bluuebunny/crossref_metadata_2025_split huggingface dataset:
ANAEROBIC METABOLISM IN THE NEWBORN INFANT
Authors: WILSON JAMES L. , REARDON HELEN S. , MURAYAMA MAKIO 
Published: December 2021

EVIDENCE of a form of metabolism in which less oxygen per unit of energy is used in the fetus and newborn than in older animals has been recognized for some time. An "anaerobic" metabolism leading to the traditional "oxygen deficit" in muscle activity is well established. The purpose of this preliminary communication is to review published observations bearing on this point and to add some of our own that indicate the existence of a similar metabolism in human young, and to discuss its practical significance. In subsequent reports we hope to follow up these studies.
The discussion will be concerned with three general topics: (1) Direct observation of resistance of newborn animals to anoxia. (2) Studies of acidosis in normal premature and full term infants. (3) Observations of the effect of oxygen on the respiratory pattern of premature infants.
RESISTANCE OF NEWBORN ANIMALS TO ANOXIA
Selle and Witten, and Thoms and Hiestand, have shown that survival of the primitive respiratory center in decapitated rats and mice is retained much longer by the anoxic newborn than by the older animal. The heads of young rats under five to six weeks of age showed a persistence of gasping for 20 to 40 minutes in anaerobic conditions while those older than five to six weeks had lost this ability.
Fazekas, Alexander, and Himwich studied adults, infants, and fetuses in utero of various animal species under conditions of oxygen lack. Nitrogen, helium, and other gases were used to produce partial or complete displacement of oxygen from the respired atmosphere. Their observations reveal that mature animals survive after breathing undiluted nitrogen for approximately three minutes, while the average survival time for a newborn animal was as follows:[see table in source pdf].
They conclude, first, that there is a greater tolerance to oxygen lack in the young than in the adult of the same species, and second, that the difference in survival time between newborn of different species is due to their difference in maturity at birth.
These workers used sodium fluoride and sodium iodoacetate as enzyme poisons to interrupt the carbohydrate breakdown series, presumably at the phosphoglyceric acid and triosephosphate levels. Table I shows the results of their experiments on the survival time of newborn rats under various conditions.
RESPIRATORY PATTERNS IN NEWBORN INFANTS AS DETERMINED BY AIRFLOW AND PNEUMOGRAPHIC STUDIES AND THEIR POSSIBLE RELATIONSHIP TO A DEFICIENT VAGAL MECHANISM
Authors: MILLER HERBERT C. , BEHRLE FRANKLIN C. 
Published: December 2021

Pneumographic tracings of the movements of the upper chest, lower chest and abdomen have been recorded individually and simultaneously with the velocity of air flow by means of electronic equipment in 70 newborn infants. A total of 114 recordings were made on infants from zero to 49 days of age and with birth weights of 1000 gm. or more. Most infants during the first 24 hours after birth had a respiratory pattern in which the inspiratory and expiratory movements of the upper chest, lower chest and abdomen were parallel and tended to be synchronous. In a few infants at birth and in most older infants this respiratory pattern was modified. The modification consisted in the lower chest tending to move in a direction opposite to that of the abdomen and upper chest.
The theory has been advanced that diaphragmatic breathing, which is so characterisitc of older infants, is not completely established at birth except in a few infants who perhaps are more mature. In the more mature infant, contraction of the diaphragm probably exerts a pull on the lower chest, causing its indrawing during inspiration. It has been suggested that inability to develop adequate diaphragmatic contractions may be an important factor in the many neonatal deaths that occur in the first few days of life. It has been pointed out that the newborn infant may have a poorly developed vagal mechanism and that this may be one of the factors causing diaphragmatic activity to be inadequate. Observations on three infants who died during the first 48 hours of life are reported which tend to support the theory that vagal deficiency is a possible cause of inadequate diaphragmatic activity, pulmonary hyaline membranes and neonatal death.
LABORATORY AND CLINICAL STUDIES IN CONGENITAL METHEMOGLOBINEMIA
Authors: WAISMAN HARRY A. , BAIN JAMES A. , RICHMOND JULIUS B. , MUNSEY FRANKLIN A. 
Published: December 2021

