American Journal of Diseases of Children

GIBSON, LEWIS E.

doi: 10.1001/archpedi.1980.02130220003001pmid: 6775524

Abstract The report by Berry et al (see p 930) raises the question of mass screening of newborns for cystic fibrosis (CF). The authors suggest that mass screening is advisable, but do not believe enough data are available to recommend the best procedure. Both of these conclusions may be questioned. The advantages of early diagnosis should be examined. Also, since their article reports the examination of 65,000 meconium specimens, and a collaborative study1 funded by the National Cystic Fibrosis Foundation reports the examination of more than 100,000 specimens, it should be possible at this point to draw some conclusions about the efficacy of various testing procedures. It is difficult to argue that the early diagnosis of any disease is not in some way beneficial. However, one may vastly overstate the benefit. This seems to have occurred when Berry et al quoted an estimate "that up to 90% of undiagnosed CF References 1. Holzclaw DS, Berry HK, Bruns W, et al: Meconium screening for cystic fibrosis: A collaborative study , in Cystic Fibrosis Club Abstracts. Rockville , Md, Cystic Fibrosis Foundation, 1977, p 54. 2. Warwick WJ: Ascertainment of CF in Minnesota , in Cystic Fibrosis Club Abstracts. Rockville , Md, Cystic Fibrosis Foundation, 1979, p 88. 3. Warwick WJ, Pogue RE: Missing patients with cystic fibrosis , in Cystic Fibrosis Club Abstracts. Rockville , Md, Cystic Fibrosis Foundation, 1978, p 99. 4. Motoyama EK, Gibson LE, Zigas CJ: Evaluation of mist tent therapy in cystic fibrosis using maximum expiratory flow volume curve . Pediatrics 50:299-306, 1972. 5. Wood RE, di Sant'Agnese PA: Bioassays of cystic fibrosis factor . Lancet 2:1452-1453, 1973.Crossref

CAREY, WILLIAM B.;MCDEVITT, SEAN C.

