bluuebunny/crossref_metadata_2025_split huggingface dataset:
INCIDENCE OF GROSS VISUAL DEFECTS DUE TO RETROLENTAL FIBROPLASIA
Authors: SCHLESINGER EDWARD R. , MCCAFFREY ISABEL 
Published: December 2021

A study was made of the incidence of gross visual impairment due to retrolental fibroplasia among infants born to residents of New York State, exclusive of New York City, in 1948 and 1949, whose birth certificates indicated birth weights of less than 2000 gm. and who survived to the age of 4 months. Information was obtained regarding 3377 infants or 92.1% of the 3667 in the group described.
A total of 50 cases with gross visual defects due to retrolental fibroplasia, or an over-all incidence rate of 1.5%, was found. The incidence rates decreased from 15.9% in the birth weight group under 1000 gm. to 4.3% in 1000-1499 gm. group, and 0.7% in the 1500 to 1999 gm. group. The infants reported to have the shortest period of gestation were found to have the highest incidence, the rate in the group with a period of gestation under seven months being 7.6% as compared with a rate of 0.3% in the group whose gestation period was reported as eight months or more.
Although the numbers are small and the measure of gestation as reported on the birth certificate is open to question, the incidence of the condition within each birth weight group was found to be inversely related to the length of gestation. In the 1000-1499 gm. birth weight group, for example, an incidence rate of 7.0% was found among the infants with recorded periods of gestation of less than seven months, as contrasted with a rate of 1.9% among those eight months or more.
There was no statistical difference in the incidence of the condition in the group of infants for whom one or more major complications of the mother's pregnancy was reported when compared with the group of infants on whose birth certificates the statement appeared that no such complication occurred. Among infants weighing less than 1500 gm. at birth, a statistically significant variation in the incidence of the condition was found in different regions of the State. The incidence rate, adjusted for differences in weight distribution was found to be 1.7% in males and 1.2% in females. The incidence rate among infants born to mothers under 30 years of age was 1.3%, which is not significantly different from the rate of 1.9% among the infants born to mothers 30 years of age or more.
NIC/Q 2000: Establishing Habits for Improvement in Neonatal Intensive Care Units
Authors: Horbar Jeffrey D. , Plsek Paul E. , Leahy Kathy 
Published: December 2021

Objectives. The Vermont Oxford Network is a group of health professionals who are committed to improving the quality and safety of medical care for newborn infants and their families. Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was the second in a series of multiorganization improvement collaboratives organized and administered by the Vermont Oxford Network. The objective of this collaborative was to make measurable improvements in the quality and safety of neonatal intensive care, develop new tools and resources for improvement specific to the neonatal intensive care unit setting, evaluate improvement progress, and disseminate the learning.Methods. The 34 centers that participated in NIC/Q 2000 learned and applied 4 key habits for improvement: the habit for change, the habit for evidence-based practice, the habit for systems thinking, and the habit for collaborative learning. A plan-do-study-act method of rapid-cycle improvement was an integral part of the habit for change. Multidisciplinary teams from the participating centers worked closely together in face-to-face meetings, conference calls, and dedicated e-mail listservs under the guidance of trained facilitators and expert faculty. Focus groups formed around specific improvement topics used critical appraisal of the published literature, detailed process analysis, benchmarking, and round-robin site visits to identify potentially better practices (PBPs).Results. The focus groups developed a total of 51 PBPs. Each focus group has developed a “resource kit” summarizing its work. Many of these PBPs have been tested and implemented at the participating centers using rapid-cycle improvement. The PBPs and descriptions of individual center PDSA cycles are available to participants on NICQ.org, the dedicated Internet site for the collaborative.Conclusions. Collaborative quality improvement based on the 4 key habits can assist multidisciplinary neonatal intensive care unit teams in identifying, testing, and successfully implementing change.
Implementation of Potentially Better Practices for the Prevention of Brain Hemorrhage and Ischemic Brain Injury in Very Low Birth Weight Infants
Authors: McLendon Debra , Check Jennifer , Carteaux Patricia , Michael Laura , Moehring Jim , Secrest Joel W. , Clark Sue E. , Cohen Howard , Klein Sharon A. , Boyle Diane , George Jeffrey A. , Okuno-Jones Susan , Buchanan Debora S. , McKinley Pam , Whitfield Jonathan M. 
Published: December 2021

