scispace - formally typeset
Search or ask a question

Showing papers in "Pediatrics in 1966"


Journal ArticleDOI
TL;DR: Charts of intrauterine growth in length, weight-length ratio and head circumference as estimated from liveborn measurements are presented to permit the identification of infants with unusual intrauterne growth patterns.
Abstract: Charts of intrauterine growth in length, weight-length ratio and head circumference as estimated from liveborn measurements are presented. These, in conjunction with intrauterine weight charts, permit the identification of infants with unusual intrauterine growth patterns.

1,064 citations


Journal ArticleDOI
TL;DR: There was significant elevation of levels of γG-, γA-, and total γ-globulins, and diminution of that ofγM in the serum of mongols over 10 years of age, and the diminutions may be implicated in the poor response of m Mongols to immunizing antigens and the increased susceptibility of such patients to infections.
Abstract: Immune globulins in sera of normal persons of various ages were quantitated by a radial diffusion technique; the levels changed considerably with age, especially during early infancy. Adult levels (γG 1158 ± 305, γM 99 ± 27, and γA 200 ± 61 mg/100 ml) generally were attained by 16 years of age. In all specimens of umbilical cord serum the level of γG was similar to that of adult serum and a trace quantity of γM (mean 10 mg/100 ml) was present; in one-third there was a trace amount of γA-globulin. The level of γM increased rapidly after birth but synthesis of γG and, especially, γA was delayed. Because of these normal alterations, it is recommended that specimens of serum be compared with those of age-matched control subjects for optimal evaluation. There was significant elevation of levels of γG-, γA-, and total γ-globulins, and diminution of that of γM in the serum of mongols over 10 years of age. The diminution of γM may be implicated in the poor response of mongols to immunizing antigens and the increased susceptibility of such patients to infections. Mongols may have a genetic instability of immune globulin synthesis analogous to their abnormality of leukopoiesis. Patients with sex chromosome abnormalities or trisomy 18 syndrome had normal levels of immune globulins, whereas those with neutropenia had elevated levels of all immune globulins. Abnormal levels determined in 12 cases of antibody deficiency diseases are presented.

557 citations


Journal ArticleDOI
TL;DR: An experimental and ecologic study concerned with estimating some of the effects which malnutrition in early childhood may have upon neurointegrative functioning finds that protein deficiency may result in structural lesions of the nervous system.
Abstract: IN THIS MONOGRAPH we report the results of an experimental and ecologic study concerned with estimating some of the effects which malnutrition in early childhood may have upon neurointegrative functioning. In particular, we have been concerned with the association between malnutrition early in childhood and intersensory organization in children during the school years. A study of these relationships has derived from a concern with the possibility that inadequate food intake, particularly as represented by protein-calorie malnutrition, affects not only stature and weight, but also the capacity to learn. If this is indeed the case, then the significance of the observable and dramatic consequences of malnutrition for physical stature may be but one visible sign of functionally, perhaps, far more important non-visible handicapping. Findings on the effects which malnutrition has on the central nervous system suggest strongly that protein deficiency may result in structural lesions of the nervous system. Animals experimentally deprived are persistently delayed in achieving simple developmental landmarks, appear to be less adequate in environmental responsiveness and slower in learning as well as poorer in the retention of that which has been learned than normal controls. Considering the animal experiments and the findings in humans as a unit, one is led to be concerned with what in an ecologic sense could be called a "spiral" effect. A low level of adaptive capacity, ignorance, social custom, infection, or environmental paucity of foodstuffs appear to result in malnutrition which may produce a large pool of individuals who come to function in suboptimal ways.

293 citations


Journal ArticleDOI
TL;DR: To the extent that a single book can crystallize a field and create a new subspecialty, Schaffer's Diseases of the Newborn has done just that.
Abstract: To the extent that a single book can crystallize a field and create a new subspecialty, Schaffer9s Diseases of the Newborn has done just that. The time was ripe with the rapid accumulation of knowledge concerning newborns and with individuals here and there beginning to devote their chief attention to neonates. There were in existence excellent handbooks on premature care, at least one fine book on the physiology of newborns, and another on the pathology of newborns.

