bluuebunny/crossref_metadata_2025 huggingface dataset:
Feeding the Low-Birth-Weight Infant III. Diet Influences Bile Acid Metabolism
Authors: Järvenpää A. -L. , Rassin D. K. , Kuitunen P. , Gaull G. E. , Räihä N. C.R.
Published: December 2021

Fasting duodenal bile acid concentrations and conjugation patterns were studied during the first 5 weeks of life in 65 low-birth-weight infants, 31 to 36 weeks of gestational age. One group was fed human milk. Approximately 55% of this milk was pooled, expressed, and pasteurized (62°C for 30 minutes), 35% was similarly treated milk from the infant's own mother, and the remainder (10%) was provided by breast-feeding. The other infants, from 3 days of age, were fed one of three formulas: an adapted formula (Fl), Fl supplemented with taurine (F2), or Fl supplemented with taurine and cholesterol (F3). The fasting intraluminal concentration of conjugated bile acids was higher in the infants fed human milk than in the infants fed formulas (F = 30.03, p < .001) reflecting the higher concentrations of all individual bile acids. No significant increase over time was found in the concentration of total bile acids in any feeding group. Chenodeoxycholic acid concentrations, however, increased significantly over time in the infants fed human milk (r = .286, P < .05). Thus, in the infants fed human milk, the ratio of cholates to chenodeoxycholates changed from 2.03 to 1.29 (P < .001), whereas it remained stable (2.61) in the groups fed formula. Tauroconjugated bile acids predominated until at least 5 weeks of life in all the infants fed human milk, F2, or F3. In the infants fed Fl, the concentration of glycoconjugates increased and that of tauroconjugates remained stable. Consequently, the ratio of glycine- to taurine-conjugated bile acids increased twofold, from 0.64 to 1.40 at 5 weeks of age. No further differences due to supplementation of formula with taurine plus cholesterol were found. Feeding human milk results in higher intraluminal concentrations of bile acids than does formulas. Dietary taurine, under the conditions of these studies, is not a limiting factor in the synthesis or secretion of tauroconjugated bile acids in the human preterm infant.
Erythema Multiforme: Confusion with Child Battering Syndrome
Authors: ADLER ROBERT , KANE-NUSSEN BRYNA
Published: December 2021

A diagnosis of battered child syndrome has important psychological and social ramifications beyond the medical realm and should not be taken lightly. In fact, most states require the physician to report suspected cases of child abuse. This has led to increased awareness of the condition but also to occasional overdiagnosis. Reports in the literature have identified some of the diseases that mimic the battered child syndrome1,2 This report describes another such condition that can be so classified: erythema multiforme (EM) lesions which progress to ecchymotic lesions, a common disease with an unusual presentation.

CASE REPORTS

Case 1

A 22-month-old male infant was seen in the emergency room (ER) with bruises on the abdomen.
Cardiac Complications in Children with Systemic Lupus Erythematosus
Authors: Englund Janet A. , Lucas Russell V.
Published: December 2021

Two patients had cardiac complications of childhood onset systemic lupus erythematosus (SLE). A 14-year-old boy had extramural and intramural coronary arteritis demonstrated by angiography. The signs and symptoms of myocardial ischemia improved dramatically when corticosteroid dose and immunosuppression were increased. A 20-year-old woman had had SLE for 18 years and had functionally significant mitral stenosis and regurgitation. Calcification of the mitral valve was observed on echocardiography. Corticosteroid treatment has controlled the renal manifestations of SLE. Cardiac complications of SLE are now a significant clinical problems.
Cutaneous Amebiasis
Authors: BROOK ITZHAK
Published: December 2021

To the Editor.—

Rimsza and Berg1 described a child with amebic liver abscess and vulvar skin lesion which they attributed to ameba. Although there is no doubt the child had amebic liver abscess, it is not certain that the vulvar lesion was due to this microorganism. It is not clear whether proper anaerobic cultures were done to isolate these pathogens from the skin lesion—and the statement that no pathogens were recovered is insufficient. Indeed when proper anaerobic cultures are done, anaerobic organisms are frequently isolated from vulvovaginal lesions in children.2
Shouldn't We Seek To Know More About Slower Growth?
Authors: WALKER ALEXANDER R. P. , STEIN HARRY
Published: December 2021

To the Editor.—

Currently, much is heard of retarded, normal, attainable, and maximal growth, although the clinical significance of such during youth, and the possible ramifications in adulthood, have been insufficiently studied.

Slower growth is characteristic of the huge bulk of the world's population, and is likely to remain so. In the not-so-distant future, because of population increase it will be imperative to make more economical use of land. Therefore, there will have to be far greater reliance on plant food, which, when consumption is large, is associated with slower growth.
Sleep and Nasal Obstruction
Authors: SHAW EDWARD B.
Published: December 2021

To the Editor.—

Many of the numerous theories that have recently been advanced to account for respiratory failure in infancy have failed to establish a single persuasive cause for this disaster and have ignored some of the early and perhaps significant proposals to account for sudden infant death syndrome (SIDS). The recent article by van Someren and Stothers1 at least refers to one possible etiology that I have always believed.

