bluuebunny/crossref_metadata_2025_split huggingface dataset:
Letters to the Editor
Authors: SEVERINGHAUS ELMER L. 
Published: December 2021

A warning needs to be given pediatricians and obstetricians about using unduly large doses of any water soluble vitamin K preparation in premature infants. Communications appearing in Lancet report fatal hemolytic anemia occurring in two small series of infants. The vitamin K was given in one on more doses of 10 mg. to these premature infants. No evidence of blood group incompatibility or Rh factor problem was found.
A further report appeared in substantiation of the hemolytic effect of very large doses (100 mg./kg.) of water soluble vitamin K given to rats. This hemolysis occurred only in rats deprived of vitamin E. It is known that vitamin E deficiency in rats leads to abnormally great hemolytic tendency.
STUDIES OF IRON REQUIREMENTS IN INFANTS AND CHILDREN
Authors: Sturgeon Phillip 
Published: December 2021

The influence of administration of approximately 90 mg. of iron per day as ferrous sulfate was studied in 23 normal infants averaging 14 months of age. Comparison of hematologic values observed at the start and end of a 6-week therapeutic course were made. The results were compared with hematologic values of normal infants of the same age.
Reports by other investigators that a significant rise in the hemoglobin concentrations in normal infants can be achieved, with a therapeutic course of iron given orally were confirmed.
Cytologic manifestations of "physiologic" anemia of infancy were not altered significantly after 6 weeks of therapy. These included the mean cell volume (microcytosis) and mean corpuscular hemoglobin concentration (hypochromasia).
The chemical manifestations of iron deficiency previously reported in a normal infant population were confirmed; these included, compared to normal values in adult males, hypoferremia, hypercupremia, reduced saturation of the total serum iron binding capacity and increased free erythrocyte protoporphyrin. As indicated previously, these values suggest that in addition to the mild degree of iron deficiency anemia in the normal infant, there is depletion of his iron stores.
The short course of iron therapy employed in this study did not significantly alter the chemical manifestations of depleted iron stores.
A BACTERIOLOGIC INVESTIGATION OF OTITIS MEDIA IN INFANCY
Authors: Mortimer Edward A. , Watterson Reich L. 
Published: December 2021

A technique is described by which the bacterial flora of exudative otitis media may be studied.
The clinical and bacteriologic data of 104 infants less than 2 years of age with clinical otitis media are presented.
The bacteriologic results indicate that pneumococci and H. influenzae are the chief bacterial causes of otitis media in infancy. Beta hemolytic streptococci were rarely isolated, and staphylococci could not be incriminated as causative agents. More than one-third of the cases of exudative otitis media were sterile.
Because of the multiplicity of potential pathogens present in the pharynx and nasopharynx, no accurate inference as to the bacterial flora of the middle ear could be made, except that an organism not found in the nose or throat was unlikely to be found in the middle ear.
The frequency with which H. influenzae was isolated from the middle ear suggests that antimicrobial drugs such as penicillin, effective primarily in Gram-positive infections, are not adequate therapy for otitis media in infancy.
THE ORIGIN AND SIGNIFICANCE OF THE ACADEMY'S DELLA ROBBIA INSIGNIA
Authors: Beaven Paul W. 
Published: December 2021

SHORTLY after the Academy was organized, a discussion took place, the object of which was to find an appropriate design for an insignia which might appear on all certificates of membership, on programs, or on Academy publications. Although Academy records are completely silent about this discussion, for they have been thoroughly searched, it is obvious that a design was selected and was used as our insignia for a period of 10 years. Figure 1 is a replica of this insiginia.
The story of the selection of time insignia [See the FIG. 1. in source pdf] shown in Figure 1 is pieced together by information obtained by letters I have received from those who must have had a hand in its selection.
Dr. Marshall Pease writes that he has a vague recollection of time matter being brought up at a meeting of a small group of Academy members in Dr. Clifford Grulee's home. He thinks he remembers that Mrs. Grulee (though she herself says she cannot remember this) suggested a Della Robbia type of insignia.
Dr. Grulee, at any rate, remembers that he consulted with Mr. Jasper King, the director of C. L. Richetts in Chicago. The firm later became the Scriptorium, and this is the name of the firm that now makes the present insignia. Mr. King was not only a business man, Dr. Grulee writes, but was well acquainted with artistic work of many kinds. Mr. King now has no memory or records of this commission, buy Dr. Grulee says Mr. King submitted 2 or 3 examples. and it was from these that the first insignia was chosen.
EVALUATION OF A CONDITIONING DEVICE IN THE TREATMENT OF NOCTURNAL ENURESIS
Authors: Behrle Franklin C. , Elkin Miriam Tate , Laybourne Paul C. 
Published: December 2021