doi: 10.1001/archpedi.1980.02130220004002pmid: 7424851

Abstract During the last 20 years much attention has been given in the medical and psychological literature to the syndrome of minimal brain dysfunction (MBD) or hyperkinesis (hyperactivity), the terms generally being used interchangeably. Experts have emphasized the high frequency and clinical importance of this condition and have warned clinicians about the necessity of early detection and proper treatment. The conscientious clinician cannot fail to be impressed by the magnitude of this literature and its sense of urgency. However, when the clinician inspects these reports closely, the concept is found to be so poorly described that deciding whether a particular case fits the definition adequately is difficult. The expert consultant, who is presented with a child with clear evidence of academic or behavioral problems, may label such a case as MBD with little hesitation, but the primary care clinician is often perplexed. The purposes of this communication are to review critically References 1. Strauss AA, Lehtinen L: Psychopathology and Education of the Brain Injured Child . New York, Grune & Stratton Inc, 1947. 2. Clements SD: Minimal Brain Dysfunction in Children . Washington, DC, Dept of Health, Education, and Welfare, 1966. 3. DSM-II: Diagnostic and Statistical Manual of Mental Disorders , ed 2. Washington, DC, American Psychiatric Association, 1968. 4. DSM-III: Diagnostic and Statistical Manual of Mental Disorders, ed 3. Washington, DC, American Psychiatric Association, to be published. 5. Thomas A, Chess S, Birch HG, et al: Behavioral Individuality in Early Childhood . New York, New York University Press, 1963. 6. Thomas A, Chess S, Birch HG: Temperament and Behavior Disorders in Children . New York, New York University Press, 1968. 7. Carey WB, Fox M, McDevitt SC: Temperament as a factor in early school adjustment . Pediatrics 60( (suppl) ):621-624, 1977. 8. Bugental DB, Collins S, Collins L, et al: Attributional and behavioral changes following two behavior management interventions with hyperactive boys: A follow-up study . Child Dev 49:247-250, 1978.Crossref 9. Swanson JM, Kinsbourne M: Stimulant-related state-dependent learning in hyperactive children . Science 192:1354-1357, 1976.Crossref 10. Firestone P, Peters S, Rivier M, et al: Minor physical anomalies in hyperactive, retarded and normal children and their families . J Child Psychol Psychiatr 19:155-160, 1978.Crossref 11. O'Leary SG, Pelham WE: Behavior therapy and withdrawal of stimulant medication in hyperactive children . Pediatrics 61:211-217, 1978. 12. Dalby JT, Kinsbourne M, Swanson JM, et al: Hyperactive children's underuse of learning time: Correction by stimulant treatment . Child Dev 48:1448-1453, 1977.Crossref 13. Harley JP, Matthews CG, Eichman P: Synthetic food colors and hyperactivity in children: A double-blind challenge experiment . Pediatrics 62:975-983, 1978. 14. Connors CK: A teacher rating scale for use in drug studies with children . Am J Psychiatr 126:884-888, 1969. 15. Kenny TJ, Clemmens RL, Hudson BW, et al: Characteristics of children referred because of hyperactivity . J Pediatr 79:618-622, 1971.Crossref 16. Lambert NM, Sandoval J, Sassone D: Prevalence of hyperactivity in elementary schoolchildren as a function of social system definers . Am J Orthopsychiatr 48:446-463, 1978.Crossref 17. Johnson CF, Prinz R: Hyperactivity is in the eyes of the beholder . Clin Pediatr 15:222-238, 1976.Crossref 18. Sandoval J, Lambert NM, Yandell W: Current medical practice and hyperactive children . Am J Orthopsychiatr 46:323-334, 1976.Crossref 19. Wender E: Food additives and hyperkinesis . Am J Dis Child 131:1204-1206, 1977. 20. Barclay RA: Recent developments in research on hyperactive children . J Pediatr Psychol 3:158-163, 1978.Crossref 21. Carey WB, Sibinga MS: Avoiding pediatric pathogenesis in the management of acute minor illness . Pediatrics 49:553-562, 1972. 22. Rapoport JL, Buchsbaum MS, Zahn TP, et al: Dextroamphetamine: Cognitive and behavioral effects in normal prepubertal boys . Science 199:560-563, 1978.Crossref 23. Weiss G, Hechtman L, Perlman T: Hyperactives as young adults: School, employer and self-rating scales obtained during ten-year follow-up evaluation . Am J Orthopsychiatr 48:438-445, 1978.Crossref 24. Eisenberg L: Hyperkinesis revisited . Pediatrics 61:319-321, 1978. 25. Riddle KD, Rapoport JL: A two-year follow-up of 72 hyperactive boys: Classroom behavior and peer acceptance . J Nerv Ment Dis 162:126-134, 1976.Crossref 26. Jones TD: Diagnosis of rheumatic fever . JAMA 126:481, 1944.Crossref 27. Rutter M: Brain damage syndromes in childhood: Concepts and findings . J Child Psychol Psychiatr 18:1-21, 1977.Crossref 28. Sandberg ST, Rutter M, Taylor E: Hyperkinetic disorder in psychiatric clinic attenders . Dev Med Child Neurol 20:279-299, 1978.Crossref 29. Shaffer D, Greenhill L: A critical note on the predictive validity of 'the hyperkinetic syndrome .' J Child Psychol Psychiatr 20:61-72, 1979.Crossref 30. Schmitt BD: The minimal brain dysfunction myth . Am J Dis Child 129:1313-1318, 1975. 31. Saravia-Campos J: 'Minimal brain dysfunction': An oversimplification? Dev Med Child Neurol 18:246-248, 1976.Crossref 32. Ingram TTS: Soft signs . Dev Med Child Neurol 15:527-530, 1973.Crossref 33. Carey WB, McDevitt SC, Baker D: Differentiating minimal brain dysfunction and temperament . Dev Med Child Neurol 21:765-772, 1979.Crossref 34. McMahon S, Greenberg LM: Serial neurologic examination of hyperactive children . Pediatrics 59:584-587, 1977. 35. Shaffer D: 'Soft' neurological signs and later psychiatric disorder: A review . J Child Psychol Psychiatr 19:63-65, 1978.Crossref 36. Touwen BCL, Sporrel T: Soft signs and MBD . Dev Med Child Neurol 21:528-529, 1979.Crossref 37. Barlow CF: 'Soft signs' in children with learning disorders . Am J Dis Child 128:605-606, 1974.