Objective. Using an evidence-based approach, a Vermont Oxford Network focus group whose goal was to reduce brain injury developed and implemented a number of potentially better practices. Each center approached implementation of the practices differently. Reducing the incidence of intraventricular hemorrhage and periventricular leukomalacia are important for improving long-term outcomes for low birth weight infants.
Methods. Implementation approaches for some but not all of the practices at the various centers are discussed. The practices reviewed include optimal peripartum management, such as resuscitation, avoidance of hypothermia, optimal surfactant delivery, early neonatal management by the most experienced providers, and measures to minimize pain and stress. Additional practices include maintenance of neutral head positioning, fluid volume therapy for hypotension, indomethacin prophylaxis, ventilator management, avoidance of routine suctioning, and limiting the use of sodium bicarbonate and postnatal dexamethasone.
Results. Approaches to implementation were center specific, and results vary. Although some practices were easier to implement than others, communication, education, and leadership were critical to the process.
Conclusions. The quality improvement multidisciplinary approach is a useful tool for finding ways to reduce the incidence of intraventricular hemorrhage and periventricular leukomalacia.
THE ROLE OF THE PULMONARY VASCULAR BED IN CONGENITAL HEART DISEASE
Authors: DAMMANN J. FRANCIS , MULLER WILLIAM H. 
Published: December 2021

In the normal human being systemic blood pressure is maintained at a high level by means of the high resistance offered to the flow of blood by the smaller systemic arteries and arterioles. In contrast, pressure in the pulmonary circulation is maintained at a low level because of the relatively large size of the pulmonary vessels. In the fetal and newborn period pulmonary arteries resemble systemic arteries in that they have a small lumen and thick media. In this period pulmonary pressure and resistance are high. As these vessels gradually thin out and enlarge, resistance to pulmonary blood flow falls and consequently pulmonary blood pressure falls.
There is evidence to suggest that the fetal state of thick-walled, thin-lumened pulmonary arteries is retained in instances where the two circulations are joined, such as in patients with a single ventricle, large ventricular defect, aortic septal defect or large patent ductus arteriosus. As the patient grows, resistance to pulmonary blood flow may: (1) decrease. If the small pulmonary arteries develop normally and become thin-walled and large-lumened, pulmonary resistance will fall. More and more blood will be shunted into the lungs and the patient will develop the signs and symptoms of cardiac decompensation. (2) remain the same. If the small pulmonary arteries retain their fetal characteristics, pulmonary resistance will remain elevated. A balance between systemic and pulmonary blood flow will be maintained compatible with a relatively normal life. (3) increase. If, because of secondary intimal changes, the pulmonary arteries become thicker-walled and smaller-lumened, pulmonary resistance will increase. Progressively less blood will be shunted to the lungs and finally the shunt will reverse and become predominantly venous arterial. The patient will develop the signs and symptoms of pulmonary stenosis with increasing dyspnea and cyanosis.
Data from two groups of patients are presented to illustrate the importance of the pulmonary vascular bed. In the first group, early and severe symptoms of cardiac failure necessitated closure of a large patent ductus arteriosus early in life. The ductus was large, comparable to the size of the aorta, pressures from the aorta and pulmonary artery were similar and a study of the lung biopsies demonstrated that the lumens of the small pulmonary arteries were decreased in size and the media were abnormally thick. In each instance closure of the ductus resulted in a cure.
In the second group the two circulations were joined by either a large ventricular defect or a single ventricle. Three patients were in cardiac failure due to excessive pulmonary blood flow. Pulmonary blood flow was decreased by the creation of pulmonary stenosis, the main pulmonary artery being narrowed 60 to 80%. The postoperative course in these three patients illustrates the value of the creation of pulmonary stenosis in instances where the two circulations are joined by a large communication between the ventricles or great vessels.
HYDROCEPHALUS TREATED BY ARACHNOID-URETEROSTOMY
Authors: MATSON DONALD D. 
Published: December 2021