Congenital idiopathic methemoglobinemia in a 12 year old boy was corrected by the administration of either ascorbic acid or methylene blue, the latter being more efficient.
The oxygen dissociation curve was normal but as would be expected the oxygen-carrying capacity of the blood was increased after methylene blue was given. Arterial oxygen saturation was determined by an oximeter to demonstrate the increased oxygen-carrying capacity after methylene blue.
Para-amino propriophenone administration caused an increase in methemoglobin level but not to the maximum value for this patient. Sodium nitrite by mouth did give the maximum level.
Enzyme studies revealed no difference in oxygen uptake of hexosediphosphate either with or without methylene blue in normal or methemoglobinemic cells in a medium which contained glucose.
No "cytochrome-reductase like" activity was demonstrated in the methemoglobinemic cell.
No definitive evidence exists to support the belief that reduced co-enzyme I reacts directly with methemoglobin in normal cells.
Round Table Discussion
Authors: DIAMOND LOUIS K. , ALLEN FRED H. , VANN DOROTHEA D. , POWERS JOHN RAY 
Published: December 2021

Chairman Diamond: Erythroblastosis fetalis is a variable disease, ranging in severity from fetal death in utero to a disturbance so mild as to be unrecognizable except by delicate laboratory tests. Intrauterine death is the greatest source of fetal loss. The development of kernicterus is the most important cause of unfavorable result in untreated liveborn babies. The use of exchange transfusion has resulted in the recovery of most liveborn babies, and has nearly eliminated kernicterus in a clinic where it has been used liberally.
Etiology
Erythroblastosis fetalis occurs as a result of fetal-maternal blood group incompatibility. Table 1 shows the most important blood group factors known at present. In Column I are the common names of the various genetically and serologically independent families or "systems" of blood group [See Table 1 in source pdf] factors. In Column II are shown those factors which may cause transfusion reactions or, presumably, erythroblastosis fetalis (although e, N, and Fya have not yet been reported as causes of erythroblastosis). The blood group factors in Column III seem not to cause clinical difficulties. At least 80% of cases of erythroblastosis fetalis are caused by "Rh" (D) incompatibility. Although D is an effective antigen, as judged by the fact that at least 75% of D-negative ("Rh-negative") individuals are sensitized by transfusion of D-positive blood, only 5% of families in which the mother is D-negative and the father D-positive ever have erythroblastotic babies. A and B, which are presumably even more effective antigens than D. cause less than 20% of the cases of erythroblastosis, although 35% of matings are incompatible for A or B.
Round Table Discussion
Authors: OSBORNE EARL D. , ROSS JOHN R. , WRONG NORMAN M. , MCKEE WALTER C. , FRAUENBERGER GEORGE S. 
Published: December 2021

Chairman Osborne: The material which we will cover will be material which must be spoken about in terms of groups of people, types of individuals and different classifications of diagnosis. We will lose a great deal of the effect of what we have to discuss if we get off on a small subject connected with an individual case, so I hope we can refrain from citing specific cases. You all recognize that we can't make progress if any of us are going to present specific individual problems on a specific case.
Fortunately we have some disagreement among members of the panel for where everyone agrees there is a lack of interest, especially in the field of cutaneous diseases, and particularly in the eczematous diseases. If we seem to disagree it is because the material calls for disagreement and the literature backs us up on that disagreement.
We are going to start with the general phase of the subject: the care of the skin of the newborn. I am going to ask Dr. Norman Ross to discuss the care of the skin of the newborn from the standpoint of the pediatrician.
Dr. Ross: In these newborn infants overzealous cleaning of the baby and too much anxiety on the part of the nurse following birth is apt to do far more harm than good. The baby when born has a membranous covering that should not be too thoroughly and vigorously removed. Soap is not advisable. Plain water will remove sufficient of it and, in fact, delay of thorough bathing of the infant for a few days would probably be advisable.
Round Table Discussion
Authors: DORFMAN ALBERT , ROTHMAN STEPHEN , POTTS ALBERT , BACON J. E. , HARPER EDWIN A. 
Published: December 2021

