A. Harold Lubin

Preschool children in the United States: who has iron deficiency?

Data on hemoglobin, hematocrit, and transferrin saturation levels in a cross-sectional sample of 2,000 United States preschool children are presented and discussed in relation to age, socioeconomic status, and stature.

Hemoglobin levels accordingto age, race, and transferrin saturation in preschool children of comparable socioeconomic status*

From the Department of Pediatrics, The Ohio State University College o[ Medicine, and Childrens Hospital Research Foundation. Supported by Grant MC-R-390050-06-O from Maternal and Child Health Services, Health Services and Mental Health Administration, Department of Health, Education, and Welfare, Rockville, Md. ~Address: Room 311, Ros5 Hall, Childrens Hospital, Columbus, Ohio 43205. Pediatr. Res., April 1971, Atlantic City, N. J., p. 99. (Abst.) Gershanik, J. J., Levkoff, A. H., and Duncan, R.: The association of hypocalcemia and recurrent apnea of prematurity, Am. J. Obstet. Gynecol. 113: 646, 1972.

INCREASED HEPARIN BINDING IN CYSTIC FIBROSIS: A REFLECTION OF ALTERED GLYCOPROTEIN BIOSYNTHESIS?“

Summary: Some of the serum proteins which bind to heparin and contribute to the pH 5.57 “heparin binding capacity” of human serum are glycoproteins; those from cystic fibrosis serum were found to be 27% higher in fucose (methylpentose) content, 27% lower in sialic acid content, and 31% lower in hexose content when compared to heparin-precipitated serum glycoproteins from normal control subjects. Hexosamine content of the heparin-precipitated serum glycoproteins was the same. Results of this preliminary investigation indicate that altered carbohydrate composition in serum glycoproteins may affect significantly their heparin binding capacity.Speculation: The glycoprotein biosynthetic mechanism in cystic fibrosis is genetically altered and produces glycoproteins of abnormal carbohydrate composition which combine with normal, acidic, glycosaminoglycans to form insoluble, viscous complexes that hinder normal cellular and subcellular transport mechanisms and metabolic processes.

Sex and Population Differences in the Incidence of a Plasma Cholinesterase Variant

Accumulating knowledge of polymorphic enzyme systems poses intriguing possibilities of anthropologic genetics. Development of an automated procedure for determination of heterozygosity or homozygosity of the atypical plasma cholinesterase allele (E1a) permitted screening of 2317 individuals during a national Preschool Nutrition Survey and several smaller population studies. Frequencies of the allele (E1a) closely parallel those previously reported. Caucasians manifested a heterozygote male preponderance of 1.85: 1.

367 A LONGITUDINAL STUDY OF INTERACTION BETWEEN ENVIRONMENTAL LEAD AND BLOOD LEAD CONCENTRATIONS DURING PREGNANCY, AT DELIVERY AND IN THE FIRST 6 MONTHS OF LIFE

Sequential evaluations of pregnant women from three cities in the second trimester, at delivery, and of their infants indicate that lead circulating in the bloodstream is readily exchanged between mother and fetus and is present in the newborn. There is no significant change in lead concentration as pregnancy progresses, indicating no hormonal influence within pregnancy as is found in other trace metals. Erythrocyte protoporphyrin concentration is twice normal in the cord and neonate samples, with no correlation to lowered serum iron. Mean blood lead concentrations are lower in maternal, cord, and neonate samples from Columbus than in the same samples from Boston and New Bedford, Mass.Environmental lead concentrations are also lower in Columbus, especially in drinking water, and in dust, to a lesser extent. No abnormally high blood leads have been found in our population, but mothers with levels at the higher range of normal have off-spring with concomitant levels. Children will be followed for two years to evaluate the relative contribution of various environmental factors to increases in body lead burden.

Nutritional status of preschool children: Plasma vitamin A

D. C.: Coronary artery-right ventricular fistula with congestive heart failure: surgical correction in the neonatal period, Surgery 67: 985, 1970. !0. Crocker, D. W., Sobin, S., and Thomas, W. C.: Aneurysms of the coronary arteries: Report of three cases in infants and review of the literature, Amer. J. Path. 33: 819, 1957. I1. Wenger, W. K.: Rarer causes of coronary artery disease, in Hurst, J. W., and Loque, R. B., editors: The heart, New York, 1970, McGraw-Hill Book Company, p. 1041. 12. Benson, P. A.: Dissecting aneurysms of right and left coronary arteries, J. Forensic Sci. 15: 65, 1970. 13. McKeown, F.: Dissecting aneurysm of the coronary artery in arachnodactyly, Brit. Heart J. 22: 434, 1960.

