Citations

Hypersensitivity pneumonitis is infrequently reported in children. This article describes a 15-year-old girl who presented with insidious onset of dyspnea and weight loss. A hamster and doves were housed in her bedroom. Chest radiographs showed bilateral nodular infiltrates. Pulmonary function tests showed a restrictive pattern with O 2 desaturation at rest. The diagnosis was substantiated by the presence of precipitating antibody to dove serum and droppings and by clinical improvement, along with marked improvement in pulmonary function test, after the doves were removed from her environment. The importance of making an early diagnosis to prevent debilitating fibrotic lung disease is emphasized. A detailed environmental history is essential.

Among 1138 newborns in a Level II nursery, breast-fed and formula-fed infants were comparable in terms of sex, mode of delivery, gestational age, birth weight, and birth temperature. Breast-fed neonates subsequently lost more weight and a greater percentage of their birth weight (mean, 7.4% vs. 4.9%) than did formula-fed infants. Loss of more than 10 percent of birth weight was associated with short gestation and low birth weight and with breast feeding. Birth weight loss of ≥3 percent was associated with a risk of fever (≥37.5°C) among breast-fed and formula-fed infants, but there was no gradient of increasing risk of fever with increasing percentage weight loss beyond 3 percent. After weight loss and other significant variables were adjusted for in a multivariate analysis, breast feeding was not independently predictive of fever. Although breast feeding may be associated with weight loss, it is not prudent to assume that this is the cause of fever in a breast-fed neonate.

To study the effect of severe undernutrition on linear growth during adolescence, a report was obtained on the ultimate adult height of 71 patients who had had anorexia nervosa at or before age 16 years. At time of diagnosis (ages 9-16 years) median height percentile was 49; at adult follow-up (ages 18-29 years) the median height percentile was 55. This change favoring growth was statistically significant (p < 0.01). Height percentile was maintained or increased in 45 patients and decreased in 26 patients. In only four patients did it change by more than 20 percentile points downward; in 12 patients height percentile increased by more than 20 points. We conclude that, despite weight loss of up to 45 percent at or before age 16 years, most patients with anorexia nervosa continue to grow in stature according to expected norms.

The difficulty of diagnosing pneumonia by chest x-ray in children less than 4 years of age was studied by comparing the chest roentgenograms of 34 healthy children with the chest roentgen ograms of 34 children previously diagnosed as having pneumonia. Review of these films without knowledge of the previous interpretation and without clinical information disclosed variations regarding the roentgenographic confirmation of pneumonia in 24 percent of the cases and variations regarding the location of the lesion in about 50 percent of the cases.

Current information relating to the clinical significance of proteinuria in children through adolescence was reviewed. Proteinuria may be transient, orthostatic, or fixed. The data indicate that only fixed proteinuria—that is, proteinuria on multiple urine examinations without pos tural exaggeration—may indicate serious glomerular disease. The patient should be followed with periodic but infrequent examinations, avoiding unnecessary, complicated, and hazardous investigations.

The best nutrition for the full-term, healthy newborn remains breast milk, lovingly provided by the mother. Every effort should be made to educate, reemphasize, and reassure the mothers of our patients about this most natural way of infant feeding. Yet, when the situation demands it, properly adjusted cow's milk preparations are a very acceptable substitute. Cow's milk also becomes a part of the diet when the infant is weaned from the breast.