bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Obesity and Risk for Birth Defects
Authors: Watkins Margaret L. , Rasmussen Sonja A. , Honein Margaret A. , Botto Lorenzo D. , Moore Cynthia A. 
Published: December 2021

Objective. Several studies have shown an increased risk for neural tube defects associated with prepregnancy maternal obesity. Because few recent studies have examined the relation between maternal prepregnancy obesity and overweight and other birth defects, we explored the relation for several birth defects and compared our findings with those of previous studies.Methods. We conducted a population-based case-control study of several selected major birth defects using data from the Atlanta Birth Defects Risk Factor Surveillance Study. Mothers who delivered an infant with and without selected birth defects in a 5-county metropolitan Atlanta area between January 1993 and August 1997 were interviewed. Maternal body mass index (BMI) was calculated from self-reported maternal prepregnancy weight and height. Women with known preexisting diabetes were excluded. The risks for obese women (BMI ≥30) and overweight women (BMI 25.0–29.9) were compared with those for average-weight women (BMI 18.5–24.9).Results. Obese women were more likely than average-weight women to have an infant with spina bifida (unadjusted odds ratio [OR]: 3.5; 95% confidence interval [CI]: 1.2–10.3), omphalocele (OR: 3.3; 95% CI: 1.0–10.3), heart defects (OR: 2.0; 95% CI: 1.2–3.4), and multiple anomalies (OR: 2.0; 95% CI: 1.0–3.8). Overweight women were more likely than average-weight women to have infants with heart defects (OR: 2.0; 95% CI: 1.2–3.1) and multiple anomalies (OR: 1.9; 95% CI: 1.1–3.4).Conclusions. Our study confirmed the previously established association between spina bifida and prepregnancy maternal obesity and found an association for omphalocele, heart defects, and multiple anomalies among infants of obese women. We also found an association between heart defects and multiple anomalies and being overweight before pregnancy. A higher risk for some birth defects is yet another adverse pregnancy outcome associated with maternal obesity. Obesity prevention efforts are needed to increase the number of women who are of healthy weight before pregnancy.
Associations of Intrauterine Growth Restriction Among Term Infants and Maternal Pregnancy Intendedness, Initial Happiness About Being Pregnant, and Sense of Control
Authors: Durousseau Sharon , Chavez Gilberto F. 
Published: December 2021

Objective. Term infants (≥37 weeks’ gestation) who weigh &lt;2500 g have intrauterine growth restriction (IUGR) and have a higher risk of mortality and morbidity. Little is known about how psychosocial factors affect the risk of IUGR. We examined the association between IUGR and maternal pregnancy intendedness, initial happiness about becoming pregnant, and maternal sense of control.Methods. We analyzed data from a survey of California mothers aged ≥15 years with term live births in 1999 and 2000 (N = 5961). Mothers were asked about pregnancy intendedness before pregnancy, initial happiness about becoming pregnant, and maternal sense of control, assessed by a standardized scale. We examined the association of having an infant with IUGR and these factors in univariate and multivariate analyses.Results. Mothers with low sense of control (3.0%) and average sense of control (2.7%) were more likely to have an infant with IUGR than mothers with high sense of control (1.8%; odds ratio: 1.8; 95% confidence interval: 1.2–2.9; and odds ratio: 1.6; 95% confidence interval: 1.0–2.5). After multivariate analysis, we found no significant association between sense of control and IUGR. We also found no significant association between IUGR and pregnancy intendedness and happiness about becoming pregnant.Conclusions. We found no statistically significant association between IUGR and maternal pregnancy intendedness, initial happiness about becoming pregnant, and maternal sense of control. Although research should continue to explore associations between psychosocial factors and IUGR, prenatal care programs should focus on known risk factors for IUGR.
Potential Role of Tetrahydrobiopterin in the Treatment of Maternal Phenylketonuria
Authors: Trefz Friedrich K. , Blau Nenad 
Published: December 2021

