bluuebunny/crossref_metadata_2025 huggingface dataset:
Stomachaches and Headaches in a Community Sample of Preschool Children
Authors: Zuckerman Barry , Stevenson James , Bailey Veira
Published: December 2021

The epidemiology of recurrent stomachache and headache was studied in a community sample of 308 preschool children, most of whom were white. When the children were 3 years old, interviews with their mothers indicated that 3% had recurrent headaches and 9% had recurrent stomachaches. Children with recurrent stomachaches were more likely than those without recurrent stomachaches to have mothers who were emotionally depressed (P < .01), had marital problems (P < .05), and perceived their own health as poor (P < .05). When maternal poor health was controlled, depression was still associated with their children having stomachaches (P < .05). Prospectively collected data demonstrate that children with recurrent stomachaches did not have bowel difficulties when they were infants. Other psychosocial stresses and demographic factors were not associated with stomachaches. The only variable associated with recurrent headache was maternal depression. Children with recurrent headaches or stomachaches were more likely to have behavior problems, as measured by the Behavior Screening Questionnaire, than were children without these symptoms. The analysis presents new data on these common symptoms of childhood.
Postnatal Weight Changes in Low Birth Weight Infants
Authors: Shaffer Stanley G. , Quimiro Cheryl L. , Anderson John V. , Hall Robert T.
Published: December 2021

Postnatal body weight changes were assessed in 385 surviving infants with birth weights of less than 2,500 g. Body weight was measured daily between birth and 45 days of age. Infants were grouped according to 100-g birth weight categories, and mean body weight changes for each group were compared. Initial postnatal weight loss occurred in each group and ranged between 7.9% and 14.6% of birth weight. Mean postnatal weight loss was greater in the lowest birth weight groups, but considerable variability was observed among individual infants. Duration of postnatal weight loss was similar among all birth weight groups. Weight gain usually began between four and six days of age, and the rate of weight gain expressed as grams per kilogram per day was similar in all birth weight groups.
Head Circumference Reference Data: Birth to 18 Years
Authors: Roche Alex F. , Mukherjee Debabrata , Guo Shumei , Moore William M.
Published: December 2021

Highly reliable data from a sample of 888 white US children, measured serially in a single study, have been used to provide reference data for head circumference from birth to 18 years of age. The present data differ little from those already available for the age range from birth to 36 months of age, but they are considerably higher (about 0.5 cm) at older ages for boys and tend to be slightly higher for girls. These new reference data are smoother across age than those used currently for screening and evaluation. Percentiles for 6-month increments from birth to 6 years have been provided.
Medication Error Prevention by Clinical Pharmacists in Two Children's Hospitals
Authors: Folli Hugo L. , Poole Robert L. , Benitz William E. , Russo Janita C.
Published: December 2021

The purpose of this study was to record prospectively the frequency of and potential harm caused by errant medication orders at two large pediatric hospitals. The objective of the study was to assess the impact of pharmacist intervention in preventing potential harm. The study was conducted during a 6-month period. A total of 281 and 198 errors were detected at the institutions. The overall error rates for the two hospitals were 1.35 and 1.77 per 100-patient days, and 4.9 and 4.5 per 1,000 medication orders, respectively. Pediatric patients aged 2 years and less and pediatric intensive care unit patients received the greatest proportion of errant orders. Neonatal patients received the lowest rate of errant orders. The most common type of error was incorrect dosage, and the most prevalent type of error was overdosage. Antibiotics was the class of drugs for which errant orders were most common. Orders for theophylline, analgesics, and fluid and electrolytes, including hyperalimentation, were also frequently in error. In general, the error rate was greatest among physicians with the least training, but no physician group was error free. Involving pharmacists in reviewing drug orders significantly reduced the potential harm resulting from errant medication orders.
Percutaneous Central Venous Silastic Catheters in Newborn Infants
Authors: CARRERA GIUSEPPE , COCCIA CARLO , COPPALINI BERNARDO , LIBERATORE ALDO , MINOLI IOLANDA
Published: December 2021

To the Editor.—

We were interested to read the paper by Durand et al,1 and wish to point out that the same technique has been

[See table in the PDF file]

used in the Department of Perinatal Pathology of the Provincial Maternity Hospital of Milan, Italy, since January 1981 by means of the Vygon catheter (internal diameter 0.3 mm, external diameter 0.6 mm). Our preliminary results have been published.2

From Jan 1, 1981, to Dec 31, 1985, we placed 555 catheters in 438 newborns (241 boys, 197 girls) with a mean birth weight of 1,845 g (range 600 to 4,000 g) and a mean gestational age of 32 weeks (range 24 to 42 weeks).
Baby Walkers
Authors: PIDCOCK FRANK S.
Published: December 2021

To the Editor.—

The list of reasons for discouraging the use of walkers in infancy is growing. The recent article by Rieder et al1 rightfully indicts infant walkers as a significant cause of accidental trauma in the "preambulatory" age group.

