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Thyroid hormones are important for both perinatal adaptation and long-term psychomotor development; however, there is limited information on the effects of extreme prematurity and antenatal TSH-releasing hormone (TRH) treatment on pituitary-thyroid function. In this study we assayed plasma triiodothyronine (T3) and TSH in infants who were part of a collaborative trial of antenatal maternal TRH therapy. Within the control population (n = 166), infants of 24-28-wk and 28-32-wk gestational age had comparable levels of T3 (0.94 and 1.06 nmol/L, respectively) and TSH (5.7 and 7.2 mU/L) at birth, but the increases at 2 h and subsequent T3 levels were less in the 24-28 wk versus 28-32-wk gestation infants. In the TRH-treated group (n = 131), T3 was lower in the first day for infants delivered 7-72 h after antenatal TRH compared with control infants. TSH at birth was approximately 3.5-fold greater for infants delivered at 0-6 h after the last TRH dose compared with the control group and was suppressed in infants delivering at 7-36 h. T3 and TSH levels were not different between control and TRH-treated groups at 3-28 d of age. In TRH stimulation tests on d 28, control and TRH-treated groups had similar peak levels of TSH and incidence of exaggerated response (TSH > or = 35 mU/L). We conclude that extremely premature infants have a reduced postnatal surge in TSH and T3 and maintain lower T3 concentrations, probably reflecting tertiary hypothyroidism. The stimulatory and suppressive effects of antenatal TRH treatment observed at birth are transient and do not affect pituitary-thyroid responsiveness at 28 d of age.

One hundred forty-four newborn infants with pulmonary interstitial emphysema were stratified by weight and severity of illness, and randomly assigned to receive treatment with high-frequency jet ventilation (HFJV) or rapid-rate conventional mechanical ventilation (CV) with short inspiratory time. If criteria for treatment failure were met, crossover to the alternate ventilatory mode was permitted. Overall, 45 (61%) of 74 infants met treatment success criteria with HFJV compared with 26 (37%) of 70 treated with CV (p less than 0.01). Eighty-four percent of patients who crossed over from CV to HFJV initially responded to the new treatment, and 45% ultimately met success criteria on HFJV. In contrast, only 9% of those who crossed over from HFJV to CV responded well to CV (p less than 0.01), and the same 9% ultimately met success criteria (p less than 0.05). Therapy with HFJV resulted in improved ventilation at lower peak and mean airway pressures, as well as more rapid radiographic improvement of pulmonary interstitial emphysema, in comparison with rapid-rate CV. Survival by original assignment was identical. When survival resulting from rescue by the alternate therapy in crossover patients was excluded, the survival rate was 64.9% for HFJV, compared with 47.1% for CV (p less than 0.05). The incidence of chronic lung disease, intraventricular hemorrhage, patent ductus arteriosus, airway obstruction, and new air leak was similar in both groups. We conclude that HFJV, as used in this study, is safe and is more effective than rapid-rate CV in the treatment of newborn infants with pulmonary interstitial emphysema.

Background Pulmonary disease is common in preterm infants, despite antenatal glucocorticoid therapy. The addition of antenatal thyrotropin-releasing hormone therapy has been reported to decrease pulmonary morbidity in these infants. Methods We enrolled 996 women at 13 North American centers who were in preterm labor at

• In a newborn infant, spinal rigidity and signs of cervical cord compression developed. Myelography suggested the presence of a spinal cord neoplasm, and pathologic studies confirmed the diagnosis of a pleomorphic cellular sarcoma originating from the leptomeninges of the thoracic spinal cord. A review of neonatal spinal cord neoplasms disclosed a high incidence of developmental tumors in this age group and, therefore, the need for early diagnosis, since many of these tumors are amenable to radiation therapy and surgical removal.