Twenty children with severe nocturnal enuresis and widely varying degrees of emotional maladjustment were treated with a conditioning device. The method proved effective in either entirely eliminating or markedly improving the enuresis in 15 of the children, regardless of their emotional status prior to treatment.
None of the children appeared to suffer significant undesirable effects as a result of therapy, and beneficial effects, other than improvement in the status of the enuresis, appeared to be confined to the subjective impressions of some of the mothers.
Adverse behavior encountered during treatment indicated a need for judicious supervision of therapy along with the cooperation of patients.
STUDIES OF CARBOHYDRATE METABOLISM IN THE NEWBORN
Authors: Cornblath Marvin , Levin Ephraim Y. , Gordon Harry H. 
Published: December 2021

Capillary-venous differences in concentrations of blood sugar were measured in 55 newborn infants during the first 15 hours of life. The capillary-venous difference is related to the capillary level under fasting conditions. The administration of glucose by gavage in doses of 2 to 3 gm./kg. led to a prompt rise in concentration of glucose in capillary blood and an increase in capillary-venous difference. The administration of .03 µg./kg. of epinephrine led to a prompt increase in concentration of glucose in capillary blood but to a decrease in the capillary-venous difference.
The relation of these findings to homeostatic mechanisms in the newborn was discussed.
IRON METABOLISM
Authors: SCHULMAN IRVING 
Published: December 2021

THE CLINICIAN has long been aware of the fact that iron deficiency anemia is most prevalent during infancy. Continuing studies of iron metabolism have disclosed many factors which help explain the basic mechanisms of the anemia and the peculiar vulnerability of the infant. The following comments pertain to a review of the subject appearing in this issue of Pediatrics.
The concept that the baby is born with "iron stores," in terms of reserve depots, is no longer tenable. Almost the entire quota of iron with which the baby begins life is that contained in his circulating hemoglobin. This initial endowment is influenced by three major factors: 1) the length of gestation; 2) the amount of blood transferred from placenta to infant in the first few minutes after delivery, and 3) prenatal factors affecting intrauterine hematopoiesis, an aspect which may be highly significant since even in normal full-term infants the concentration of hemoglobin in cord blood has been found to vary within a range of 5 gm./100 ml. of blood.
DETERMINATION OF CONCENTRATION OF BILIRUBIN IN SERUM
Authors: Hsia David Yi-Yung , -Hsia Hsio Husan , Gofstein Ralph M. , Winter Augusto , Gellis Sydney S. 
Published: December 2021

DURING the past few years, the measurement of the concentration of bilirubin in the serum has become very important in the pediatric field because of its value in the management of erythroblastosis fetalis and other forms of jaundice during early infancy. In previous communications, a micro modification of the standard method of Malloy and Evelyn was presented for the determination of the concentration of bilirubin in the serum of capillary blood. Although this method has proved to be very satisfactory, some have found the long waiting period for the development of the azobilirubin color a real objection.
The present method overcomes this drawback by employing a dilute solution of caffein sodium benzoate as a catalyst, as first suggested by Jendrassak and Grof, and an increased strength of the diazo reagent as described by White and Duncan. It is well known that although the azobilirubin reaction continues to progress at a slower rate indefinitely, Malloy and Evelyn have shown that a 30-minute waiting period can be considered sufficient for the development of color when the ordinary diazo reagent is used. Using the 30-minute reading as the end point at which the reaction may be considered 100% completed, it can be seen (Fig. 1) that this same point is reached using caffein alone in 15 minutes, and using both caffein and a strengthened diazo reagent at 3 minutes. In the latter instance, the reaction does not change appreciably during the ensuing 26 minutes and may for all practical purposes be considered as complete at 4 minutes. [See the FIG. I. in Source pdf]
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION, American Academy of Pediatrics, Inc.
Published: December 2021

THE Committee on Nutrition has been designated by the Executive Board of the American Academy of Pediatrics to serve in a consultative capacity in determining the suitability of advertisements of nutritional products in the official publications of the Academy.
Understanding between industry and the medical profession will be fostered by a readily available statement of the basis upon which judgment of advertisements of nutritional products will be made. Assurance can be given that this will be applied objectively, fairly and with sympathetic understanding of the position of industry.
It is hoped that thereby this statement can assume the status of a Code of Ethics and Etiquette in the promotion of products intended for maintenance of optimal nutrition or treatment of disorders of nutrition in infancy, childhood and adolescence.
The Committee on Nutrition will remain receptive to counsel from all sources, and sensitive to the implications of its own statements and actions. The following principles will be continuously re-examined in the light of experience and pertinent evidence.
Good Advertising
Good advertising serves the interest of both merchant and consumer. Good advertising begins with a reliable product. Good advertising achieves a pleasant informative memory of the product and its usefulness in the mind of the consumer. In short, this implies an honest product, truthfully and artistically advertised. Honesty is the best cornerstone upon which to build the type of promotion that will serve the mutual interest of industry, the consumer, and the medical profession.
Quality of the Product
Proof of quality of the product must at all times be available to those who must evaluate promotional material. This applies to foods and to individual ingredients such as vitamins, minerals, amino acids, fatty acids, etc.
HYPOCALCEMIA OCCURRING ON THE FIRST DAY OF LIFE IN MATURE AND PREMATURE INFANTS
Authors: Gittleman I. F. , Pincus J. B. , Schmerzler E. , Saito M. 
Published: December 2021

