al1 reported the interesting finding that 91 of 100 patients with pertussis syndrome were infected with Bordetella pertussis or had been exposed to this agent. Their article, however, did not mention the precise age distribution of the patients who "ranged from six weeks to adulthood." It is possible that the etiologic factors of pertussis syndrome in young infants is somewhat different from the etiology of pertussis syndrome in older children.
We believe that the laboratory investigation of pertussis syndrome during the first months of life should include examinations for Chlamydia trachomatis infection in addition to the search for Bordetella, Mycoplasma pneumoniae, and viruses, as demonstrated by the following case: A 4-week-old boy with previous history of conjunctivitis was admitted because of paroxysms of staccato cough followed by occasional vomiting or cyanosis.
Editor's Note
Authors: Lucey Jerold F. 
Published: December 2021

This is obviously a muddled, complex, and very controversial subject. The American pediatric community, American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics were not brought into these deliberations until April 1981, months after the fourth and final draft of the Code had been made. It is unfortunate that the three United States representatives in the negotiations for the Code did not see fit to involve the pediatric scientific community. They not only didn't ask for pediatric input they also failed to consult the National Academy of Sciences Committee on International Nutrition Programs!
Dr Barbara Starfield, Past President of the Ambulatory Pediatric Association, and a member of our Editorial Board was asked to present the viewpoint of the Ambulatory Pediatric Association which has "endorsed in its entirety" the Code.
Sodium Intake of Infants in the United States
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W. , Tomarelli Rudolph M. , Benson John D. , Purvis George A. , LiCari Jerome , Lockhart Haines B. , Saperstein Sidney , Taif Betty , White Philip L. , Egan Mary C. , Cheney Margaret , Pencharz Paul , Moore Melinda , Chopra Joginder , Brown Myrtle L. , Sarett Herbert P. , Fjellstedt Thorsten J. , Teply L. J. , Kennedy Eileen , Darby William J. , Lewy Peter 
Published: December 2021

Since 1963 there has been public concern that prepared infant foods might be providing more sodium than was needed for normal infants.1
The suggestion that salt intake is an etiologic factor in the development of hypertension in adults rests largely on epidemiologic evidence and animal studies. Additional factors of genetic and nutritional origin play a role in its pathogenesis.2 The hypothesis that the sodium content of infant foods contributes toward hypertension in later life has not been confirmed in two areas. (1) Infant foods, even with salt added, have not been shown to contribute as much sodium to the diet as whole milk or table foods. (2) Studies of infants fed diets that were either high or low in sodium (9.25 mEq/100 kcal vs 1.93 mEq/100 kcal) from ages 3 to 8 months showed no correlation between salt intake during infancy and blood pressure at 1 and 8 years of age.3
The Subcommittee on Safety and Suitability of Monosodium Glutamate and Other Substances in Baby Foods, Food Protection Committee, Food and Nutrition Board, National Academy of Sciences,4 observed in 1970 that, between the fourth and 12th months of life, the introduction of supplemented foods and cow's milk increased the intake of sodium to approximately 5 mEq/100 kcal/day. Some of this sodium came from prepared infant foods. It was recommended that the manufacturers of infant foods add no more than 0.25% salt to foods requiring this in their formulation. This recommendation was implemented. The Committee on Nutrition observed in 1974 that this reduction in added salt had decreased the sodium intake only of infants less than 8 months old.2
Summarizing Remarks
Authors: Shih Vivian E. 
Published: December 2021

The foregoing presentations have been most informative. Snodgrass, who has developed microassays of the urea cycle enzymes and has been instrumental in the study of a number of patients with urea cycle disorders, reviewed the biochemistry of the urea cycle in normal and in diseased states. He, as well as the others, has drawn our attention to acetylglutamate synthetase and its important role in the regulation of the urea cycle. Although the mechanism is not entirely clear, acetylglutamate synthesis seems to be a critical step in governing the entry of ammonia into the urea cycle. Perhaps it may also regulate the overall functioning of the urea cycle. The reason that patients with a defect of this enzyme have not been described is most likely due to our ignorance.
Another important message from Snodgrass is that at physiologic conditions, the urea cycle enzymes do not function at maximum rates and the ratio of enzyme activity as obtained by in vitro studies does not exist in vivo. Rather, the enzyme activities are limited in vivo by the availability of substrates that are present at Km levels. Therefore, small changes in concentration cause large changes in velocity.
Ornithine transcarbamylase (OTC) deficiency and argininosuccinate lyase deficiency are the two most common of the five urea cycle disorders. Enzyme studies have revealed several variants (or mutants) in each disorder including defects in altered enzyme kinetics and the absence of enzyme proteins. There has been no satisfactory explanation for the cause of hyperammonemia found in all five urea cycle disorders.
Letters to the Editor
Authors: Brook Itzhak 
Published: December 2021

