1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320003001
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1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320021002pmid: 6846287
Abstract The issue of clinical and laboratory criteria for brain death in the child has been marked by confusion and controversy since the Harvard Medical School criteria were published in 1968.1 In the many reports that have since appeared, the most recent ones have emphasized clinical criteria rather than laboratory data in diagnosing brain death in adults. Although we, as pediatricians, have recognized the same clinical signs of brain death in children, virtually every report to date has excluded their applicability to the pediatric population. To determine brain death in children in our intensive care practice, we have relied both on clinical criteria, as well as laboratory confirmation, for several reasons. Many pediatricians are reluctant to depend exclusively on clinical skills for making such an important decision. Also, parents in a state of shock and disbelief at the loss of a previously healthy child need time and objective data before References 1. A definition of irreversible coma: Report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death . JAMA 1968;205:337-340.Crossref 2. Freeman JM, Rogers MC: On death, dying, and decisions . Pediatrics 1980;66:637-638.
Rowland, Thomas W.;Donnelly, Joseph H.;Jackson, Anthony H.;Jamroz, Susan B.
1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320023003pmid: 6846288
Abstract • The establishment of criteria for brain death is important for decision making in the treatment of critically ill patients. Our experience involving 15 children with coma, apnea, and absent brain-stem reflexes for a period of greater than three days supports previous reports in adults that the diagnosis of brain death can be made by clinical criteria alone. None of these patients survived, and each of the 11 autopsies performed revealed marked liquefactive necrosis in the brain. (Am J Dis Child 1983;137:547-550) References 1. Byrne PA, O'Reilly S, Quay PM: Brain death: An opposing viewpoint . JAMA 1979;242: 1985-1990.Crossref 2. Bernat JL, Culver CM, Gert B: On the definition and criterion of death . Ann Intern Med 1981;94:389-394.Crossref 3. Black PM: Brain death . N Engl J Med 1978;229:338-344, 393-401.Crossref 4. Molinari GF: Review of clinical criteria of brain death . Ann NY Acad Sci 1978;315:19-38.Crossref 5. Mohandas A, Chou SN: Brain death: A clinical and pathological study . J Neurosurg 1971;35:211-218.Crossref 6. Ouaknine G, Kosary IZ, Braham J, et al: Laboratory criteria of brain death . J Neurosurg 1973;39:429-433.Crossref 7. JorgensenPB, Jorgensen EO, Rosenklint A: Brain death pathogenesis and diagnosis . Acta Neurol Scand 1973;49:355-367.Crossref 8. Korein J, Maccario M: On the diagnosis of cerebral death: A prospective study on 55 patients to define irreversible coma . Clin Electroencephalogr 1971;2:178-199. 9. Becker DP, Robert CM, Nelson JR, et al: An evaluation of the definition of cerebral death . Neurology 1970;20:459-462.Crossref 10. Conference of Royal Colleges and Faculties of the United Kingdom: Diagnosis of brain death . Lancet 1976;2:1069-1070. 