The incidence of hypocalcemia on the first day of life in mature infants born to mothers per vias naturales who had uncomplicated pregnancies and labors is 1.2%.
In our series of infants born to mothers who had complications during pregnancies and/or labors, every one had hypocalcemia on the first day of life.
Infants delivered by cesarean section because of cephalopelvic disproportion or because of "repeat" section had an incidence of hypocalcemia of 13.7% while those infants delivered by section because their mothers had pathologic states during pregnancy had an incidence of 36.8%.
The effect of complications during pregnancy and/or labor was not apparent when we studied the incidence of hypocalcemia in premature infants on the first day of life. We noted that the avenue of birth or the presence or absence of complications during pregnancy and/or labor did not affect significantly the incidence of hypocalcemia on the first day of life.
There is a significant positive correlation between weight of the premature infant and the total concentration of calcium in the plasma.
There was no significant statistical correlation between the mean concentrations of protein and of calcium in the serums of the premature infants studied.
We have speculated that, because premature births occur during the third trimester of pregnancy, the adrenocorticosteroids, which attain their highest concentration in the maternal serum during this period, may exercise a depressing effect on the concentrations of calcium in plasma of infants.
PSYCHOSOMATIC FACTORS WITH PARTICULAR REFERENCE TO THE PARENTS OF THE COLICKY INFANT
Authors: Bakwin Ruth M. 
Published: December 2021

Whatever the etiology of colic in infancy, and multiple causes seem most likely, there is little doubt that emotional factors enter the picture. Whether these constitute one of the causes of colic on only intensify it, is at present impossible to determine.
Some investigators have found the colicky infant to be hypertonic, tense, fussy, unhappy even before the onset of specific symptoms. McGee in 1943 suggested that fetal hiccoughs were common in babies who later developed colic.
Spock has emphasized that fatigue of the infant in late afternoon may be a factor, and Gesell has pointed out that there is heightened tension and increased irritability in infants, starting at about 4 weeks of age and continuing to 2 on 3 months, as evidence by increased appetite, more frequent crying, and greaten difficulty in getting to sleep.
Wessel and others have found family tensions greater and more frequent where there are colicky babies than where the infants are contented.
The mother of the infant with colic has been described as tense, anxious, uncertain, inconsistent in her handling of the baby and often rejecting him. The psychiatrist's explanation of the reasons for this personality includes early rejection of the baby, rivalry with infant on husband, conflicts about accepting the feminine or maternal role and her dependency needs.
A simpler explanation would seem to be that as it is the mother who first responds to the infant's needs, she feels frustrated and concerned if she is unable to satisfy them. Feeding is the focus of the first emotional relationship between the mother and child, and if this does not go well, the mother may become very upset.
AN ANALYSIS OF ETIOLOGY OF COLIC IN INFANTS
Authors: Breslow Lawrence 
Published: December 2021

The subject of so-called "three-months-colic" in infancy can be considered from two major viewpoints. The first, and by far the most popular today, is the emotional or psychosomatic; other papers in this panel consider this in some detail. The second point of view is based on the belief that colic in infants is essentially a manifestation of gastroenterospasm, resulting from overloading the small intestine with disturbing substances. This may be due to a low threshold in a hypertonic (psychosomatic) infant when subjected to an ordinary quantity of poorly tolerated material, or to a normal threshold being exceeded by an abnormal quantity.
With the latter in mind, 90 infants who seemed to have the usual manifestations of colic were studied as to etiology. Five main factors were considered:
1. Poor feeding technique.
2. Hunger.
3. Intolerance to carbohydrate added to the formula.
4. Intolerance to butter fat added to the formula.
5. Intolerance for, or allergy to, cows milk proteins.
After the first 2 factors were eliminated by the usual methods from consideration as a cause of gastroenterospasm, carbohydrate was removed from the formula as completely as possible. In those infants in whom the symptoms disappeared, this procedure was repeated one or more times until there was no question as to the role played by the sugars. If the symptoms failed to be alleviated, the infant was placed on a formula low in, or free of, butter fat.
STUDIES OF RESPIRATORY INSUFFICIENCY IN NEWBORN INFANTS
Authors: Miller Herbert C. , Behrle Franklin C. , Smull Ned W. , Blim Richard D. 
Published: December 2021