Objective. To evaluate the clinical relevance of tetrahydrobiopterin (BH4) supplementation for pregnant women with phenylketonuria (PKU)/hyperphenylalaninemia (HPA) and the possibility of treating these patients with BH4 instead of a phenylalanine (Phe)-restricted diet.
Methods. Genotyping was performed on 41 patients with PKU/HPA identified by newborn screening. Evaluating the genotype according to their BH4 responsiveness is published. Follow-up of 3 patients with mild PKU treated with BH4 is evaluated. Discussion of the transfer of these experiences to the possibility of treating mothers at risk for maternal PKU is presented.
Results. In 41 patients with PKU/HPA, we found 17 (41%) bearing at least 1 allele with a mutation described as being responsive to BH4. In 8 of the patients, BH4 loading had been performed in the newborn period, in 6 of whom the test showed a clear decrease of blood Phe 4 and 8 hours after loading. One of the nonresponders was reinvestigated at 3 years of age, showing a clear response (genotype Y414C/R408W): BH4 supplementation resulted in a much higher Phe tolerance (500 instead of 250 mg/day) with blood Phe levels &lt;200 μmol/L. Two children (genotype E390G/IVS10–11g&gt;a and L48S/L48S, respectively) were treated with BH4 only (15–20 mg/kg body weight/day), one from birth, the other from 2 years of age. Blood Phe decreased from &gt;800 μmol/L to a mean of 321.4 and 331.7 μmol/L, respectively (range: 141–718 μmol/L) under a normal diet (total observation time: 4 years). Development was normal with no adverse reactions.
Conclusions. BH4 supplementation seems to be a promising alternative treatment in some patients with mild PKU. Because blood Phe levels in maternal PKU should be maintained at 120 to 360 μmol/L, clinical relevance may be even greater than for treatment of children with PKU/HPA. BH4 supplementation may also be combined with a Phe-restricted diet, allowing higher Phe intake and protecting mothers from high Phe blood peaks. However, additional studies are necessary to prove the safety and economy of such an alternative treatment in patients with PKU/HPA, especially during pregnancy.
Measuring the Quality of Children’s Health Care: A Prerequisite to Action
Authors: Dougherty Denise , Simpson Lisa A. 
Published: December 2021

Objective. To assess the availability and use of quality measures for children’s health care, highlight promising developments, and develop recommendations for future action steps by the child health quality measurement and improvement fields, pediatrics, and the national quality of care enterprise generally.Study Design. Two-day invitational expert meeting, informed by 3 commissioned articles.Results. Quality of care for children is far less than optimal. A number of measures are available for measuring children’s health care quality on a regular basis, although measures are scarce at least in many areas (eg, pediatric patient safety, end-of-life-care, mental health care, oral health care, neonatal care, care for school-aged children, and coordination of care). Many of the available measures are not being applied regularly to measure the quality of children’s health care; barriers to implementation include lack of an information infrastructure that is child- and quality-friendly and lack of public support for improving children’s health care quality. To improve the availability and use of quality measures for accountability and improvement, meeting participants recommended that at least 4 activities be national priorities: 1) build public support for quality measurement and improvement in children’s health care; 2) create the information technology infrastructure that can facilitate collection and use of data; 3) improve the reliability, validity, and feasibility of existing measures; and 4) create the evidence base for measures development and quality improvement.Conclusions. Although substantial progress has been made in the development of quality measures and the implementation of quality-improvement strategies for children’s health care, interest in quality of care for children lags behind that for adult conditions and disorders. Making significant progress will require not only sustained attention by those concerned about improving children’s health and health care but also activities to build a broad base of support among the public and key health care decision-makers.
INTERSTITIAL "PLASMA CELL" PNEUMONIA OF PREMATURE AND YOUNG INFANTS
Authors: DEAMER WILLIAM C. , ZOLLINGER HANS U. 
Published: December 2021

An unusual type of infantile pneumonia occurs frequently in certain European countries, but thus far is undescribed in the American literature. It is remarkable clinically in being almost asymptomatic until late in its course, in showing a marked predilection for premature or immature infants, and for being confined to the age period of 6 weeks to 4 months.
Pathologically, it is remarkable for a diffuse interstitial pulmonary infiltration by mononuclear cells which, for the most part, closely resemble plasma cells. An alveolar exudate is also present.
About 22% of patients with clinically recognized cases die of asphyxia. In these cases death appears to be predominantly due to asphyxia.
The most commonly held opinion, in which the authors concur, is that the disease is infectious and probably of viral origin, but as yet there has not been a convincing demonstration of the etiologic agent. Up to the present time no effective therapeutic agent has been found.
BEHAVIOR CHANGES INDICATING EMOTIONAL TRAUMA IN TONSILLECTOMIZED CHILDREN
Authors: JACKSON KATHERINE , WINKLEY RUTH , FAUST OTTO A. , CERMAK ETHEL G. , BURTT MARJORIE MURRAY 
Published: December 2021

