THE EFFECT OF EARLY DIAGNOSIS OF CONGENITAL DISLOCATION OF THE HIP

Abstract. The effects of early diagnostic measures of congenital dislocation of the hip (CDH) in Malmo during the years 1956-1972 were investigated. Of 58759 newborns 548 were diagnosed as having CDH. Only 4 cases were missed at the initial examination. Thus, all, or almost all, children with CDH can be diagnosed at birth provided that the initial examination is undertaken within 24 or 48 hours.     

新生儿败血症260例临床分析

目的分析我所10年间新生儿败血症的临床和转归特点。方法对我所260例新生儿败血症患儿的临床资料和血培养阳性菌进行回顾性研究。结果新生儿败血症发病构成比和死亡构成比总体呈下降趋势。血培养结果显示凝固酶阴性葡萄球菌占44．7％，金黄色葡萄球菌14．9％，大肠埃希氏菌12．8％。病死率9．6％，发病日龄越小，病死率越高，≤3天发病者病死率高达22．5％。结论新生儿败血症的病死率仍然很高，防治工作有待进一步加强。     

RESERVOIR AND EMPTYING FUNCTION OF THE STOMACH OF THE PREMATURE INFANT

Cavell, B. (Department of Paediatrics, University of Lund, Sweden). Reservoir and emptying function of the stomach of the premature infant. Acta Paediatr Scand, Suppl. 296: 60, 1982. — Gastric emptying of meals of human milk and infant formula was studied in 11 healthy preterm (AGA) infants using a marker dilution technique. Gastric emptying rate and gastric half-emptying time were compared with data from 17 healthy infants aged 4 weeks to 6 months. The amounts of human milk emptied from the stomach per 0.1 m² of body surface area were 19.4±4.5 ml in preterm infants and 29.5±4.6 ml in term infants. The corresponding amounts with meals of infant formula were 13.8±2.8 and 22.7±4.2 ml, respectively. With the volumes given gastric half-emptying times for meals of human milk and infant formula were 25.1±11.5 and 51.9±9.8 min, respectively, in preterm infants. The corresponding half-emptying times for term infants were 48±15 and 78±14 min, respectively. The differences in gastric emptying rate as well as in gastric half-emptying time between the two meals were significant (p<0.01) both in preterm and term infants.     

THE INFLUENCE OF HORMONE TREATMENT ON THE NATURAL EVOLUTION OF THE IDIOPATHIC NEPHROTIC SYNDROME IN CHILDHOOD

In 43 children with idiopathic nephrotic syndrome (INS) who were treated with ACTH or corticosteroids, the evolution was studied after 4 to 14 ½ years. Frequent control investigations revealed that 29 patients were probably cured, 3 were dead, 2 showed a late recurrence and in 1 sequelae were found. In 7 patients, the NS was characterized by the occurrence of multiple relapses. The comparison of these data with those of a prior identical follow-up study in 44 patients of the pre-hormonal era, permitted a gross evaluation of the influence of hormone therapy on the natural course of the INS. It was demonstrated that more hormonally treated patients cured, but that, due to the more frequent occurrence of relapses, definitive healing was significantly postponed. Less patients died, the number of late relapses and sequelae was not very different in both groups. Multiple relapses were seen only in the hormonal group. The cured patients and those with multiple relapses thus probably represent the patients who would have died in the pre-hormonal era, but it is not known which effect is due to antibiotics and hormones respectively. The long-term effect of hormone therapy will depend on the evolution in this group with multiple relapses. The histologic lesions in the kidney, found in some of these patients suggest that probably in a part of them, a fatal issue is to be expected. Further follow-up studies in the other patients with multiple relapses but with shorter follow-up periods, will reveal if identical lesions occur later in all these patients. If this is the case, the long-term effect of hormone therapy in our patients consisted in an important postponement of the fatal issue.     