Berry, Helen K.;Kellogg, Frank W.;Lichstein, Shirley R.;Ingberg, Robert L.

doi: 10.1001/archpedi.1980.02130220008003pmid: N/A

Abstract • Screening of newborn infants could provide information needed to evaluate the effects of early treatment on the course and prognosis of cystic fibrosis (CF). Two procedures of screening meconium for CF were compared: increased albumin levels, detected by a commercial test strip; and increased lactase activity, detected by glucose production after incubation of meconium with lactose. Specimens positive by the lactase test were retested for albumin. Low-birth-weight infants accounted for more than half the positive test results with both procedures. Sweat chloride measurements were carried out only on infants whose meconium specimens had albumin concentration greater than 12 mg/g (wet weight), measured by radial immunodiffusion. Twelve infants with CF were identified through screening, six while testing 44,816 specimens by lactase activity test. Three additional infants with CF were missed because meconium specimens were negative to both tests. (Am J Dis Child 134:930-934, 1980) References 1. Green MN, Shwachman H: Presumptive tests for cystic fibrosis based on serum protein in meconium . Pediatrics 41:989-992, 1968. 2. Davidson AG, Anderson CM: Diagnosis of cystic fibrosis . Br Med J 4:362-364, 1971.Crossref 3. Hellsing K, Kollberg H: Analysis of albumin in meconium for early detection of cystic fibrosis: A methological study . Scand J Clin Lab Invest 33:333-340, 1974.Crossref 4. Stephan U, Busch EW, Dannemann R: Ein neuer 'screening test' auf mukoviszedose Nachweis des erhohten Albumingehaltes im Mekonium . Pediatr Prax 12:487-490, 1973. 5. Stephan U, Busch EW, Kollberg H, et al: Cystic fibrosis detection by means of a test strip . Pediatrics 55:35-38, 1975. 6. Holsclaw DS, Berry HK, Bruns WT, et al: Meconium screening for cystic fibrosis: A collaborative study , in Cystic Fibrosis Club Abstracts . Rockville, Md, Cystic Fibrosis Foundation, 1977, p 54. 7. Antonowicz I, Ishida S, Shwachman H: Studies in meconium: Disaccharidase activities in meconium from cystic fibrosis patients and controls . Pediatrics 56:782-787, 1975. 8. Westler WB, Neal JL: Assay of proteolytic activity by gelatin liquefaction (trypsin assay by gelatin liquefaction) . Clin Chim Acta 78:151-157, 1977.Crossref 9. Shwachman H, Antonowicz I, Mahmoodian A: Studies in meconium: An approach to screening tests to detect cystic fibrosis . Am J Dis Child 132:1112-1114, 1978. 10. Warwick WJ: Ascertainment of CF in Minnesota , in Cystic Fibrosis Club Abstracts . Rockville, Md, Cystic Fibrosis Foundation, 1979, p 88. 11. Lubin AH, Bonner JL: Growth parameters compared with time of diagnosis in CF , in Cystic Fibrosis Club Abstracts . Rockville, Md, Cystic Fibrosis Foundation, 1978, p 71. 12. Palmer J, Huang N, Laraya-Cussay LR, et al: Long-term follow-up of patients with CF diagnosed at birth . Cystic Fibrosis Club Abstracts . Rockville, Md, Cystic Fibrosis Foundation, 1978, p 83. 13. Antonowicz I, Ishida S, Shwachman H: Screening for cystic fibrosis . Lancet 1:746-747, 1976.Crossref

Leape, Lucian L.;Ramenofsky, Max L.

