Showing papers in "JAMA Pediatrics in 1979"

Dietary Goals for the United States

Abstract: The announcement on Jan 14, 1977, of Dietary Goals for the United States by the Senate Select Committee on Nutrition and Human Needs' may be a turning point in the role of government in determining nutrition priorities for the American people. Before commenting on these goals and their political source, I would like to review the events that led to this controversial announcement and the events that led to its subsequent modification. Since 1968, Sen George McGovern (Democrat, SD) and his committee have been concerned with bridging the gap between the food and farm interests in the Agriculture Committee and the health, welfare, and research interests in the Labor and Public Welfare Committee. They were provided with oversight responsibilities in nutrition and initiated legislation concerned with preventing hunger. Among the accomplishments of the committee had been expansion of the food stamp program, the school lunch program, the summer food program,

Recurrent abdominal pain.

Abstract: • A long-term follow-up study (minimum of five years) of 161 children with recurrent abdominal pain disclosed that three had organic disease that was missed—inflammatory bowel disease. Anorexia nervosa developed in one patient. Three fourths of the patients recovered from the initial symptom; most recovered within a few weeks; but some patients continued to have complaints for a number of years. Approximately 20% of patients underwent additional surgical or medical treatments of doubtful necessity. In 18% of patients, other psychosomatic symptoms developed. ( Am J Dis Child 133:486-489, 1979)

US Cancer Incidence and Mortality in the First Year of Life

Abstract: Based on the Third National Cancer Survey (1969 to 1971), the incidence of malignant neoplasms in the United States was 183.4 per million live births per year in infants younger than 1 year and 36.5 in newborns younger than 29 days. In both age groups, neuroblastoma was the most commonly diagnosed neoplasm. Overall, cancer incidence in infants younger than 1 year was almost 3.5 times greater than mortality determined from US death certificates from 1960 to 1969. For individual tumor types, the ratio between incidence and mortality varied between 159 for retinoblastoma and 1.5 for leukemia largely reflecting relative differences in survival due to treatment.

Sensitivity of group A streptococci to antibiotics. Prevalence of resistance to erythromycin in Japan.

Abstract: More than 60% of all strains of group A streptococci isolated during the period from 1974 to 1975 from children with streptococcal infections in Hokkaido district, Japan, were highly resistant to erythromycin. These strains were found to be multiply resistant to lincomycin hydrochloride monohydrate, chloramphenicol, and tetracycline, and were exclusively type 12 by T-protein typing. The clinical symptoms produced by these organisms were rather mild, responded to penicillin well, and were rarely complicated with glomerulonephritis. The high prevalence of resistant group A streptococci was nationwide, which may have been related to recent excessive use of erythromycin and other macrolide antibiotics. Erythromycin can no longer be considered the drug of choice in the management of streptococcal infections in Japan. This suggests that a periodic surveillance of antibiotic sensitivity of streptococcal isolates may be necessary in other countries in which macrolide antibiotics are frequently prescribed.

Acquired Cytomegalovirus Infection in Preterm Infants

Abstract: • Small sick preterm infants requiring care in a neonatal intensive care unit for more than 28 days were cultured for cytomegalovirus in urine and/or nasopharynx during two periods lasting a total of 13 months. Sixteen of 51 such infants began excreting the virus at 28 to 148 days of age (mean, 55 days). In 14 of the 16, a recognizable, self-limited symptom complex developed that consisted of respiratory deterioration, hepatosplenomegaly, a remarkable gray pallor, and both an atypical and absolute lymphocytosis. All of the infants with the clinical symptom complex had underlying chronic lung disease and all had received multiple blood transfusions during their hospitalization. Acquired cytomegalovirus may be relatively common in sick preterm infants and should be distinguished from other causes of rapid deterioration. ( Am J Dis Child 133:482-485, 1979)

Prenatal Methylmercury Poisoning: Clinical Observations Over Five Years

Abstract: • Thirty-two infants prenatally exposed to methylmercury and their mothers were examined over a five-year period after the Iraqi methylmercury epidemic. Severity of poisoning in mothers was related to the peak mercury concentration in their hair and in the infants to the maximum concentration in maternal hair during pregnancy. In nine cases of cerebral palsy, methylmercury exposure occurred only during the last trimester. All infants except three (two were orphaned soon after birth and one was bottle-fed) were exposed postnatally via suckling. Whereas the mother's symptoms usually improved, the damage to the fetal nervous system appears to be permanent. Milder cases previously not identified in other studies are reported. The syndrome consists of varying degrees of developmental retardation in addition to exaggerated tendon reflexes and the pathologic extensor plantar reflex (minimal brain damage syndrome). ( Am J Dis Child 133:172-177, 1979)

Endocrine abnormalities in thalassemia major.