Serial determinations of pH, carbon dioxide tension, carbon dioxide content and oxygen saturation of the blood were made on newborn infants and correlated with the trends of their respiratory rates.
Some infants whose respiratory rates were normal from birth and some whose rates were initially high but subsequently returned to normal levels exhibited mild uncompensated respiratory acidosis for 3 or 4 hours after birth. Thereafter, acid-base balances were normal. All infants whose respiratory rates followed either of the above two trends oxygenated their blood 91% or better within a few minutes of birth.
There was a marked tendency for infants whose respiratory rates increased significantly on the first day or two after birth to have a moderate to severe uncompensated respiratory acidosis which was worse at birth and sometimes persisted for several days, usually with improvement. Some of the infants whose respiratory rates increased significantly after birth had moderate to severe hypoxemia, which also was worse at birth and tended to improve with increasing age.
The hypothesis was advanced that one of the basic difficulties in neonatal respiratory insufficiency was a reduction of resting tidal volume; the latter was universally associated with a significant increase in respiratory rates during the first day or two after birth and sometimes with an uncompensated respiratory acidosis and occasionally with hypoxemia.
A Pictorial History of Medicine
Authors: SHRYOCK RICHARD H. 
Published: December 2021

Dr. Bettmann has at last provided us with a pictorial history of medicine which is comprehensive in scope, rich in its illustrations, and generally sound in its running commentaries. Anyone who will consider the difficulties inherent in each of these connections, will recognize the extraordinary nature of the achievement.
With regard to scope, the work covers the entire story of Western medicine from the Egyptian period to the end of the Nineteenth Century. Moreover, it includes the social and professional, as well as the scientific history. Since the text is secondary to the illustrations, rather than the reverse as in most histories, content is divided into units with appropriate headings.
THE UMBILICAL POLYP, A REMNANT OF THE OMPHALOMESENTERIC DUCT
Authors: Crawford Stanley E. 
Published: December 2021

THE PURPOSE of this paper is to report a recent case of an umbilical polyp and intestinal obstruction during the neonatal period. Umbilical polyps are rare. When present, they may be associated with Meckel's diverticulum because both are remnants of the omphalomesenteric duct. The presence of the visible polyp may give an external clue to otherwise obscure intraabdominal symptoms.
A review of the literature earlier than 1916 is well summarized in a book by Thomas Cullen. This unusual volume lists six cases of umbilical polyp accompanied by other pathologic complications of Meckel's diverticulum. This author stressed that in these cases it should be pointed out to either the patient or his parents that possible intra-abdominal duct remnants may, at any time, give rise to symptoms such as intestinal obstruction. Penberthy and Benson reported a 9-year-old male with an umbilical polyp which had been present since birth and was without discharge. This youngster died following operation for intestinal obstruction due to volvulus about the diverticulum and its fibrous connection with the umbilical polyp. These authors pleaded for early elective operations in these cases prior to such complications. Gross gave other reasons for observation, and exploration at a reasonably early age, if a Meckel's diverticulum is suspected. Peritonitis from a ruptured Meckel's diverticulum is peculiarly dangerous; in young children the protecting omentum is inadequate and the migrating nature of the anomaly adds to the danger. Fluid from perforation of a diverticulum is usually of greater volume than that found in appendiceal rupture and abscess.
ACTIVITY OF GLUTAMIC-OXALOACETIC TRANSAMINASE IN THE SERUM IN THE NEONATAL PERIOD
Authors: Kove Simon , Goldstein Stanley , Wróblewski Felix 
Published: December 2021

The activity of glutamic oxaloacetic transaminase (GOT) in the serum was determined by the spectrophotometric method in 63 normal term newborn infants, varying from birth to 11 days of age. The normal range of activity in the newborn period varied from 13 to 105 units (with the exception of one infant in whom the level was 160 units). This is a considerably wider range than that of 5 to 45 units found in normal adults. Allowing for an error of about ±10% inherent in the method of determination of GOT, activity as great as approximately 120 units, which in adults would be indicative of some pathologic state, must be considered physiologic in the newborn infant.
The activity of GOT was not related to the age of the infant within the neonatal period studied, and varied widely in different infants for each day of age, without any distinctive pattern. Variations of the activity of GOT in specimens of cord blood studied ranged below 59 units, which was lower than for any other day of the neonatal period adequately investigated. No infants were studied repeatedly.
No relation was found between the concentration of bilirubin and the activity of GOT in the serum.