doi: 10.1001/archpedi.1980.02130220013004pmid: 7424852

Abstract • One hundred children underwent Nissen's fundoplication for complications of gastroesophageal reflux. Indications for fundoplication included refractory pneumonia, apneic spells, intractable vomiting, failure to thrive, esophagitis, esophageal stricture, and Sandifer's syndrome. Except for those with life-threatening complications, fundoplication was performed only in those who had failure with a strict medical antireflux regimen. Four patients were not helped by operation or had a recurrence of symptoms. Of these, three with refractory pneumonia were judged to be failures of selection since reflux was absent postoperatively. The fourth had massive reflux and recurrent vomiting. Eight other patients had radiologic evidence of reflux postoperatively. Six of these were asymptomatic and two had minor symptoms. There was one death and 11 postoperative complications. (Am J Dis Child 134:935-938, 1980) References 1. Leape LL, Holder TM, Franklin JD, et al: Respiratory arrest in infants secondary to gastroesophageal reflux . Pediatrics 60:924-928, 1977. 2. Herbst JJ, Johnson DG, Oliveros MA: Gastroesophageal reflux with protein-losing enteropathy and finger clubbing . Am J Dis Child 130:1256-1258, 1976. 3. Bray PF, Herbst JJ, Johnson DG, et al: Childhood gastroesophageal reflux: Neurologic and psychiatric syndromes mimicked . JAMA 237:1342-1345, 1977.Crossref 4. Demeester TR, Johnson LF, Kent AH: Evaluation of current operations for the prevention of gastroesophageal reflux . Ann Surg 180:511-525, 1974.Crossref 5. Nissen R: Gastropexy and 'fundoplication' in surgical treatment of hiatus hernia . Am J Dig Dis 6:954, 1961.Crossref 6. McCauley RGK, Darling DB, Leonidas JC, et al: Gastroesophageal reflux in infants and children: A useful classification and reliable physiologic technique for its demonstration . AJR 130:47-50, 1978.Crossref 7. Boix-Ochoa J, in Gellis SS (ed): Gastroesophageal Reflux: Report of the 76th Ross Conference on Pediatric Research . Columbus, Ohio, Ross Laboratories, 1979, pp 65-69, 73-76. 8. Carre IJ: Postural treatment of children with a partial thoracic stomach ('hiatus hernia') . Arch Dis Child 35:569-580, 1960.Crossref 9. Herbst JJ, Book LS, Bray PF: Gastroesophageal reflux in the 'near miss' sudden infant death syndrome . J Pediatr 92:73-75, 1978.Crossref 10. Sutcliffe J: Torsion spasms and abnormal postures in children with hiatus hernia: Sandifer's syndrome . Progr Pediatr Radiol 2:190-197, 1969.

Lin, Hai-Peng;Menaka, Hariharan;Lim, Kok-Hoo;Yong, Hoi-Sen

doi: 10.1001/archpedi.1980.02130220017005pmid: 6448543

Abstract • A serial clinical, hematologic, and cytogenetic study was done on a baby with Down's syndrome in whom a myeloid leukemoid reaction developed at birth that spontaneously regressed within a month only to relapse two years later to an acute undifferentiated stem cell leukemia. He died 1½ months after onset. The unresolved controversy of the diagnosis of the congenital leukemia-like state is discussed. The importance of following up such patients with apparent remission of their congenital leukemia-like disorder is emphasized. (Am J Dis Child 134:939-941, 1980) References 1. Krivit W, Good RA: Simultaneous occurrence of mongolism and leukemia . Am J Dis Child 94:289-293, 1957. 2. Wald N, Borges WL, Li CC, et al: Leukaemia associated with mongolism . Lancet 1:1228, 1961.Crossref 3. Ross JD, Maloney WC, Desforges JF: Ineffective regulation of granulopoiesis masquerading as congenital leukemia in a mongoloid child . J Pediatr 63:1-10, 1963.Crossref 4. Engel RR, Hammond D, Eitzman DV, et al: Transient congenital leukemia in seven infants with mongolism . J Pediatr 65:303-305, 1964.Crossref 5. Honda F, Punett HH, Charney E, et al: Serial cytogenetic and hematologic studies on a mongol with trisomy 21 with acute congenital leukemia . J Pediatr 65:880-887, 1964.Crossref 6. Conen PE, Erkman B: Combined mongolism and leukemia: Report of eight cases with chromosome studies . Am J Dis Child 112:429-443, 1966. 7. Kauffman HJ, Hess R: Does congenital leukaemia exist? Br Med J 1:867-868, 1966.Crossref 8. Rosner F, Lee SL, written for the Acute Leukemia Group B: Down's syndrome and acute leukemia: Myeloblastic or lmyphoblastic? Report of 43 cases and review of the literature . Am J Med 53:203-218, 1972.Crossref 9. Schunk GJ, Lehman LW: Mongolism and congenital leukemia . JAMA 155:250-251, 1954.Crossref 10. O'Connor RE, McKay RN, Smith J: Congenital leukemia with septicemia as a terminal event . Am J Dis Child 88:740-742, 1954. 11. Weinberger MM, Oleinick A: Congenital marrow dysfunction in Down's syndrome . J Pediatr 77:273-279, 1970.Crossref 12. Miller JM, Sherrill JG, Hathaway WE: Thrombocythemia in the myeloproliferative disorder of Down's syndrome . Pediatrics 40:847-850, 1967. 13. Nagao T, Lampkin BC, Hug G: A neonate with Down's syndrome and transient abnormal myelopoiesis: Serial blood and bone marrow studies . Blood 36:443-447, 1970. 14. Rosner F, Ong BH, Paine RS, et al: Biochemical differentiation of trisomic Down's syndrome (mongolism) from that due to translocation . N Engl J Med 273:1356-1361, 1965.Crossref

