The early history of the treatment for dehydration.

The difficulties of managing dehydration in infants, along with the special problems of infant feeding in the wake of the industrial revolution, led to the specialty of pediatrics. The scientific and clinical beginnings that preceded the specialty are reviewed; much that came later can be credited to pediatric scientists.

Dietary guidelines for children: U.S. recommendations.

The primary goal for pediatric dietary guidelines is to provide nutrients to support optimal growth and development at different ages from infancy through the end of adolescence. Over the past 15 years increasing attention has been directed toward developing nutrition recommendations that may lower the risk of chronic illness later in life. Recent evidence supports earlier studies that demonstrate that atherogenesis begins in childhood, is an evolving process and is influenced by environmental factors. As a result, in part, because of nutritional recommendations to lower the fat content of the diet, total fat and saturated fat as a percentage of total energy intake have declined in the diet of children and adolescents over the past 20 years. At the same time there has been no increase in the prevalence of growth failure; children, in fact, are heavier than their counterparts of 15 years ago. With a decrease in dietary fat, the mean serum cholesterol of the population as a whole has decreased steadily over the past 20 years. Children can safely eat a lower fat diet in which fat contributes 30% of total energy and saturated fat < 10% of total energy.

Direct calorimetry for the measurement of heat release in preterm infants: methods and applications.

Direct calorimetry is a sensitive and accurate method for the measurement of biologic heat release in humans. At the Children's Medical Center of Brooklyn, State University of New York, we have established direct calorimetry for the measurement of heat release by low birth weight premature infants. We have tested the method and find it to be simple, safe, and accurate. We studied heat release in 10 low birth weight infants on 22 occasions. The smallest infant in the study group weighed 1.43 kg. All the infant underwent direct calorimetry between 1 week and 18 weeks of age. Heat release in the infants ranged from 1.31 kcal/kg/hr. This method of direct calorimetry offers a tool for measuring total metabolic heat release from the first weeks of life in very low birth weight infants to estimate the insensible water losses and to examine the effect of various feeding regimens and disease states on total heat release.

Reminiscences of poliomyelitis past.

The article by Markel in the new Historical Perspectives of Pediatrics section of the ARCHIVES brings back a flood of memories, as I belong to the generation of pediatricians who actually used tank respirators in treating patients with poliomyelitis. In 1949, the city of Baltimore, Md, closed its contagious disease hospital (Sydenham), which served all of Maryland, and transferred its function to the Baltimore City Hospitals. The reasoning, in addition to a very low occupancy rate at Sydenham, was that the only contagious disease then likely ever to occur in epidemic form was poliomyelitis.

Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method.

A single-day large dose of vitamin D (stosstherapy) was given to 42 patients with nutritional vitamin D-deficiency rickets. Stosstherapy is safe and effective, obviates problems with compliance, and, by evoking a response in 4 to 7 days in nutritional rickets, becomes a valuable diagnostic aid for patients in whom initial findings do not clearly distinguish nutritional rickets from familial hypophosphatemic rickets.

Magnesium deficiency as a cause of hypocalcemia in the CHARGE association.

OBJECTIVE: To discover the mechanism of hypocalcemia in a patient with the CHARGE (coloboma, heart disease, atresia choanae, retarded growth and development, genital hypoplasia, and ear anomalies) association. RESEARCH DESIGN: Chemical and metabolic studies of serum, urine, stool, and muscle specimens. SETTING: A university hospital affiliated with a municipal hospital. PARTICIPANT: One patient with the CHARGE association and refractory hypocalcemia. MEASUREMENTS AND RESULTS: Serum calcium level was 0.91 mmol/L (reference range, 2.20 to 2.58 mmol/L) and serum magnesium level was 0.34 mmol/L (reference range, 0.80 to 1.20 mmol/L) prior to any therapy. After parenteral calcium and magnesium therapy, hypocalcemia persisted (1.46 mmol/L), while the serum magnesium level was 0.84 mmol/L. A needle biopsy of skeletal muscle tissue for the magnesium content confirmed a total magnesium deficiency despite normomagnesemia (muscle magnesium content, 517 micrograms/g [reference range, 800 to 1100 micrograms/g]). Magnesium deficiency was secondary to secretion of magnesium into the gastrointestinal tract (with a daily magnesium intake of 190 mg, a 24-hour nondiarrheal fecal excretion of magnesium was 2019 mg/kg [reference range, < 1000 mg/kg of stool weight]). INTERVENTIONS: Hypocalcemia was corrected only after 7 weeks of continual parenteral magnesium supplements to replenish the tissue magnesium deficiency. CONCLUSIONS: Patients with the CHARGE association often have hypocalcemia. Magnesium deficiency (with or without hypomagnesemia) is a cause of the hypocalcemia in at least one patient and may prove of significance in others.