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position of the great vessels with situs inversus to-talis. Israel

J.

Med. Sci., 8:529, 1972.

5. Linde, L. M., Higashino, S. M., Berman, G., Sapin, S. 0., and Emmanouilides, C. C.: Umbilical vessel cathe-terization and angiography. Circulation, 34:984, 1966.

6. Newfeld, E. A., Eisenberg, R. A., and Young, D.: Trans-position of the great arteries: The changing prog-nosis. Amer. J. Dis. Child., 120:320, 1970. 7. Fisher, E., and Paul, M. H.: Transposition of the great

ar-teries: Recognition and management. In

Cardio-vascular Clinics, Vol. 2, No. 1 (Congenital Heart Disease), 1970, pp. 212-230.

8. Rashkind, W.

J.,

and Miller, W. W.: Transposition of the great arteries: Results of palliation by balloon sep-tostomy in thirty-one infants. Circulation, 38:453, 1968.

9. Singh, S. P., Astley, R., and Burrows, F. C. 0.: Balloon septostomy for transposition of the great arteries. Bnt. Heart J., 31:722, 1969.

10. Baker, F., Baker, L., Zoltun, R., and Zuberbuhler, J. R.: Effectiveness of the Rashkind procedure in trans-position of the great arteries in infants. Circula-tion, 43(Suppl. 1):1, 1971.

Growth

Charts

for Children

0 to 18 Years

of Age

The purpose of this communication is to

pre-sent growth

grids

which

incorporate

many

of the recommendations set forth by the Committee on Growth and Development of the American Acad-emy of Pediatrics and the Maternal, Child Health Service of the Department of Health, Education

and

lf’

The percentile curves depicted on these grids are based on longitudinal data collected by the Child Research Council of Denver2 which repre-sent optimal values for whites living in this area.

The

charts

have

been

in use

at the

University of

Colorado

Medical

Center

for over

one

year

and

have proven to be quite satisfactory.

CLINICAL MATERIAL AND METHODS FOR

THE

GROWTH

CURVES

The anthropometric measurements from the

Child

Research

Council

in

Denver

were

used.

These data were meticulously obtained and re-corded at monthly intervals during the first year and at six-month intervals thereafter.

The

children

followed

by the

Child

Research

Council

staff

were

born

to middle

and

upper-mid-dle class parents, predominantly of Northern

Eu-ropean

extraction,

and

all were

cared

for by

pri-vate physicians.

Data

from

236 children

(1

14 girls

and

122 boys)

1966

were

used for

the

growth

curves. The num-ber of measurements at each interval on which the percentiles are based varied from a maximum of

95

in the early years to considerably fewer during the later and more independent adolescent years.

Approximately

3,000

measurements were made for weight, height, and head circumference for each sex with an average of 69 sets of measure-ments recorded at each age interval.

Infants were measured and weighed without

clothing, and older subjects were measured and

weighed

with only undergarments. The subjects were measured supine to 2 years of age and

thereafter in the erect position.

From these data, percentiles of growth in weight, length, and head circumference were

cho-sen.

The

3rd

and

97th

percentiles

were

calculated

from the mean and standard deviations. The final curves, presented here (Figs.

1 and

2),

required very little smoothing and included the 3rd, 50th, and

97th

percentiles.

DISCUSSION

The advantages of these

grids,

which

conform

to the conference recommendations, are as fol-lows:

1. The

charts

are

sex

specific.

2.

The

charts

cover

the

two

age

spans

of

new-born to 6 years and 6 years to 18 years. In order to make this feasible and to obtain sufficient separa-tion between the percentile curves in the first two

years

of life,

and

particularly

in the

first

six months

of life when growth is so rapid, a logarithrnical scale

was

used for the first 24 months and an arith-metical scale

was

used

thereafter.

3.

Weight,

height,

and

head

circumference

were incorporated on

the

same

sheet.

Those

as-sessments

of growth

are

plotted

in that

respective

order to serve as a constant reminder that the child who is failing to thrive lags first in weight,

then in length or height, and finally in head growth.

4.

The measurements are plotted in the metric

system.

The growth curves on these

grids

are

represen-tative

of a

white

population

in Colorado

and

may

not

be

ideal

for

other

populations.

When

popula-tion-specific growth curves become available, perhaps they should replace the curves presented

here. The

grids

can be used universally.

Bumus

DUNCAN,

M.D.

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Fic. 1.Left, Growth grids for boys from birth to 6 years of age utilizing the metric system and a logarithmic scale for the first 24 months of life. The data for the 3rd, 50th, and 97th percentiles represented on the weight, height, and head circumference grids

were taken from McCammon.’

(4)

UNIVERSITY OF COLORADO MEDICAL CENTER DEPARTMENT OF PEDIATRICS

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FIG. 2. Left, Growth grids for girls from birth to 6 years of age utilizing the metric system and a logarithmic scale for the first

24

months of life. The data for the 3rd, 50th, and 97th percentiles represented on the weight, height, and head circumference grids were taken from McCammon.2

(6)

Denver,

Colorado

University of Colorado

Medical

Center

Supported in part by Continuing Research Fund and Newborn Infant Care Program.

REFERENCES

1. Owen, G. M.: The assessment and recording of measure-ments of growth of children: Report of a small con-ference. Pediatrics, 51:461, 1973.

2. McCammon, R. W. : Human Growth and Development.

Springfield, Illinois: Charles C Thomas Publisher,

1970.