234 citations


Journal ArticleDOI
TL;DR: The case histories of 29 infants in whom purulent meningitis developed during the first month of life were reviewed in this paper, showing that the inflammatory reaction was essentially limited to the spinal fluid pathways and their contents, a wide-spread, at times devastating, non-infectious encephalopathy occurred in every case.
Abstract: The case histories of 29 infants in whom purulent meningitis developed during the first month of life were reviewed. There was a high incidence of maternal perinatal infections, and identical organisms were frequently isolated from both the mother and offspring. Gram-negative intestinal organisms were the most frequent etiologic agents. Because signs suggesting meningeal and nervous system involvement developed only late in the course of the illness, the diagnosis was frequently not made until the spinal fluid was examined. The course of the illness was usually fulminant; death occurred within 4 days from the onset of symptoms in the majority of infants. Of the five infants who recovered from the meningitis, four died from neurologic complications within a few months. Postmortem examinations were performed on 25 infants. Although the inflammatory reaction was essentially limited to the spinal fluid pathways and their contents, a wide-spread, at times devastating, non-infectious encephalopathy occurred in every case. Our observations emphasize the paucity and subtlety of the clinical manifestations of meningitis in the neonate and the remarkably high mortality that seems to be little influenced by standard methods of therapy. The pathological features of a meningitis in the newborn are similar to those in the more mature individuals, except for the sparsity of lymphocytes in the subacute stage of the meningeal reaction, the prominence of bacteria in the meningeal exudate long after appropriate antibiotics have been employed, and the high frequency of sequelae in the survivors. The sparsity and delay in appearance of lymphocytes and plasma cells in the inflammatory response may be an important factor in the inadequate defense of the newborn to this infection.

211 citations


Journal Article
TL;DR: In this paper, skeletal anomalies of the lower extremities and lower spine have been observed in infants of diabetic mothers, and Maternal diabetes may play a role in the etiology of these malformations.
Abstract: Skeletal anomalies of the lower extremities and lower spine have been observed in infants of diabetic mothers. Forty-three such cases have been collected from the literature. Maternal diabetes may play a role in the etiology of these malformations.

169 citations


Journal ArticleDOI
TL;DR: The problem of chronic upper airway obstruction caused by tremendously enlarged tonsils and adenoids in children warrants further investigation and more widespread recognition as being potentially dangerous from cardiorespiratory standpoints.
Abstract: Partial airway obstruction and respiratory abnormality due to enlargement of tonsils and adenoids is a well-recognized clinical entity, but the cardiorespiratory changes which severe chronic obstruction may cause have not been widely documented. Four patients with severe nasopharyngeal obstruction have been observed to have cardiorespiratory complications ranging from moderate cardiac enlargement and right ventricular hypertrophy to cor pulmonale and pulmonary edema. Hemodynamic studies showed swings in pulmonary artery and aortic pressures; pCO2 was varyingly elevated in arterialized capillary blood. It is believed that hypoxia leads to increased pulmonary resistance and elevated pulmonary artery pressure which, over a period of months, results in right heart hypertrophy and failure. Furthermore, hypoxia may contribute to the development of pulmonary edema in a manner similar to that which occurs at high altitudes. Wide swings in intrathoracic pressure also probably played an important role in the etiology of pulmonary edema. Individual susceptibility to hypoxia and pressure changes is suspected to be an important etiologic factor. The problem of chronic upper airway obstruction caused by tremendously enlarged tonsils and adenoids in children warrants further investigation and more widespread recognition as being potentially dangerous from cardiorespiratory standpoints.