Abstract: Endocrine function evaluations in 16 patients with beta-thalassemia indicate that hypogonadotropic hypogonadism, hypoparathyroidism, and reduced adrenocorticotropic hormone reserve occur frequently, whereas reduced growth hormone and thyroid reserve are less common manifestations. Hemosiderosis-induced damage of the endocrine glands seems to be the main cause for endocrine dysfunction in the patients studied.

The nonhematologic manifestations of iron deficiency.

Abstract: Question: What disorder can produce apathy, irritability, anorexia, decreased exercise tolerance, and a craving for ice? Answer: Iron deficiency. Question: What disorder can produce angular stomatitis, glossitis, "spoon nails," and the excretion of a pink urine after the ingestion of beets? Answer: Iron deficiency. Question: What disorder can produce gastric achlorhydria, evidence of small bowel dysfunction, occult gastrointestinal bleeding, and failure to thrive? Answer: Iron deficiency. In the days of the Roman empire, medicinal iron was purported to produce "great effectes and marvelous works," as reported by Nicholas Monarde, 1 a 16th century physician of Seville, Spain. Evidence exists that, even prior to that time, iron was employed for a variety of purposes in the major civilizations of the Mediterranean area and Asia. Today we tend to equate iron deficiency with anemia. Because iron deficiency anemia is easy to recognize and easy to treat, we have tended to overlook the

Trace elements in the fetus and young infant. I. Zinc.

Abstract: Perhaps the most remarkable fact about trace elements is not their scarcity, but their abundance in the tissues of the human body. Table 1 gives the relative amounts in a baby at term of some of the substances that are thought to be essential for normal growth and development. From such data one can calculate that a full-term infant, comprising some 3.4 × 1026atoms, contains 1.4 × 1022trace element atoms. Chromium is perhaps one of the least abundant essential trace elements in the body, and yet the newborn baby contains about 3.6 × 1018chromium atoms, and even a single hepatocyte contains some 4.5 million atoms of this element. The name "trace element" is, of course, quite arbitrary and survives from the time when early investigators, with the methods then available, were experiencing great difficulties in measuring these substances in plant and animal tissues. The

Transfer of Measles, Mumps, and Rubella Antibodies From Mother to Infant: Its Effect on Measles, Mumps, and Rubella Immunization

Abstract: • Sera from 42 mother-infant pairs were examined to determine the effect of passively acquired enhanced neutralizing (ENt) antibody on immunization. The ENt antibodies to measles, mumps, and rubella were greater in term newborns than in their mothers, with a mean ratio of 1.8:1, 1.3:1, and 1.2:1, respectively. In 21% to 25% of the children, these antibodies persisted until 12 months of age. When immunized with trivalent measlesmumps-rubella vaccine, children who had persisting ENt measles and rubella titers had significantly lower mean antibody responses than children without detectable antibodies to the two viruses. Persisting ENt mumps antibodies did not affect the postimmunization titers. Seroconversion rates to any of the three viruses were not different in children with or without preexisting ENt antibody. ( Am J Dis Child 133:1240-1243, 1979)

Periodic Transfusions for Sickle Cell Anemia and CNS Infarction

Abstract: Recurrences of CNS infarction often lead to progressive neurologic disability in sickle cell anemia. To prevent such reccurrence, a periodic blood transfusion program was begun in 1969. Currently, 27 patients are on this regimen. Before inclusion in the program, 12 patients had had one to nine CNS recurrences each. Since the program was started, two patients have had transient CNS ischemia. There were no other recurrences and none of the patients have shown progression of neurologic abnormalities. In addition, there was a striking decrease in bacterial infection and pain. We conclude that periodic transfusions are effective in preventing recurrent CNS infarction in sickle cell anemia. The benefits must be weighed against the potentially serious problem of iron overload, as evidenced by moderately elevated serum ferritin values.