juvenile thyrotoxicosis. Single-dose antithyroid medicine should be reserved for those children in whom a perchlorate discharge test demonstrates suppressibility while under the influence of the thioamides.s There is disagreement concerning the etiology of thyroid storm. Although in one patient' a high T, level in the presence of a normal T, concentration correlated with an episode of storm, further data have shown no significant difference inT, levels between uncomplicated thyrotoxicosis and thyroid storm." Circulating thyroid hormones increase after radioiodine therapy; and the very high levels seen in our patient would tend to support a relationship of such therapy to the clinical manifestations of storm. Propranolol has been found to be an excellent drug in the control of thyrotoxic manifestations in adults," and at least one other child with an episode of storm has been successfully managed with this beta-adrenergic-blocking agent.' The wide variation in the dose of propranolol required for control-s mandates very careful clinical follow-up of children treated with radioiodine. When significant side effects to the thioamides require a change of therapy, it may be best to attempt to use other drugs, such as perchlorate or lithium, to control thyrotoxicity prior to ablative therapy for juvenile hyperthyroidism.

A nursey outbreak of gastroenteritis caused by Escherichia coli 0142/K86/H6 is described. Over a period of nine months, 59 epidemiologically linked cases of diarrhea occurred, including 21 intractable cases with four deaths. The epidemic strain, which was not agglutinated by commercial diagnostic antisera, was isolated from every case of acute diarrhea in which definitive E. coli serotyping was performed. Isolation from the hands of personnel in five instances directly incriminated hand carriage as the mode of spread. Acquisition of illness, which was especially high among low-birth-weight infants less than 17 days old, did not correlate with any treatment modality investigated and appeared to be related to a host factor. Noninvasive small intestinal colonization, production of enterotoxin, and multiple antibiotic resistance of the epidemic strain were demonstrated and helped to explain the intractability of clinical illness in many infants, despite intensive parenteral antibiotic therapy. Surveys of fecal coliforms on the hands of nursery personnel revealed no change in prevalence after introduction of a policy of “triple” handwashing with 3% hexachlorophene soap, but a significant decrease occurred during the use of disposable gloves. The frequent occurrence of E. coli 0142 in throast swabs of affected infants suggested that pharyngeal colonization may serve as an important diagnostic clue in E. coli diarrhea.

• Ultrasound and computerized tomographic (CT) methods were used in detecting hydrocephalus and intraventricular hemorrhage (IVH) in three premature infants, with excellent anatomic and pathologic correlation. Ultrasonography may offer an advantageous alternative to CT scanning in evaluating suspected IVH and/or posthemorrhagic hydrocephalus in critically ill infants.

FIVE recent episodes of jequirity-bean ingestion in the Boston area have prompted the writing of this report. The jequirity bean (botanical name, Abrus precatorius) is variously known as the rosary pea, prayer bead, Buddhist rosary bead, crab's eye, mienie-mienie, Indian bead, Seminole bead, weather plant and lucky bean.1 It is small, measuring 0.3 by 0.8 cm., and scarlet in color, with a black "eye" at the hilus, and is very beautiful. It is indigenous to tropical and subtropical areas throughout the world. Because of its intense colors and beauty it has been used extensively in beadwork and jewelry in . . .

A book which deals exclusively with pulmonary disease in children is long overdue. In the present volume the authors have prepared an encyclopedic text which reflects their extensive clinical experience. The stated aim was to provide a clinical source of information for pediatricians, roentgenologists, and medical students. No attempt was made to cover the physiology, biochemistry, or pathology of pulmonary disease. There are 15 chapters. The first, little more than an introduction, describes the normal lung. The next four concern malformations and anomalies of the lung and related structures. The final chapter describes diagnostic procedures for pulmonary disease in infancy and childhood, while the others deal with various diseases and conditions in which pulmonary involvement may be primary or secondary. A skeletal outline preceding each chapter is useful for quick information retrieval. The chapter dealing with useful diagnostic techniques for pulmonary disease is well written. The illustrations and radio-grams are