936 STORM DOOR HAZARDS
Fic. 1. First obstructive episode. blood in premature infants. PEDIATRICS, 31: 580, 1963.
13. Norval, M. A. : Blood sugar values in prema-ture infants.
J.
Pediat., 36:177, 1950.14. Ward, 0. C. : Blood sugar studies on prema-ture babies. Arch. Dis. Child., 28: 194, 1953. 15. Lubchenco, L. 0., Homer, F. A., Reed, L. H.,
Hix, I. E., Jr., Metcalf, D., Cohig, R., Elliot, H. C., and Bourg, M. : Sequelae of prenla-ttire birth, evaluation of premature infants of low birth weights at ten years of age.
J.
Dis. Child., 106:101, 1963.Nosogenic
Prehension
of the Nasus by
a Neonate:
A Resumption
of
Fetal Posture
The extremities of the newborn infant not in-frequently assume a position which reflects fe-tal posture. We wish to describe an infant who obstructed his breathing on three occasions in
the immediate post-delivery period by grasping
his nose in what we assume to be a resumption of fetal posture. The observation of a fetal hand-to-face attitude is not unusual during am-niography. Indeed, blebs on the skin of the
forearm or hand, presumably caused by in
utero sucking, are occasionally observed in the neonate.
CASE REPORT
A 6-pound, 13-ounce full-term infant was born after an uneventful pregnancy, labor, and delivery. The Apgar score at 1 minute was 8. The mother was given 25 mg of promethazine hydrochloride (Phenergan) intramuscularly 4 hours before
deli-ery. Continuous epidural anesthesia was also ad-ministered for 3 hours prior to delivery. On
admis-sion to the nursery, the baby’s axillary temperature was 96.8#{176}F,the pulse was 140 per minute, and the respirations were 68 per minute. The infant was in no distress, and the remainder of the physical ex-amination was within normal limits.
At approximately 3 hours of age the infant was observed to have intense cyanosis and marked xy-phoid retractions. His right hand at this time was tightly grasping his nose. Apnea ensued. It was necessary to force the hand away from the nose; and further tactile stimulation was needed before normal respirations and color returned. During the next 4 hours, there were two more occasions when the infant again grasped his nose with his right hand and became cyanotic. Recovery both times was immediate after the hand was pulled away by
the nurse. No further incidences occurred during the remainder of the infant’s hospital stay.
SUMMARY
Occlusion of the nares by the same hand on three occasions, producing respiratory
obstruc-tion and cyanosis in a newborn infant in the immediate post-delivery period is described. It is presumed that this unusual behavior repre-sented a temporary resumption of the fetal pos-ture.
GAmus K. CONNER, RN.
ABNER H. LEVKOFF, M.D.
Department of Pediatrics
Medical University of South Carolina
80 Barre Street
Charleston, South Carolina 29401
Storm Door Hazards
The apparent increase’ of injuries to children by broken glass in doors may well require in-creased attention by safety-minded pediatri-cians. The problem stems from the use of ordi-nary glass which shatters readily upon impact.
In this practice alone, six such accidents have
occurred within the last 18 months. Five of
these involved aluminum frame storm doors, a
familiat fixture in the American home. Had safety glass been used in these doors, injuries
would most likely have been averted.
An outline of the recent experience here is
presented in Table I. Ages ranged from 2 to 10 years. There were three girls and three boys. Two head and three volar forearm lacerations
Date N ame Age Sex History of (yr) Injury Type of Door Lower or Upper Pane Descption of
Injury Size RX
and Location Lower Lower Lower Aluminum frame storm Aluminum frame storm
5/69 C.J. 3 m Child chased into
door
11/69 A.M. 8 f Child, chased by sister, ran against
a locked storm
door
Spring A.S. 54 f Sister of above
1968 (Sister patient-at play
of AM.)
