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, Educationand
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 ofColorado
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
wereborn
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 forthe
growth
curves. The num-ber of measurements at each interval on which the percentiles are based varied from a maximum of95
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 andthereafter 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, and97th
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 scalewas
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 metricsystem.
The growth curves on these
grids
arerepresen-tative
of a
white
population
in Colorado
and
maynot
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.’
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.2Denver,
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 infectionoccurring
insiblings
or close
family
members hasbeen
reported
infrequendy.1 Recent evidencesug-gests
that genetically controlled host characteristics may determine risk for infection and perhapstype
of
disease
due
to
H.
influenzae
type
b.2 We havehad
the
opportunity
to study
some
of these
factors
in
two
cases
of meningitis.This
report describesH.
influenzaetype
b
meningitis
in
two
identicalmembers
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 tendays 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 childrenwere 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 typedalso for histocompatibility (HL-A) antigens by an
in
vitro
microcytotoxicity test. L.G. inherited oneHL-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.6Sera from these