THE EFFECT OF DISACCHARIDES ON THE HYPERLACTACIDAEMIA OF GLUCOSE-6-PHOSPHATASE-DEFICIENT CHILDREN

ABSTRACT. Fernandes, J. (Department of Paediatrics, Sophia Children's Hospital and Neonatal Unit, Erasmus University, Rotterdam, The Netherlands). The effect of disaccharides on the hyperlactacidaemia of glucose-6-phosphatase-deficient children. Acta Paediat Scand, 63: 695, 1974.—Two unrelated children with hepatic glycogenosis due to glucose-6-phosphatase deficiency were investigated as regards the influence of dietary disaccharides on their hyperlactacidaemia. The disaccharides were administered orally as 10% solutions hourly during 12 hours in an A-B-A sequence, i.e. maltose-lactose-maltose, or maltose-sucrose-maltose. Each disaccharide was given in repeated doses. Blood lactate levels increased during the lactose or sucrose feedings and decreased during the maltose feedings, while normoglycaemia was maintained throughout the experiments. It is concluded that lactose and sucrose should be restricted in the diet of children with a glucose-6-phosphatase deficiency.     

THE EFFECT OF LYSINE FORTIFICATION OF IRANIAN BREAD ON THE NUTRITIONAL STATUS OF SCHOOL CHILDREN

The effect of enrichment of bread with lysine was studied on a group of Iranian village children receiving free school lunch over a period of 210 days. Two groups received typical dishes, which were purposely modified to make them limited by lysine; one with enriched and the other with non-enriched bread. The third group did not receive lunch and served as control to assess the changes in the nutritional status of the former groups. The food intake at the homes was not controlled. Markedly greater increases in weight and mid-arm circumference were observed in groups which received the school lunch (with or without lysine) than in the control group. Lysine enrichment showed no significant effect in improving the nutritional status except that children who received the amino acid supplementation exhibited significantly higher increments in mid-arm circumferences. An increment in height and weight was observed in children of non-lysine group over those who received lysine which was significant in respect to height. The latter group also showed a small but significant decrease in serum albumin.     

THE INFLUENCE OF CHILDHOOD DISCIPLINARY EXPERIENCE ON THE DEVELOPMENT OF ALCOHOLISM AND DEPRESSION

In this case-control study, respondents from the general population with a lifetime diagnosis of major depressive disorder, alcohol abuse and/or dependence, or the absence of any psychiatric disorder ascertained by the St. Louis Epidemiological Catchment Area Study were reinterviewed about their early home environments during the period when they were 6 to 13 years of age. Two discipline scales were developed through factor analysis, and logistic regression was used to build a model using all the predictors. Unfair, inconsistent and harsh discipline by parents predicted both alcohol and depressive disorders independently of the influence of parental psychiatric history, the respondent's sex, and childhood behavior problems.     

AN EXPERIMENTAL EVALUATION OF THE EFFECTS OF FIVE STYLES OF TEACHER CONVERSATION ON THE LANGUAGE OF HEARING-IMPAIRED CHILDREN

This study of conversation was undertaken to test experimentally conclusions reached in earlier work with deaf primary school children and pre-school hearing children. Both of these studies revealed significant negative correlations between a measure of teacher control of the conversations and measures of children's initiative and loquacity. This study was designed to investigate the direction of causality in these correlations. Teachers were asked to change their conversational styles in specific ways with the same pairs of children. On each of five occasions they were to bias their conversations towards one of five "levels of control"--enforced repetitions, two-choice questions, wh-type questions, personal contributions and phatics. The results show that as teachers change style, their children follow them with the predicted changes in initiative and mean length of turn.     