Parents of an infant with hydrocephalus are interested not in having their child kept alive but in giving it a chance for normal development. Therefore, once it is established that progressive hydrocephalus exists, temporizing measures and prolonged observation should be discouraged in favor of a definitive procedure which will immediately and continuously reduce spinal fluid pressure to within normal limits. This series of patients indicates that this objective can be accomplished by diversion of cerebrospinal fluid into the urinary tract. The complications of this procedure are three: (1) mechanical obstruction of the shunt, which has been seen in only a few cases and has always been remediable; (2) meningitis, which has occurred in 8 out of 50 patients postoperatively and has been fatal in 3; and (3) acute dehydration secondary to intercurrent infection because of unreplaced loss of fluid and electrolytes through the shunt, which has been fatal in 8 to 10 of these patients.
Thirty-three out of 50 patients with severe communicating hydrocephalus treated by arachnoid-ureterostomy are living, and of these 31 are satisfactory to excellent results to date. At least 24 of these children appear to be entirely asymptomatic with normal or close to normal mental and physical development at periods from a few months to over four years.
DIAGNOSIS AND TREATMENT OF PATENT DUCTUS ARTERIOSUS IN INFANCY
Authors: ADAMS PAUL , ADAMS FORREST H. , VARCO RICHARD L. , DAMMANN J. FRANCIS , MULLER WILLIAM H. 
Published: December 2021

A large patent ductus arteriosus can produce obvious cardiac difficulty and death in infancy. The diagnosis of a patent ductus arteriosus in infancy can be difficult in the absence of a continuous murmur. In such instances special studies such as cardiac catheterization or retrograde aortography should be performed to establish the diagnosis.
Surgical closure of the patent ductus arteriosus can and should be performed in those infants with symptoms and findings of cardiac difficulty—dyspnea, cardiomegaly, murmur, and marked growth failure.
Data have been presented on 16 infants with patent ductus arteriosus in whom surgical closure of the patent ductus arteriosus was deemed necessary before 18 months of age.
Of the 16 infants, one died during surgery (6% mortality rate) and the remaining showed marked improvement following surgery. Postoperative rate of growth was variable in patients followed one year or less, consistently improved in those followed 1½ years or more.
PROBLEM OF DIFFERENTIAL DIAGNOSIS IN INFANTS WITH LARGE HEARTS AND INCREASED BLOOD FLOW TO THE LUNGS
Authors: FERENCZ CHARLOTTE , JOHNSON ARNOLD L. , GOLDBLOOM ALTON 
Published: December 2021

This paper deals with the differential diagnosis of the cardiac lesion in infants who have enlargement of the heart associated with increased blood flow to the lungs, and in whom cyanosis is not a prominent feature. Some patients in this group have a patent ductus arteriosus in the absence of a typical continuous murmur, and these infants may urgently require the benefits of surgical therapy. Since the diagnosis can be established by aortography or heart catheterization, some criteria are required for the better selection of infants from this group in whom these investigations should be performed.
Twenty-five infants form the subject of this study. In 19 the diagnosis was confirmed at autopsy. Eight patients had a patent ductus, either as an isolated lesion or in association with other defects; 10 had ventricular septal defects with or without overriding of the aorta; 5 had anomalous pulmonary vein drainage; one had an ostium atrioventricular communis and in one there was a functional single ventricle.
Clinical, electrocardiographic and radiologic findings were analyzed. Important features which appear to favour the diagnosis of patent ductus arteriosus are full or collapsing pulses and a normal ECG or one showing evidence of combined ventricular hypertrophy. Suggestive, but of lesser importance, is the finding of an apical diastolic rumble and enlargement of the left atrium. All these findings may, however, be present in patients with other malformations, especially defects involving the ventricular septum.
Evidence of marked hypertrophy of the right atrium and right ventricle by electrocardiography and fluoroscopy renders the presence of patent ductus unlikely and is consistent with the diagnosis of anomalous drainage of pulmonary veins.
INTESTINAL OBSTRUCTION DUE TO ASCARIASIS
Authors: JENKINS MARGARET Q. , BEACH M. W. 
Published: December 2021