The use of walkers has been shown to have adverse developmental implications for both normal and abnormally developing children. A study by Kauffman and Ridenour2 demonstrated an abnormal electromyographically documented walking pattern in one randomly selected twin from each of six twin pairs who received a gait-training program consisting of two hours per day in a walker.
Cytomegalovirus and the Brain
Authors: ADES A. , PECKHAM C. S. , PREECE P. M.
Published: December 2021

To the Editor.—

Conboy et al1 report a study on the intellectual development of 6- to 12-year-old children with congenital cytomegalovirus infection. We are in complete agreement with the authors' emphasis on looking for impairment in asymptomatic children with cytomegalovirus, who make up about 90% of all children with congenital cytomegalovirus. However, we believe that their study is less than definitive in ruling out the possibility that congenital cytomegalovirus infection, even when asymptomatic, can lead to intellectual impairment:

Size of Study.
Benzyl Alcohol in Neuromuscular Blocking Agents
Authors: JORDAN GLENN D. , THEMELIS NICHOLAS J. , MESSERLY SUSAN O. , JARRETT ROBERT V. , GARCIA JOSE , FRANK C. GILBERT
Published: December 2021

In Reply.—

The comments of van der Hal et al serve to further underscore our concerns regarding the uncritical appropriation for use in neonates of pharmacologic agents belonging to the "adult" formulary. The issue is pervasive—the overwhelming preponderance of drugs used in neonatal intensive care settings are the adopted progeny of research into adult pathophysiology.

Following our initial identification of the risk of benzyl alcohol toxicity associated with continuous infusions of doxapram (Pediatrics 1986;78:540-541), we subjected to close scrutiny the formulation of all agents administered iv in our nursery.
Junctional Epidermolysis Bullosa of the Larynx
Authors: GONZALEZ ANA , SCHACHNER LAWRENCE , MILLER MADELINE
Published: December 2021

To the Editor.—

The article by Kenna et al (Pediatrics 1986;78:172-174) points out the complication of respiratory compromise secondary to laryngeal involvement in junctional epidermolysis bullosa. Junctional epidermolysis bullosa, a mechanobullous disorder with autosomal recessive inheritance, has been associated with not only skin lesions but gastrointestinal, respiratory tract, and genitourinary tract abnormalities as well.1 The figure that was presented in the article incorrectly showed a split in the upper layers of the epidermis inconsistent with junctional epidermolysis bullosa.
Light, Sleep, and Development
Authors: SHELDON STEPHEN H. , BELL ERIC
Published: December 2021

To the Editor.—

The commentary by Avery and Glass1 on light and retinopathy of prematurity was read with great interest. It points out a significant area of human development of which little is known.

Intensive care nurseries and advances in the care of the neonate and critically ill child have given life to those who would have not survived immaturity and illness a mere 25 years ago. Major efforts have focused on pulmonary, cardiovascular, and CNS support; the treatment of infections; and the physiologic maintenance of other vital functions.
Bed-Wetting Therapy
Authors: LENOIR G. , BARTHELEMY J. , JUIF-BIELSKY M. C.
Published: December 2021

To the Editor.—

We read the recent article1 concerning childhood enuresis and offer the following comments from our group regarding this common pediatric problem.

An obvious mistake was made in table 4: the distress associated with this condition occurred "a great deal" in 31 of 140 children, ie, 22% (and not 32% as reported), thus inverting the boys to girls ratio; indeed, we know that girls are much more distressed than boys in this situation.
Bed-Wetting Therapy
Authors: VALDEZ R. BURCIAGA
Published: December 2021

In Reply.—

We thank Drs Lenoir, Barthelemy, and Juif-Bielsky for pointing out the error in table 4, 22% of boys were rated as experiencing "a great deal" of distress about their bed wetting and 27% of girls are so distressed. Thus, parents are more likely to worry about their daughters (21% v 14%) and the girls are also more likely to be reported as distressed.