11. A definition of irreversible coma: Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death . JAMA 1968;205:337-340.Crossref 12. Report of the Medical Consultants on the Diagnosis of Death for The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: Guidelines for the determination of death . JAMA 1981;246:2184-2186.Crossref 13. An appraisal of the criteria of cerebral death—a summary statement: A collaborative study . JAMA 1977;237:982-986.Crossref 14. Milhaud A, Riboulot M, Gayet H: Disconnecting tests and oxygen uptake in the diagnosis of total brain death . Ann NY Acad Sci 1978; 315:241-251.Crossref 15. Schafer JA, Caronna JJ: Duration of apnea needed to confirm brain death . Neurology 1978; 28:661-666.Crossref 16. Allen N, Burkholder J, Comisconi J: Clinical criteria of brain death . Ann NY Acad Sci 1978;315:70-96.Crossref 17. Pasternak JF, Volpe JJ: Full recovery from prolonged brain stem failure following intraventricular hemorrhage . J Pediatr 1979;95:1046-1049.Crossref 18. Moseley JI, Molinari GF, Walker AE: Respirator brain: Report of a survey and review of current concepts . Arch Pathol Lab Med 1976; 100:61-64. 19. Masland R, in discussion, Walker AE, Molinari GE: Criteria of cerebral death . Trans Am Neurol Assoc 1975;100:29-35. 20. Walker AE, Diamond EL, Moseley JI: The neuropathological findings in irreversible coma: A critique of the respirator brain . J Neuropathol Exp Neurol 1975;34:295-323.Crossref 21. Green JB, Lauber A: Return of EEG activity after electrocerebral silence: Two case reports . J Neurol Neurosurg Psychiatry 1972; 35:103-107.Crossref 22. Ashwal S, Schneider S: Failure of electroencephalography to diagnose brain death in comatose children . Ann Neurol 1979;6:512-517.Crossref 23. Bolton CF, Brown JD, Cholod E, et al: EEG and 'brain life.' Lancet 1976;1:535.Crossref
Wilson, Ann L.;Wellman, Lawrence R.;Fenton, Lawrence J.;Witzke, Donald B.
1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320027004pmid: 6846289
Abstract • A questionnaire assessing physicians' understanding of the prognosis of preterm newborns was sent to every pediatrician, obstetrician, family practitioner, and general practitioner in South Dakota. Fifty-three percent of the total sample completed and returned the questionnaire that covered the mortality, general care, and physical, developmental, and psychosocial morbidity of the preterm newborn. The average physician answered 75% of all items with responses consistent with our interpretation of the medical literature. The physicians did better on items concerning mortality and physical morbidity than on those items related to psychosocial or developmental morbidity. Stepwise multiple regression analysis showed that a physician's years of experience was the most significant predictive variable and was negatively related to his or her overall score. (Am J Dis Child 1983;137:551-554) References 1. Vital Statistics . Pierre, SD, South Dakota State Health Department, 1981. 2. Wilson AL, Wellman L, Fenton L, et al: Development of a correspondence CME course for rural physicians . J Med Educ 1982;57:635-637. 3. Clyman R, Sniderman S, Ballard R, et al: What pediatricians say to mothers of sick new-borns: An indirect evaluation of the counseling process . Pediatrics 1979;63:719-723. 4. Sibley J, Sackett D, Neufeld V, et al: A randomized trial of continuing medical education . N Engl J Med 1982;306:511-515.Crossref
Kitchen, William H.;Yu, Victor Y. H.;Orgill, Anna A.;Ford, Geoffrey;Rickards, Anne;Astbury, Jill;Lissenden, Jean V.;Bajuk, Barbara
1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320031005pmid: 6189391
