bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for Congenital Metabolic Disorders in the Newborn Infant: Congenital Deficiency of Thyroid Hormone and Hyperphenylalaninemia
Authors: Scriver Charles R. , Feingold Murray , Mamunes Peter , Nadler Henry L. 
Published: December 2021

The Committee on Genetics of the American Academy of Pediatrics was formed in 1976. The initial reports from the Committee are published in this supplement to Pediatrics: one on guidelines for screening the newborn infant for hyperphenylalaninemia (including phenylketonuria [PKU]) and the other on screening for congenital hypothyroidism.
The first statement describes guidelines for screening for thyroid hormone deficiency in newborn infants; it concerns a traditional problem in pediatrics, the prevention of cretinism. A statement on "T4 screening" has already been issued by the American Thyroid Association.1 Why is there need for another (and longer) statement from the Academy? The Task Force on Genetic Screening recommended a special review of T4 screening, and that recommendation has been acted on quickly in the hope that most of the mistakes made in PKU screening will not be repeated in T4 screening. The American Thyroid Association statement adequately describes the status of testing for T4 deficiency; it does not cover other essential components of an effective screening program, namely, provision for serving patient retrieval, diagnosis, and treatment. The Committee urges pediatricians and endocrinologists who elect to push ahead with T4 testing to pause and examine the many issues of mass newborn infant screening before they act too hastily, perhaps to the detriment of their patients and newborn infant screening programs.
Dr. Jean Dussault served as consultant to the Committee when it examined T4 screening; his personal experience extends to ¼ million screened subjects and emanates from a model program which has largely avoided many pitfalls of newborn infant screening.
Acne: Current Concepts
Authors: Esterly Nancy B. , Furey Nancy L. 
Published: December 2021

At the patient's initial visit an assessment of general medical health and degree, type, and extent of acne is made. A careful history is obtained to determine possible aggravating factors, such as the ingestion of hormones or drugs, or the use of moisturizing or corticosteroid creams.
If the patient has a few comedones and papules, benzoyl peroxide alone may be adequate. If comedones are large and numerous, retinoic acid plus benzoyl peroxide is useful. If there are a significant number of deep pustules and nodules, tetracycline or erythromycin orally can be prescribed. The dosage of antibiotic should be tapered and the drug discontinued as soon as the inflamniatory lesions subside. The patient should be informed that topical medications must be used indefinitely even when the eruption improves because the medications will prevent formation of new lesions. The patient should also be told that acne responds over a period of weeks, not days, and that improvement may not be noticed for four to eight weeks. Provision of a realistic time frame helps the adolescent to maintain confidence in the peeling medications which, at times, will cause irritation and redness of the face.
Frequency of cleansing and appropriate cleansing agents and shampoos should be discussed. Dietary facts and fictions should also be mentioned, and, in some instances, parents should be included to preveiit confrontations at home. Girls who feel the need to cover blemishes should be advised to avoid greasy foundations and substitute one of the many cosmetically acceptable water-based formulations now available.
Patient compliance will increase if a brief explanation of the pathogenesis of acne lesions and the effects of therapeutic agents is provided. Above all, the teenager should be told that the outlook for improvement is good, that acne can be treated successfully, and that for most patients, excellent control can be achieved if there is cooperation and interest on the part of both physician and patient.
Rare Diseases, Common Problems: Recognition and Management
Authors: Holtzman Neil A. 
Published: December 2021