Recently, we became aware of numerous groups in the United States that have been successful in treating children with reinforcement approaches.
Super Diapers and Premature Infants
Authors: HERMANSEN MARCUS C. , BUCHES MARY
Published: December 2021

To the Editor.—

Lavin (Pediatrics 1986;78:1173-1174) recently reported that superabsorbent Pampers brand diapers felt dry, even after urination. This could lead to the false impression of inadequate urine output in newborn infants. We have observed the opposite phenomena with the use of superabsorbent diapers—evidence of urine production in the presence of no urine output.

Four superabsorbent Pampers were weighed and then placed in an incubator (model C-86, Air Shields, Hatboro, PA) set for maximum heat and humidity outputs.
Frequency and Cost of Diagnosis-Related Group Outliers Among Newborns
Authors: Berki S. E. , Schneier Nancy B.
Published: December 2021

Analysis of outliers, as defined by the Health Core Financing Administration, among 47,776 newborns discharged from 33 short-term hospitals in Maryland in 1981 shows that the three prematurity diagnosis-related groups (DRGs) (386 to 388) represented only 5.3% of all discharges of newborns, but more than one fifth of all outliers and more than three fifths of outlier days of care for newborns. The disparity in charges for outliers and inliers (not exceeding the "trim point") is even more dramatic. Newborns with "extreme immaturity" (DRG 386) and "prematurity with major problems" (DRG 387) together accounted for less than 3% of all newborn discharges but for nearly one fourth of all outlier discharges. The mean length of stay in hospitals for outliers in those two DRGs was more than 2 months. The mean charge per outlier discharge in DRG 386 was $27,061 in 1981. Nearly one third of the discharges and more than two thirds of the days of care in this DRG were for outliers. Outliers occurred up to five times more often among premature neonates than among normal newborns and occurred preponderantly in teaching hospitals, especially those with more than 400 beds. This finding may require a reevaluation of the outlier trim points and the reimbursement method for newborn DRGs to assure adequate payment to the providers of neonatal intensive care, mainly large teaching hospitals.
Convulsions Caused by Endrin Poisoning in Pakistan
Authors: Rowley Diane L. , Rab Mohammed A. , Hardjotanojo Witjaksono , Liddle John , Burse Virlyn W. , Saleem Mohammed , Sokal David , Falk Henry , Head Susan L.
Published: December 2021

From July through September 1984, acute convulsions caused by endrin poisoning occurred in the subdistrict of Talagang, Attock District, Punjab province, Pakistan. Eighteen of the 21 affected villages were surveyed; 70% of the cases for which ages were known (106 of 152) were in children 1 to 9 years of age; 9.8% of all affected persons (19 of 194) died. The outbreak occurred in villages on the main roads of the subdistrict and peaked in early September. Endrin was detected in the blood of 12 of 18 patients with a history of convulsions but was not found in the blood of four hospitalized control patients. One composite sugar sample taken from the homes of three persons had an endrin level of 0.04 ppm. Because of the high toxicity, repeated association with large-scale outbreaks of neurologic illness, and the difficulties of monitoring distribution, endrin should not be used for agricultural purposes.
PULMONARY HYALINE MEMBRANES IN NEWBORN INFANTS
Authors: BLYSTAD WILHELM , LANDING BENJAMIN H. , SMITH CLEMENT A.
Published: December 2021

The results of statistical, morphologic and experimental studies on the nature, occurrence and significance of hyaline (asphyxial) membranes seen in the lungs of infants who die in the neonatal period are presented. Analysis of material from 509 consecutive autopsies on newborn infants, together with analysis of the infants' histories, shows that these membranes occur most commonly in premature infants and in more mature infants with a history of a complication of pregnancy, labor or delivery capable of causing fetal anoxia. These hyaline membranes are not seen in stillborn infants nor in infants living less than one hour. They appear to cause atelectasis, by blocking the mouth of alveoli, and to be a major cause of death in the neonatal period.

Studies on vernix, meconium and amniotic fluid indicate that these hyaline membranes are not formed of vernix or meconium, but of the concentrated protein of aspirated amniotic fluid. A rise in the squamous cell content of amniotic fluid during the third trimester of pregnancy is demonstrated; this may explain the difference in microscopic appearance between hyaline membranes formed of amniotic fluid which is aspirated before this rise in squamous cells takes place and those containing squamous cells which are seen if the fluid is aspirated after this increase occurs. The membranes are demonstrated to be independent of pulmonary hemorrhage, edema or inflammation and not to be formed of degenerated airway epithelium.