Abstract • Two large maternity services studied consecutive inborn infants (birth weight range, 500 to 1,500 g) born between 1977 and 1978. The multidisciplinary team members used identical assessment methods and documentation. Of 259 long-term survivors, 252 (97.3%) were seen at 2 years of age. Survival rates for hospitals 1 and 2 were 68.5% and 69.0%, respectively. Cerebral palsy rates for hospitals 1 and 2 were 11.8% and 11.2%, respectively. Major handicaps (cerebral palsy, mental developmental index [MDI] on the Bayley scales less than 69, epilepsy, deafness, or blindness) occurred in 30 (18.6%) and 17 (17.3%) of hospitals 1 and 2 survivors, respectively. Both cerebral palsy and developmental delay (MDI below 75 without severe or moderate cerebral palsy) were significantly correlated with a number of perinatal variables, but none were common to the two hospitals. Of the 30 children with cerebral palsy, 15 (50%) were not ventilated, and 28 (93%) had a five-minute Apgar score greater than 4; there was no indication that selective treatment to prevent cerebral palsy was possible. (Am J Dis Child 1983;137:555-559) References 1. Kitchen WH, Yu VYH, Lissenden JV, et al: Collaborative study of very low birthweight infants: I. Techniques of perinatal care and mortality . Lancet 1982;1:1454-1457.Crossref 2. Kitchen WH, Yu VYH, Orgill A, et al: Collaborative study of very low birthweight infants: II. Outcome of 2-year-old survivors . Lancet 1982;1:1457-1460.Crossref 3. Committee on Perinatal Health: Towards Improving the Outcome of Pregnancy . New York, The National Foundation—March of Dimes, 1976. 4. Bajuk B, Kitchen WH, Lissenden JV, et al: Perinatal factors affecting survival of very low birthweight infants: A study from two hospitals . Aust Paediatr J 1981;17:277-280. 5. Lubchenco LO: The High Risk Infant . Philadelphia, WB Saunders Co, 1976, pp 236-237. 6. Davies PA: Infants of very low birthweight , in Hull D (ed): Recent Advances in Paediatrics , ed 5. New York, Churchill Livingstone, 1976, pp 112-120. 7. Bennett FC, Chandler LS, Robinson NM, et al: Spastic diplegia in premature infants: Etiologic and diagnostic considerations . Am J Dis Child 1981;135:732-737.Crossref 8. Hagberg B, Hagberg G, Olow I: The changing panorama of cerebral palsy in Sweden, 1965-1970 . Acta Paediatr Scand 1975;64:187-192.Crossref 9. Fitzhardinge PM, Kalman E, Ashby S, et al: Present status of the infant of very low birth-weight treated in a referral neonatal intensive care unit in 1974 . Ciba Found Symp 1978;59: 139-144. 10. Sinclair JC, Torrance GW, Boyle MH, et al: Evaluation of neonatal-intensive-care programs . N Engl J Med 1981;305:489-494.Crossref 11. Stanley FJ: An epidemiological study of cerebral palsy in Western Australia, 1956-1975: I. Changes in incidence of cerebral palsy and associated factors . Dev Med Child Neurol 1979; 21:701-713.Crossref 12. Dale A, Stanley FJ: An epidemiological study of cerebral palsy in Western Australia, 1956-1975: II. Spastic cerebral palsy in perinatal factors . Dev Med Child Neurol 1980;22:13-25.Crossref 13. Jonson AR, Garland MJ: Ethics of New-born Intensive Care . Berkeley, Calif, University of California Health Policy Program and Institute of Governmental Studies, 1976, p 185. 14. Thorburn RJ, Lipscomb AP, Stewart AL, et al: Prediction of death and major handicap in very preterm infants by brain ultrasound . Lancet 1981;1:1119-1121.Crossref 15. Shankharan S, Slovis TL, Bedard MP, et al: Sonographic classification of intracranial hemorrhage: A prognostic indicator of mortality, morbidity and short-term neurologic outcome . J Pediatr 1982;100:469-475.Crossref
1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320035006