Although a growing number of inherited metaboic diseases can be treated effectively, diagnosis often comes too late to benefit the patient. There are at least two ways, however, in which diagnosis can be made before irreversible damage occurs. First, physicians whose services are sought when a patient becomes ill could be attuned to the possibility of metabolic conditions. This is difficult when the initial symptoms, for example, vomiting or poor feeding, resemble those of common, self-limited illnesses, or when they suggest, as with respiratory distress, other categories of serious illness. Second, all infants could be screened for indicators of some of these conditions. Then the primary physician has a responsibility to determine the significance of both positive and negative results and to decide whether follow-up is needed.
This study had three objectives: (1) to determine whether physicians are aware of the common problems with which inherited metabolic conditions often present; (2) to determine whether their management of common problems facilitates the early diagnosis of such conditions; and (3) to assess their evaluation of screening test results.
METHODS
Physicians who were participating in three continuing education programs were asked to answer, anonymously, several questions dealing with recognition and in management of geneticmetaboic diseases before they were given any instruction on the subject. The same questionnaire was distributed to the pediatric house staff at The Johns Hopkins Hospital. The tabulated results were discussed with the respondents collectively during hour-long conferences.
RESULTS AND COMMENTS
Classification of Respondents
One hundred fifty-six physicians returned the questionnaire: 67 pediatricians (in practice, 56; full-time faculty, 6: unknown, 5), 30 general or family practitioners, and 59 pediatric house officers.
Estrogen Treatment of Girls With Constitutional Tall Stature
Authors: Bierich Jürgen R. 
Published: December 2021

We define "tall stature" as a body height 2 SD or more above the mean of the population. The mean height for adult women in our country is 166 cm; the 97th percentile is 179 cm.
Up to 1976, we treated tall girls if their expected definite height surpassed 180 cm. Under the impression of the publications of Ziel and Finkle1 and Smith and co-workers,2 at the end of last year we decided to restrict the indication for estrogen treatment to girls with a growth prognosis above 183 cm. The prognosis has been made with the Greulich-Pyle Atlas and the tables of Bayley and Pinneau. Bone age was always determined independently by two experts.
This report is based on the therapeutic results in 41 girls aged 10 to 15 years whose treatment now is finished. At the start, their average age was 13 years and 2 months. In half of the girls, menarche had already occurred; their mean age was 13½ years. In the other half, this had not been the case; their mean age was 12 years and 9 months. Mean midparents' height was 177 cm for the whole series. This is considerably higher than the average for the population, which in Great Britain is 168 cm, according to Tanner et al.3
METHODS
Therapy was performed with conjugated natural estrogens (Presomnen [Germany]; Premarin, comparable US product). The daily dose was six 1.25-mg tablets, ie, 7.5 mg/day. The estrogens were given continuously without any interruption. To obtain menstruation-like bleedings, the girls took an oral estrogen for five days in the fourth week, at first megestrol, later dydrogesterone.
Contraceptives and the Young: Present Status and Future Prospects
Authors: Segal Sheldon J. 
Published: December 2021

Although today's couples have access to a greater array of relatively safe and effective methods of fertility regulation than ever before, these methods are neither safe enough nor effective enough. The need for improvement in contraception is clear from the frequent resort to termination of unwanted pregnancies through induced abortion and from the rise in the incidence of sterilization, a surgical and generally irreversible method often chosen simply because of the unavailability of a suitable nonsurgical and reversible method.
Reproductive behavior is shaped by many dimensions of human experience, including sexuality and the social and economic roles of women and men. It is important that fertility regulation technology take these other dimensions into account for different cultures and for different age groups. It is important also, in different circumstances, that the risks of fertility regulation methods be balanced against the risks of pregnancy.
JOHN LOCKE ON THE CARE OF THE NEWBORN INFANT (1684)
Authors: C. T. E. 
Published: December 2021

John Locke (1632-1704), physician and philosopher, is best known for his Essay Concerning Human Understanding (1690). His reputation as a philosopher has overshadowed the extent of his medical interests. Locke's journals between 1678 and 1698 contain thousands of items of medical interest.
An entry in his journal for September 1684 contained the following recommendations for the care of the newborn infant.1
1. Soon after birth the baby can be given 1 or 2 spoonfuls of syrup of violets with almond oil, to loosen the bowels and keep it from convulsive colic. Or else distilled olive oil can be mixed with sugar.
2. If the newborn baby is in a weak condition you can blow on it the smell of chewed onions and cloves; smear its nostrils and lips with Cinnamon water; press warm slices of meat on its head and anus; wrap in bandages soaked in red wine and place in a bath composed of water or beer and fresh butter. If the baby is lively give a little after a mixture of 1 spoonful of distilled almond oil and syrup of Cowslip flowers and ½ spoonful of wine tempered with sugar, so that it can purge itself properly.
3. As soon as it begins to feed on pap, give it for the first few days a little powder of Marchion.
4. If it is weak apply to the region of the heart a cloth coaked with warm Embryon. The best ways to stimulate its strength are baths, putting warm wine on its head, placing hot meat on its chest, smearing its nose and lips with cinnamon water, putting onions near its nostrils, etc.
In Reply: Obese-Writing
Authors: Barness Lewis A. 
Published: December 2021