During the early months of life, most infants breathe via the nasal passage.
Short-Course Chemotherapy for Tuberculosis in Children
Authors: Abernathy Rosalind S. , Dutt A. K. , Stead William W. , Moers D. J.
Published: December 2021

Short-course, largely twice-weekly chemotherapy for tuberculosis was introduced in the United States for treatment of adults with pulmonary disease by the Arkansas State Department of Health in 1976. Since 1977, 50 children with tuberculosis have been treated with rifampin, 10 to 20 mg/kg, and isoniazid, 10 to 20 mg/kg daily for one month followed by 10 to 20 mg/kg of rifampin and 20 to 40 mg/kg of isoniazid twice a week for another 8 months. Ages ranged from 4 months to 15 years with a median age of 3 years. A presumptive diagnosis of tuberculosis was made on the basis of 10 mm or more of induration to 5 TU of purified protein derivative and a chest film or other findings compatible with tuberculosis. Three children had extrapulmonary disease (two had cervical adenitis, one had tuberculosis arthritis). Of the 47 children with pulmonary disease, 32 were asymptomatic. The results were excellent. Symptoms cleared in 1 to 2 months. Most pulmonary infiltrates had cleared by 10 months, but hilar adenopathy rarely cleared in less than 2 years. Drug toxicity occurred in only one patient (vomiting of rifampin). This treatment appears to be safe, effective, inexpensive, short and simple enough to ensure cooperation or to allow personnel to administer drugs directly to children from socially disorganized families.
Acute Cerebellar Ataxia in Pediatric Legionellosis
Authors: Nigro Giovanni , Pastoris Maddalena Castellani , Fantasia Mirella Mazzotti , Midulla Mario
Published: December 2021

Acute-phase and convalescent-phase sera of 66 children, aged 3 months to 12 years, with neurologic disorders of unknown etiology were tested against Legioneila pneumophila polyvalent and monovalent antigens (groups 1 to 4). Three significant antibody titer increases were obtained, all in childlren with acute cerebellar ataxia. This neurologic syndrome was characterized by sudden onset of muscle hypotonia and inability to sit or walk, with no other specific neurologic or systemic symptoms. Persisting pharyngitis always preceded ataxia. Fever of short duration was still present. Gastrointestinal disturbance occurred in two of the three children. Abnormal laboratory findings were, not always simultaneously, high ESR and leukocytosis with lymphocytosis. CSF levels and electromyographic findings were normal in two of the children. Two children received oral betamethasone. Recovery was complete within seven to ten days without antibiotic treatment. These studies indicate the possible etiologic role of L pneumophila in acute cerebellar ataxia.
Decreased Plasma Fibronectin in Neonatal Sepsis
Authors: Gerdes Jeffrey S. , Yoder Mervin C. , Douglas Steven D. , Polin Richard A.
Published: December 2021

Fibronectin is a large opsonic glycoprotein which promotes reticuloendothelial system clearance of bacteria, immune complexes, collagenous debris, and damaged platelets. The concentration of plasma fibronectin is decreased in the newborn infant; however, the role of fibronectin in the onset and course of neonatal sepsis is unknown. Serial plasma fibronectin levels were determined in 19 neonates with documented bacterial sepsis. Plasma fibronectin concentrations decreased significantly (P<.001) in all study infants concurrent with the development of septicemia. Recovery of plasma fibronectin to normal levels occurred by day 5 in premature neonates and by days 7 to 10 in term neonates. Fibronectin deficiency and resultant reticuloendothelial system impairment may decrease the ability of newborn infants to resist or clear bacterial infections. An acute reduction in the concentration of plasma fibronectin may be a valuable marker for neonatal sepsis.
Special Susceptibility of Children to Radiation Effects
Authors:   Committee on Genetics and Environmental Hazards
Published: December 2021

In a nuclear war, children who survive the acute effects of radiation—the blast and intense heat—may also have to survive the loss or disability of parents who provide food, shelter, and love, so necessary for physical and emotional development. The likelihood of provision of even limited medical services following a nuclear blast is virtually nil. Finally, persons exposed to radiation as children have a substantially greater susceptibility to delayed effects than do those persons exposed as adults.

1. The peak frequency for leukemia is higher and occurs earlier among those less than 15 years of age exposed to radiation than among those who are older.

2. Breast cancer occurs excessively when females who were exposed to radiation during childhood reach the usual age for developing this malignancy. The rates for breast cancer for those who were 10 to 19 years of age at the time of the bomb are greater than those for females who were older at that time. Unexpectedly, an excessive occurrence of breast cancer has been observed among females who were 9 years old or younger at the time of the bomb, an age range when they would have had very little breast tissue. If cases continue to occur at the same rate as these women grow older, the excessive occurrence of breast cancer will be greater than among all other age groups.

3. Persons less than 30 years old at the time of the bomb are apparently more susceptible than older persons to radiogenic thyroid cancer. Benign thyroid tumors have occurred among nearly all children exposed to radioiodine-containing fallout from a nuclear weapons test on the Marshall Islands in 1954.
Subgaleal Hemorrhage
Authors: FALVO CATHEY E. , FILIPPO J. ANTHONY SAN
Published: December 2021

In Reply.—

We are pleased to see Beauchamp and Metcalf's case report and discussion of the management of subgaleal hematoma. Inasmuch as subgaleal hematoma not accompanying other trauma is rare, the best method of treatment is not well delineated. We had had experience with two patients with subgaleal hematoma from other causes. One patient developed infection and died; the other patient developed calcification.