Similar membranes were produced experimentally by repeated intratracheal injection of small amounts of amniotic fluid into the excised respiratory tracts of animals while the lungs were alternately expanded and contracted for one hour. The time and volume factors necessary for successful experimental production of these membranes are discussed.

The significance of pulmonary hyaline membranes in the production of neonatal atelectasis is indicated. No instances of "congenital alveolar dysplasia" were found in the 509 cases reviewed, and evidence that it may not be a valid clinical and pathologic entity is presented.
Telephone Dissatisfaction in Pediatric Practice: Denver and Baltimore
Authors: Fosarelli Patricia , Schmitt Barton
Published: December 2021

A survey of pediatricians in private practice in the Denver and Baltimore metropolitan areas was conducted to assess pediatricians' satisfaction with the telephone in their practices. The response rates were 84% (89/106) in Denver and 72% (90/125) in Baltimore. In both cities, 42% of the physicians were dissatisfied with their telephone systems. Dissatisfied physicians were less likely to provide a morning telephone hour (P < .02), less likely to delegate calls to office staff (P < .01), more likely to believe that they lacked sufficient time to handle daytime calls (P < .0001), and more likely to be in group rather than solo practice (P < .05). Younger age of the respondent approached, but did not reach, statistical significance in its association with dissatisfaction.
Patient Age Distribution in Thalassemia Major: Changes From 1973 to 1985
Authors: Pearson Howard A. , Guiliotis Dorothy K. , Rink Linda , Wells James A.
Published: December 2021

Major advances have occurred in the treatment and prevention of thalassemia major, but their impact on incidence and survival have not been well assessed. In 1973, a survey was done of the ages of 243 living patients with thalassemia major followed at 12 centers in the United States and Canada. Twenty-two percent were younger than 5 years and 2.1% were older than 25 years of age (mean 11.4 ± 6.7 [SD] years). In 1985, there were 303 patients at the same centers; 11% were younger than 5 years and 7.9% were older than 25 years (mean 14.2 ± 7.3 years). A similar pattern was found in Connecticut, characterized by a marked decrease of new cases of thalassemia major during the past 15 years. This was not a result of fewer persons at genetic risk or a change in marital ethnic choices. Eleven of 14 families who had a child with thalassemia major assured that another affected child would not be born by having no more children, using prenatal diagnosis, or having therapeutic abortions. Extensive community programs of education and testing for thalassemia trait in Connecticut may also have contributed to the observed reduction in new cases.
Developmental Intervention for Low Birth Weight Infants: Improved Early Developmental Outcome
Authors: Resnick Michael B. , Eyler Fonda Davis , Nelson Robert M. , Eitzman Donald V. , Bucciarelli Richard L.
Published: December 2021

This prospective longitudinal study was designed to evaluate the effects of a multidisciplinary infant development program (IDP) on the mental and physical development of low birth weight infants (<1,800 g). Infants in the neonatal intensive care were randomly assigned to the IDP or to traditional care (control group). IDP infants received developmental interventions in the hospital and at home through the first 2 years of life. Counseling and parenting education were provided to their parents during this same period. The control group received all the postnatal care and referrals customarily given in traditional care. Both IDP and control infants were enrolled in an independent follow-up program, which used the Bayley Scales of Infant Development in a blind evaluation design. The IDP group had a significantly lower incidence of developmental delay (P < .05) and scored significantly higher than the control group (P < .05) on mean mental and physical indices at 12 and 24 months of adjusted age.
Psychologic and Behavioral Effects of Antiepileptic Drugs in Children: A Double-Blind Comparison Between Phenobarbital and Valproic Acid
Authors: Vining Eileen P. G. , Mellits E. David , Dorsen Marilyn M. , Cataldo Michael F. , Quaskey Shirley A. , Spielberg Stephen P. , Freeman John M.
Published: December 2021