On reading your letter, the first question that comes to mind is, how come your wife is so smart. Apparently she is the one who makes up the new words and develops the hypotheses about physicians and their lab tests.
Secondly, it is my firm belief that treatment of obese-writing is about as effective as treatment of any other kind of obesity. If the patient isn't very interested in reducing, no type of behavior modification or any other treatment is likely to be effective.
B Cell Ontogeny: Immunoglobulin Genes and Their Expression
Authors: Lawton Alexander R. , Cooper Max D. 
Published: December 2021

B cell development occurs in a series of discrete stages which can be distinguished on the basis of morphologic and functional criteria. Genesis of B cells begins within the fetal liver as early as eight weeks gestation, and is later maintained in bone marrow. The first recognizable developmental stage is the rapidly-dividing pre-B cell which synthesizes cytoplasmic IgM but lacks surface receptors for antigen. Immature B lymphocytes emerging from pre-B cells express surface IgM, but are uniquely susceptible to inactivation as a consequence of specific antigen binding. Progeny of these cells express different classes of cell surface immunoglobulin and become committed to differentiate into plasma cells synthesizing IgM, IgD, IgG, IgA, or IgE immunoglobulins, respectively.
By the beginning of the second trimester, the human fetus has an adult proportion of B lymphocytes expressing different immunoglobulin classes and capable of recognizing an extensive variety of antigens. The qualitative and quantitative deficiencies in antibody responses of newborns, as compared to adults, appear to reflect regulatory interactions with T cells and macrophages rather than absence of B lymphocytes capable of generating a response.
Recent research with recombinant DNA technology has provided remarkable new knowledge of the structure and organization of immunoglobulin genes. This developing information, in concert with more detailed studies of the cellular expression of these genes during ontogeny, holds the promise of generating insights into the molecular mechanisms regulating gene expression during differentation.
Complement in the Newborn Infant
Authors: Johnston Richard B. , Altenburger Karl M. , Atkinson Alva W. , Curry Robert H. 
Published: December 2021

Classical pathway activities and component concentrations in sera from newborns can be compared more realistically to normal adult values than to maternal values since activities and components are increased in maternal sera. Whole complement hemolytic activity appears to be subnormal in approximately half of term infants, with mean activity being about 70% to 90% of normal. Concentrations of Clq, C4, C2, C3, and C7 have been 60% to 100% of adult concentrations in term infants and somewhat less in preterm infants. Younger gestational age has been correlated with lower levels of total hemolytic activity, Clq, C4, and C3.
Activity of the alternative pathway appears to be more frequently subnormal in newborn sera than does activity of the classical pathway. Factor B and properdin concentrations have varied from about 35% to 60% and 35% to 70% of adult values, respectively. Opsonization and hemolysis mediated by the alternative pathway have been subnormal in 15% to 75% of term infants, depending upon the assay. Gestational age appears to correlate with alternative pathway hernobytic activity and properdin concentration but not with concentration of factor B.
Reductions such as these in single complement components and functions probably would not predispose an otherwise normal individual to infection. However, it seems likely that the multicomponent and dual pathway deficiencies found in neonates, especially in conjunction with the decreased phagocyte function known to exist in that population, could increase the likelihood of serious infection. Predicted infections with this configuration of abnormalities would be extracellular bacterial. Whether the newborn infant is actually predisposed to infection because of the complement deficiencies summarized here remains to be proved. This and other unanswered questions lead us to conclude that understanding of the complement system in the newborn is, pardon the expression, still in its infancy.
Paratesticular Mass as a Presenting Sign of Sarcoidosis
Authors: Schaeffer Janis , Nussbaum Michael , Meyersfield Sandy 
Published: December 2021