A study of 140 children was made before and after tonsillectomy to determine the incidence of behavior changes indicative of emotional trauma.
A method of procedure, presented in earlier papers, is briefly described. The difficulties and problems of this type of research are evaluated. The limitations of the research method in proving the presence or absence of emotional trauma are acknowledged.
Findings were: 1. Thirteen children presented behavior changes indicative of emotional trauma. 2. Children treated with consideration for emotional factors gave less evidence of trauma. 3. Children who had suffered previous emotional trauma reacted less well to this experience. 4. Younger children showed more but milder adverse behavior changes. 5. The large majority, 91%, seemed either benefited by or were scarcely affected by the experience.
ACTH IN THE TREATMENT OF ERYTHROBLASTOSIS
Authors: GEPPERT LEO J. , AKEROYD JOSEPH H. , SIMPSON JOHN W. 
Published: December 2021

Twenty erythroblastotic infants were treated with ACTH. Immediately after delivery 12.5 mg. were given and 6.25 mg. every six hours thereafter for a median period of 8.5 days.
These infants showed a delayed adrenal response as measured by a fall in the eosinophile count by the third day.
As indicated by the reversal of the Coombs' test there was a sharp drop in the degree of sensitization of red cells in a shorter period than would have been expected naturally.
The nucleated cell counts decreased to normal ranges by the fourth day chiefly because of the disappearance of erythroblasts.
Red blood cell counts and hemoglobin determinations showed a tendency to rise during the period of ACTH administration and an invariable decrease when ACTH was discontinued.
Hemolysis was certainly not completely prevented since most patients became clinically jaundiced and a concurrent rise in serum bilirubin was demonstrable.
Four infants who had clinical erythroblastosis without demonstrable antibodies (negative Coombs' test) were treated with ACTH and responded in a similar manner.
The Coombs' test became strongly positive in one patient after ACTH was discontinued on the tenth day. Serum bilirubin rose to 12 mg./100 cc. blood and the patient became clinically jaundiced. Fecal urobilinogen increased to 70 mg./24 hours on the fifteenth day. Administration of ACTH was resumed on the seventeenth day followed by a reversal of these processes.
Antibiotic therapy was added to the study regime because of the possibility that ACTH may enhance infection in the newborn infant.
A peculiar local reaction to pork ACTH was not noted with sheep ACTH.
Three patients died, all on the third day. One of these patients was found to have kernicterus at autopsy. No surviving patient has any evidence of kernicterus.
A much larger series will be required to demonstrate any effect on the mortality rate of erythroblastosis.
Seven infants with mild erythroblastosis were not treated because the potential dangers of ACTH were considered to carry more risk than their state of the disease.
Several modifications of the treatment regime used in this study are suggested.
STUDIES ON ERYTHROBLASTOSIS DUE TO ABO INCOMPATIBILITY
Authors: HSIA DAVID YI-YUNG , GELLIS SYDNEY S. 
Published: December 2021

Detailed clinical and laboratory data have been presented on 21 infants with erythroblastosis due to ABO incompatibility. A careful survey in one newborn service over a six-month period showed that there were 11 cases of erythroblastosis due to ABO incompatibility as compared to 7 cases of erythroblastosis due to Rh incompatibility, suggesting that the disease occurs with greater frequency than has been hitherto reported.
No one test is available which can in every case be absolutely diagnostic of the disease. The criteria useful in suggesting the diagnosis are listed. Practically, the presence of a major blood group incompatibility between infant and mother with a negative Coombs' test, clinical jaundice in the first 24 hours, and a serum bilirubin level of more than 10 mg./100 cc. at 24 hours or less is sufficient to make the diagnosis in the absence of manifest infection.
The same criteria for treatment as applied to Rh erythroblastosis should be applied to erythroblastosis due to ABO incompatibility in the light of our present knowledge.
HEMATOPOIESIS IN PREMATURE INFANTS WITH SPECIAL CONSIDERATION OF THE EFFECT OF IRON AND OF ANIMAL-PROTEIN FACTOR
Authors: Wolff James A. , Goodfellow Alice M. 
Published: December 2021