Thirty-one patients with obstruction of the small intestine due to ascaris are discussed, with two deaths. These patients were seen during a five year period.
Treatment consisted of Wangensteen suction, parenteral fluids and small doses of hexylresorcinol crystoids without a laxative, given for several days, or of hetrazan®, 6 mg./kg, three times daily for one week.
Obstruction was relieved and no evidence of toxicity occurred.
EFFECTS OF VITAMIN B12 AND AUREOMYCIN ON NITROGEN RETENTION IN INFANTS
Authors: KAYE ROBERT , CAUGHEY RONALD H. , MCCRORY WALLACE W. 
Published: December 2021

The effects of vitamin B12 on weight, nitrogen and electrolyte balances were studied in six male infants. Three of the infants were offered nitrogen intakes of approximately 1.0 gm./kg./day, and the remaining three an intake of 0.1 gm./kg./ day.
The effects of aureomycin were studied by the same criteria in two of the infants on low nitrogen intakes.
The authors were unable to obtain unequivocal evidence that vitamin B12 exerts a nitrogen anabolic effect in infants maintained on constant intakes of high and low protein content.
Vitamin B12 administration to the subjects on a high protein intake resulted in an increased urinary nitrogen excretion which may be a reflection of an enhanced rate of conversion of protein into carbohydrate or fat.
Averages of the control and B12 period nitrogen retentions and weight gains in gm./kg./day were 0.235 and 11.8 for the high protein-fed subjects, and .011 and 2.4 for the low protein-fed subjects.
Aureomycin did not produce beneficial effects on weight or nitrogen retention, but rather showed a tendency to augment fecal nitrogen losses.
Appetite stimulation was noted in 2 of the 6 subjects given B12.
A nitrogen intake of 0.1 gm./kg./day derived from cow's milk protein approximates the minimum requirement for equilibrium in male infants under the conditions of this study.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: WEGMAN MYRON E. 
Published: December 2021

UNDER this title Alan Moncrieff, Nuffield Professor of Child Health in the University of London, delivered the Newsholme Lectures in 1953. The series is now published in a slim volume by Oxford University Press and makes stimulating reading. Professor Moncrieff's experience and present position as physician-in-chief at The Hospital for Sick Children, Great Ormond Street, fit him particularly well for combination of curative, clinical thinking, with prevention.
Opening the series is an introduction setting the stage in the light of Sir Arthur Newsholme's works in an earlier generation. Newsholme said that the health of every individual is a social concern and responsibility, but he raised important practical questions. How much can we afford for health, or, more particularly, for child health? And we are getting value for our money? Does state interference, state control, state provision of benefits or whatever it is called remove a sense of parental responsibility?
Moncrieff examines the problem under four headings: Infant Welfare; School Health; The Deprived Child; Parental Responsibility and The State. Considering under the first the question of medical care for motherhood, Newsholme noted that maternity and child welfare work represented a practical escape from the pathological to the physiological in public health problems. Yet Moncrieff notes that even now maternity care as provided in Britain has not been up to what it should be.
TOTAL BODY CHLORIDE IN TUBERCULOUS MENINGITIS
Authors: CHEEK DONALD B. 
Published: December 2021

