It is high privilege to participate in a ceremony in which the American Academy of Pediatrics honors the memory of one of its founders and most illustrious Fellows. The C. Anderson Aldrich Award for 1973 is presented to Dr. Gunnar Dybwad, Professor of Human Development at the Florence Heller Graduate School of Advanced Studies in Social Welfare, Brandeis University. The Award is made for Dr. Dybwad's contributions to the development of children, particularly those with mental retardation. Inherent in his choice as awardee by the Section on Child Development of the Academy is recognition of mental retardation as a disability in development, one that is subject to change with time, either amelioration or deterioration, depending in a major way on the child's social surroundings. It is to these latter that Dr. Gunnar Dybwad has particularly addressed himself. For the benefit of younger members and guests of the Academy, a few biographical notes seem in order about Dr. Aldrich who died 25 years ago. Born in Plymouth, Massachusetts, in 1888, Dr. Aldrich received his early education in Boston and New York; his college and medical school degrees at Northwestern University. After general practice in Winnetka, Illinois, for five years, he limited his practice to pediatrics. While in practice, he worked at the Children's Memorial Hospital of Chicago rising to a full Professorship at Northwestern University, and succeeding Dr. Joseph Brenneman in 1941 as Chief of Staff at the Children's Memorial Hospital. In 1944 he moved to Rochester, Minnesota, and founded the Rochester Child Health Institute, interested in research on the development of normal infants and children and in a program of delivery of child care to an entire community.
THE FEEDING of premature infants in the hospital nursery will be discussed under three headings: (a) problems during the first week of life, (b) problems after the first week and (c) problems on discharge to the home.
PROBLEMS DURING THE FIRST WEEK OF LIFE
During the first week, while the infant is making numerous physiologic adjustments incident to birth, the problem is to meet his minimum maintenance food requirements without exceeding his ability to ingest and retain the foodstuffs offered. There are, then, two considerations: technic of feeding and a correct estimate of maintenance requirements. Technic of Feeding.—Major emphasis must be placed, during this period, on the proper choice of the method of feeding, i. e., from nipple, medicine dropper or gavage, whichever is indicated by the individual infant's strength. The quality and the quantity of nursing care will also help determine the choice of the method of feeding,
HUMAN milk is widely regarded as the food of choice for premature infants. Recently summarized laboratory investigations1have cast doubt on this widely held clinical impression. To reassess the problem, carefully controlled clinical studies were undertaken comparing the progress of premature infants fed isocaloric amounts of human milk or mixtures of cow's milk under comparable conditions of nursing, medical and environmental conditions. The present report compares the gains in weight of 122 premature infants whose weights at birth were between 1,000 and 2,000 grams (2 pounds, 3 ounces and 4 pounds, 6 ounces), all of whom were fed isocaloric amounts of either human milk, a simple mixture of evaporated milk or a mixture of partially skimmed cow's milk. The results indicate that greater gains in weight were achieved with the mixture of partially skimmed milk2than with evaporated milk, and that both mixtures of cow's milk were superior
Quantitative measurements of the water exchange of premature infants are essential for defining their fluid requirements because of their weak appetites and because factors other than feeding contribute so much to their well-being. This paper presents the results of such measurements made on 12 premature infants fed varying diets but studied under constant environmental conditions.
APPARATUS AND METHODS
A detailed description of the methods employed for analysis of the diet and excreta (urine and feces), for measurement of the twenty-four hour insensible loss from skin and lungs, for determination of the daily respiratory exchange and for calculation of the composition of the metabolic mixture was given in previous papers.1The "direct," or "metabolic," method2of calculation of the water exchange was used because it gives information concerning not only the total water balance but also the partition of excretion via urine, feces and skin and lungs. According to
VITAMIN E was recognized some 35 years ago as a fat-soluble substance necessary for reproduction in the rat. Its potency is measured by assay for fertility and its synonym, tocopherol, comes from Greek words which mean bear offspring. Review of the original studies of Mason and his co-workers and of his interpretive writings provides a good stimulus for pediatric interest in the subject. It is proposed to review some literature on the pathologic lesions produced in animals and on the tocopherol content of foods, and then summarize data collected at the Colorado General, Sinai and Johns Hopkins Hospitals on tocopherol deficiency in infants and children. Most of the latter data and detailed references to the literature have been published elsewhere. PATHOLOGIC FINDINGS IN EXPERIMENTAL ANIMALS Although vitamin E has been dubbed the anti-sterility vitamin, its absence from the diet has produced a variety of pathologic states, differing from one species to another, and at different ages in the same species. Some of the conditions found are: Fetal resorption; testicular degeneration; encephalomalacia; exudative diathesis; generalized edema; brownish discoloration of smooth muscle, adipose tissue and liver; acute hemorrhagic necrosis of the liver; degeneration of renal tubules; focal necrosis of cardiac muscle; and nutritional muscular dystrophy. Provocative findings in E-deficient animals that call to mind clinical problems in premature infants are: Hemorrhagic manifestations in rat fetuses and chick embryos; hemorrhages in the lungs, visceral and cranial cavities in puppies; subcutaneous, pulmonary and cerebral edema in young chickens, anemia in monkeys; and hemolysis after administration of large doses of vitamin K to rats.
Three children with acute anuria treated by peritoneal lavage and two others from whom it was withheld are reported. Peritoneal lavage should be reserved for the treatment of a progressing uremic state associated with an acute yet probably reversible anuria of renal origin. The procedure, when suitably indicated, is effective for removal of nitrogenous waste products and may prove life-saving. Technical aspects of the method are discussed, and the use of variation of the glucose concentration in the lavage fluid as a means of controlling water retention is demonstrated. Peritoneal lavage is a complex, expensive, yet effective method of partially simulating the kidney glomerulus. The absence of tubular function in anuric patients who are receiving peritoneal lavage makes management of their acid-base balance a difficult problem.
Glucagon in varying doses was given to 40 infants born to diabetic mothers, and the blood sugar concentrations were determined at intervals thereafter. Glucagon (30 µg/kg) produced a hyperglycemia in vaginally delivered infants but not in those delivered by cesarean section. Glucagon (300 µg/kg) produced a hyperglycemia in infants delivered by cesarean section. Distressed infants seemed to respond less well than those who had an uneventful course. The data are interpreted as indicating the desirability of avoiding generalizations concerning all infants of diabetic mothers.