Sarcoidosis is a chronic granulomatous process of obscure origin. Although the disorder is characterized by multisystem disease, involvement of the genital tract is uncommon. The purpose of this paper is to record a patient with a scrotal mass as a presenting symptom of sarcoid. Sarcoidosis should be considered when the differential diagnosis of scrotal masses is under consideration.
CASE REPORT
An 18-year-old black man was admitted to the Adolescent Service of Long Island Jewish-Hillside Medical Center with the chief complaint of a right scrotal mass. His past medical history and review of symptoms were entirely negative except for a 14-lb weight loss in four months.
Postscript to Incubator-Baby Side Shows
Authors: Silverman William A. 
Published: December 2021

When my article about premature infant "shows" appeared in Pediatrics1 it caught the eye of Felix Marx, of Bonn, Germany. He called attention2 to an 1896 popular-magazine story3 in which the identity of the man named "Lion" was revealed (see citation 7 in reference 1).
According to the profusely illustrated piece, Doctor Alexandre Lion, of Nice, was a philanthropic physician who established "The Baby Infant Charity" (Oeuvre Maternelle des Couveuses D'Enfants, located at 26, Boulevard Poissonière, Paris) for the saving of infant life.
Mothers Who Work—Differing Views
Authors: Bell Reed 
Published: December 2021

I question your judgment in publishing the special article "The Working Mother in Contemporary Perspective" (Pediatrics 64:862, 1979). Certainly all of us should be aware of the special needs of working parents, single or married, especially with young children, and provide support services to meet their needs.
However, the thinly veiled liberationist-feminist propaganda is out of order in a professional scientific publication. Jingoist phrases such as "anachronistic societal values," political "changers," "change-oriented activities,", "familial egalitarianism," etc reveal the bias of the writers sponsored by the Business and Professional Women's Foundation of Washington, DC.
Letters to the Editor
Authors: Chan James C. M. , Bartter Frederic C. 
Published: December 2021

In the treatment of renal hypophosphatemic rickets, the risks of hypercalcemia and vitamin D toxicity are always imminent. The use of 1,25-dihydroxyvitamin D with its shorter half-life offers a distinct advantage in conjunction with the continuous phosphate supplementation.1-3
The accelerated growth velocity secondary to the use of 1,25-dihydroxyvitamin D has now been extended to five patients. The initial report in a 3-year-old girl2 showed acceleration of growth velocity from the 25th to the 78th percentile.
Got a Minute?
Authors: Hoekelman Robert A. 
Published: December 2021

Once or twice during each of the past three decades we have been presented with the results of studies concerning the content of well child visits.1-6 These studies have analyzed the amount of time physicians spend in the several components of such visits and have shown that very little attention is given to discussion of child behavior and development or to the provision of anticipatory guidance and assurance to the mother.
The most recent of these studies, by Reisinger and Bires in this issue of Pediatrics (p 889),6 is perhaps the most discouraging to those who advocate periodic well child visits as a mechanism for providing support and guidance to mothers in child rearing and as a means for preventing emotional, behavioral, and developmental problems.
Letters to the Editor
Authors: Scanlon John W. 
Published: December 2021

We thank Drs Goldenring and Franklin for their interest in our case report. Their theoretical concerns seem well founded and should be considered. The cases reported were infants without pulmonary hypertension or the need for tolazoline.
It is of interest that a paper by Adams and colleagues in the very same issue of Pediatrics (62:298, 1980) reports on the use of cimetidine to treat gastric hypersecretion from chronic tolazoline administration in the syndrome of persistent fetal circulation.
Letters to the Editor
Authors: Fallot Mary , Oski Frank A. 
Published: December 2021