Clearly, a compilation of national experience with subgaleal hematoma in different age groups and of differing etiologies is needed if we are not to be excessively or insufficiently aggressive in our treatment of these patients.
Adolescent Chest Pain
Authors: BROWN ROBERT T.
Published: December 2021

To the Editor.—

The study by Pantell and Goodman1 on adolescent chest pain was most interesting and informative. I have a question, however, about their statement that their criteria for diagnosis of costochondritis were more restrictive than were mine in my previous study. 2 On the contrary, our criteria for the diagnosis of costochondritis were exactly the same: pain that is reproducible by palpating the affected rib cartilage when no other signs or symptoms are present. There are other reasons possible for the discrepancy between the prevalence of costochondritis in our two reports.
Neonatal Circumcision
Authors: ICHTER JOSEPH T.
Published: December 2021

To the Editor.—

In the June 1983 issue of News and Comments, the following letter to the editor was published.

Strong stand against routine circumcision

It is my impression that most physicians, and pediatricians in particular, are of the belief that routine neonatal circumcision in the male infant is not a medically necessary procedure. It is my understanding that the AAP Committee on Fetus and Newborn has made statements about the issue.

There are several reasons that are promulgated to justify the performance of the procedure.
Neonatal Circumcision
Authors: LITTLE GEORGE A.
Published: December 2021

In Reply.—

Don't circumcise neonates. That message has been stated in various fashion in communications of the American Academy of Pediatrics for at least 13 years. For example:

There are no valid medical indications for circumcision in the neonatal period.1

There is no absolute medical indication for routine circumcision of the newborn.2

There are no medical indications for routine circumcision, and the procedure cannot be considered an essential component of health care.3

Furthermore, the AAP through its postgraduate effort, Pediatrics in Review, has this year included a module that makes a strong attempt to meet the need for education in counseling parents of the uncircumcised infant.
Postmortem Protocol
Authors: NEIDENGARD LEE , LONG KATHY , TEDONE LOUIS , EKEGREN JAMES K. , PETERSON RICHARD
Published: December 2021

To the Editor.—

We were interested in the article by Kronick and colleagues on a penimortem protocol for suspected genetic disease.1 They have emphasized the collection of specific body fluids and tissue samples. In 1981, Opitz2 outlined methods for study of a dysmorphic stillborn infant that would be appropriate for a teaching hospital. In San Luis Obispo County, we have several community hospitals that provide care for virtually all newborn infants, and we have recently adopted a protocol for the local evaluation of infants and stillborns with genetic-dysmorphic concerns.
Esophageal Spasm Associated with Apnea and Bradycardia in an Infant
Authors: Fontán Julio Pérez , Heldt Gregory P. , Heyman Melvin B. , Marin Mark S. , Tooley William H.
Published: December 2021

A newborn infant was found to have diffuse esophageal spasm in association with apnea and bradycardia. This association has not been physiologically documented before. The infant's condition improved after the administration of glycopyrrolate, an anticholinergic agent. It is speculated that the association of esophageal spasm and bradycardia may be mediated by the vagus.
Recurrence of Patency of the Ductus Arteriosus After Surgical Ligation in Premature Infants
Authors: Daniels Stephen R. , Reller Mark D. , Kaplan Samuel
Published: December 2021

Two premature infants who had surgical ligation of their patent ductus arteriosus are described. These infants initially did well postoperatively but then developed congestive heart failure. Both infants had echocardiographic evidence of recurrence of their patent ductus arteriosus. One of the infants required a repeat ligation procedure. It is important to continue to monitor premature infants for the return of clinical signs of a patent ductus arteriosus after surgical ligation.
A System for Individualized Dosing of Intravenous Aminophylline Using a Programmable Calculator
Authors: Mitsuoka J. Chris , Fleck Richard J.
Published: December 2021

A program that calculates a value of clearance for an individual patient prior to reaching steady state in the early stages of aminophylline therapy is presented. The program is written for the Texas Instruments TI-59 programmable calculator and may be used with or without the PC-100C printer. The program can provide clinically useful information concerning projected plasma concentrations prior to reaching steady state with an accurate history of the dose administration and serum concentration determination. If the patient has not received xanthene therapy prior to admission, only one serum sample is required. If there has been prior drug exposure, a second serum sample is required. An iterative technique, which would be impractical to use without calculator assistance, is employed to make these determinations.
A Method for Evaluating Performance of Ambulatory Pediatric Tasks
Authors: Palmer R. Heather , Strain Rose , Maurer Judith V. W. , Thompson Mark S.
Published: December 2021

Four evaluations of ambulatory pediatric tasks were used for quality assurance in eight pediatric group practices situated in two teaching hospitals and six related health centers. The evaluations used criteria incorporating branching logic to judge the quality of care revealed in data abstracted from medical records. Performance was evaluated for follow-up of positive urine cultures, assessment and follow-up of otitis media, initial assessment for gastroenteritis, and "well child" care for infants. A computerized data system was developed to process evaluation data and produce easily read reports. This work is part of a controlled trial of the feasibility, cost, and effectiveness of quality assurance as a means to improve patient care, but this preliminary report concerns only the principles for design of the evaluations and their use in quality assurance. Acceptance of evaluations by site providers was high: of 203 provider responses to a survey, only four reported disagreement with the criteria. Rates of cases "variant" from criteria and found on peer review to represent deficiencies in care, when averaged across sites, ranged by task from 1% to 47% of cases evaluated. In most sites, providers planned and implemented actions to correct these deficiencies. It is noted that improvements in care may increase costs of care.
Adolescent Mothers and Their Infants
Authors: McAnarney Elizabeth R. , Lawrence Ruth A. , Aten Marilyn J. , Iker Howard P.
Published: December 2021