Seven children with tuberculous meningitis have been studied. In the absence of fluid restriction and vomiting, hypotonic expansion of the extracellular fluid has been revealed. This draws attention to an alteration in water excretion. Metabolic alkalosis yields evidence of cell potassium depletion.
The serum chloride is no indication as to the status of total body chloride.
THE TREATMENT OF LEAD ENCEPHALOPATHY—A METHOD FOR THE REMOVAL OF LEAD DURING THE ACUTE STAGE
Authors: BESSMAN SAMUEL P. , RUBIN MARTIN , LEIKIN SANFORD 
Published: December 2021

1. A theoretical basis for the use of the Calcium complex of ethylene diamine tetraacetic acid for the deleading of patients in the acute stage of lead poisoning is presented.
2. Of seven cases of lead encephalopathy treated with this agent, one expired soon after admission, and the others showed prompt clinical improvement.
3. Urinary excretion studies show that approximately 1.8 mg. of lead are excreted for each 500 mg. of CaEDTA administered under conditions calculated to realize the maximum efficiency of the therapy.
4. No signs of toxicity from CaEDTA were noted.
5. A general plan of therapy of lead encephalopathy with CaEDTA is presented.
6. It is too early to evaluate the effects of this form of treatment in minimizing brain damage from this disease.
DECREASE IN SERUM GAMMA GLOBULIN (AGAMMAGLOBULINEMIA): REPORT OF 3 CASES
Authors: HAYLES ALVIN B. , STICKLER GUNNAR B. , MCKENZIE BERNARD F. 
Published: December 2021

A study has been made regarding three boys who had agammaglobulinemia and who were seen at the Mayo Clinic during a period of seven months. In each there was a history of frequent infections since infancy. All three patients demonstrated relatively normal serum proteins except for greatly decreased amounts of gamma globulin. The deficiency in gamma globulin was demonstrated by use of paper electrophoretic analysis of serum proteins.
One of the patients, an infant, died while under treatment at the clinic. The second patient continued to have frequent infections in spite of the administration of gamma globulin at frequent intervals; he died later at home. The third patient has been maintained in good health by monthly injection of gamma globulin.
EVALUATION OF THE FLUSH TECHNIQUE FOR THE DETERMINATION OF BLOOD PRESSURE IN INFANCY
Authors: Sullivan Margaret P. , Kobayashi Mahomi 
Published: December 2021

Using the flush technique, 3 systolic blood pressure readings were taken in the right arm and right leg of 160 Japanese infants of approximately 9 months of age. Analysis of the data obtained on 103 babies who were quiet or nursing when all determinations were made showed the following:
1. A sex difference in systolic blood pressure could not be demonstrated by statistical methods; there was no apparent relationship between blood pressure and height or weight.
2. No difference could be demonstrated between arm and leg pressures by statistical methods.
3. The difference in systolic pressures among infants in this study was highly significant. This variability among patients was greater than the variability among the 3 observations on an extremity of an individual patient.
4. The method may be considered a satisfactory clinic or office procedure if its limitations are recognized. One blood pressure reading on a patient by this method is of little value. A minimum of 3 readings should be obtained and averaged. Five readings are recommended for routine blood pressure determinations. For more exacting studies, 8 readings might be taken and averaged.
CITRIC ACID METABOLISM IN INFANTS DURING THE NEONATAL PERIOD
Authors: Gittleman I. F. , Pincus J. B. , Kramer B. , Sobel A. E. , Schmerzler E. 
Published: December 2021

1. Serum citric acid, calcium and phosphorus levels were measured on the first day of life and on the day of discharge from the hospital in 275 newborns. A statistically significant fall in the serum citric acid level by the end of the first 5 days of life was found in all groups studied.
2. A statistically significant positive correlation between calcium and citric acid levels was found in Groups I, III, V and VIII. Groups VI and IX had a positive correlation which was statistically not significant. In Groups II, IV and VII the correlation was negative but statistically not significant.
3. No single known factor that influences citric acid metabolism was considered to completely and adequately explain the serum citric acid fall during the first week of life and the tendency for the serum citric acid to rise in the second week of life.
4. Fluctuation in parathyroid activity comes closest to providing an explanation.