Sonographic findings in infants with macrocrania.

This study compares the sonographic and CT findings in a group of infants with macrocrania and correlates those findings with neurologic outcome to determine the diagnostic accuracy and prognostic value of sonography. Sonographic findings in 255 infants with macrocrania are described. Of the 195 term infants examined, 130 had normal sonograms, 11 (5.6%) had significant abnormalities, and 54 had increased intra- and/or extraaxial fluid spaces. Of the 60 former preterm infants, 33 had normal sonograms, four (6.7%) had significant abnormalities, and 23 had increased fluid spaces or small resolving germinal matrix hemorrhages. The patients with significant abnormalities usually had head circumferences greater than the 95th percentile and had neurologic abnormalities. There was good correlation between sonography and CT in 30 of the 36 patients evaluated by both. In six there was mild discrepancy in the volume of the extraaxial fluid. No significant abnormality was missed by sonography. CT did not contribute any additional information. Neurologic follow-up was available for 202 patients. Nineteen percent of the term infants and 24% of the former preterm infants were abnormal on neurologic follow-up. Most patients with normal sonograms were normal on follow-up. Twelve of the term and four of the preterm infants with normal sonograms were developmentally delayed on follow-up. Increased CSF in the ventricles and/or extraaxial spaces was a common abnormality, but it usually is associated with a normal neurologic outcome and represents "benign macrocrania." We conclude that an infant with an enlarged or enlarging head should have a neurologic examination and head circumference measurement. If the patient has a head circumference greater than the 95th percentile, particularly if there are abnormal neurologic findings, further evaluation is indicated. Sonography is the initial procedure recommended since it accurately evaluates ventricular size, extraaxial fluid, and congenital malformations. If sonography is normal or shows mildly increased fluid spaces, then follow-up head circumference measurement and clinical evaluation will probably suffice. CT is indicated if there is a significant abnormality on sonography that requires further clarification.

Relative velocity of accretion of weight and height using the Benn index in the first nine years of life.

Using the power ponderosity index of Benn, weight (W)/height (H)p, (W/Hp) where the value of p is determined so that the correlation of height and W/Hp is zero, a set of p values was obtained from longitudinal data of 630 healthy, white, middle class children ranging in ages from birth to 9 years. Our data revealed two turning points in the relative velocity of change of height and weight not previously recognized by separate studies of velocity changes in weight and height related to chronological age. The value of p increased from birth (1.72) until about 1 month (2.39) for girls, and 5 months for boys (2.30), the first turning point, and then fell to a nadir at age 18-21 months for girls (1.75) and 21-24 months for boys (1.73), the second turning point. This fall to the nadir represents the greater influence of velocity change in height over weight. From then to age 9 years, there was a gradual and steady increase in p, greater for girls than for boys, representing the greater influence of velocity change in weight over height. The values of p have now been estimated for white, middle class children over the ages of birth to 9 years and may have utility in studies which compare obesity indicators.

Intentional poisoning of children--an overlooked category of child abuse: report of seven cases and review of the literature.

Seven instances of child abuse due to poisoning are reported; two of the children died. Forty-one cases of this form of poisoning are found in the literature. Of the total of 48 children, eight (17%) died as a result of the incident; and one was mentally retarded. The seven different agents described here are alcohol, glutethimide (Doriden), propoxyphene hydrochloride (Darvon), diazepam, insulin, lye, and pepper, constituting 27 different types of poison used by abusing guardians. The most common cause of abuse reported is excessive salt ingestion with water restriction. Excessive ingestion of water is the second most common cause. Barbiturates and tranquilizers are also frequent agents. In 30% of the cases, poisoning persists even after hospitalization. Child abuse by battering is associated in 20% of the cases. The need for a high index of suspicion of abuse in bizarre presentations of children for medical care when the etiology is obscure is emphasized.

Measles immunity after revaccination: results in children vaccinated before 10 months of age.

Measles immunity was studied in children in a private pediatric practice who had been revaccinated because they had received their primary measles vaccination before 1 year of age. Antibody was measured in 72 of these children who had received the first injection of live measles virus vaccine at less than 10 months of age, and the second at greater than 1 year of age. Of the 72 children, 29 (40%) had no detectable antibody and the geometric mean titer for the group was approximately 1:4. Of the children with low antibody titers, 15 were given a third injection of measles vaccine and five (33%) still did not respond. Cell-mediated immunity as indicated by lymphocyte transformation to measles antigen was measured in 11 of the children. Five (45%) had responses to measles antigen, but the responses did not correlate with the presence or absence of antibody. This study confirms the observation that revaccination is unsuccessful in many children who received measles vaccine in the first year of life, and shows that even a third injection of vaccine may fail to produce a significant antibody response.