165 citations


Journal ArticleDOI
TL;DR: In this paper, the difference between the data on cortisol production and urinary excretion is accounted for by the utilization of different pathways for metabolic disposal of cortisol in newborn infants less than five days of age.
Abstract: Newborn infants less than five days of age secrete more cortisol per meter square of body surface area than do older infants, children, and adults. However, their urinary 17-hydroxycorticosteroids corrected for surface area are lower than those of infants 5-20 days of age. The difference between the data on cortisol production and urinary excretion is accounted for by the utilization of different pathways for metabolic disposal of cortisol. Between birth and age 5 days, vaginally delivered and cesarean section babies produce similar amounts of cortisol (18.7 ± 3.7 and 17.2 ± 5.8 mg/M2/24 hr, respectively). When corrected for body surface area, the CPR of 20 subjects 4 months to 20 years of age and of 28 subjects 21 to 48 years of age fell in a similar range, the mean and standard deviation for the 48 individuals being 11.8 ± 2.5 mg/M2/24 hr.

163 citations


Journal ArticleDOI
TL;DR: The purposes of this are paper are to review the clinical problem which led to re-examination of the role of the spleen in immunity, particularly, as it relates to the early development of the immune mechanism, and to offer a hypothesis which may explain the clinical observation of overwhelming infection after splenectomy in the young infant.
Abstract: IN VIEW Of the success of splenectomy in dealing with certain clinical problems, and the lack of any clearly unfavorable effects of this procedure, the idea that the spleen is not physiologically essential has been widely accepted. The first serious challenge to this concept arose with the clinical observation of King and Schumaker of a high incidence of serious bacterial infection following splenectomy performed in infancy. This original report has been supplemented during the last decade by additional clinical data, and renewed interest in the role of the spleen in immunity has resulted. Recent experimental data have defined more clearly immunological functions for the spleen that are of special significance during early development. The purposes of this are paper are (1) to review the clinical problem which led to re-examination of the role of the spleen in immunity, particularly, as it relates to the early development of the immune mechanism, and (2) to offer a hypothesis which may explain the clinical observation of overwhelming infection after splenectomy in the young infant. THE CLINICAL PROBLEM In 1952 King and Schumaker reported an unusual incidence of infection in infants who had undergone splenectomy for congenital hemolytic anemia. The hazards of splenectomy in early life were pointed out in a number of papers which appeared subsequently with large series of cases reinforcing the validity of the earlier observations. Most recently Horan and Colbatch have incisively reviewed the problem and added a number of their own cases to those already in the literature. In spite of the preponderance of evidence, dissenting reports have appeared and the subject remains somewhat controversial.

158 citations


Journal Article
TL;DR: Intrauterine growth charts prove useful in studying factors influencing twin growth during both the prenatal and postnatal periods.
Abstract: Percentile curves representing intrauterine growth of monochorionic and dichorionic twins were constructed from the birth weights of liveborn infants at gestational ages ranging from 24 to 42 weeks. The median weights of twins were progressively lower than median weights for single-born infants during late gestation. Monochorionic twins were both smaller and had a greater intrapair variation in birth weight than dichorionic pairs. Intrauterine growth charts prove useful in studying factors influencing twin growth during both the prenatal and postnatal periods.

143 citations


Journal Article
TL;DR: Newborn infants whose mothers received a single dose of obstetric sedation during labor sucked at significantly lower rates and pressures, and consumed less nutrient than infants born to mothers who received no obstetric Fig. 5.
Abstract: Newborn infants whose mothers received a single dose of obstetric sedation during labor sucked at significantly lower rates and pressures, and consumed less nutrient than infants born to mothers who received no obstetric Fig. 5. Effect of obstetric sedation on nutrient consumption during sucking. sedation. Significant drug effects persisted throughout the 4-day period that the infants remained in the newborn nursery.