Traditional clinical monitoring of children with epilepsy does not appear to be sufficiently sensitive to cognitive functioning and behavioral problems. Although subtle, these changes may alter a child's ability to perform well in school and in society. Physicians must prevent seizures without producing intolerable side effects, and ways of more appropriately assessing these side effects must be developed. In this double-blind, counter-balanced, crossover study of 21 children, the effects of phenobarbital and valproic acid on cognitive functioning and behavior were measured. There was no difference in seizure control between the drugs, and each medication was maintained in the therapeutic range for 6 months (mean phenobarbital level, 21.2 µg/mL; mean valproic acid level, 94.1 µg/mL). Children were treated with each drug for 6 months. Differences between the drugs were seen on measurements of cognitive function and behavior. On four tests of neuropsychologic function, children performed significantly less well while receiving phenobarbital (P < .01). There was no evidence that the patients were sedated or less able to perform continuous performance tasks while receiving phenobarbital. Parental assessment of behavior indicated significantly worse behavior with the phenobarbital regimen for three items (P < .01) and children were measureably more "hyperactive" (P < .05). Routine clinical assessment of the patients did not reveal differences between the drugs with respect to routine laboratory measurements or side effects as assessed by history or physical examination. Although children may appear to tolerate a medication without clinically apparent problems, subtle but significant changes in intellectual function and behavior may be occurring. Additional, more sensitive, methods of monitoring patients while receiving these drugs is necessary.
Munchausen Syndrome by Proxy: Considerations in Diagnosis and Confirmation by Video Surveillance
Authors: Epstein Mark A. , Markowitz Robert L , Gallo Diane M. , Holmes June Walker , Gryboski Joyce D.
Published: December 2021

Munchausen syndrome by proxy is a form of abuse in which the child suffers from a factitious illness induced by a parent. A case report of an 18-month-old boy who suffered from intractable diarrhea because of the surreptitious administration of laxatives by his mother is presented. The evolution of this case is discussed, as are the legal and ethical considerations in the diagnosis of Munchausen syndrome by proxy.
Car Seats for Children With Mechanically Assisted Ventilation
Authors: STROUP KAREN BRUNER , WYLIE PATSY , BULL MARILYN J.
Published: December 2021

Car safety seat use has increased because of child restraint legislation in all 50 states and educational efforts by medical professionals. Not all children, however, can fit into commercially available car seats, and some modification is necessary to accommodate these children with special needs.1 Safe transportation is a problem faced by physicians and parents with increasing frequency as more children with special problems are discharged to home: one such example is the child with mechanically assisted ventilation. We have recently determined that these children who weigh less than 18.2 kg (40lb) can be transported properly and safely in commercially available car seats while the ventilator system remains attached to the child and in operation.
Perinatal Statistics
Authors: SOFATZIS JOHN , IOAKIMIDOU VASSO
Published: December 2021

To the Editor.—

Evaluation of the effect of good medical care of pregnant women and newborn infants and/or the impact of birth weight distribution on crude perinatal mortality rates is based upon the use of birth weight-specific mortality rates and standardized perinatal mortality rates.1-4 We agree with the suggestion made by Hermansen and Hasan5 that all future reports on perinatal statistics should comply with the recommendations made by WHO. Moreover, meaningful comparisons of standardized perinatal mortality rates over time and place require the use of a standard birth weight distribution.
Psychosocial Screening
Authors: BOROWITZ KATHLEEN , GLASCOE FRANCES P.
Published: December 2021

In Reply.—

Dr Frankenburg has raised a number of interesting points. Initially, he addresses concern about the use of "questionable" scores for individual sectors of the Denver Developmental Screening Test (DDST). Although we understand that the DDST should not be scored by individual sectors, to obtain a total test result each sector must be scored. On page 26 in the DDST manual/workbook currently distributed, a questionable score results with the following circumstances: "1 or more sectors with 1 delay and in that same sector no passes intersect the age line" (underline appears in manual).1
Breast-Feeding and Jaundice
Authors: FLEISS PAUL M. , JELLIFFE DERRICK B.
Published: December 2021

To the Editor.—

Recently Maisels and Gifford1 stated that 123 mothers who breast-fed their infants on demand while in the hospital with encouragement from nursing staff nursed on the average only six to eight times in 24 hours. Experience with unmedicated mothers at home revealed that newly born infants will breast-feed on demand ten to 12 times per day. These babies were not jaundiced. Similarly, in an earlier study in 1982, De Carvalho et al2 found significantly lower bilirubin levels in infants nursed more than eight times in 24 hours.
Drug Errors
Authors: BULLABOY CHARLES A.
Published: December 2021

To the Editor.—

Excellent recommendations to avoid error in drug dosage and administration were made by Koren et al1 and in the "Letters to the Editor" correspondence between him and Dr Lamont.2 However, I believe two statements require further clarification.