Kobayashi, Roger H.;Hyman, Charles J.;Stiehm, E. Richard

doi: 10.1001/archpedi.1980.02130220020006pmid: 7424853

Abstract • An infant born to a mother with agammaglobulinemia was followed up since birth to study immunologic maturation uninfluenced by circulating maternal antibodies. Immunoglobulin levels remained low and antibodies to immunizing antigens appeared late. These observations, together with findings in two other reported infants born to agammaglobulinemic mothers, suggest that transplacental maternal antibodies play little or no role in modulating newborn IgG production and that the delay in achieving normal levels of IgG are probably due to the immaturity of newborn B lymphocytes. (Am J Dis Child 134:942-944, 1980) References 1. Miller ME, Stiehm ER: Phagocytic, opsonic and immunoglobulin studies in newborns (medical progress) . Calif Med 119:43-63, 1973. 2. Bellanti JA, Hurtado RC: Immunology and resistance to infection , in Remington JS, Klein JO (eds): Infectious Diseases of the Fetus and Newborn Infant . Philadelphia, WB Saunders Co, 1976, pp 33-70. 3. Bridges, RA, Condie RM, Zak SJ, et al: The morphological basis of antibody formation development during the neonatal period . J Lab Clin Med 53:331-357, 1959. 4. Holland NH, Holland P: Immunologic maturation in an infant of an agammaglobulinemic mother . Lancet 2:1152-1155, 1966.Crossref 5. Laursen HB, Christensen MF: Immunoglobulins in normal infant born of severe hypogammaglobulinemic mother . Arch Dis Child 48:646-648, 1973.Crossref 6. Saxon A, Stevens RH, Ashman RF: Regulation of immunoglobulin production in human peripheral blood leukocytes: Cellular interactions . J Immunology 118:1972-1976, 1977. 7. Boxer LA: Immunological function and leukocyte disorders in newborn infants . Clin Haematol 7:123-146, 1978. 8. Evans DG, Smith JW: Response of the young infant to active immunizations . Br Med Bull 19:225-229, 1963. 9. Stiehm ER: Fetal defense mechanisms . Am J Dis Child 129:438-443, 1975. 10. Miller ME: Current topics in host defenses of the newborn . Adv Pediatr 25:59-95, 1978. 11. Smith RT, Eitzman DV, Catlin ME, et al: Development of the immune response: Response of newborn and mature humans to salmonella vaccines . Pediatrics 33:163-183, 1964. 12. Pearlman DS: Antibody formation in infancy . Am J Dis Child 102:239-248, 1961. 13. Zak SJ, Good RA: Immunochemical studies of human serum globulins . J Clin Invest 38:579-586, 1959.Crossref 14. Hayward AR, Lawton AR: Induction of plasma cell differentiation of human fetal lymphocytes: Evidence of functional immaturity of T and B cells . J Immunol 119:1213-1217, 1977. 15. Morito T, Bankhurst AD, Williams RC: Studies of human cord blood and adult lymphocyte interactions with in vitro immunoglobulin production . J Clin Invest 64:990-995, 1979.Crossref 16. Waldmann TA, Broder S, Blaese RM, et al: Role of suppressor T cells in pathogenesis of common variable hypogammaglobulinemia . Lancet 2:609-613, 1974.Crossref 17. Waldmann TA: Disorders of suppressor cells with common variable hypogammaglobulinemia and selective IgA deficiency , in Waldmann TA (ed): Disorders of suppressor immunoregulatory cells in the pathogenesis of immunodeficiency and autoimmunity. Ann Intern Med 88:226-238, 1978. 18. Discussion: Practical experience with poliomyelitis vaccine . Am J Pub Health 46:563-574, 1956.Crossref 19. McLeod DR, Wilson RJ: Status on combined vaccines , in Poliomyelitis . Philadelphia, JB Lippincott Co, 1960, pp 196-199. 20. Peterson JC, Christie A: Immunization in the young infant: VI. Tetanus . Am J Dis Child 81:518-529, 1951. 21. Welch JK, May JT: Anti-infective properties of breast milk . J Pediatr 94:1-9, 1979.Crossref 22. Baker CJ, Kasper DL: Correlation of maternal antibody deficiency with susceptibility to neonatal group B streptotococcal infection . N Engl J Med 294:752-756, 1976.Crossref 23. Baker CJ, Kasper DL, Tager IB, et al: Quantitative determination of antibody to capsular polysaccharide in infection with type III strains of group B streptococcus . J Clin Invest 59:810-818, 1977.Crossref 24. Baker CJ, Edwards MS, Kasper DL: Immunogenicity of polysaccharides from type III, group B streptococcus . J Clin Invest 61:1107-1110, 1978.Crossref