Hemophilus

Influenzae

b

Meningitis

in

Identical

Twins of a Triplet

Sibship

Hemophilus

influenzae

type

b

systemic infection

occurring

in

siblings

or close

family

members has

been

reported

infrequendy.1 Recent evidence

sug-gests

that genetically controlled host characteristics may determine risk for infection and perhaps

type

of

disease

due

to

H.

influenzae

type

b.2 We have

had

the

opportunity

to study

some

of these

factors

in

two

cases

of meningitis.

This

report describes

H.

influenzae

type

b

meningitis

in

two

identical

members

of a triplet

sibship

and

discusses

the

im-plications

of these cases in terms of host defense.

CASE

REPORT

Case Il-i

MG., an 11-month-old male infant, was the second born of triplets and had been well except for two episodes of otitis media after 7 months of age. Two weeks prior to admission he developed a vesicular eruption and fever, diag-nosed as varicella. The morning of admission he became lethargic and cried on passive motion of his neck. Physical examination showed a semicomatose infant with a tempera-tare of 103.2 F. Pertinent findings were closed fontanelle; “cracked pot” sign; distended, nonpulsatile retinal veins; bulging, injected tympanic membranes; and positive Kemig and Brudzinski signs. Laboratory studies disclosed the fol-lowing values: white blood cell count (WBC), 27,400/cu mm, with 83% polys; CSF, 4,000 red blood cells (RBC) per

Cu mm and 789 WBC per cu mm, with 98% polys; protein,

347

mg/100 ml; glucose, 80 mg/100 ml; CSF, 134 mg/100 ml of blood; and numerous gram-negative rods. Cultures of blood and CSF grew H. influenzae type b. Cultures of ear and throat canals postmyringotomy were negative. Intra-venous ampicillin (400 mg/kg/day) was prescribed for ten

days with a rapid response. A repeat lumbar puncture after ten days of therapy showed 31 WBC/cu mm

(

16% PMN) and a protein concentration of 27 mg/100 ml. An EEG per-formed one day after admission showed a severe slow-wave disturbance which was markedly improved five days later.

Case

11-2

S.C. developed meningitis at 1 year of age, one month

after case 1. This male infant was the third born of the sibship and also had been treated twice for clinical otitis media since 7 months of age. Three weeks prior to admis-sion he became febrile and received ampicillin intramuscu-larly for acute otitis media. On admission to the Montreal

Children’s Hospital the following morning, examination

re-vealed a well-developed, lethargic, irritable infant almost identical in physical appearance to case 1. The right tym-panic membrane was markedly injected; there were posi-five Kernig and Brudzinski’s signs. Laboratory investigation

disclosed the following values: WBC, 25,200/cu mm (75% polys); CSF-RBC, 1,195/cu mm; CSF-WBC, 23,978/cu mm (98% polys); protein, 201 mg/100 ml; glucose, 90 mg/100 ml; CSF, 150 mg/100 ml of blood; no organisms on gram stain. Culture of CSF grew H. influenzae type b. Treatment was begun with intravenously administered ampicillin, 400 mg/ kg/day for ten days. Temperature retumed to normal after 24 hours of treatment, and CSF at ten days showed 14 WBC/cu mm (21% PMN). An EEG nine days after admission showed a mild, diffuse slow-wave disturbance. The patient has done well subsequently and has no obvious sequelae at the age of 2 years.

Case

11-3

L.G. was the first born of the triplet sibship. She had no history of middle ear infections. She did develop van-celia one day after the patient in case 2, but never devel-oped a subsequent illness. No further episodes of otitis or other infections were encountered in any of the triplets during the year’s follow-up.

GENETIC

AND

ANTIBODY

DATA

The

accompanying Figure 1 shows the pedigree for these cases. The triplet sibship includes 11-3, a female, nonidentical by appearance as well as by genetic cell surface antigens. Parents and children

were typed for

known

erythrocyte

antigens

by

standard microscopic hemagglutination using

corn-mercial antisera. L.G. and her siblings were

non-identical by ABO

type

but genotypically identical for the MNS antigens.

All

members were typed

also for histocompatibility (HL-A) antigens by an

in

vitro

microcytotoxicity test. L.G. inherited one

HL-A

haplotype

in common

with

her brother,

but

the other haplotype was distinct. The

two

affected males were identical by all parameters studied.

Methods

and

individual

genetic data are described elsewhere.6

Sera from these

two

patients as well as from the parents and unaffected sibling were studied for

H. influenzae

type

b

antibody by a quantitative radioimmunoassay.7 Results are shown in Table I, “day-” being the interval following the presenta-tion of case 1. The

two

affected males (IT-i and

11-2)

showed

a

significant but transient rise in anti-body whereas 11-3 had a high level of antibody

(7)

1974;54;497

Pediatrics

Burris Duncan, Lula O. Lubchenco and Charlotte Hansman

Growth Charts for Children 0 to 18 Years of Age

Services

Updated Information &

http://pediatrics.aappublications.org/content/54/4/497

including high resolution figures, can be found at:

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entirety can be found online at:

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(8)

1974;54;497

Pediatrics

Burris Duncan, Lula O. Lubchenco and Charlotte Hansman

Growth Charts for Children 0 to 18 Years of Age

http://pediatrics.aappublications.org/content/54/4/497

the World Wide Web at:

The online version of this article, along with updated information and services, is located on

American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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