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Studies in new-born calves had demonstrated that virtually no agglutinins to B. abortus are transmitted from the cow via placental blood. Calves who failed to obtain colostrum died of B. coli septicemia in 80% of cases. Other studies demonstrated that the cow placenta is impermeable to the passage of euglobulin and pseudoglobulin. These investigators studied levels of diphtheria antitoxin in paired maternal and cord sera. The studies were done by the Kellogg method. This involves using Schick testing on guinea-pig skin that is injected locally with varying dilutions of the study serum. There was a close correspondence between maternal and cord blood antitoxin levels. Similar studies by this method done on human colostrum suggested that antitoxin, while sometimes present in colostrum, is consistently lower than that of maternal serum. They conclude that human colostrum plays no role in the development of immunity
Maisels, M. Jeffrey;Gifford, Kathleen
1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320037007pmid: 6846290
Abstract • Serum bilirubin determinations were performed on 264 term infants who were consecutively delivered via the vaginal route. Forty-one infants (15.5%) had serum bilirubin concentrations greater than 12 mg/dL. No cause for this was found, initially, in 23 (56%) of these infants. On the third hospital day, the mean (±SD) serum bilirubin level was 6.9±3.6 mg/dL in breast-fed infants and 6.5±3.2 mg/dL in bottle-fed infants. Of the 23 infants without obvious cause for hyperbilirubinemia, eight (four bottle-fed and four breast-fed infants) had serum bilirubin concentrations greater than 12 mg/dL on the third hospital day, whereas in 15(14 breast-fed infants and one bottle-fed infant), the elevated serum bilirubin level occurred on day 4 or 5. Breast-feeding does not seem to affect the total serum bilirubin level in the first three days of life but may be associated with an increased incidence of hyperbilirubinemia subsequently. In a normal full-term population, routine investigations do not disclose a cause for hyperbilirubinemia in about half of the patients. (Am J Dis Child 1983;137:561-562) References 1. Wood B, Culley P, Roginski C, et al: Factors affecting neonatal jaundice . Arch Dis Child 1979; 54:111-115.Crossref 2. Calder AA, Ounsted MK, Moar VA, et al: Increased bilirubin levels in neonates after induction of labour by intravenous prostaglandin E2 or oxytocin . Lancet 1974;2:1339-1342.Crossref 3. Boylan P: Oxytocin and neonatal jaundice . Br Med J 1976;3:564-565.Crossref 4. Dahms BB, Krauss AN, Gartner LM, et al: Breast feeding and serum bilirubin values during the first four days of life . J Pediatr 1973;83:1049-1054.Crossref 5. McConnell JB, Glasgow JFT, McNair R: Effect on neonatal jaundice of oestrogens and progestogens taken before and after conception . Br Med J 1973;3:605-607.Crossref 6. Gould SR, Mountrose U, Brown DJ, et al: Influence of previous oral contraception and maternal oxytocin infusion on neonatal jaundice . Br Med J 1974;3:228-230.Crossref 7. Drew JH: Breastfeeding and jaundice . Keeping Abreast J Hum Nutr , (January) -March 1978, pp 53-57. 8. Maisels MJ: Neonatal jaundice , in Avery CB (ed): Neonatology, Pathophysiology and Management of the Newborn , ed 2. Hagerstown, Md, Harper & Row Publishers Inc, 1981, pp 473-544. 9. Krauss AN, Dahms BB, Gartner LM, et al: Significance of 'no statistically significant difference.' J Pediatr 1974;84:286. 10. Kandall SR, Landaw SA, Thaler MM: Corrected carboxyhemoglobin: A sensitive index of hemolysis in jaundiced newborns . Pediatr Res 1973;7:356.
Clarke, Thomas A.;Maniscalco, William M.;Emmens, Robert W.