Chairman Dorfman: We thought that this subject was so broad and had so many ramifications that an attempt at complete coverage would result in nothing but a listing of the diseases in which ACTH and cortisone have been used. Therefore, it would seem instead worth while to consider general problems relating to ACTH and cortisone and then proceed to a discussion of a limited number of diseases. It is going to be difficult for us to give an expert opinion on every possible phase of this subject.
We should consider first of all: (1) What type of therapy these drugs represent and (2) how the effects observed relate to the pathogenesis of the diseases in question. When the announcement of the effect of ACTH and cortisone was made in 1949, they were heralded widely by many people as a new approach to the disease state and consequently these agents were studied in a wide variety of apparently unrelated diseases. Originally there was great enthusiasm. I can recall attending the first Armour conference; it was more like attending a meeting of a mystic cult than a scientific meeting. Everybody arose and shouted, "I, too, have seen the miracle!"
Since that time investigators have come to a more careful assessment of the usefulness of these drugs. We now are in the process of a swing toward a more pessimistic viewpoint, with some people saying, "they are not any good for anything, they are just poison and shouldn't be used at all." Most people who have thought about the problem feel that the truth lies somewhere between the extremes. ACTH and cortisone are not effective in all diseases.
CHANGING PATTERNS OF RESPIRATION IN NEWBORN INFANTS
Authors: MILLER HERBERT C. , BEHRLE FRANKLIN C. 
Published: December 2021

The respiratory activity of quiet and sleeping healthy infants has been studied by pneumographic tracings and by clinical observations. Four successive stages of respiration have been described through which all healthy, full term newborn infants pass.
The first stage is concerned with the establishment of postnatal respirations and lasts for a few minutes following birth.
The second stage lasts from several hours to a day or more. Respiratory activity is characterized by a wide range of rates, a regular rhythm and a single respiratory pattern, to which the term "synchronous" has been given. The term is based on the fact that all parts of the chest and abdomen expand and contract together in an easy, smooth and regular fashion. Any signs of chest retraction indicate that the infant either is not well or has passed into the third stage.
The third stage lasts several days or weeks. Infants in this stage exhibit rapidly fluctuating rates, variable rhythms and a wide variety of respiratory patterns. Two of the common patterns seen in this stage have been given the terms "simple retraction" and "see-saw." In simple retraction the lower end of the sternum and adjacent costal margins are pulled inwards as the abdomen and upper chest expand. In "see-saw" breathing the whole anterior chest wall is pulled inwards and downwards as the abdomen expands. There is much shifting back and forth from one pattern to another.
The fourth stage begins several weeks after birth and is characterized by a return to more stable rhythms and respiratory patterns. All previous bizarre patterns have disappeared leaving "synchronous" and "simple retraction" as the only patterns of breathing.
The same four stages of respiration have been identified in a small group of surviving premature infants.
Knowledge of these stages has made it possible to give a more accurate prognosis during the first 24 hours of life on the infant's chances for survival The absence of retraction during stage 2 has been associated with an excellent prognosis for the infant. The presence of any degree of retraction in the first 24 hours of life, except as it may occur in the first few minutes after birth, has been associated with serious illnesses in the infants in the small series of cases observed to date.
Factors which might explain the presence of stages 2, 3 and 4 have been explored only partially. One of the factors involved in the change from stages 2 to 3 is the increasing vigor of diaphragmatic contractions.
STUDIES OF THE IMMUNOLOGY OF THE NEWBORN INFANT
Authors: DANCIS JOSEPH , OSBORN JOHN J. , KUNZ HANS W. 
Published: December 2021

The antibody response of premature infants immunized at birth with a single injection of diphtheria toxoid was compared to that of a group of term infants similarly immunized. No significant difference was demonstrated.
A group of premature infants was immunized about the time that was estimated to be their normal birth date and the antibody response compared to that of term infants at birth. The performance of the premature infants was superior to that of the term infants.
The significance of these findings is discussed.
LYMPHOID HYPERPLASIA OF THE APPENDIX
Authors: NATHANS ALFRED A. , MERENSTEIN HYMAN , BROWN SAMUEL S. 
Published: December 2021