There is ample evidence to indicate that administration of antimicrobial therapy alone to patients with intracranial abscess can result in neurologic deterioration1 and higher mortality.2
In our article entitled "Complications of Sinusitis in Children" we described the occurrence of intracranial complications following sinusitis.3 Surgical drainage accompanied by antimicrobial therapy resulted, eventually, in complete cure of all of our patients. However, three out of four of our patients with intracranial abscess initially did not respond to appropriate antimicrobial therapy directed against the organisms recovered from their abscesses.
Letters to the Editor
Authors: Rossi Thomas M. , Lebenthal Emanuel 
Published: December 2021

Our report1 clearly documents prolonged mucosal atrophy in infants with intractable diarrhea of infancy. We feel that this highlights the pathophysiology of the diarrhea and accounts for the malabsorptive state which leads to malnutrition in many infants.
In their letter, Drs Byrne and Euler focus on a tangential isue. We are aware of the limitations of the use of the small intestinal biopsy and recognize that disaccharidase activities are not absolute in predicting the clinical response of a given infant to a certain disaccharide-containing formula.
Adoption of the Hard-to-Place Child
Authors: Sherry S. Norman , Riecke William C. , Sokoloff Burton , Sterne George G. , Wagner Virginia , Davis Joseph , Lewis Donald , Seidel Henry 
Published: December 2021

The Committee on Adoption and Dependent Care reaffirms its position that adoption is a positive social process that provides a family for children whose parents cannot rear them. A permanent family is a primary need of all young children and the majority of older children. The handicapped child is also best served by a stable and secure placement which, in turn, offers ideal conditions for effective medical treatment of the child's particular condition.
The needs of the child have become the center of the adoption process; this replaces the earlier emphasis on meeting the needs of the childless couple. Today, candidates for adoption include children who are school-aged, of mixed or minority heritage, mentally, physically, or emotionally handicapped; or brothers and sisters who need to be placed together. Although many couples stifi want to adopt a newborn infant, many other couples are opening their homes to "hard to place" children.
The factors that will made the adoption of these "special" children a reality are as follows.
SUITABLE ADOPTIVE PARENTS
Families who adopt "special needs" children experience unusual demands on their parenting skills; they must extend themselves beyond the usual time and effort required of most parents. Often these families have had experience with handicaps. For example, parents who raise children with birth defects such as Down syndrome are increasingly choosing to adopt a child with a similar special need; this is proving beneficial to all concerned.
TRAINED SOCIAL WORKERS AND SPECIAL AGENCIES
In the last six or seven years, special agencies have been developed to care for the needs of the hard-to-place child.
Sucrose or Glucose for Diarrhea
Authors: Hughes-Davies T. H. 
Published: December 2021

Water moves along osmotic gradients. Acute diarrhea is due to impaired solute absorption or to increased solute excretion. It seems reasonable, as well as traditional, to lower the osmolarity of the gut's contents in diarrhea by starvation and water.
Breast milk, when fully digested, has nearly twice the osmolarity of plasma, and giving it (or bread and butter1) as advocated in Dacca2 might prolong diarrhea. The 24-hour purging rate of the patients of Black et al on an unknown quantity of milk equalled that of the first eight hours, and diarrhea persisted for 60 hours.
Reading X-rays
Authors: Bowen A'Delbert 
Published: December 2021

Mata and Rosengart1 believe that interobserver variability in interpreting radiographs may play a part in the disparate incidence of necrotizing enterocolitis (NEC) reported from various centers. Underlying their contention is the implication that the diagnosis of NEC rests upon abnormal radiographic findings. I do not dispute their observations, but let us examine the underlying premise.
Leonidas et al2 and Daneman et al3 analyzed the radiographic signs of NEC. Both groups found bowel dilation to correlate well with severity of the disease, but dilation is a highly subjective sign and is entirely nonspecific.4
On the Perceptual Distortion of Data: Early Intervention Programs Are Effective in Overcoming Environmental Deprivation
Authors: Lazar Irving 
Published: December 2021

Your publication of a series of papers1-4 on early intervention with handicapped children is an important contribution to a critical area of theory and research, and your introductory caveat needs increased emphasis.
As a scientist with a more than passing knowledge of early intervention programs, I was astonished at the sweeping generalizations and selective use of the literature which characterized Ferry's contribution to this senes.4 By lumping together all forms of intervention and all kinds of conditions she ignores the considerable knowledge we do have, and, potentially, discourages fellow practitioners from the appropriate use of these techniques.
Letters to the Editor
Authors: Waskerwitz Steven , Christoffel Katherine K. 
Published: December 2021

Since the publication of our article, "Hypersensitivity Vasculitis Presenting as Suspected Child Abuse: Case Report and Literature Review," we have received replies from physicians at several other centers relating other experiences with children misdiagnosed as being victims of abuse. These experiences confirm our speculation that this phenomenon is more common than the scanty reports in the medical literature would suggest.
Several correspondents have expressed concern that our paper may deter reporting of abuse cases and may be used to refute physicians' testimony if cases of suspected abuse are not subjected to exhaustive work-ups.