It is unclear why children of adolescent mothers experience more developmental problems than children of adult mothers. There has been minimal systematic investigation of whether there is a relationship between the young age of the mother and her mothering behaviors. Our data fail to demonstrate any relationship between adolescent maternal age and the counts of maternal behaviors three days following birth. Seventy-five normal primiparous mothers less than 20 years old were videotaped with their normal infants for ten minutes in a standardized laboratory setting during the three days following birth. The frequency of maternal behaviors was counted from the videotapes by trained observers. Future studies of primiparous adolescent mothers should consider the effects of maternal race/culture and socioeconomic status on their mothering behaviors. The relationship between adolescent maternal age and the vocalizations expressed by the mother to her infant should also be explored further.
Hemorrhagic Periventricular Leukomalacia and Spastic Diplegia
Authors: KUBAN KARL C. , GILLES FLOYD H.
Published: December 2021

To the Editor.—

Levene et al1 recently described their experience with a new application for real-time ultrasonography. They reported that hemorrhagic periventricular leukomalacia (PVL) could be diagnosed by ultrasound in 7.5% of their series of 120 infants of birth weight less than 1,501 g. The report of Levene et al is important in that it expands the clinical utility of this relatively new technology. However, comments about the issue of pathologic verification are warranted.

The authors report that autopsy was performed in two of the nine cases with ultrasound-documented hemorrhagic PVL.
DPT in the Finger
Authors: GEDISSMAN A.
Published: December 2021

To the Editor.—

I would like to share with my colleagues an incident that occurred recently in my office.

One of the nurses working in my office reported to me that her right index finger started to hurt suddenly a few hours into the working day and because of the swelling she was unable to move it. The finger was very edematous but not erythematous, and it was very tender to touch in an area that appeared to have a very small puncture wound.
Prognosis for Black Infants with Leukemia
Authors: SEELER RUTH ANDREA
Published: December 2021

To the Editor.—

In a recent paper, Sadowitz and Oski1 demonstrated that black infants both healthy and ill (with bacterial meningitis) had significantly lower absolute granulocyte counts than white infants. They pointed out that granulocyte counts may not be as valuable in arriving at the diagnosis of infection in black infants as in white infants. However, I would like to raise another implication for serious consideration, namely, the poorer prognosis of black children with acute lymphocytic leukemia.
Frostbite
Authors: BROWN FORST E.
Published: December 2021

In Reply.—

Rowlingson and Carron suggest consideration of transcutaneous electrical nerve stimulation (TENS) in the management of frostbite. As they mentioned, sympathetic blocks have been effective in the management of early frostbite; blood flow increase has resulted in the salvage of damaged digits. Interarterial reserpine and prostacycline also have been shown to overcome digital vasoconstriction.

In the two patients we described, persistent vasoconstriction as seen in reflex sympathetic dystrophy (RSD) was not the problem. Moreover, the changes seen in the radiographs were not comparable to those seen in RSD.
Everybody Needs Reeducation
Authors: DE CARVALHO MANOEL
Published: December 2021

In Reply.—

The table presented by Michael is similar to one published by Holt in 1899.1 Although up to ten feedings were recommended during the first month of life, a predetermined schedule was considered important because "the baby should be taught to be regular in its habits."

Until the 19th century, feeding schedules were rarely mentioned in English-language guidebooks for parents. The industrial revolution and the significant changes in the sociologic, economic, and cultural conditions of women may all have contributed to changing the recommendations on feeding schedules.
Colonoscopy in Childhood
Authors: Hassall Eric , Barclay Glen N. , Ament Marvin E.
Published: December 2021

A review was made of 139 fiberoptic colonoscopies performed between 1975 and 1982 on 113 patients aged 1 month to 20 years. General anesthesia was used in four procedures. All others were done under sedation with meperidine (mean dose 2.9 mg/kg) and diazepam (mean dose 0.5 mg/kg). Indications were rectal bleeding in 52 patients; assessment and surveillance of known inflammatory bowel disease in 33 patients; and diagnostic evaluation of abdominal pain, diarrhea, and/or fever in 28 patients. The cecum was reached in 84% of diagnostic examinations. Comparison of findings on colonoscopy with barium enema in 75 patients showed agreement in 46, colonoscopic superiority in 25, and barium enema superiority in four. Bleeding sufficient to cause anemia was seen in 10/26 patients with polyps. Five minor complications and no major complications occurred. Flexible fiberoptic colonoscopy and polypectomy may be done usefully in childhood by physicians well versed and experienced with these procedures. Colonoscopy and biopsy changed the radiographic diagnosis from ulcerative colitis to Crohn's disease in several cases and indicated greater extent of colonic disease in several cases of ulcerative colitis and Crohn's disease. Colonoscopy is usually the most sensitive and accurate diagnostic tool for the evaluation of colonic disease, but barium enema and colonoscopy are complementary tests and barium enema should usually precede colonoscopy, with certain exceptions.
Role of Acetyl Salicylic Acid and Sodium Metabisulfite in Chronic Childhood Asthma
Authors: Towns S. J. , Mellis C. M.
Published: December 2021