Journal Article
TL;DR: Heredity of hereditary angioneurotic edema is inherited as an autosomal dominant trait and swellings tend to be much more severe and the failure of anti-allergic medications and lack of evidence for allergy as a cause of attacks tend to differentiate this disease from the more common allergic forms.
Abstract: Inasmuch as hereditary angioneurotic edema has generally been overlooked in the pediatric literature, it is hoped that this report may alert pediatricians to the possibiity of the existence of the disease in children of families with appropriate histories. It is likely that the symptomatology will not be severe in childhood; nonetheless, swellings and abdominal attacks do occur. Most important, the possibility that abdominal surgery will be helpful during bouts of abdominal pain due to hereditary angioneurotic edema should be considered unlikely. Markedly edematous viscera may provide technical difficulty during surgery, and undue physical trauma is not helpful. Hereditary angioneurotic edema differs from other non-allergic angioneurotic edema in that the tendency to attacks of edema is inherited as an autosomal dominant trait and swellings tend to be much more severe. The failure of anti-allergic medications and lack of evidence for allergy as a cause of attacks of hereditary angioneurotic edema tend to differentiate this disease from the more common allergic forms. Absence of serum inhibitor of C9lesterase further characterizes hereditary angioneurotic edema. Sera from persons with non-familial allergic and non-allergic angioneurotic edema have contained normal or greater than normal amounts of this inhibitor.7 In view of the definition of biochemical alterations in the blood of patients with hereditary angioneurotic edema and the possibility of identifying affected individuals before the onset of symptoms, it is to be hoped that a rational means for the prevention of symptoms can be devised.

Journal ArticleDOI
TL;DR: The incidence of Hemophilus influenzae otitis media found in this study is higher than that reported in previous studies, and the finding of Neisseria catarrhalis in exudate from Otitis media has been reported only by Gronroos, et al.
Abstract: In this study cultures of middle ear exudate were obtained from 267 cases of otitis media in infants and children. Pneumococci were found in 34.5%, Hemophilus influenzae in 27%, Group A beta hemolytic streptococci in 1.9%, and pneumococci mixed with hemophilus influenzae in 2.8%. Neisseria, probably Neisseria catarrhalis, were grown in pure culture in 5.2%. Pseudomonas aeruginosa, Staphylococcus hemolyticus (coagulase positive), and Escherichia coli were found in isolated cases. The remaining 27.7% were sterile, these usually being from chronic exudative (secretory) otitis media cases. The incidence of Hemophilus influenzae otitis media found in this study is higher than that reported in previous studies. The finding of Neisseria catarrhalis in exudate from otitis media has been reported only by Gronroos, et al., and observation of the organisms in an intracellular state was not reported. Examination of exudate obtained from recurrences or relapses of acute exudative otitis media often reveals a different organism from that found in previous infections; one cannot assume that an apparent relapse is due to the same organism cultured previously. Most cases of otitis media occur in infants who cannot localize their symptoms, and diagnosis requires careful examination of the ears. Adequate bacteriological studies of exudate from the tympanic cavity require uncontaminated specimens which are best obtained with an apparatus using a needle attached to a collecting trap and a source of negative pressure.

Journal ArticleDOI
TL;DR: Suggestions are made for increasing the frequency of bacteriologic diagnoses and for initiating the antibiotic therapy of patients with septic arthritis based upon age groups and observations of bacterial stains of joint fluid.
Abstract: A review of 117 cases of septic arthritis in infants and children revealed that the concept of staphylococci and streptococci as the major etiologic organisms should be modified to stress the frequency of Hemophilus influenzae in the 6-month to 2-year age bracket and to emphasize the variety of bacteria that must be anticipated in individual cases. Suggestions are made for increasing the frequency of bacteriologic diagnoses and for initiating the antibiotic therapy of patients with septic arthritis based upon age groups and observations of bacterial stains of joint fluid.