Stockman, James A.;Oski, Frank A.

doi: 10.1001/archpedi.1980.02130220023007pmid: 7424854

Abstract • Hemoglobin, RBC mean corpuscular volume (MCV), and other RBC indices were studied in a group of 40 infants, each with a birth weight of less than 1,500 g. Results indicated that the hemoglobin level fell from 18.2 ± 2.7 g/dL at birth to a low of 9.5 ± 1.5 g/dL at 6 weeks of age. During this time, the MCV declined from 115 ± 5 fentoliters (fL) to 97 ± 5 fL and did not again rise as the hemoglobin stabilized. Although the decline in MCV may simply reflect an aging RBC population, these data raise the possibility that RBC size may in part be determined by postnatal factors independent of time from conception. (Am J Dis Child 134:945-946, 1980) References 1. Schmaier AH, Maurer HM, Johnston CL, et al: Alpha thalassemia screening in neonates by mean corpuscular volume and mean corpuscular hemoglobin determination . J Pediatr 83:794-797, 1973.Crossref 2. Pearson HA, Diamond LK: Fetomaternal transfusion . Am J Dis Child 97:267-273, 1959. 3. Dallman PR, Siimes MA: Percentile curves for hemoglobin and red cell volume in infancy and childhood . J Pediatr 94:26-31, 1979.Crossref 4. Saarinen UM, Siimes MA: Developmental changes in the red blood counts and indices in infants with iron deficiency excluded by laboratory criteria and by continuous iron supplementation . J Pediatr 92:412-416, 1978.Crossref 5. Instruction Manual for the Model 'S' Coulter Counter , ed 5. Hialeah, Fla, Coulter Electronics, 1969. 6. Quaife ML, Scrimshaw NS, Lowry OH: A micromethod for assay of total tocopherols in blood stream . J Biol Chem 180:1229-1235, 1949. 7. Zaizov R, Matoth Y: Red cell values on the first postnatal day during the last 16 weeks of gestation . Am J Hematol 1:275-279, 1976.Crossref 8. Matoth Y, Zaizov R, Varsano I: Postnatal changes in some red cell parameters . Acta Paediatr Scand 60:317-323, 1971.Crossref 9. Garby L, Sjolin S, Vaille JC: Studies on erythrocyte kinetics of hemoglobin F and hemoglobin A during the first months of life . Acta Paediatr Scand 53:33-38, 1964.Crossref 10. Lundström U, Siimes MA, Dallman PR: At what age does iron supplementation become necessary in low-birth weight infants? J Pediatr 91:878-883, 1977.Crossref

Rosen, Barbara;Stein, Martin T.