COARCTATION OF THE AORTA

Abstract. Sørland, S. J., Rostad, H., Forfang, K. and Åbyholm, G. (Departments of Paediatrics, Surgery and Medicine, Rikshospitalet, The National Hospital, Oslo 1, Norway). Coarctation of the aorta. A follow-up study after surgical treatment in infancy and childhood. Acta Paediatr Scand, 69: 113, 1980.—Between 1951 and 1973, 138 patients aged 0 to 12 years were operated on for coarctation of the aorta. Ten of 18 infants died early. There were 3 late deaths, 2 occurred suddenly and 1 after reoperation. Three of the 125 late survivors had severe, 19 had slight symptoms, while 103 had no complaints, 3 of whom refused examination. The remaining 122 cases were examined between 2 and 24 years (mean 10.9 years) after the operation. Two patients had sequelae from an operative spinal cord injury and 2 had late hemipareses (traumatic in one). Recoarctation, defined as arm/leg pressure gradient exceeding mmHg, totally occurred in 18.7%, and in 4 of 7 cases operated on in infancy. Hypertension without recoarctation was observed in 17.2% and associated cardiovascular anomalies in 18% of the late survivors. It is suggested that the optimal age for surgical repair of coarctation of the aorta is between 4 and 6 years of age. A long-term follow-up is recommended in all patients     

PREDICTION OF THE SEVERITY OF ABO HAEMOLYTIC DISEASE OF THE NEWBORN BY CORD BLOOD TESTS

ABSTRACT. Whyte, J. and Graham, H. (Bellshill Maternity Hospital, Bellshill, Lanarkshire, Scotland). Prediction of the severity of ABO haemolytic disease of the newborn by cord blood tests. Acta Paediatr Scand, 70:217, 1981. –Seventy-one ABO incompatible (heterospecific) infants and 71 controls, who were free from other potential causes of jaundice, were studied to ascertain which cord blood tests reliably predict the severity of ABO haemolytic disease of the newborn (ABO HDN). The modified Direct Antiglobulin Test (spin DAGT) was positive in all infants who required treatment for haemolytic jaundice and only DAGT positive children showed evidence of impending haemolytic anaemia or compensated haemolysis in cord or capillary blood. Cord serum bilirubin concentration had some predictive value, particularly when the level exceeded 85 µmol/l, but it was a less reliable indicator and had greater value if used in association with the DAGT. The elution test, which is frequently used as a diagnostic tool in ABO HDN, had no predictive value and we felt that its putative value is due to overdiagnosis of ABO HDN in jaundiced heterospecific infants. We conclude that the spin DAGT, despite the weakness of the reaction, reliably identifies infants at risk from severe ABO HDN and is sufficiently sensitive to be used as a single screening test for the early detection of the disorder.     

RELATIONSHIP OF MATERNAL SMOKING TO MORBIDITY AND MORTALITY OF THE CHILD UP TO THE AGE OF FIVE

ABSTRACT. The effect of maternal smoking during pregnancy on the morbidity and mortality of the child up to the age of five was studied in 12068 births. The children of the smokers were compared with those of controls of similar age, parity, marital status and place of residence. Perinatal mortality was no higher among the smokers, but postneonatal mortality from 28 days to 5 years was almost significantly ( p <0.05) higher. The children of the smokers were highly significantly ( p <0.001) more often hospitalized in pediatric departments, the difference being clearest below the age of one. The average duration of hospital admissions was longer among the children of the smokers, and similarly the numbers of visits to the doctor and hospital admissions to any hospital under the age of one were more frequent among the children of the smokers. Respiratory diseases caused highly significantly more hospitalizations among these children.     

IMPERFORATE ANAL MEMBRANE - THE ANATOMY AND FUNCTION OF THE SPHINCTERS OF THE ANAL CANAL*

An undamaged specimen of an imperforate anal membrane, including the rectum, anal canal and its sphincters became available for serial histological sections. The membrane was diaphanous, the internal, and the external sphincters were defective, but the puborectalis muscle though modified by the deformity, was well developed. In living patients, the rectal continence which ensues on division of the membrane is effective because of the presence of an efficient puborectalis muscle.     