Journal Article
TL;DR: The purpose in the present report is to show that it is possible to create laboratory models useful in the study of human population problems and to emphasize in particular some of the lasting biological effects of early environmental influences.
Abstract: Many experiences of early life affect the biological characteristics of the adult in a lasting manner. This phenomenon has been illustrated by epidemiological observations in man and by several experimental models in mice. It has been shown, for example, that when newborn animals are nursed by mothers fed diets that are slightly inadequate, their size remains subnormal throughout their life span, even though the young are fed an optimum diet after weaning. A similar depression of growth can be produced by subclinical infections shortly after birth. Decrease in resistance to various forms of stress can be brought about in young animals by various types of nutritional and environmental disturbances so mild that their effects are not recognized when the animals are maintained under usual laboratory conditions. These findings indicate the possibility of devising laboratory models for the analysis of many puzzling sociomedical problems.

Journal Article
TL;DR: Intellectual understimulation seemed to arise from spending the majority of time with children who did not require their special talents, so pediatricians are urged to play a decisive role in formulating the alternative patterns of child health care that must inevitably develop in the United States.
Abstract: Four practicing pediatricians were followed by an observer with a stopwatch for a total of 18 days to gain a profile of how their working days were spent. An average of 48% of the day was spent with patients, 12.5% on the phone, and 9% on paper work. Fifty per cent of patient time was spent with well children, and 22% on children with minor respiratory illness. Intellectual understimulation seemed to arise from spending the majority of time with children who did not require their special talents. In view of the alarming decline in ratio of physicians to child population, pediatricians are urged to play a decisive role in formulating the alternative patterns of child health care that must inevitably develop in the United States.

Journal Article
TL;DR: Relative nutritional deprivation was produced in groups of 16 to 21 newborn rats who were all nursed by one dam (deprived group) and compared with control litters containing 10 or less animals and found the initially deprived animals were essentially equal to those in the control animals.
Abstract: Relative nutritional deprivation was produced in groups of 16 to 21 newborn rats who were all nursed by one dam (deprived group) and compared with control litters containing 10 or less animals. Both groups were weaned at 21 days and thereafter allowed an unlimited supply of food. There was diminished somatic growth in all of the deprived group and, at 2 and 3 weeks, the weight of many of the deprived animals was approximately one-half that of the controls. Brain weight, total brain lipids, cholesterol, and phospholipids were reduced to approximately 80% of the control. Brain cerebrosides were affected to a greater extent than the other lipids, being only 50% of the control values. Histological sections showed less myelin. At 6 weeks, following 3 weeks of ad lib. food intake, the body weight, brain weight, and concentrations of the brain lipids of the initially deprived animals were essentially equal to those in the control animals.

Journal Article
TL;DR: Infants born by Cesarean section and not subjected to abdominal compression by the birth process had an even more alkaline gastric residuum at birth, suggesting the presence of excessive amniotic fluid in the stomach of these babies.
Abstract: Elevated pH in the gastric contents of babies immediately after birth suggests the presence of alkaline amniotic fluid in the stomach of the fetus. After the stomach had been lavaged, a strongly acid secretion was immediately noted, implying that the secretory ability of the gastric mucosa is unimpaired immediately after birth. Therefore, no delay in the onset of oral feedings based on poor gastric functioning seems warranted. Infants born by Cesarean section and not subjected to abdominal compression by the birth process had an even more alkaline gastric residuum at birth, suggesting the presence of excessive amniotic fluid in the stomach of these babies. The recommendation that babies9 stomachs be emptied immediately after Cesarean section seems justified to avoid an increased hazard from vomiting and aspiration. This has proved an innocuous and beneficial procedure in our hands.

Journal ArticleDOI
TL;DR: Under the conditions of the study outlined above, 22 patients with bronchiolitis treated with corticosteroids did not show any statistically significant difference from an equal number of patients treated with a placebo.
Abstract: Under the conditions of the study outlined above, 22 patients with bronchiolitis treated with corticosteroids did not show any statistically significant difference from an equal number of patients treated with a placebo. This included hospital course, 2-week or 4-week follow-up, as judged by clinical, radiological, and biochemical means. There was no evidence that the patients on steroids had a less favorable course or outcome. There were no complications or deaths in the entire study. The use of uniform criteriae for diagnosis and follow-up of these patients is discussed. A bronchiolitis scoring system is suggested.