Relationship of head circumference to length in the first 400 days of life: a mnemonic.

The relationship between length and head circumference can be expressed by the simplified formula: head circumference (centimeters) = 0.5 length +9.5 +/- 2.5; head circumference (inches) = 0.5 length + 3.75 +/- 1. This formula is accurate for 95% of measurements in the first 400 days of life. The correlation coefficient of length to head circumference is .94 (P = .0001).

Evaluation of the free erythrocyte porphyrin (FEP) test in a private practice: the incidence of iron deficiency and increased lead absorption in 9- to 13-month-old infants.

With the free erythrocyte prophyrin (FEP)/hematocrit ratio as a screening test, three of 122 9- to 13-month-old children had iron deficiency (FEP 147 to 286 microgram/100 ml of RBCs). The hematocrit alone could not identify these children. All three were drinking more than one quart of cow's milk per day. On follow-up examination of seven children with values of FEP of 100 to 140 microgram/100 ml of RBCs, two became anemic and one demonstrated increased lead absorption. Children with values of FEP below 100 microgram/100 ml of RBs (2 SD above the mean) did not develop anemia. Teaching parents to restrict cow's milk intake below one quart per day could be an effective means of preventing iron deficiency as identified by FEP screening. The child with increased lead absorption could not have been recognized by hematocrit alone.

Where do the heaviest children come from? A prospective study of white children from birth to 5 years of age.

A prospective follow-up study, from birth to age 5, of height, weight, and weight/height indices in 582 white children was carried out in a suburban private pediatric practice. The purpose of the study was to examine trends in height and weight over time, to evaluate any differences in measures of ponderosity between breast-fed and bottle-fed infants, and to locate the heaviest children at age 5. There were significant correlations between height, weight, the ratio of height to weight, the ponderal index (height/weight 1/3), and the Quetelet index (weight/height2) achieved during the first year of life, and that attained at age 5 years. However, approximately 70% of the variance in weight and ponderosity indices at age 5 could not be accounted for by measurement of weight and ponderosity during the first year of life. Breast-fed and bottle-fed infants did not differ in weight and weight/height indices. There was a modest, but consistent, "tracking" pattern among children in the upper decile for weight and ponderosity at age 5 years in that 30% of them were also in the top decile for weight and ponderosity at age 6 months, and 30% to 40% were in the top decile at age 1 year. More than half of the variance in weight or indices of body proportion at age 5 is not accounted for by these variables in the first year of life, indicating limitations to the generalizability of the concept, that obese infants become obese children.

Tick-borne relapsing fever in the Eastern United States.

Tick-borne relapsing fever is endemic in the western part of the United States, but it has not been reported east of the Mississippi River. Sporadic cases have been reported in the eastern part of the United States, but travel to the West during the incubation period appeared to provide the source of infection. In the fall of 1975, a case of relapsing fever was diagnosed in Cincinnati in a child who had not traveled outside of Ohio, indicating the presence of Borrelia in this area. Serial serological studies indicated that B turicatae was the species involved. The occurrence of this case suggests that relapsing fever may exist in the eastern part of the United States, but its presence may not be appreciated because of the rarity of the disease and the difficulty in confirming the diagnosis.

Malrotation with gastric volvulus, midgut volvulus, and pancreatitis.

A 2-year-old child with intestinal malrotation had simultaneous gastric volvulus, midgut volvulus, acute pancreatitis, and gastric perforation, followed postoperatively by a temporary period of both lactosuria and sucrosuria. The gastric volvulus and midgut volvulus resulted in both proximal and distal obstruction of the duodenum, reproducing clinically a previously reported experimental model designed to produce pancreatitis. Operative reduction of the midgut volvulus and the gastric volvulus and repair of the gastric perforation was accomplished. The child has had normal growth and development during the ensuing nine years.

Effects of anti-Ia sera on mitogenic responses. II. Differential expression of the Ia marker on phytohemagglutinin and concanavalin A-reactive T cells.

Genes mapping in the I region of the H-2 complex control a system of lymphocyte alloantigens (Ia) which are expressed on a subpopulation of T cells and on most B cells. Specific anti-Ia serum in the presence of rabbit complement removed the splenic T-cell subpopulation responsive to Con-A, but did not affect the response to phytohemagglutinin (PHA) or Leucoagglutinin. Antibodies specific for Ia, H-2K, or H-2D membrane antigens were used without complement to pretreat spleen cells. These antibody pretreated cells responded normally to Con-A and PHA.