INSULIN ANTIBODIES IN THE SERUM OF DIABETIC CHILDREN TREATED FROM THE DIAGNOSIS OF THE DISEASE WITH HIGHLY PURIFIED INSULINS

Abstract. Fitly-one diabetic children, treated with highly purified, porcine insulins from the diagnosis of the disease were studied for the development of insulin antibodies during the first years of treatment. Sera were obtained before the start of treatment and at repeated intervals thereafter. Serum insulin antibodies were measured by three methods in three laboratories. Twenty-nine children were treated with R.I. (rare immunogenic) insulins at one department and 22 with MC (monocomponent) insulins at the other department. Before the start of treatment, serum insulin antibodies were almost invariably zero or below the limit of detection. During the first year a considerable number of cases, more than that reported for adults, formed detectable amounts of antibodies, and more so in the R.I. than in the MC series. The levels were however definitely lower than those observed with the Same methods in diabetic children on conventional insulins. Analysis of variance showed no differences between the various age groups. No significant correlation was found between the highest titre of serum insulin antibodies on the one hand and insulin dose or glucosuria on the other hand. The results confirm the concept that children form antibodies to insulin more actively than adults.     

VISCOSITY OF THE BLOOD IN THE NEWBORN INFANT

ABSTRACT. Bergqvist, G. (Department of Paediatrics, Karolinska Institutet, St Göran's Hospital for Children, Stockholm, Sweden). Viscosity of the blood in the newborn infant. Acta Paediatr Scand, 63: 858, 1974.—Whole blood viscosity has been measured with a Brookfidd LVT viscometer on newborn infants with varying hematocrit values. Normal term infants appropriate for gestational age, preterms and small for gestational age infants were studied during the first week. Viscosity/hematocrits varied enormously both in different infants, but also between groups, i.e. terms, preterms and SGA. Marked variations occurred during the first week of life. The normal viscosity values were found to be roughly twice as high as in adults, whereas the plasma viscosity was the same or rather lower. The difference in viscosity in relation to adults seems to be due almost entirely to the higher hematocrit values. With late clamping of the cord, infants (and especially small for gestational age infants) may have extremely high hematocrit and viscosity valUS.     

DEFINING THE SOCIAL DEFICITS OF AUTISM: THE CONTRIBUTION OF NON-VERBAL COMMUNICATION MEASURES

Young autistic children were compared to normal and control samples on measures of non-verbal communication skills and object play skills. Deficits in non-verbal indicating behaviors best discriminated the children diagnosed as autistic from the other groups. Although the autistic children also exhibited deficits in object play behavior, these deficits did not add appreciably to the discriminant function based on the non-verbal communication behaviors. These results suggest that a deficit in the development of non-verbal indicating behaviors is a significant characteristic of young children who receive the diagnosis of autism.     

THE INFLUENCE OF OROTIC ACID ON THE SERUM BILIRUBIN LEVEL OF MATURE NEWBORN

Fifty-two mature newborn were treated with a daily dose of 200 mg of orotic acid from their 1st to their 5th day of life. An equally large number of untreated children served as a control group. Contrary to the premature infants, in the mature newborn no decrease in the serum bilirubin was achieved by administration of orotic acid. The question of the possible mode of action of the orotic acid is discussed.     

PANCREOZYMIN - SECRETIN TEST OF EXOCRINE PANCREATIC FUNCTION IN CYSTIC FIBROSIS AND THE SIGNIFICANCE OF THE RESULT FOR THE PATHOGENESIS OF THE DISEASE*

Pancreozymin-secretin tests were performed on 10 children with cystic fibrosis of the pancreas, who did not show any clinical symptoms of exocrine pancreatic insufficiency. The results indicate that in this particular group of patients water and bicarbonate secretion from the pancreas is more severely affected by the disease than enzyme secretion. Thus these patients secrete a small amount of pancreatic juice with a very low bicarbonate content but an abnormally high concentration of enzymes. Based on these results, a hypothesis for the pathogenesis of cystic fibrosis is put forward using the concept that in most exocrine glands, 2 different types of secretion contribute to the final secretory product: a highly concentrated secretion of organic substances and a more dilute secretion containing mainly electrolytes. During the secretory process, the organic constituents of the first type of secretion are diluted by the electrolyte-containing fluid of the second secretion. Evidence is presented, that the pathological features in the pancreas in cystic fibrosis could result from the failure to produce an adequate amount of electrolyte-containing fluid and it is suggested that the changes occurring in other organs affected by the disease may result from a similar phenomenon.     