Dr Lamont's PEDICard gives an energy dose of 1 to 3 joules/kg for cardioversion. Cardioversion is the timed depolarization of myocardial cells used to restore a stable rhythm and must be synchronized with the QRS complex(es).
Cost-Benefit Analysis of Two Strategies for Prevention of Haemophilus influenzae Type b Infection
Authors: Hay Joel W. , Daum Robert S.
Published: December 2021

A cost-benefit analysis for Haemophilus influenzae type b disease prevention was developed to examine two officially recommended preventive strategies: H influenzae type b capsular polysaccharide immunization and rifampin prophylaxis of exposed contacts. The social costs of H influenzae type b disease in the 1984 US birth cohort will be $1.937 billion when base case assumptions are made. If it is assumed that 60% of all children could be vaccinated at 24 months of age, universal vaccination has the highest economic benefits of any single preventive strategy considered (net savings $64.8 million). Rifampin prophylaxis of appropriate household contacts has the highest benefit to cost ratio (59:1), but because rifampin prevents only secondary disease, only half as many cases can be prevented with rifampin prophylaxis of appropriate household contacts (501 cases prevented, $1,994 per case prevented) as with universal vaccination at 24 months (985 cases prevented, $63,484 per case prevented). Single-dose vaccination of day-care attendees at 18 months of age is the most expensive preventive strategy considered ($148,445 per case prevented, 306 cases prevented). Rifampin prophylaxis of appropriate day-care contacts prevents the fewest H influenzae type b cases ($46,041 per case prevented, 72 cases prevented).
Declining Prevalence of Anemia in Childhood in a Middle-Class Setting: A Pediatric Success Story?
Authors: Yip Ray , Walsh Kim M. , Goldfarb Mace G. , Binkin Nancy J.
Published: December 2021

To study trends of anemia among middle-class children, we collected 6,162 hematocrit measurements from the medical records of 2,432 children, ages 9 months through 6 years, as seen at a private pediatric clinic during the past 18 years. A decline in prevalence of anemia was observed during that period. The overall age-adjusted rate of anemia decreased from 6.2% in 1969 to 1973, 5.8% in 1974 to 1977, 3.8% in 1978 to 1981, and 2.7% in 1982 to 1986. The decline was also observed when trends were determined for three age groups using a single hematocrit measurement per child. The 1982 to 1986 prevalences of anemia for various age groups among this middle-class pediatric population were relatively low: 2.8% among 9- to 23-month-old children, 2.4% among 24- to 47-month-old children, and 2.7% among 48- to 83-month-old children. Most of these recent cases of anemia were mild—most were only slightly less than the hematocrit values used to define anemia—and most did not show strong evidence of iron deficiency based on elevated levels of erythrocyte protoporphyrin. We conclude that iron deficiency is now mild and uncommon in these middle-class children. This improved nutritional status with regard to iron is probably related to increased intake of iron among infants and young children during the past two decades. These findings suggest that the recommended screening schedule for iron deficiency with hemoglobin or hematocrit measurements may need to be reassessed for well-defined populations of low-risk children.
Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in a Randomized Prospective Study
Authors: Hickson Gerald B. , Altemeier William A. , Perrin James M.
Published: December 2021

We used a resident continuity clinic to compare prospectively the impact of salary v fee-for-service reimbursement on physician practice behavior. This model allowed randomization of physicians into salary and fee-for-service groups and separation of the effects of reimbursement from patient behavior. Physicians reimbursed by fee-for-services scheduled more visits per patient than did salaried physicians (3.69 visits v 2.83 visits, P < .01) and saw their patients more often (2.70 visits v 2.21 visits, P < .05) during the 9-month study. Almost all of this difference was because fee-for-service physicians saw more well patients than salaried physicians (1.42 visits and .99 visits per enrolled patient, respectively, P < .01). Evaluating visits by American Academy of Pediatrics' guidelines indicated that fee-for-service physicians saw more patients for well-childcare than salaried physicians because they missed fewer recommended ommended visits and scheduled visits in excess of those recommendations. Fee-for-service physicians also provided better continuity of care than salaried physicians by attending a larger percentage of all visits made by their patients (86.6% of visits v 78.3% of visits, P < .05), and by encouraging fewer emergency visits per enrolled patient (0.12 visits v 0.22 visits, P < .01). Physicians' interest in private practice, as determined by their career plans, correlated significantly with total number of patients enrolled (r = .48, P < .05) and total clinic patients seen by each resident during the study (r = .40, P < .05): reimbursement was not significantly related to these two outcomes after correction for differences in career plans by fee-for-service and salaried physicians. A resident continuity clinic was used as a model, and it was possible to isolate the effect of reimbursement from patient/parent behavior and to demonstrate that reimbursement method and physician interest in practice motivated physicians to influence the use of outpatient services by their patients.
Prevention of Childhood Poisoning: Efficacy of an Educational Program Carried Out in an Emergency Clinic
Authors: Woolf Alan , Lewander William , Filippone Gay , Lovejoy Fred
Published: December 2021