The role of a commonly ingested food additive, the preservative sodium metabisulfite (MBS), and aspirin (ASA), in chronic asthma has been studied in 29 children. After 1 week on a strict elimination diet, all 29 children were challenged, in a single-blind fashion, in the pulmonary function laboratory on three consecutive days with placebo, MBS (capsule form and solution), and ASA. Children with a positive response to MBS were prescribed a diet that excluded foods containing MBS. Patients with a positive response to ASA were prescribed a diet excluding medications containing aspirin and natural salicylates. After 3 months on these restricted diets, the children were reassessed to determine whether there had been any therapeutic response. There was a 66% (19/29) incidence of positive challenge (>20% decrease in forced expiratory volume in one second) with MBS and a 21% (6/29) incidence of positive challenge with ASA. None of the children reacted to MBS in capsule form (maximum dose = 100 mg), but 19/29 reacted to MBS in solution with 30 mL of 0.5% citric acid. After 3 months on the restricted diet, four of 19 children on the MBS-free diet and one of six on the salicylate-free diet had objective signs of improvement, namely, reduction in asthma medications and/or improvement in lung function. Unfortunately, compliance with the restrictive diet during this 3 month period was poor, particularly with the ASA-sensitive children. It was demonstrated that two commonly ingested chemicals (MBS and ASA) can provoke bronchospasm in asthmatic children; however, long-term elimination of these substances, particularly natural salicylate, from a child's diet is difficult and does not, in general, improve the chronic asthma.
Pediatricians as Counselors: The Relationship as Treatment
Authors: BERGMAN ANNE STURMTHAL
Published: December 2021

As a social worker practicing with pediatricians and psychiatrists in a children's hospital, I have followed with interest the pediatrician's growing role in counseling parents. More and more articles, which appear in the pediatric literature, describe family and patients' response to catastrophic events, identify areas in which the pediatrician can intervene, and offer helpful hints about techniques. It is increasingly acknowledged that pediatric practice includes a "considerable proportion" of behavioral and social problems.1 Many factors favor the pediatrician's expanding involvement in these areas. "Changing life-styles,"2 the growing number of children with chronic illness, and the availability of the pediatrician as an entry into the mental health system3 present opportunities for the pediatrician to clarify and pursue psychosocial issues with patients.
Suctioning and Cerebral Blood Flow
Authors: MARSHALL TERRY A.
Published: December 2021

To the Editor.—

The article by Perlman and Volpe1 provides interesting information on physiologic changes associated with suctioning in the preterm infant. My observations during laryngoscopy and endotracheal intubation in preterm infants have also revealed a significant increase in arterial blood pressure which occurred before the onset of hypoxemia. It is possible that mechanical stimulation of the laryngopharyngeal and tracheobronchial regions as described in cats2 may arouse reflexes that increase sympathetic efferent activity, thereby contributing to the increase in blood pressure.
Soy Formula
Authors: MOFENSON HOWARD C.
Published: December 2021

To the Editor.—

The excellent commentary by the Committee on Nutrition of the American Academy of Pediatrics on soy-protein formulas1 needs an addition to the instances when soy-protein should not be used. Soy-protein may be harmful in cystic fibrosis of the pancreas as the protein is contaminated with trypsin inhibitors which can aggravate the pancreatic insufficiency and interfere with absorption of protein resulting in hypoalbuminemia and its manifestations.2-4

I think this addition will remind pediatricians that soy-based formulas are not recommended for patients with cystic fibrosis.
Dental and Maxillofacial Abnormalities in Long-Term Survivors of Childhood Cancer: Effects of Treatment with Chemotherapy and Radiation to the Head and Neck
Authors: Jaffe Norman , Toth Béla B. , Hoar Robert E. , Ried Hubert L. , Sullivan Margaret P. , McNeese Marsha D.
Published: December 2021

Sixty-eight long-term survivors of childhood cancer were evaluated for dental and maxillofacial abnormalities. Forty-five patients had received maxillofacial radiation for lymphoma, leukemia, rhabdomyosarcoma, and miscellaneous tumors. Forty-three of the 45 patients and the remaining 23 who had not received maxillofacial radiation also received chemotherapy. Dental and maxillofacial abnormalities were detected in 37 of the 45 (82%) radiated patients. Dental abnormalities comprised foreshortening and blunting of roots, incomplete calcification, premature closure of apices, delayed or arrested tooth development, and caries. Maxillofacial abnormalities comprised trismus, abnormal occlusal relationships, and facial deformities. The abnormalities were more severe in those patients who received radiation at an earlier age and at higher dosages. Possible chemotherapeutic effects in five of 23 patients who received treatment for tumors located outside the head and neck region comprised acquired amelogenesis imperfecta, microdontia of bicuspid teeth, and a tendency toward thinning of roots with an enlarged pulp chamber. Dental and maxillofacial abnormalities should be recognized as a major consequence of maxillofacial radiation in long-term survivors of childhood cancer, and attempts to minimize or eliminate such sequelae should involve an effective interaction between radiation therapists, and medical and dental oncologists.
Free Amino Acids in Citrullus vulgaris (Watermelon)
Authors: TEDESCO T. A. , BENFORD S. A. , FOSTER R. C. , BARNESS L. A.
Published: December 2021

To the Editor.—

Currently accepted dietary management of citrullinemia and other urea cycle disorders includes protein restriction, sodium benzoate, and dietary supplements of keto acids or essential amino acids with postblock intermediates such as arginine in citrullinemia and arginino-succinic aciduria. When a child survives the neonatal period on such a regimen and solid foods are introduced into the diet, there is at least one fruit that should be avoided, Citrullus Vulgaris, commonly known as watermelon.