One hundred ninety-eight cases of lymphoid hyperplasia of the appendix, some of which had other associated pathology, have been analyzed.
Comparison has been made with an analogous series of acute appendicitis in children.
There is no precise differential diagnosis between acute appendicitis and lymphoid hyperplasia of the appendix. Each case has to be watched carefully, and any increase in local signs is an indication for surgery.
Lymphoid hyperplasia is frequently the precursor of acute appendicitis.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: TURNBLADH WILL C. 
Published: December 2021

INCREASINGLY, in recent years, pediatricians have been called on to work with the problem of juvenile delinquency. Published statistics on crimes and antisocial activities by children have sometimes been frightening, and loose remarks are often made about drastic remedies being needed to "curb" modern youth. In such a situation, parents naturally turn to their physicians for advice and counsel.
Within the community pattern of the attack on juvenile delinquency, the "juvenile court" has a central role. If the ignorance of this editor is any index, pediatricians, in general, know little of the structure, responsibilities, jurisdiction, community relationships, and standards of juvenile courts. It is, for example, both revealing and reassuring to learn that ". . . the court stands in the position of a `protecting parent' rather than a prosecutor. . . ."
The National Probation and Parole Association, a nonprofit citizen and professional organization with professional and technical staff, seeks to extend and improve probation and parole services for both children and adults throughout the country, to promote juvenile and domestic relations courts and to develop specialized facilities and programs for the detention of children. At the request of the editor, Mr. Will C. Turnbladh, Executive Director of the Association, has prepared the following interesting and informative article on the background and some of the problems of juvenile courts.
PYRIDOXINE DEPENDENCY: REPORT OF A CASE OF INTRACTABLE CONVULSIONS IN AN INFANT CONTROLLED BY PYRIDOXINE
Authors: HUNT ANDREW D. , STOKES JOSEPH , MCCRORY WALLACE W. , STROUD H. H. 
Published: December 2021

A case of convulsions in an infant requiring pyridoxine for their control has been described. On oral dosage of pyridoxine 2 mg./day, seizures have now been controlled for 21 months, with no increase in dosage being required. A continuing need for pyridoxine is demonstrated by the recent reappearance of seizures following a short lapse of pyridoxine administration.
In the absence of biochemical evidence of pyridoxine deficiency, as measured by xanthurenic acid excretion following a tryptophane load, and with meager clinical evidence for the complete picture of such deficiency, the authors prefer to designate this phenomenon "pyridoxine dependency" The hypothesis has been propounded that this infant suffers a metabolic anomaly in pyridoxine metabolism resulting in convulsions in the absence of regular dietary pyridoxine supplements.
EVALUATION OF THE SKELETAL AGE METHOD OF ESTIMATING CHILDREN'S DEVELOPMENT
Authors: MAINLAND DONALD 
Published: December 2021

An observer's variable error in skeletal age assessment of hand RGs (i.e., the irregular ion between independent readings of the same film) was studied on 1,124 readings of 326 films from 233 children aged 16 months to 17 years. seventy-nine of the RGs were full-size reproductions in Macyr's Nutrition and Chemical Growth in Childhood; the remainder were actual films of children in Halifax, Canada (healthy Orphanage residents and children examined in a nutrition survey).
There was no significant difference in variable error associated with the atlas (Todd, Greulich-Pyle), age of child, sex, differences between skeletal and chronologic age, differences between children, or differences between RGs of the same child, except for a tendency in the Macy Series for the poorest reproductions to have a larger variable error than the best reproductions. ions. In most readings the individual indicators were assessed separately and the results averaged, but a quicker method (over-all appraisal) did not produce a significantly different variable error. The quick method may be useful in large surveys, although it appears too coarse for the study of individual children.
The observer's variable error was expressed by standard deviations of approximately three months (Macy Series—both atlases; Nutritirn Series—Greulich-Pyle atlas) and four months (Orphanage Series—both atlases). With a standard deviation of three months an assessor must affix an error of ± 8.3 months to his estimate of a child's progress in skeletal age, in order to obtain confidence limits with 95% probability. If his standard deviation is four months he must allow ± 11.1 months. For evaluation of the assessment method, many observers' estimates of variable error are needed, and an appeal for data is issued.
After more than 1200 readings had been made the observer's practice lapsed for about a year. Reassessment of a random sample of RGs then showed, besides variable error, a mean systematic difference of approximately three months from the previous readings of the same films with the same atlas. To avoid this risk, any two films that are to be assessed for skeletal progress should be read within a few weeks of each other, and special precautions are therefore necessary to secure independence of the two readings.
CONGENITAL HYPOPLASTIC ANEMIA
Authors: BURGERT E. OMER , KENNEDY ROGER L. J. , PEASE GERTRUDE L. 
Published: December 2021