Normal values in the first 3 months of life have been determined for hemoglobin, erythrocytes, reticulocytes, platelets, leukocytes and differential counts for premature infants with birth weights less than 1200 gm., and for those between 1200 and 1500 gm. at birth. No significant difference was found in the degree of depression of levels of hemoglobin and erythrocytes when values in the 2 weight groups were compared.
Two reticulocyte peaks occur during the first 3 months of life. The first peak is present immediately after birth. The second peak, at about the eighth week, coincides with the occurrence of the greatest degree of anemia.
Neither iron therapy nor treatment with animal-protein factor containing vitamin B12 and Aureomycin®, started before the end of the third week of life, had a statistically significant effect on the early phase of the anemia of prematurity.
Untreated premature infants and those given animal-protein factor were anemic at the end of the first year of life. Subjects given iron therapy had normal hemoglobin values at one year of age.
Blood transfusion is rarely necessary in the treatment of the anemia of prematurity.
DEMONSTRATION OF ANTIBODIES AGAINST ENTEROPATHOGENIC ESCHERICHIA COLI IN SERA OF CHILDREN OF VARIOUS AGES
Authors: Neter Erwin , Westphal Otto , Lüderitz Otto , Gino Rosalie M. , Gorzynski Eugene A. 
Published: December 2021

A study on the presence of Escherichia coli 0111, 055, and 026 hemagglutinins and agglutinins in the sera of children and adults selected at random yielded the following results.
The E. coli hemagglutination test proved to be far more sensitive for the detection of these antibodies than the conventional bacterial agglutination test.
A relationship was found to exist between the presence of E. coli hemagglutinins and the age of the individuals; these antibodies were found in over 90 per cent of human sera selected at random from individuals 12 years of age and older, and less than 14 per cent of sera from infants up to the age of 3 months.
Placental transfer of E. coli hemagglutinins was demonstrated in only 3 out of 26 cases, and in these instances the maternal antibody titers were from 4 to 16 times higher than those of the cord blood.
These E. coli hemagglutinins were demonstrated also with red blood cells modified with purified lipopolysaccharides, indicating that they react with the somatic antigens of these serogroups of E. coli.
The specificity of the hemagglutinins was established by absorption tests, utilizing red blood cells modified by one or the other of the lipopolysaccharides.
E. coli 0111, 055, and 026 hemagglutinins were demonstrated in 2 commercial gamma globulin preparations, indicating that these antibodies are not restricted to a population in a small geographical area.
The potential diagnostic usefulness of the E. coli hemagglutination test deserves further investigation.
SPECIAL ARTICLE
Authors: Faber Harold K. 
Published: December 2021

THE INVITATION with which you have honored me on this memorable occasion has given me a tempting opportunity to discuss certain problems with which my associates and I have been engaged for nearly a quarter of a century, and to correlate the results of some 25 separate studies on the various aspects of pathogenesis, published, mainly in the Journal of Experimental Medicine, during that time. Most of these have dealt with the beginnings and evolution of the disease up to the onset of paralysis, in search of answers to such questions as: How and where does the virus enter the body? Where do the initial lesions occur? What are the sources of viral excretion? How is viremia produced? By what routes is the central nervous system invaded? What is the explanation of silent infections? What are the defenses, natural and artificial, against the disease? And, finally, can a unitarian concept be sustained of the pathogenesis of poliomyelitis in terms of the relation between host and virus?
Before discussing these questions, certain prefatory remarks are in order about the host-cell affinities of poliomyelitis virus. While it is interesting and in various ways very important that these can be radically altered in vitro by Enders' methods of tissue culture, and in vivo by pretreating animals with cortisone or ACTH, as shown by Schwartzmann and Aronson, nevertheless such results should be applied with the greatest caution to the pathogenesis of the human disease, in which cytopathic changes in such extraneural tissues as kidney, muscle, skin and testis, when they occur at all, are exceptional and not part of the characteristic pathologic picture.
THE ROLE OF EDUCATION IN ACCIDENT PREVENTION
Authors: Dietrich Harry F. 
Published: December 2021