Quantitation of free amino acids extracted from 1 g wet weight of watermelon fruit yielded the following (in mmoles per gram wet weight): Phenylalanine, 1.25; histidine, 0.24; tryptophan, 0.35; lysine, 0.82; ornithine, 0.32; arginine, 11.36; aspartic acid, 0.97; threonine, 0.74; serine, 1.05; glutamine, 3.86; glutamic acid, 1.38; citrulline, 23.68; alanine, 1.15; valine, 0.17; isoleucine, 1.24; leucine, 0.24.
Usefulness of Screening for Hypertension
Authors: FIXLER DAVID E.
Published: December 2021

In Reply.—

Grossman has expressed the opinion that among the criteria for any screening procedure is that the disease being screened for is either prevalent or has severe health consequences. Although these are notable criteria, they in no means represent indications for initiating mass screening programs. Justification for a screening program is based on its having a high yield, that is, that early detection in a significant number of patients will lead to appropriate treatment and a significant decrease in morbidity and mortality.
Learning Disabilities, Dyslexia, and Vision
Authors:   Committee on Children with Disabilities of the AAP, and Ad Hoc Working Group of the American Association for Pediatric Ophthalmology and Strabismus and American Academy of Ophthalmology
Published: December 2021

POLICY

The American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus upport the position that a child or adult with dyslexia or a related learning disability should receive: (1) early medical, educational, and/or psychological evaluation and diagnosis; and (2) remediation with educational procedures of proven value, demonstrated by valid research.

BACKGROUND

Dyslexia and related learning diabilities have become matters of increasing public attention. A child's or adult's inability to read with understanding is a major obstacle to school learning and may have far-reaching social and economic implications. The normal and appropriate concern of parents for the welfare of their children and of society for its disadvantaged children and young adults has fostered a proliferation of purportedly diagnostic and remedial procedures, many of which are controversial. Research has shown that deficient visual perception of letters or words accounts for inability to read in only a small minority of children; the majority suffer from a variety of linguisting defects.1,2 Therefore, the diagnosis and treatment of dyslexia and associated learning disabilities have recently been reviewed with the following conclusions endorsed by the three societies named above.

EVALUATION AND CONCLUSIONS

1. Learning disabilities, including the dyslexias, as well as other forms of learning underachievement, often may require a multidisciplinary approach from medicine, education, and psychology in evaluation, diagnosis, and treatment. Certain problems may be detected during early childhood through the use of screening techniques by educational specialists. Children with potential problems include those with language defects, emotional problems, or a family history of learning disability.
The Pediatrician's Role in Promoting the Health of a Patient in Day Care
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

American families have changed. More mothers are working, and more young children are being cared for outside the home. The stresses inherent in this sociologic change are great.

Pediatric practice has also changed. Increasingly, pediatricians are involved not only in the medical care of the child, but in the ecologic system in which the child exists. The pediatrician has traditionally worked with parents and children to promote healthy functioning, which encompasses the physical, emotional, cognitive, and social health of the growing and developing child. Now, the pediatrician must expand this role to include working with significant other adults who interact closely with the child who spends much of the day away from home. In this way, the pediatrician will contribute to the promotion of the child's general wellbeing, and some maladaptive behaviors will be prevented.

Parents and adults whom parents delegate to provide child care on a regular basis have the greatest responsibility for children. With increasing numbers of single-parent families and families in which both parents work, there is a greater use of the variety of alternative care-giving arrangements involving adults who are neither parents nor relatives of the child. Effective communication among the child's pediatrician and regular care givers is more difficult to achieve than in the past when parents provided most of the child's care. When developmental irregularities or a chronic illness are a concern, it is particularly important for pediatricians to communicate to the person(s) providing child care the unique features of the child and family. Thus the care giver will be better able to prepare an individualized program that enhances the child's development, increases self-esteem, and supports the parents' child-caring capacity.
Biliary Atresia and Liver Transplantation: The National Institutes of Health Point of View
Authors: LILLY JOHN R.
Published: December 2021

In August 1983, a bulletin, Liver Transplantation,1 printed and distributed under the aegis of the National Institutes of Health (NIH), was mailed to physicians throughout the United States. The bulletin was the product of a concensus panel convened to consider offered evidence (expert presentation of the available data) about liver transplantation. The panel was composed of a singular assortment of individuals including physicians in private practice, medical and pediatric department chairmen, a dean, a hospital director, and a person with a PhD in mathematics and statistics.