Peripheral blood values and the results of bone marrow studies in 12 children suffering from congenital hypoplastic anemia are presented. In these cases the erythrocyte counts were more than 1,000,000 cells below normal, the values for hemoglobin were more than 1 gm. below normal, and the total leukocyte counts were within the range of normal except in two cases. The differential leukocyte counts showed lymphocytosis (50 to 90.5%). The mean percentage for reticulocytes was 0.3, and the platelet counts ranged from 71,000 to 409,000, except in two instances.
Studies of bone marrow concentrations in six children showed a decreased myeloiderythroid layer. In 10 children differential counts of 1,000 nucleated cells in the marrow showed decrease of the percentages for normoblasts, with a range from 1.2 to 13.8 and a mean of 3.7. Myelopoiesis was fairly active, percentages for myeloid cells ranging from 32.5 to 63.4 with a mean of 46.4. The percentages for lymphocytes were increased with a range from 30.6 to 63.6 and a mean of 48.5. Maturation of the normoblasts blasts was arrested at the polychromatic stage. The myeloid-erythroid ratio was greatly increased, with a range from 4:1 to 43:1 and a mean of 19:1.
In the 12 children of this series the onset was before 15 months of age. There was a familial incidence of the disease in three cases. The anemia recurred every 3 to 8 weeks as long as the hypoplasia persisted, and transfusions provided the only means of controlling the anemic state. Nevertheless, most of these children grew, developed normally, and carried on normal activities. Sponstaneous remissions occurred in five. The duration of these remissions at the time of the last reports ranged from 20 months to approximately 8 years.
OBSTRUCTIVE JAUNDICE IN INFANTS WITH NORMAL BILIARY TREE
Authors: HARRIS RUTH C. , ANDERSEN DOROTHY H. , DAY RICHARD L. 
Published: December 2021

Of 50 infants with persistent signs of biliary obstruction, not atresia, seen in the past 7 years, 16 had preceding hemolytic disease from ABO or Rh-incompatibility and 3 had acquired hemolytic anemia. One infant had probable serum hepatitis and 30 others had hepatitis of unknown etiology. All had a patent external biliary tract.
Clinically these patients had jaundice, light stools and dark urine. All appeared in a good state of nutrition except those with hepatitis of unknown cause. The results of laboratory studies have been similar in these patients and have included a high direct serum bilirubin, usually negative cephalin flocculation, frequently elevated zinc sulfate turbidity and low cholesterol esters. The urine urobilin may be absent or increased in amount.
Histologic studies of liver have shown the presence of multinucleated giant liver cells, much myelopoiesis and erythropoiesis, plugging of bile canaliculi and mild bile duct proliferation. Large amounts of yellow pigment have been found within the liver cells but this pigment has not taken the usual iron stains. Livers from patients with hepatitis of unknown etiology have shown more evidence of inflammation, cell necrosis and portal fibrosis than the others.
Pertinent laboratory studies to help differentiate these cases from biliary atresia have included determinations of serum bilirubin, zinc sulfate turbidity, cholesterol and cholesterol esters and urine urobilin. Studies of maternal and infant blood factors and search for evidence of agglutination and increased production of erythrocytes are also important. Tests not found to be useful in differentiation are cholesterol esterase, alkaline phosphatase and prothrombin time.
If diagnosis is impossible from clinical and laboratory information, exploration of the biliary tract with liver biopsy and diodrast cholangiography may be necessary. This procedure should be delayed until an adequate period of observation has elapsed and until the infant is over 4 months of age. Such a delay may result in spontaneous clearing of the jaundice with complete recovery.