For many inner-city families, the emergency clinic is the most frequent and sometimes the only point of contact with medical services. We hypothesized that this setting could serve as an opportunity to direct a health promotion at a population that might not receive such a message elsewhere. The objectives of the program were (1) to remind parents of the telephone number of the Massachusetts Poison Center, (2) to ensure that parents have ipecac for use in an emergency, and (3) to counsel parents on how to use ipecac. Of 403 families recruited from the emergency clinic and divided randomly into intervention and nonintervention groups, 262 families completed the follow-up interview 6 months later (65%). Results showed that 68% of intervention families compared with 42% of control families reported ipecac storage at follow-up (χ2 = 7.65, P = .005) and that 40% of intervention families v 25% of control families reported familiarity with the use of ipecac (χ2 = 4.04, P = .04). Accessibility to the poison center's telephone number was reported by 62% of intervention families and by 49% of control families (χ2 = 4.60, P = .13). Finally, 42% of intervention families v 25% of control families reported that they had a sticker on their phone with the number of the poison center on it (χ2 = 4.60, P = .03). Our results suggest that a brief intervention, even in an emergency clinic, can introduce the topic of poisoning prevention to families and can encourage the storage of syrup of ipecac in the home.
Urgent and Emergent Embolization of Lesions of the Head and Neck in Children: Indications and Results
Authors: Burrows Patricia E. , Lasjaunias Pierre L. , Brugge Karel G. Ter , Flodmark Olaf
Published: December 2021

Indications for and results and complications of embolization of lesions of the head and neck were analyzed retrospectively. The procedures were performed since 1980 on an emergent or urgent basis in 30 infants and children by an experienced interventional neuroradiologist in Bicetre, France. Indications for embolization included hemorrhage, occular occlusion, respiratory obstruction, CNS complications or potential complications, interference with nutrition, and functional impairment related to the effect of the lesion on the developing facial skeleton and teeth. The specific lesions included seven hemangiomas (palpebral, subglottic, and nasal) and 20 vascular malformations (maxillofacial), auricular, dural, cerebral [including three vein of Galen malformations] and spinomedullary). Embolization was efficacious in 28 of 30 patients. Hemangiomas (potentially involutive tumors) responded dramatically with arrest of the proliferative phase and shrinking of the mass. Combined hemovascular lymphatic malformations (hemolymphangiomas) of the tongue demonstrated a variable decrease in size. High-flow evolutive arteriovenous malformations involving the teeth and dura were controlled but required multiple embolizations. One infant with a vein of Galen arteriovenous malformation died. Three local complications occurred in two patients. No cerebral ischemic or femoral artery complications occurred.
Has Routine Screening of Infants for Anemia Become Obsolete in the United States?
Authors: DALLMAN PETER R.
Published: December 2021

Iron deficiency anemia was common and often severe as recently as 15 years ago in the United States.1 During that period, it had become a well-established routine to evaluate all term infants for anemia at about 1 year of age2; screening at the preschool checkup and in adolescence also became widespread.

Declining Prevalence of Iron Deficiency Anemia

During the past decade, iron deficiency anemia has become less and less common.1,3 The first strong evidence of a relatively low nationwide prevalence of anemia was provided by the second National Health and Nutrition Examination Survey (NHANES II) conducted between 1976 and 1980.4 In that large, representative sampling of the US population, only about 6% of adolescent girls between 15 and 17 years of age were anemic.4
Treatment of Swallowing Syncope
Authors: KENIGSBERG KENNETH
Published: December 2021

To the Editor.—

Woody and Kiel reported a child in whom syncopal episodes occurred while swallowing.1 They treated the child by implanting a permanent pacemaker. In the article, they referred to other possible treatments such as the use of atropine to block the, presumably, vagal reflux. Unfortunately, there was no mention made of a test of this hypothesis.