Whatever the validity of their transplantation conclusions, the panel's recommendations about extrahepatic biliary atresia appear arbitrary and suspect, if not downright erroneous.
Care of Infants with Myelomeningocele
Authors: VENES JOAN L.
Published: December 2021

To the Editor.—

In the era of "Baby Doe," Gross et al (Pediatrics 1983;72:450-458) are to be commended for their forthright presentation of the Oklahoma Children's Memorial Hospital Center policy concerning those children born with meningomyelocele.

I would agree with their premise that immediate operation is not indicated but would not agree that prolonged delay is without hazard for increased rates of infection. Nevertheless, certainly time is available for reasoned and considered discussion with at least one, and preferably both parents, prior to the initiation of therapy.
Care of Infants with Myelomeningocele
Authors: MCLONE DAVID G.
Published: December 2021

To the Editor.—

I read with disbelief the article by Gross et al,1 concering the treatment of children with a myelomeningocele. They stated "...it is prima fascie irresponsible to obtain knowledge about the results of surgery on high risk infants and then not to use the negative results..." I would argue that it is equally and probably more irresponsible not to use the positive results. The authors believe not only in selecting death—"if one is persuaded that death is preferable to life under certain circumstances" but also in the selective use of the literature.
Neonatal Mortality Statistics
Authors: SHAPIRO SAM , MCCORMICK MARIE C. , STARFIELD BARBARA
Published: December 2021

In Reply.—

Sepkowitz uses data in our paper to question the influence of neonatal intensive care units (NICUs) during the 1970s in reducing neonatal mortality. Part of the argument is based on the calculation that about 43% of the total reduction in such deaths between 1976 and 1978 to 1979 occurred among infants weighing more than 2,500 g at birth, a group for which "neonatal intensive care ... would seldom be necessary ..."

Certainly there are many factors—social, environmental, and medical, including improved care in the antenatal and intrapartum periods—that have affected the reduction in neonatal mortality.
Apnea of Prematurity: I. Lung Function and Regulation of Breathing
Authors: Gerhardt Tilo , Bancalari Eduardo
Published: December 2021

It has been suggested that apnea of prematurity may be caused by "immaturity" of central control of breathing. To test the validity of this hypothesis tidal volume (VT), alveolar ventilation (VA), alveolar Pco2 (PACO2), esophageal pressure change, and the slope of the CO2 response curve (ΔVE [minute ventilation]/ΔPAco2) were determined in 18 infants with apnea (mean of 32 episodes of more than 20 seconds duration per day) and in 18 healthy newborns used as control subjects. The infants were matched for birth weight (1,068 g v 1,065 g), gestational age (30.2 weeks v 30.2 weeks), and postnatal age (8.6 days v 8.3 days). The results were as follows: VT (4.4 ± 1.0 mL/kg v 5.3 ± 1.6 mL/kg), VA (96 ± 21 mL/kg/min v 129 ± 33 mL/kg/min), PAco2 (45.4 ± 8.5 mm Hg v 35.6 ± 4.7 mm Hg), esophageal pressure change (4.5 ± 0.9 cm H2O v 6.0 ± 1.8 cm H2O), ΔVEΔPAco2 (20.2 ± 10.6 mL/min/kg/mm Hg CO2 v 40.7 ± 19.9 mL/min/kg/mm Hg CO2). There was a significant difference between infants with and without apnea for all measurements. The results indicate a decreased respiratory center output and a depressed ventilatory response to CO2 in infants with apnea. As there was no difference between the two groups in pulmonary mechanics or oxygenation, the findings support the hypothesis that a central disturbance in regulation of breathing is the cause of apnea in these infants.
Informed Consent: Influence on Patient Selection Among Critically III Premature Infants
Authors: WALTERSPIEL JUAN N.
Published: December 2021

Each clinical investigator must deal with the emotional burden of obtaining informed consent. The role resembles that of a sales person who must find the right way to communicate with potential customers. Procurement of extramural grant monies, academic pressures, and personal biases toward one form of treatment are motivations to secure consent. The "sales pitch" is frequently made with the emotional pressure of acute illness; medical issues and uncertainties must be simplified. The mandatory and often frightening legal jargon at the end of institutional consent forms is defused by remarks about the system or statement that being in a study provides protection and supervised care.
Neonatal Bacteremia and Circumcision
Authors: WISWELL THOMAS E.
Published: December 2021

In Reply.—

Dr Braun's conjecture regarding our study's conclusions is incorrect. He has misinterpreted the methods and results presented in our recent report.1 We stated that we were interested in bacteremia that related to the uncircumcised state or to the circumcision procedure itself. We did not include cases of neonatal bacteremia that could not be attributed to either condition. Of 108 boys with urinary tract infections, 37 (34.3%) had concomitant bacteremia (virtually all were due to Escherichia coli).
Is There Lead in the Suburbs? Risk Assessment in Chicago Suburban Pediatric Practices
Authors: Binns Helen J. , LeBailly Susan A. , Poncher John , Kinsella T. Randall , Saunders Stephen E. ,   Pediatric Practice Research Group
Published: December 2021

Objective. This study was designed to determine: (1) the prevalence of elevated blood lead (BPb) levels (BPb ≥ 10 µg/dL) in Chicago suburban children attending Pediatric Practice Research Group practices at 12 and 24 months of age, and (2) the efficacy of the Centers for Disease Control and Prevention (CDC) and Illinois lead exposure risk assessment questions.