We wish to thank the writers for taking the time to reanalyze our report and point out that our data merely justify the statement that bottle-feeding increases the risk of hospitalization only among private patients. We hope that we will ultimately be able to have a sufficiently large population of clinic patients who are breast-fed in order to determine whether breast-feeding can be shown statistically to confer protection in this group as well.
We can assure Dr Margolis that a selection bias was not operative.
Hyperlipidemia Screening and Semmelweis Re-revisited
Authors: Holtzman Neil A. 
Published: December 2021

Dietary modification can lower lipid levels in children, but will such modification, or therapeutic intervention, lower the probability of developing future coronary heart disease? The answer is still not in, as Dr Glueck well knows. "...diet-heart trials have not unequivocally proved or disproved the underlying hypothesis that cholesterol-lowering leads to reduced incidence of atherosclerotic disease." Moreover, "there is no evidence, either observational or experimental, that conclusively demonstrates a causative relationship between dietary fat per se and human and atherosclerotic disease."1
Faced with an unproved hypothesis pediatricians have four choices: (1) make no recommendation regarding diet changes; (2) Advocate a prudent diet to all families; (3) Screen for hypercholesterolemia and recommend diet changes and other measures to those with high levels; (4) Intervene, either by screening or by diet modification without screening, in only those children with a strong family history of coronary heart disease.
Ivory Tower Expense Calculations
Authors: Lighter Donald E. 
Published: December 2021

The economic analysis of the residents' outpatient practice at Thomas Jefferson University Hospital (Pediatrics 66:91, 1980) piqued my interest, because I am firmly in favor of housestaff becoming better versed in the financial vicissitudes of private practice. I respectfully would like to offer a few suggestions that I feel would make the study more valid and provide a better teaching model for residents.
First, the program should stand on its own financial merits, and the hospital subsidies should be excluded in the economic analysis of self-sufficiency.
Letters to the Editor
Authors: Weiss Jeffrey C. , De Jong Allan R. 
Published: December 2021

We read Dr Lighter's letter with interest and thank him for the helpful suggestions regarding accounting methods.
Our analysis reflects the nature of our educational model in a university setting, which cannot always be compared to a private practice. We cannot compete with the hospital laboratory and cannot charge for immunizations (we get vaccines free from the Philadelphia Health Department). In addition, patient fees, which are determined by the hospital administration, are much lower than those of practicing pediatricians.
INFANT BOTULISM IN CALIFORNIA–1980 SUMMARY
Authors: M. E. K. 
Published: December 2021

1980 was a record year for infant botulism in California in several respects; the most hospitalized cases (30); the oldest case yet documented (8½ months); the longest and costliest hospitalization (8 months and $300,000); the first occurrence, sequentially in twins (dizygotic) and, finally, the first death of a hospitalized baby since 1977. These 30 patients represent one third of all cases of infant botulism hospitalized in California in the five years since infant botulism was first recognized in 1976.
Age at onset ranged from 4 to 37 weeks; 20 cases (67%) were male; 24 (80%) were white, 6 (20%) Hispanic; and (this year) none were Asian or black. Fifteen cases were caused by type A toxin and 15 by type B toxin. Cases occurred in every calendar month except January and November; half the cases had onset in August, September, and October. Ten percent of cases (3/30) ingested honey before onset of illness, and when tested, honey specimens fed to these patients were culture negative for Clostridium botulinum.
The 30 California patients in 1980 represent almost half of the 65 cases hospitalized nationally for the year. The reasons for the marked increase of the State's infant botulism in 1980 are the subject of continuing investigation by the Infant Botulism Research Unit of the State Department of Health Services.
Diet and Hyperactivity
Authors: Crook William G. 
Published: December 2021

I read with great interest the article by Stare and associates entitled, "Diet and Hyperactivity: Is There a Relationship?" (Pediatrics 66:521, 1980). I agree with their statements, "Hyperactivity will continue to be a frustrating problem until research resolves the questions of its cause or causes and develops an effective treatment .... The reality is that we still have a great deal to learn about this condition."
However, I disagree strongly with the last sentence of their article which stated, "... it appears now that diet plays, at most, a very minor role."