Errors in Drug Computations During Newborn Intensive Care

Abstract: Medical personnel in a pediatric center were tested for their ability to correctly compute drug doses for sick newborns. One of every 12 doses computed by 95 registered nurses contained an error that would result in the administration of an amount that was ten times higher or lower than the dose ordered. The error rate was no different for experienced or inexperienced nurses. The test also included an evaluation of the nurse's ability to judge the appropriateness of the drug dose ordered for a specified infant. Experienced nurses tended to be more certain, although wrong, in their judgment when compared to inexperienced nurses. Eleven pediatricians, when given the same test, scored higher than the nurses but still made errors at the rate of one of every 26 computations attempted. Five registered pharmacists who were tested demonstrated far better computational skills than either the nursing or physician group.

Birth Weight and Gestational Age in Children With Cerebral Palsy or Seizure Disorders

Abstract: • Birth weight and gestational age of single-born children with cerebral palsy (CP) and those with seizure disorders were compared with norms for 40,000 single-born children in the same prospectively identified population. Low birth-weight and short gestation were important risk factors for CP, but these characteristics were uncommon, and the majority of children with CP were of normal birth weight and term gestational age. Preterm children with CP by age 7 years tended to have been even smaller at birth than was appropriate for their short gestations. Among term infants with later CP, the birth weights of the majority were appropriate for dates, but a subgroup were noticeably small for dates at term. Low birth weight, preterm birth, and smallness for dates at term were not significantly related to the risk of seizure disorders in children free of CP. ( Am J Dis Child 133:1044-1048, 1979)

Immunological bases for superior survival of females.

Abstract: Evolutionary selection has equipped females with immunoregulatory genes on the X chromosome for coping with life-threatening illness. Five immunodeficiency syndromes occur solely in males, suggesting that they arise from mutant immunoregulatory genes located on the X chromosome. These syndromes, although rare, could contribute to poorer survival of males. Females have higher serum IgM concentrations, superior ability to form antibodies to infectious agents, and experience a lower incidence of viral and bacterial infectious diseases. Preponderance of autoimmune disorders in females could arise from modified immune responses owing to estrogens. Clinical and animal studies indicate that male hormones suppress autoantibody production whereas female hormones support their production. Superior immunocompetence and survival of females is based, in part, on their being protected from mutant immunoregulatory genes located on the X chromosome.

Zinc therapy of depressed cellular immunity in acrodermatitis enteropathica. Its correction.

Abstract: • A child with hypogammaglobulinemia and intractable diarrhea underwent parenteral alimentation for five months. A clinical syndrome of acrodermatitis enteropathica subsequently developed associated with a depression in thymus-dependent lymphocyte (T cell) numbers, abnormal T-cell mitogen-induced blast transformation, and anergy to skin test antigens. Plasma zinc levels were found to be abnormally low. Zinc therapy resulted in dramatic resolution of the clinical manifestations of acrodermatitis enteropathica. Cell-mediated immune function was also restored to normal, suggesting an important role for zinc and possibly other trace metals in cellular immune responses. ( Am J Dis Child 133:915-918, 1979)

Infancy: Its Place in Human Development

Abstract: One of the most important issues in contemporary child welfare has to do with the possible benefits and dangers of day care for infants and young children. Like so many problems facing us today, the issue of day care is enormously complex because so many different factors of unknown quantity and degree can contribute to the outcome. And, if that were not enough, we really do not know what, when, and how to measure the outcome. Unlike a laboratory problem that we can define and limit, real life social phenomena challenge our traditional conceptualizations and methodologies and plead for new methods of investigation. The issue of day care, and its impact on children, is a central concern of the two books considered here. In the first book,Infancy: Its Place in Human Development, Jerome Kagan and his colleagues describe an investigation of the effects of a day-care program in Boston's

Clinical and physiological manifestations of bronchiolitis and pneumonia. Outcome of respiratory syncytial virus.

Abstract: • The physiological abnormalities and clinical correlates of 32 infants consecutively hospitalized with lower respiratory tract disease from respiratory syncytial virus (RSV) were studied in an attempt to characterize the infant most at risk for the acute and long-term complications of RSV infection. Arterial oxygen saturation (Sao 2 ) determinations were obtained daily by means of an ear oximeter. On admission all infants were hypoxemic with a mean Sao 2 of 87% (range, 74% to 95%). The mean of the lowest Sao 2 recorded during their hospitalization was 85.5% (range, 53% to 96%). The hypoxemia improved little during hospitalization but showed improvement three to seven weeks later. The severity of the hypoxemia correlated significantly with the duration of viral shedding, occurrence of apnea, respiratory rate, age, and percentage of immature neutrophils. Clinical severity did not correlate with the degree of hypoxemia. ( Am J Dis Child 133:798-802, 1979)

Demineralization in cystic fibrosis detected by direct photon absorptiometry.