Journal ArticleDOI
TL;DR: Close cooperation between the surgeon and pediatrician and the early application of an intensive prophylactic and therapeutic pulmonary program are essential if the authors are to improve the mortality and morbidity in this disease.
Abstract: Meconium ileus is a complication of cystic fibrosis which still causes a high mortality rate in the first year of life. The condition is frequently complicated by meconium peritonitis, volvulus, and/or atresia, but these complications are not necessarily fatal. In the last ten years, the mortality rate for babies with meconium ileus has been about 40%. Thirty-five percent of children who survived the operation died from pneumonia in the first 6 months of life. Children who lived to 6 months had a prognosis similar to other children with cystic fibrosis who did not suffer from meconium ileus, and this will depend on the degree of pulmonary involvement. Some children with meconium ileus may have few pulmonary symptoms and, with good medical care reach adult life. Close cooperation between the surgeon and pediatrician and the early application of an intensive prophylactic and therapeutic pulmonary program are essential if we are to improve the mortality and morbidity in this disease.

Journal Article
TL;DR: Karyotypic differences between carriers and their affected children present evidence of an excess of some chromosome A 3 material producing the clinical disorder.
Abstract: Familial de Lange syndrome is described in three siblings and a maternal first cousin. A new chromosomal aberration has been found in this family in all affected children and in 7 unaffected carriers. Karyotypic differences between carriers and their affected children present evidence of an excess of some chromosome A 3 material producing the clinical disorder.

Journal Article
TL;DR: Five premature infants with delayed closure of the ductus arteriosus have been presented and hemodynamic data from serial cardiac catheterization studies document a decrease in left-to-right shunt through theductus with clinical evidence of spontaneous closure.
Abstract: Five premature infants with delayed closure of the ductus arteriosus have been presented. In 3 of these infants, hemodynamic data from serial cardiac catheterization studies document a decrease in left-to-right shunt through the ductus with clinical evidence of spontaneous closure. The possible roles of inadequate muscular development of the ductus, hypoxemia, the degree of prematurity, and the association of neonatal complications in delayed closure are discussed.

Journal Article
TL;DR: Data from the 12 cases in this series and from those in the literature suggest that the likelihood of metastasis may be correlated with the relation of tumor weight to body weight.
Abstract: In 12 children with hyperadrenocorticism caused by tumor of the adrenal cortex the most common clinical picture was that of a mixture of adrenogenital and Cushing's syndromes. All tumors were surgically removed; adrenal steroids were used in the preparation of 11 patients for operation. One patient died with extensive metastasis 5 months after operation, while 11 were alive and well 18 months to 29 years after operation. Data from the 12 cases in this series and from those in the literature suggest that the likelihood of metastasis may be correlated with the relation of tumor weight to body weight.

Journal Article
TL;DR: A male infant is described showing all the major features of the oral-facial-digital syndrome (OFD): lobulated tongue with hypertrophic frena, fibrous bands extending into alveolar clefts, pseudocleft of upper lip, cleft palate, hypoplastic alae nasi, dystopia canthorum, various digital anomalies, and typical X-ray appearance of the skull.
Abstract: A male infant is described showing all the major features of the oral-facial-digital syndrome (OFD): lobulated tongue with hypertrophic frena, fibrous bands extending into alveolar clefts, pseudocleft of upper lip, cleft palate, hypoplastic alae nasi, dystopia canthorum, various digital anomalies, and typical X-ray appearance of the skull. A partial agenesis of the corpus callosum with a lipoma was indicated by pneumoencephalography and angiography. The OFD syndrome is confined to females. In the present case an XXY chromosome constitution was demonstrated by cytogenetic studies. The occurrence of OFD and Klinefelter9s syndrome in one and the same person is ascribed to a very rare coincidence. OFD is considered to be due to an X-linked dominant mutant gene, with a recessive lethal effect. X-linkage is supported by the pattern of a more extreme lethal expression in hemizygous males versus viability of heterozygous females. An XXY individual is viable, presumably because of the normal allele which is active in a fraction of its cells. Other reports of males with OFD are critically evaluated.