10/69 W.M. 24 m Fell through
storm door
at play
12/69 M.M. 10 f Wind blew door out as child stooped to pick up sled; head thrust
through pane
4/70 T.R. 3 m Thrust fist
through pane Sutures #7 at E.R. No medical attention; mother applied “butterfly” Sutures # at E.R. Laceration of ear
lobe
Lacerations of lower forearm, volar surface: A. 6 cm laceration, continuous with an 8 cm excoriation B. A smaller paral-lel laceration (Fig. 2) Full length (single) pane
14 cm longitudinal
laceration, dorsum second finger lefthand
EXPERIENCE AND REASON-BRIEFLY RECORDED
TABLE I CASE HIsToRIEs Aluminum frame storm Aluminum frame storm Wood frame storm Aluminum frame storm 937
Lower 8cm curved lacer- Sutures #16 ation, ulnar aspect at E.R. lower forearm,
volar surface
9cm laceration,
ulnar aspect of lower forearm, volar surface (Fig. 1)
Lower 5 cm vertical laceration left anterior scalp; fracture of nose Sutures #10 plus nose splint at E.R. Sutures #5 at E.R.
play, and five involved the (child level) lower
storm door pane.
Ten mothers were consecutively briefly
in-terviewed during the course of routine or sick
child examination. In the 10 families there
were 28 children and 21 glass doors, 17 of
alu-minum frame construction. There were 14
sep-arate instances of accidental glass breakage,
one with injury. The 10 families surveyed knew of 10 other neighmors (or relatives) who
have had glass breakage experience, six with
injury.
DISCUSSION
The literature contains little reference to
storm door injuries. Sachatello2 and Szczypin-ski3 separately recorded two near fatal glass
door accidents, both of which resulted in
inju-!
Fm. 1. Example of laceration. (See Table I.)
938 HEARING SCREENING
ries. But the best indication of the problem’s scope may be found in public health statistics’ which recorded over 30,000 children injured by glass in 1967 alone.
Ordinary glass breaks into sharp pieces
which may cut or stab. On the other hand,
tem-pered glass is four times stronger than ordinary
glass and breaks safely into rounded pieces.
Tempered glass storm doors are now offered by at least several manufacturers.
Plastic materials are also safe. Cast acrylic sheets are inexpensive and can be purchased in a size that will exactly replace unsafe glass panes. There is economy in replacing only the
glass and not the whole storm door.
Other safety measures appear less suitable. Metal guards offer only incomplete protection and are unsightly. Decals do prevent distracted
adults from strolling through an otherwise
in-visible sliding patio door or full length
win-(low. Storm door accidents, however, mainly
involve children at play, who back into, are
chased into, or are thrust against a quite
visi-Fic. 2. Another example of laceration. (See Table I.)
ble, but closed storm door. Decals are not
likely to prevent accidents that occur during
the heat of play.
SUMMARY
Six children in this pediatric practice have
suffered accidental glass door injury during the
last 18 months. Five of these accidents
in-volved the familiar aluminum frame storm
doors and four accidents occurred at play. The
experience in this practice and throughout the
country indicates a significant increase in the
number of such injuries. The problem is thus
defined as a distinct hazard of childhood.
It is necessary to alert both pediatrician and
parent to the danger of storm and other glass
doors and to the possibility of replacing easily
broken glass, in whole or part, with a safety
material. In addition, there is a distinct need for legislation that will eventually eliminate un-safe glass in doors.
SHELDON N. FEINBERG, M.D., F.A.A.P. 98 Broadwa,
Flillsdale, New Jersey 07642
REFERENCES
1. U.S. Department of Health, Education and Welfare: Safety glass needed in doors and panels. Public Health Rep., 82:720, 1967. 2. Sachatello, C., and Sawyers, J.: The invisible
glass door: Another hazard of modern living. J. Tenn. Med. Ass., 61:395, 1968.
3. Szczypinski, A. F., and Fuerst, E. J.: Accidental severance of the major vessels and nerves of the axilla with report of two patients success-fully treated. J. Trauma, 4:175, 1964.
4. Keddy, J. A.: Accidents in childhood: A report
on 17,141 accidents. Canad. Med. Ass.
J.,
91: 675, 1964.5. White, J. J., Talbert, J. L., and Haller, J. A., Jr.: Peripheral arterial injuries in infants and chil-dren. Ann. Surg., 167:757, 1968.
Modified
Hearing
Screening
Method
The subject of this communication is a
modi-fled technique for hearing screening in young
children that is quick, easy to use, and appears
to be effective. In the original method
de-scribed by Hardy, et al.,1 based on earlier work
by Ewing and Ewing,2 the child sits on his