Abstract: • Bone mineral content, bone width, and their ratio were measured in patients with cystic fibrosis (CF) using monoenergetic photon absorptiometry. Serial measurements of the radius and ulna were made in 27 patients with CF and were compared with 968 age-matched controls. Demineralization was found in 37% of the boys and 63% of the girls. Patients under age 10 years had normal bone mineral content and nine of 15 patients aged 13 or older were demineralized ( P P ( Am J Dis Child 133:632-635, 1979)

Breast Milk Immunology: A Frontier in Infant Nutrition

Abstract: There has recently been renewed interest in the unique protective properties of breast milk. A part of this interest has focused on the immunocompetent cellular components and has followed the reports of colostrum halting otherwise uncontrollable epidemics of newborn Escherichia coli diarrhea 1,2 and its content of specific substances that neutralize both cholera and E coli enterotoxin. 3,4 The specific antitoxin seems to be secretory IgA (SIgA), which is the only immunoglobulin synthesized in vitro by human milk B-lymphocytes. 5,6 Additional interest in breast milk has been generated by the observation that colostral feeds stimulate growth and maturation of intestinal mucosa in beagle puppies 7 and that higher concentrations of SIgA develop in breast-fed infants in their salivary and nasal secretions in the first four days of life than do bottle-fed infants. 8 Thus, the complex interactions of breast milk constituents resulting in the immunoprotection, development, and maturation of the

Influenza A virus associated with acute encephalopathy.

Abstract: • During the period of February 1972 until February 1976, we documented six cases of influenza A-associated acute encephalopathy. The illnesses occurred during periods of influenza A activity in our community. The encephalopathy was invariably preceded by an upper respiratory tract infection, and, thereafter, patients soon became confused, vomited, and showed noticeable restlessness. Patients then followed either of two courses, some becoming comatose within 24 hours and others improving rapidly within three days or less. None of these patients exhibited the hepatic and biochemical abnormalities associated with Reye's syndrome. All patients survived but some had sequelae. The syndrome of influenza-associated acute encephalopathy deserves wider recognition. (Am J Dis Child133:822-824, 1979)

Contemporary Issues in Bioethics

Abstract: A new field of study creates the need for teaching material, and this anthology fills a crucial need. Bioethics, medical ethics, or philosophy of medicine (different names are used) is a new academic discipline. A decade ago, few medical or undergraduate schools offered courses in this area, but today it is rare to find one that has no such program of study. At least three reasons can be given for the extraordinary growth of this interdisciplinary field. First, controversy or call for policy change occurred from within the medical profession itself. For example, current federal regulations regarding consent are easily traced to physicians, such as Henry Beecher, who documented instances of patient and subject abuse even at prestigious institutions in this country. Second, new technologies such as ventilators and dialysis machines lead to controversy about what new policies needed to be formulated and defended; it was clear they were needed.

Infantile Atlantooccipital Instability: The Potential Danger of Extreme Extension

Abstract: • During early infancy, adventitious sliding and slipping movements between the vertebral column and skull are possible in the cadaver. In ten of 17 infants, the posterior arch of the atlas inverted through the foramen magnum during extension of the head on the atlas, resulting in the anatomic potential of bilateral vertebral artery compression. These anatomic conditions may be the basis for a chain of events that contributes to death in some neonates and infants with conventional diseases and may be one source of unanticipated death. ( Am J Dis Child 133:30-37, 1979)

Penicillin-insensitive pneumococci. Case report and review.

Abstract: • Infections due to pneumococci with decreased susceptibility (or resistance) to penicillin have been infrequently recognized. Our experience and that of others suggest that (1) penicillin susceptibility testing of significant pneumococcal isolates should become routine; (2) penicillin may not be adequate therapy for CNS infections due to pneumococci whose penicillin minimal inhibitory concentration is > 0.1 μg/ml; and (3) long-term penicillin "prophylaxis" may be inappropriate in the splenectomized patient in areas where these organisms are prevalent. ( Am J Dis Child 133:187-191, 1979)

The cutaneous manifestations of child abuse and neglect.