The basic problem in childhood accident prevention is one of education involving physicians, parents and children. The physician must learn more about the causes of accidents, he must also perfect his techniques of teaching parents how to assume their role in accident prevention.
The ultimate responsibility for juvenile accident prevention falls on the parents, but this should be conveyed to them in a non-frightening manner and with an assurance of possible achievement. This is possible with a theory of accident prevention which embraces a reciprocal relationship between protection and education related to age.
It is essential that parents realize the importance of parental example in the education of their children. The most stimulating educational device is supervised participation. If parental example is good and supervised experience is imaginatively conceived, then and then only can didactic instruction of the child be effective.
Finally, attention is called to the fact that here presented is a paper on accident prevention in childhood which is devoid of statistics.
A STUDY OF PLASMA VALUES OF SODIUM, POTASSIUM, CHLORIDE, CARBON DIOXIDE, CARBON DIOXIDE TENSION, SUGAR, UREA AND THE PROTEIN BASEBINDING POWER, pH AND HEMATOCRIT IN PREMATURES ON THE FIRST DAY OF LIFE
Authors: Pincus J. B. , Gittleman I. F. , Saito M. , Sobel A. E. 
Published: December 2021

Seventy-three premature infants were studied on the first day of life before fluid therapy or feedings were begun. These were divided into 3 groups according to weight. A fourth group was included in this study as a "control."
The following chemical constituents of the plasma were measured: sodium, potassium, chloride, CO2 content, total protein, urea and sugar. The blood pH and the hematocrit were also determined. The protein base-binding power was calculated. The observations were made on capillary blood obtained by heel puncture. Ultramicro-methods were used for the estimation of the various chemical constituents.
The mean concentration of potassium is significantly higher in the lowest weight group; the protein and correspondingly the base-binding power of the protein is also significantly lower in this group. The mean values for sodium, chloride, CO2, pH, sugar and urea did not vary significantly with the birth weights of the infants. While the lowest pH values were encountered in the lowest weight group, the mean did not significantly differ from group to group. The mean concentration of urea was higher in the lowest weight group but did not significantly vary with the birth weight of the infants. The mean concentration of glucose in the plasma was lowest in the lowest weight group. The hematocrit values were uniformly above normal in all groups, but the mean did not vary from group to group.
TREATMENT OF ACUTE LEUKEMIA
Authors: Burchenal Joseph H. , Murphy M. Lois , Tan Charlotte T. C. 
Published: December 2021

IN TREATMENT of acute leukemia in children, as in treatment of any form of cancer, early diagnosis is of great importance. Although in contrast to many other tumors in children, leukemia is never curable even when detected at the early stages, the sooner treatment can be initiated, the more chance there is of having sufficient time to achieve a beneficial effect. The most important single factor in making the diagnosis of leukemia is a high degree of suspicion. Patients with pains in the bones and joints, with any hemorrhagic tendency, with increased susceptibility to infection or with an unexplained anemia or fever should have an immediate determination of total and differential leukocyte count, hemoglobin, and platelets. If any abnormality is found or if the symptoms persist, a bone marrow aspiration is essential. If these procedures are utilized, it is the rare case in which the diagnosis cannot be made with relative ease.
In most cases of acute leukemia, there is almost complete replacement of the normal elements in the marrow by leukemic cells. Depression or absence of erythropoietic activity in the marrow and possibly decreased life span of the circulating erythrocytes leads to severe anemia with the accompanying symptoms of pallor, easy fatigability, and dyspnea on exertion. The decreased megakaryocytic activity in the bone marrow and the decrease of platelets in the circulating blood lead to petechiae, ecchymoses, and other hemorrhagic manifestations.
In the peripheral blood the total leukocyte count may be high, normal, or low but, as most of the cells are abnormal in type, the patient is less able to combat infection.