doi: 10.1001/archpedi.1980.02130220025008pmid: 7424855

Abstract • Parents who abuse their children may not accept traditional therapy but may be influenced by the child's primary care physician. A comparative study of abusive and nonabusive mothers showed abusers to have lower self-concept and higher self-concept incongruence and inconsistency than nonabusers. They were also found to value authority over others more, and conformity and benevolence less, than nonabusers. Practically applied, the data lead the pediatrician to an educative and supportive role in which he or she may enhance self-esteem and lower unrealistic expectations in the course of treating the child. In addition, there seems to be a need to develop access to support groups, day care, and other avenues for the mother's personal growth. This may be done either within a pediatric practice or through liaison with community resources. (Am J Dis Child 134:947-950, 1980) References 1. Morris M, Gould R: Role Reversal: A Necessary Concept in Dealing With the Battered Child Syndrome . New York, Child Welfare League of America, 1963. 2. Elmer E: Children in Jeopardy . Pittsburgh, University of Pittsburgh Press, 1967. 3. Gil D: Violence Against Children . Cambridge, Mass, Harvard University Press, 1970. 4. Steele B, Pollack C: A psychiatric study of parents who abuse infants and small children , in Helfer R, Kempe CH (eds): The Battered Child . Chicago, University of Chicago Press, 1974, pp 89-133. 5. Paulson MJ, Schwemer GT, Bendel RB: Clinical application of the Pd, Ma and (OH) experimental MMPI scales to further understanding of abusive parents . J Clin Psychol 32:558-564, 1976.Crossref 6. Pelton LH: Child abuse and neglect: The myth of classlessness . Am J Orthopsychiatry 48:608-617, 1978.Crossref 7. Klein M, Stern L: Low birth weight and the battered child syndrome . Am J Dis Child 122:15-18, 1971. 8. Helfer RE: The responsibility and role of the physician , in Helfer R, Kempe CH (eds): The Battered Child . Chicago, University of Chicago Press, 1974, p 25. 9. Carney RE, Spielberg G, Weedman C: Self-Concept Evaluation of Location Form: Manual . San Diego, Carney, Weedman & Associates, 1980. 10. Gordon IV: Survey of Interpersonal Values, Revised Manual . Chicago, Science Research Associates, 1976. 11. Rosen B: Self-concept disturbance among mothers who abuse their children . Psychol Rep 43:323-326, 1978.Crossref 12. Rosen B: Interpersonal values among child abusive women . Psychol Rep 45:819-822, 1979.Crossref 13. Rucker R: A value-oriented framework for education and the behavioral sciences , in Laszlo E, Wilbur J (eds): Human Values and Natural Science . New York, Gordon and Breach, 1970, pp 81-94. 14. Maslow A: Toward a Psychology of Being . New York, Van Nostrand & Co, 1968. 15. Lasswell H: Power and Personality . New York, Norton & Co, 1948. 16. Stein MT: The providing of well-baby care within parent-infant groups . Clin Pediatr 16:825-828, 1977.Crossref

Pelton, Stephen I.;Teele, David W.;Shurin, Paul A.;Klein, Jerome O.

doi: 10.1001/archpedi.1980.02130220029009pmid: 6968508

Abstract • Cultures of middle ear fluids (MEFs) are needed to determine both efficacy of antibiotics and vaccines, and microbiologic outcome of otitis media (OM). We reviewed data on 221 children, aged 2 months to 12 years; 122 had acute otitis media (AOM), 99 had asymptomatic MEF. We included only Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, and Staphylococcus aureus as pathogens. Of children with AOM, MEF was sterile or contained nonpathogens in both ears in 51, and one or more pathogens in 71. Of these 71, 40 had the same pathogen or pathogens in both ears; 25 patients had a pathogen in one ear and sterile fluid or only nonpathogens in the other; four patients had a different pathogen in each ear; and two patients had two pathogens in one ear and only one in the other. Of those with asymptomatic MEFs, in 80 the effusion was sterile or contained only nonpathogens in both ears, and in 19 contained one or more pathogens. Of these 19, ten had the same pathogen isolated from both ears; nine had a pathogen in one ear and sterile fluid or only nonpathogens in the other. Thus, in 31 children with AOM and nine with asymptomatic MEFs, results of cultures of MEF were different. (Am J Dis Child 134:951-953, 1980) References 1. Shurin PA, Pelton SI, Donner A, et al: Trimethoprim-sulfamethoxazole compared with ampicillin in the treatment of acute otitis media . J Pediatr 96:1081-1087, 1980.Crossref 2. Healy GB, Teele DW: The microbiology of chronic middle ear effusions in children . Laryngoscope 87:1472-1478, 1977.Crossref 3. Teele DW, Healy GB, Talley FP: Persistent effusions of the middle ear: Cultures for anaerobic bacteriology. Ann Otol Rhinol Laryngol, to be published. 4. Grönroos JA, Kortekangas AE, Ojala L, et al: The aetiology of acute middle ear infection . Acta Otolaryngol 58:149-158, 1964.Crossref 5. Van Dishoeck HAE, Derks ACW, Voorhorst R: Bacteriology and treatment of acute otitis media in children . Acta Otolaryngol 50:250-262, 1959.Crossref 6. Austrian R, Howie VM, Ploussard JH: The bacteriology of pneumococcal otitis media . Johns Hopkins Med J 141:104-111, 1977.