Abstract: • The most easily recognizable physical manifestations of child abuse and neglect are seen in the skin. The findings may be the result of intentional trauma, neglect to provide adequate child care, alterations in family dynamics, or the emotional problems secondary to the maltreatment. ( Am J Dis Child 133:906-909, 1979)

Cardiovascular Disease Risk Factor Variables During the First Year of Life

Abstract: • Cardiovascular risk factor variables were measured in a cohort of 440 infants at birth, 6 months, and 1 year of age. Blood pressures at 6 months of age were 93/47 mm Hg (systolic/diastolic pressure, fourth phase) and 97/51 mm Hg at 1 year of age. Serum total cholesterol, β-lipoprotein, and α-lipoprotein levels rose dramatically from birth to 1 year of age. Serum triglycerides also showed an increase from birth to 6 months of age, but a decrease from 6 months to 1 year of age. At 6 months of age, the infants were consuming 949 kcal and at 1 year, 1,356 kcal. A statistically significant correlation between serum cholesterol level and protein, fat, cholesterol, and carbohydrate intake was noted at 1 year of age. These observations provide a background for tracing the evolution of risk factor variables as part of the early natural history of arteriosclerosis. ( Am J Dis Child 133:1049-1057, 1979)

Cholelithiasis in children with sickle cell disease.

Abstract: • A group of 47 children with homozygous sickle cell disease ranging in age from 2 to 18 years was studied for the prevalence of gallstones. All of these patients had oral cholecystogram and cholecystosonogram. Eight of the 47 patients (17%) had gallstones both on oral cholecystography and on cholecystosonography. These eight patients had a history of recurrent abdominal pain usually localized to the right upper quadrant. All were admitted on several occasions for sickle cell abdominal crises and four of these were admitted for acute hepatic crisis. These patients have undergone elective cholecystectomy and gallstones were found in every patient. The patients have been followed up from seven to 17 months after cholecystectomy and none have had abdominal symptoms or required hospitalization for abdominal crises. ( Am J Dis Child 133:306-307, 1979)

Risk of nutritional rickets among vegetarian children.

Abstract: • Records of the dietary intake of 52 preschool vegetarian children seen from 1974 to 1976 revealed that macrobiotic vegetarian diets provided amounts of vitamin D, calcium, and phosphorus that were marginal as well as less than the amounts provided by other vegetarian diets. Vitamin D supplements were rarely given. Two subjects had roentgenographic evidence of rickets. The medical histories of 32 children on macrobiotic diets who were examined in 1977 more frequently included prior physical and roentgenographic findings indicative of rickets, whereas those of 17 other vegetarian children did not. Children in the former group were more likely to have elevated levels of serum alkaline phosphatase. Two additional cases of rickets in children consuming a macrobiotic diet confirmed by roentgenograms were brought to our attention during the study. ( Am J Dis Child 133:134-140, 1979)

Wormian bones. A marker of CNS abnormality

Abstract: • The present investigation was undertaken to determine the incidence and significance of Wormian bones (WBs) in a random group of infants and children seen at the Jewish Hospital Medical Center of Brooklyn. Ninety-one (17%) of 515 infants and children were found to have WBs; 82 of these children (90%) had a gross disorder of the CNS and five (6%) had the so-called minimal brain dysfunction syndrome. In the remaining four patients, the data and follow-up are incomplete. Three of these did have developmental anomalies of other organ systems. Thus, the presence of WBs is almost invariably associated with abnormal development of the CNS and may serve as a useful marker for the early identification and treatment of the affected infant or child. (Am J Dis Child133:380-382, 1979)

Dientamoeba fragilis: An Intestinal Pathogen in Children?

Abstract: • A retrospective study was conducted of 35 children in whomDientamoeba fragiliswas the only parasite found in the gastrointestinal (GI) tract. Gastrointestinal symptoms were present in 32 (91%) of these children; diarrhea was the most common finding in patients with acute symptoms, whereas abdominal pain was more common in children with chronic symptoms. Peripheral eosinophilia was present in half of the children examined and was statistically more significant in patients withD fragilisthan in a control group of children admitted for elective surgery. Therapy with diiodohydroxyquin or metronidazole was effective; children's symptoms were diminished or were eliminated on follow-up evaluation after treatment. From this association between therapy and symptomatic relief,D fragilisshould be considered pathogenic in those children with GI symptoms. (Am J Dis Child133:390-393, 1979)

Diagnosis and management of infant botulism.

Abstract: • Infant botulism is a widespread and long-extant infectious disease that was only recently recognized as a distinct entity. By examining the original and, in retrospect, incorrect diagnoses of some of the early cases, this report distinguishes those clinical features that may now permit the correct diagnosis of presently occurring cases. In addition, detailed suggestions for the management of infant botulism, derived from experience with a total of 50 proven hospitalized cases, are presented. ( Am J Dis Child 133:586-593, 1979)