THE PROGNOSIS OF NEAR-DROWNED CHILDREN

Abstract. Thirty children were treated for near-drowning in the Children's Hospital, University of Helsinki during 1971–1976. The patients were divided into 3 groups according to the prognosis: group I included 13 children (43%) with a favourable prognosis, group II four children (13%) with a less favourable prognosis who developed severe sequelae, and group III 13 children with poor prognosis and in whom the subsequent outcome proved fatal. The surviving children underwent neurological, neurophysiological and psychological examination 6–58 months after the accident. The children in group I had slight neurological or psychological signs, some children presented a lowered intellectual functioning level. The children in group II were tetraplegic, unable to speak and had convulsions. The following factors were important in affecting prognosis: the longer the immersion time, the worse the prognosis. However, prognosis could still be favourable with an immersion-time of 11–20 min. Prognosis was bad if the first pH value was <7.00. The arterial oxygen pressure values measured during the treatment did not correlate with the prognosis but a low rectal temperature on admission was usually associated with a bad prognosis. The degree of EEG-disturbance had a prognostic value. However, the follow-up recordings correlated better with the prognosis than the recordings during the first 24 hours, after which worsening of the EEG sometimes showed a progressive brain lesion.     

A DEVELOPMENTAL DOSE-RESPONSE ANALYSIS OF THE EFFECTS OF METHYLPHENIDATE ON THE PEER INTERACTIONS OF ATTENTION DEFICIT DISORDERED BOYS

Mixed dyads of 42 normal and 42 ADD boys were videotaped in free play, co-operative task, and simulated classrooms. ADD boys received placebo, 0.15 mg/kg, and 0.50 mg/kg of methylphenidate. ADD boys were more active and off task, watched peers less, and scored lower on mathematics and visual-motor tasks. Older boys interacted less, ignored peer interactions and play more frequently, were less controlling, and more compliant. In class, methylphenidate improved visual motor scores, and reduced the controlling behaviour, activity level, and off task behaviour of ADD boys. Normal peers displayed reciprocal reductions in controlling behaviour, activity level, and off task behaviour.     

THE ROLE OF FINE NEEDLE ASPIRATION BIOPSY IN THE DIAGNOSIS AND MANAGEMENT OF OSTEOSARCOMA

We retrospectively reviewed our experience with fine needle aspiration biopsy (FNAB) in the diagnosis and management of skeletal osteosarcoma. The bi-institutional study sample involved 30 consecutive aspirates from 29 patients (28 primary tumors, 1 pulmonary metastasis, 1 local recurrence). There were 17 children and 12 adults. Two aspirates were unsatisfactory for diagnosis. Of the adequate primary osteosarcoma cases analyzed by FNAB, 24 of 26 were diagnosed as osteosarcoma. All pediatric cases were correctly interpreted as osteosarcoma and treated appropriately. There were 2 incomplete diagnoses. A secondary osteosarcoma arising within an otherwise clinically, radiologically, and histologically typical giant cell tumor (malignant giant cell tumor) was not diagnosed preoperatively on FNAB due to nonrepresentative sampling. Chronologically, the first patient with osteosarcoma analyzed by FNAB was diagnosed simply as "spindle cell neoplasm." No complications resulted from the procedure. With adequate clinical and radiologic correlation, FNAB represents a technically, easily performed, cost-effective, and accurate procedure for establishing the diagnosis of skeletal osteosarcoma. Immediate interpretation of aspirated material allows for therapy planning and oncologic consultation at the initial clinic visit.