Gowdar, Kusuma;Bull, Marilyn J.;Schreiner, Richard L.;Lemons, James A.;Gresham, Edwin L.

doi: 10.1001/archpedi.1980.02130220032010pmid: N/A

Abstract • Seventy-two infants were treated with nasal continuous positive airway pressure for one day to five weeks, and nasal deformities developed in none. One hundred thirty-six infants were treated with nasotracheal tubes and eight (6%) were found to have nasal deformities. There was a strong correlation between duration of intubation and birth weight and the presence of deformities. In no infant receiving ventilation therapy for less than six days did nasal deformities develop. The incidence of nasal deformities in infants weighing less than 1,000 g was 50%, whereas in infants heavier than 1,000 g it was 2.4%. No infant had clinical symptoms suggestive of subglottic stenosis during the first year of life. The data do not support the use of routine tracheostomy in newborn infants even after prolonged intubation. (Am J Dis Child 134:954-957, 1980) References 1. Strong RM, Passy V: Endotracheal intubation: Complications in neonates . Arch Otolaryngol 103:329-335, 1977.Crossref 2. Joshi VV, Mandavia SG, Stern L, et al: Acute lesions induced by endotracheal intubation . Am J Dis Child 124:646-649, 1972. 3. Schild JP, Wuilloud A, Kollberg H, et al: Tracheal perforation as a complication of nasotracheal intubation in a neonate . J Pediatr 88:631-632, 1976.Crossref 4. Aplin CE, Smith M, Harrison R, et al: Acquired tracheoesophageal fistula in a premature infant . J Pediatr 91:983-984, 1977.Crossref 5. Touloukian RJ, Beardsley GP, Ablow RC, et al: Traumatic perforation of the pharynx in the newborn . Pediatrics 59:1019-1022, 1977. 6. Saunders BS, Easa D, Slaughter RJ: Acquired palatal groove in neonates: A report of two cases . J Pediatr 89:988-989, 1976.Crossref 7. Duke PM, Coulson JD, Santos JI, et al: Cleft palate associated with prolonged orotracheal intubation in infancy . J Pediatr 89:990-991, 1976.Crossref 8. Boice JB, Krous HF, Foley JM: Gingival and dental complications of orotracheal intubation . JAMA 236:957-958, 1976.Crossref 9. Sinclair JC: Problems associated with prolonged nasotracheal intubation . Problems of Neonatal Intensive Care Units . Columbus, Ohio, Ross Laboratories, 1969, pp 69-80. 10. Jung AL, Thomas GK: Stricture of the nasal vestibule: A complication of nasotracheal intubation in newborn infants . J Pediatr 85:412-414, 1974.Crossref 11. Baxter RJ, Johnson JD, Goetzman BW, et al: Cosmetic nasal deformities complicating prolonged nasotracheal intubation in critically ill newborn infants . Pediatrics 55:884-887, 1975. 12. Verhoog-Bloembergen MPJ, Leader GL: Long-term nasotracheal intubation . Int Anesth Clin 12:241-257, 1974.Crossref 13. Berry FA Jr, Blankenbaker WL, Ball CG: A comparison of bacteremia occurring with nasotracheal and orotracheal intubation . Anesth Analg 52:873-876, 1973. 14. Choffat JM, Goumaz CF, Guex JC: Laryngotracheal damage after prolonged intubation in the newborn infant , in Stetson JB, Swyer PR (ed): Neonatal Intensive Care . St Louis, Warren H Green Inc, 1976, pp 253-270. 15. Pettett G, Merenstein GB: Nasal erosion with nasotracheal intubation . J Pediatr 87:149-150, 1975. 16. Gregory GA: Respiratory care of newborn infants . Pediatr Clin North Am 19:311-324, 1971. 17. Heroy JH, MacDonald MG, Mazzi E, et al: Airway management in the premature infant . Ann Otol Rhinol Laryngol 87:1-7, 1978. 18. Filston HC, Johnson DG, Crumrine RS: Infant tracheostomy: A new look with a solution to the difficult cannulation problem . Am J Dis Child 132:1172-1176, 1978.