Journal Article
TL;DR: The capacity of a neonate to fix, follow, and alert to a visual stimulus appears to be good evidence for an intact central nervous system.
Abstract: Ninty-six infants were tested for their ability to fix on, pursue, and alert to a test object visually. These infants were evaluated for subsequent development. Of the 9 infants later deemed to be abnormal or suspect, none showed positive visual responses in the newborn period. However, 57.5% of the normal infants demonstrated this ability. Opticokinetic responses were obtained in 76% of the normal group but in none of the suspect. Eliciting visual responses as part of the neonatal examination may offer reassurance to the clinician as to the infant9s future prognosis. Their absence on any one examination is not a definite indication of central nervous system deficit. The capacity of a neonate to fix, follow, and alert to a visual stimulus appears to be good evidence for an intact central nervous system.

Journal ArticleDOI
TL;DR: The best predictor of maternal protectiveness was maternal anxiety, and it was found that the addition of other variables such as incapacity and child dependence failed to improve prediction substantially.
Abstract: This study considers the behavioral implications of congenital heart disease for the pediatric patient, his siblings, and his parents. The effects of a disease on the child, on his siblings, and on his parents and the interplay among these individuals are explored. The impact of the physician9s diagnosis is illustrated by the induced significant changes in family attitudes, which are not necessarily related to disease severity or child incapacity. Poorer adjustment and anxiety in the cardiac child related more highly to maternal anxiety and pampering than to his degree of incapacity. Maternal protectiveness and pampering were significantly greater in the cardiac than in the normal group and were highest in the cyanotic group. The best predictor of maternal protectiveness was maternal anxiety, and it was found that the addition of other variables such as incapacity and child dependence failed to improve prediction substantially. Maternal anxiety seemed related to the presence rather than to the severity of the heart condition.

Journal ArticleDOI
TL;DR: The distribution of birth weights at various gestational ages are presented for all single births occurring in Baltimore City in 1959, 1960, and 1961 and there is striking agreement between these data and those of a similar study from New York City.
Abstract: The distribution of birth weights at various gestational ages are presented for all single births occurring in Baltimore City in 1959, 1960, and 1961. These data are presented as pregnancy distributions or percentile curves for comparison with data of several other studies. In general, the frequency distribution of birth weights at any given gestational age spans a wide weight range. The neonatal, fetal, and perinatal mortality rates for various cell groups are presented. There is striking agreement between these data and those of a similar study from New York City. The clinical implications of these mortality rates and percentile curves are discussed.

Journal Article
TL;DR: The histological aspect similar to celiac disease seems to indicate a common pattern of reaction of the jejunal mucosa due to different causes in kwashiorkor, while in marasmic infants fed on the same diet the mitotic index is significantly lower.
Abstract: The histological aspect and the mitotic index of jejunal biopsies were studied in 8 normal infants, in 18 marasmic infants, and in 10 infants with kwashiorkor. The mucosa of the marasmic infants was similar to the normal controls, although thinner. In kwashiorkor the mucosa was similar to celiac disease. In marasmic infants fed on the same diet, the mitotic index is significantly lower in infants who do not show weight increase when compared with those who do increase in weight. In kwashiorkor the mitotic index is closer to, although also significatively lower than, normal. It is suggested that these differences are due to the low caloric intake in marasmus where the energy supply is not sufficient to maintain the rate of cell proliferation; a hormonal mechanism governed by the pituitary gland is also suggested. In kwashiorkor the histological aspect similar to celiac disease seems to indicate a common pattern of reaction of the jejunal mucosa due to different causes.