Methods. Parents bringing their 1- and 2-year-old children for health supervision visits at pediatric practices completed questionnaires. BPb levels were drawn on children. Both questionnaire and an analyzable BPb level were obtained on 1393 subjects (79.2%).

Results. Only 2.1% of our sample had a venous BPb level ≥10 µg/dL (0.48 µmol/L); no subjects had a level ≥30µg/dL (1.45 µmol/L). The CDC risk assessment questions had a sensitivity of .69 and specificity of .70. Due to the low prevalence of elevated BPb levels in this sample, CDC and Illinois screening strategies had high negative predictive values (.99) and low positive predictive values (.05 and .04, respectively). However, some of the subjects with BPb levels ≥10 µg/dL were not at high risk by CDC and Illinois screening questions; 9 of 29 subjects with elevated lead levels (31%) did not respond affirmatively to any CDC risk assessment questions. The question best predicting an elevated BPb was the determination that the house the child lives in was built before 1960 (sensitivity = .83, specificity = .67). This question is not currently included in CDC or Illinois screening strategies. Screening based on the single question "Was your house built before 1960?" would have missed only five (17%) of the children with BPb levels ≥10 µg/dL. Three of these five children were among the 17.1% of 1-year-olds and 26.3% of 2-year-olds in our sample who had moved.

Conclusions. In this sample, children living in houses built before 1960 should be considered at high risk for high-dose lead exposure. Due to the high mobility of our sample, phrasing the question to include lifetime exposure (ie, Has your child ever lived in a house built before 1960?) should also be considered. Selective BPb testing of high-risk children in low-prevalence suburban areas using this question would miss few children with elevated BPb. Useful risk assessment questions in other areas and other populations may differ.
Toluene Embryopathy: Clinical Delineation and Developmental Follow-up
Authors: Arnold Georgianne L. , Kirby Russell S. , Langendoerfer Sharon , Wilkins-Haug Louise
Published: December 2021

Objective. To expand the phenotype of toluene embryopathy.

Method. Review of case records of 35 deliveries with antenatal exposure to toluene. Six children were examined and their features are compared with previously reported cases.

Results. There were three perinatal deaths. Of the survivors, review of available data revealed a high incidence of prematurity (42%), low birth weight (52%), and microcephaly (32%). Birth weight, length, and head circumference and gestational length were significantly less than a control group closely matched for gender, race, and socioeconomic status. Follow-up pediatric evaluation revealed growth retardation (46% <5th percentile for weight, 38% <5th percentile for height), microcephaly (46%), and developmental delays (38%). Maternal toluene abuse of 4 or more years was positively correlated with weight <5th percentile and microcephaly in childhood. The six children examined demonstrated many previously described features of toluene embryopathy including microcephaly, narrow bifrontal diameter, short palpebral fissures, hypoplastic midface, wide nasal bridge, abnormal palmar creases, and blunt fingertips. Only one of the six children examined had antepartum exposure to alcohol as well as toluene.

Conclusion. In utero exposure to toluene seems to be associated with teratogenicity in the developing fetus. A preliminary picture of toluene embryopathy is now emerging.
Differences in Child Pedestrian Injury Events by Location
Authors: Agran Phyllis F. , Winn Diane G. , Anderson Craig L.
Published: December 2021

Objective. To compare child pedestrian injury events occurring in driveways and parking lots and at midblock and intersections with respect to characteristics and activity of the child, injury outcome measures, and characteristics of the vehicle and roadway.

Design. Descriptive case series.

Setting. Data were obtained from a multihospital/coroner monitoring system, during 2 years in an urban county, by record review and interviews.

Patients. The sample consisted of 345 pedestrians 0 through 14 years of age treated for injuries at one of the participating facilities.

Results. Eleven percent were injured in driveways, 8% in parking lots, 53% at midblock, and 28% at intersections. Median age was 2 years for driveways, 4 years for parking lots, 6 years for midblock, and 10 years for intersection. Events in driveways and parking lots had significantly more vehicles backing up, fewer automobiles, and more pedestrians with adults. Events at intersections occurred more often on streets with more than two lanes, with speed limits >25 mph, and with moderate or heavy traffic than events at midblock. Sixteen percent of those injured in driveways and parking lots sustained head injury of moderate or greater severity versus 35% injured in the street.

Conclusions. Interventions to prevent child pedestrian injuries must consider normal child behavior and driver awareness as it relates to location of the events. Driveway events involve small children, larger vehicles, and backing up. Midblock events involve children too young to cross even quiet residential streets safely. Traffic controls and safe street crossing skills are measures to consider for intersection events involving older children.
PET FOOD FOUND TO OUTWEIGH REFUGEE RATIONS IN NUTRITION
Authors: L. J. F.
Published: December 2021

LONDON, Aug. 9 (Reuters)—Dogs and cats in Western households eat food that is more nutritious than the typical rations that relief workers give refugees, British scientists say.

In a letter to the Aug. 8 issue Lancet medical journal, researchers said experiments had shown that pet food eaten by dogs and cats contained more riboflavin, niacin, vitamin A and iron than the same quantity of a typical refugee ration.

A daily refugee ration was described as about 14 ounces of cereals, 1 ounce of lentils or legumes, three-quarters of 1 ounce of oil and a small quantity of sugar.