1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320039008pmid: 6405611
Abstract • The return of stable premature infants to community hospitals from level III neonatal intensive care units is becoming more common. While these infants usually need only to gain weight, they are still at risk for significant neonatal problems. We report four cases of necrotizing enterocolitis (NEC) in nine stable, growing premature infants who weighed less than 1,300 g and returned to community hospitals. The onset of NEC was within 60 hours of transport, suggesting that transport and early feeding after transport may have been contributory to NEC. (Am J Dis Child 1983;137:563-565) References 1. Touloukian RJ: Neonatal necrotizing enterocolitis: An update on etiology, diagnosis and treatment . Surg Clin North Am 1976;56:281-298. 2. Avery GB, Fletcher AB: Nutrition , in Avery GB (ed): Neonatology, Pathophysiology and Management , ed 2. Hagerstown, MD, Harper & Row Publishers Inc, 1981, p 1049. 3. Zarif MA, Rest J, Vidyasagar D: Early transfer: A method of optimal bed utilization of NICU beds . Crit Care Med 1979;7:327-329.Crossref 4. Kliegman RM, Fanaroff AA: Neonatal necrotizing enterocolitis: A nine-year experience: I. Epidemiology and uncommon observations . Am J Dis Child 1981;135:603-607.Crossref 5. Santulli TV, Schullinger JN, Heird WC, et al: Acute necrotizing enterocolitis in infancy: A review of 64 cases . Pediatrics 1975;55:376-387. 6. Bunton GL, Durbin GM, McIntosh M, et al: Necrotizing enterocolitis: Controlled study of three years' experience in a neonatal intensive care unit . Arch Dis Child 1977;52:772-777.Crossref 7. Kosloske AM: Necrotizing enterocolitis in the neonate . Surg Gynecol Obstet 1979;148:259-269. 8. Eidelman AI, Inwood RJ: Necrotizing enterocolitis and enteral feeding: Is too much just too much? Am J Dis Child 1980;134:545-546.Crossref 9. Stoll BJ, Kanto WP, Glass RI, et al: Epidemiology of necrotizing enterocolitis: A case control study . J Pediatr 1980;96:447-451.Crossref 10. Kliegman RM: Neonatal necrotizing enterocolitis: Implications for an infectious disease . Pediatr Clin North Am 1979;26:327-344. 11. Morett L, Harin A, Ferrara A: Adverse effect of transportation on neonates as measured by Pao2 . Pediatr Res 1978;12:530-535.Crossref 12. Longo LD: The biological effects of carbon monoxide on the pregnant woman, fetus and newborn infant . Am J Obstet Gynecol 1977;129: 69-73. 13. Shenai JP, Johnson GE, Varven RV: Mechanical vibration in neonatal transport . Pediatrics 1981;68:55-57. 14. Clark JB, Williams JD, Hood WB, et al: Initial cardiovascular response to low frequency whole body vibration in humans and animals . Aerospace Med 1967;38:464-467.
1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320042009pmid: 6342365
Abstract • Abraham and Mary Jacobi, two general physicians from widely differing backgrounds, shared a lifelong commitment to the health and welfare of children. Together, they planted the seeds of the modern specialty of pediatrics. Education for the care of children was a major focus of the Jacobis' lives. In their day, emphasis in pediatric practice was on infant feeding and on ameliorating the appalling level of mortality from infectious diseases. In subsequent decades, advances in knowledge about diseases and in basic medical science enabled physicians to deal confidently with these problems, so that emphasis shifted to diagnosis and treatment of less common conditions and, most recently, to recognition of the pediatrician's role in treatment of psychosocial disorders. Throughout the evolution of the medical education process, the role of the pediatrician as child advocate, so efficiently modeled by the Jacobis, has continued to be a major theme. (Am J Dis Child 1983;137:566-571) References 1. Truax R: The Doctors Jacobi . Boston, Little Brown & Co, 1952, pp 1-270. 2. Cone TE: History of American Pediatrics . Boston, Little Brown & Co, 1979, pp 1-278. 3. Rosiniski E, Blanton WB: A system of cataloguing the subject matter content of a medical school curriculum . J Med Educ 1962;37:1092-1100. 4. Foundations for Evaluating the Competency of Pediatrics . Chapel Hill, NC, American Board of Pediatrics, 1974. 5. Levine HD, Daeschner CW, Emory J: Evaluation of a modularized system of instruction in pediatrics . J Med Educ 1977;52:213-215. 6. Caldwell B, Lockhart L: A care-by-parent unit: Its planning, implementation and patient satisfaction . Child Health Care 1981;10:4-7.Crossref
1983 American Journal of Diseases of Children
doi: 10.1001/archpedi.1983.02140320047010
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Phrase Added to Sentence.—In the article "Bacteriology of Acute Otitis Media in Japanese Children," published in the February Journal (1983;137:152-154), a phrase was omitted. On page 152, in the "Materials and Methods" section, the sentence beginning on the 20th line should have read: "The exudate was cultured on 5% sheep blood agar and chocolate agar at 37 °C for 24 hours."
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