Changes in Levels of Hemoglobin and Hematocrits Among Children and Youth Registrants Between 1968 and 1971

During March and April 1968, hemoglobin and hematocrit results were collected independently by each of 36 participating C & Y Projects for some 24,000 children seen during the two-month interval. This information was submitted to and analyzed by Systems Development Project’ in terms of age, sex, and race. The data submitted did not constitute a random sample of C & Y populations, nor were methods of hemato-

THE ROLE OF SELENIUM (SE) IN THE DEVELOPMENT OF BRONCHOPULMONARY DYSPLASIA (BPD)

Plasma Se, erythrocyte Se and erythrocyte glutathione were measured in nineteen premature infants with severe Respiratory Distress Syndrome (RDS) in cord blood, at 3 days and 30 days of age. Plasma vitamin E (vitE) was also assessed for its role in peroxide degradation. Patients (pts) were evaluated for BPD and divided into 2 groups by this diagnosis. The 2 groups consisted of 8 pts with RDS alone and 11 pts with RDS and BPD. The demographic data profiles and the requirements for supplemental oxygen and mechanical ventilation during the first 3 days of life, were similar.No difference was found in the levels of Se in plasma between the 2 groups. Erythrocyte Se and glutathione values were somewhat lower in the BPD group than in the RDS group at age 3 days. In infants with BPD the levels were higher in cord blood than at 3 days and at 30 days. Pts with BPD had significantly lower plasma vitE levels at age 3 days than pts with RDS alone. VitE levels in infants with BPD increased significantly over time but still remained lower than in infants with RDS at 30 days. Findings from this study shows a possible interaction between Se and vitE in the development of BPD. (Grants from Research Foundation of GSH, #12 and Childrens Hospital, Columbus, Ohio #74-345).

479 THE INCIDENCE OF DRUG USAGE IN LACTATING MOTHERS

To identify incidence and patterns of medication usage 134 breastfeeding mothers were surveyed 4-6 weeks after discharge from hospital. 96% were using one or more meds; 55% were self-medicated, non-Rx items, & 41% were physician prescribed. 64% of those breastfeeding had completed one or more yrs. of college although ed. level was not correlated with predictions of med. usage patterns. A significant (p<.025) level of women with high school or less ed. had stopped breastfeeding within 4 wks. after their infants birth. Less than 50% of the pediatricians knew the mother was taking any med. even though significant #s of meds. for which adverse effect has been reported for the breastfeeding infant were being utilized & despite availability of safer alternatives. Of health professionals involved, only 22% of obstetricians, 19% of pediatricians, & 9% of pharmacists discussed med. with the mother. By category incidence of med. usage was: vitamins 50%, analgesics 20%, iron preparations 10%, laxatives 5%, antacids 2%. Info. supplied by manufacturers in their product labelling about drug excretion into breast milk was poor or non-existing; for many meds which were being utilized, published info did suggest that significant doses could be ingested by the breastfeeding infant. The study indicates the need for additional drug excretion info & health professional counseling for breastfeeding mothers to avoid potential adverse reactions for their infants.

589 PHYSICIANS FAILURE TO ALTER FAILURE TO THRIVE (FTT)

Non-organic failure to thrive often results in expensive, but ineffective hospital stay, which occurs without adequate prior outpatient work-up. To improve the management of these pts., we performed a 1 year retrospective review of children over 12 mos. admitted and discharged with 1° dx. of FTT. 10 of 21 cases were non-organic FTT. All pts. had at least 1 prior physician contact and adequate immunization status. 5 children had received prior dietary instruction. Our results indicate that even when hospitalized, these children did not receive adequate nutritional assessment: 1) Dietary hx. by physician either lacking or inadequate; hx. by a hospital dietitian often contributed the only clues to the pt.s problem. 2) Anthropometric data for all pts. included only ht., wt., & growth charting; often missing was head circ., MAC, TSF, or data on parental and family stature. 3) P.E. specified nutritional status indicators only 50% of the time. 4) Biochemical evaluation revealed an average/pt. of 14 diagnostic tests, of which all WNL except FE/TIBC(2) and HCT/Hb(3). The course of the hospital stay included daily wts. (90% of cases), calorie counts (100%) and nutrition consults (50%). Outcomes were:We conclude that 50% of admissions could have been prevented initially by additional counseling and reassurance. 50% of pts. required significant social intervention for which hospitalization and subsequent follow-up did little.