Journal Article
TL;DR: In this article, Rowe et al. employed a clinical approach to the categorization of newborn cardiovascular defects, a list of probabilities has been prepared to aid the pediatrician who is confronted with the common problem of the severely ill newborn heart patient.
Abstract: Employing a clinical approach to the categorization of newborn cardiovascular defects, a list of probabilities has been prepared to aid the pediatrician who is confronted with the common problem of the severely ill newborn heart patient. This study presents the analysis of 155 newborn cardiac autopsies along with 10 surgical successes. These cases were selected from 187 autopsied live-born neonates with major cardiovascular malformations by excluding patients with associated severe non-cardiac disease and major non-cardiac malformations. One-half of the neonatal deaths occurred during the first week with a stepwise decrease in the succeeding weeks. Hypoplastic left heart (rudimentary left ventricle with aortic or mitral stenosis or atresia) was the commonest malformation (37 cases). The second most frequent was complete transposition of the great vessels (25 cases). Most newborns with these two defects died in the first week of life, indicating the urgent need for attention to infants with such anomalies. In contrast, in patients with other malformations, deaths were spread throughout the first month. Neonates who died with combinations of major defects composed the third largest group in this series, emphasizing the difficulties in diagnosis and treatment. Ventricular septal defects, and patent ductus arteriosus were found to be uncommon causes of death or severe distress in the first month of life. As a result of these findings it is evident that a large number of newborns in severe distress from cardiovascular malformations will have defects which are beyond help. However, in many newborn cardiacs, the defects can be relieved or made less severe. Consequently, it is felt by the authors that a newborn infant who is seriously ill due to a suspected cardiac anomaly should be regarded as both a medical emergency and as a potential surgical emergency. Such a patient should be transferred at once to an institution where all facilities and personnel are available for complete investigation and for surgery. Cardiac catheterization and angiocardiography should be performed as soon as the pediatric cardiologist feels that these tests are indicated, often within a matter of hours. This will frequently be in the first days or even in the first twenty-four hours of life. The techniques, problems, and hazards involved in such studies have been presented in detail by Rowe. A maximum of information should be sought inasmuch as the additional risk is usually more than compensated for by the increased accuracy and completeness of the diagnosis. Admittedly, the risk of cardiac catheterization and selective angiocardiography is high in a seriously ill newborn cardiac, perhaps of the order of 5 to 10%, but if this hazard is balanced against the extremely high one of death in a matter of hours or days from the underlying disease, there will be little hesitation about proceeding with the investigation. In certain instances it may be advisable to perform surgery without prior cardiac catheterization and angiocardiography. Such unusual instances involve severely ill newborns in whom the clinical diagnosis seems clear and for whom surgery may be lifesaving. The outstanding example of this is the infant who has the classical findings of pulmonic stenosis with an intact ventricular septum, and who appears to be dying in heart failure. Here the risk of cardiac catheterization may outweigh that of surgery. Other instances include occasional critically ill patients with typical findings of coarctation of the aorta, tetralogy of Fallot, complete transposition of the great vessels, vascular rings, and the rare patent ductus arteriosus in whom the clinical diagnosis is obvious. The authors believe that an aggressive approach to the diagnosis and treatment of the distressed newborn cardiac will substantially improve his chances for survival.

Journal ArticleDOI
TL;DR: It is apparent that the basic functional defect has not yet been identified, though a humoral anomaly, very possibly enzymatic, still seems a reasonable interpretation of the underlying cause of the physiological abnormalities reported.
Abstract: 1. A tabulation of "essential" and helpful criteria for the diagnosis of familial dysautonomia is presented. The importance of accurate diagnosis is stressed. 2. Two cases where the diagnosis of familial dysautonomia was strongly suggested but was not justified are presented by way of contrast to the typical syndrome. 3. Current literature offering new observations of a pharmacological, physiological and anatomical nature is reviewed. Some of these appear to offer important new diagnostic criteria as well as bases for hypotheses for the pathogenesis of the disorder. 4. An attempt to synthesize the various findings is made. It is apparent that the basic functional defect has not yet been identified, though a humoral anomaly, very possibly enzymatic, still seems a reasonable interpretation of the underlying cause of the physiological abnormalities reported.