We reported a similar case in 19722 and were able to document blocking of the reflux with atropine.
Blood Pressure
Authors: HORAN MICHAEL J.
Published: December 2021

In Reply.—

Dr Park's first question centers around why data from the earlier NIH report were excluded from the current report. As indicated in the new report, because of the absence of prospective cohort data that can clearly link level of BP to cardiovascular risk, the Task Force did the next best thing which was to gather together the most comprehensive and reliable normative BP data to establish normal BP curves for children by age.
Meconium Suctioning
Authors: EISNER PERRY
Published: December 2021

In Reply.—

The technique that I described is briefly as follows. The finger device is removed from a standard suction catheter and attached to a 3.0- or 3.5-mm endotracheal tube after removing the endotracheal tube's adaptor. The infant is intubated with this endotracheal tube and the wall suction tubing is attached with low wall suction applied. The technique has two advantages over Dr Beck's procedure. Although they both are effective means of removing meconium without risk to the resuscitator, the delivery room must first be stocked with a 10-F semistiff suction catheter with a side suction control valve.
Cow's Milk Protein Intolerance
Authors: GILBERTSON NICOLA J. , BENTLEY DONALD
Published: December 2021

To the Editor.—

With regard to the diagnosis of cow's milk protein intolerance, we were interested by the findings of Kahn et al (Pediatrics 1985;76:880-884) and Dr Lecks' subsequent comments (Pediatrics 1986;78:378). A hitherto undescribed clinical feature that may contribute to the establishment of this diagnosis is the presence of hyperemia of the rectal mucosa in affected infants. Proctoscopy may readily be performed using a lubricated pediatric otoscope. The procedure is well tolerated, inexpensive, and takes only a few seconds.
More on Human Immunodeficiency Virus Embryopathy
Authors: losub Silvia , Bamji Mahrukh , Stone Richard K. , Gromisch Donald S. , Wasserman Edward
Published: December 2021

Eight patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex, ranging in age from 4 to 33 months, were evaluated for the presence of dysmorphic features recently described as human immunodeficiency virus embryopathy. Birth data and growth charts were available. Growth failure, a prominent box-like head, large wide eyes, and a well-formed philtrum were seen in the majority of patients. The significance of hypertelorism, obliquity of eyes, long palpebral fissures, blue scleras, depressed bridge of nose, and prominent upper vermilion border is discussed.
Percutaneous Central Venous Catheter Colonization With Malassezia furfur: Incidence and Clinical Significance
Authors: Aschner Judy L. , Punsalang Amado , Maniscalco William M. , Menegus Marilyn A.
Published: December 2021

Malassezia furfur colonization of central venous catheters has been implicated in the pathogenesis of systemic infections with this lipid-dependent yeast. To determine the incidence of catheter colonization in our neonatal intensive care unit (NICU), 25 consecutively removed percutaneous central venous catheters were examined by rinsing the lumen with saline and plating the rinse fluid on Sabouraud dextrose agar overlaid with olive oil. M furfur grew from the lumina of eight catheters (32%). Surveillance skin cultures were performed in the NICU on two occasions to determine the prevalence of skin colonization with M furfur. M furfur was found on the skin of 64% of the infants. In contrast, only 3% (1/33) of healthy, nonhospitalized infants 2 to 8 weeks of age had skin colonized with M furfur. During the 5-month study period, two NICU infants had evidence of systemic infection with M furfur. We conclude that M furfur frequently colonizes both the skin and percutaneous central venous catheters in NICU infants. Further studies are needed to determine the relationship between skin colonization and catheter colonization, and the factors contributing to systemic disease with this organism.
Atlantoaxial Instability in Individuals With Down Syndrome: Epidemiologic, Radiographic, and Clinical Studies
Authors: Pueschel Siegfried M. , Scola Francis H.
Published: December 2021

Atlantoaxial instability is a relatively frequent finding in individuals with Down syndrome. We examined 404 patients with this chromosome disorder and observed their atlanto-dens intervals and spinal canal widths to be significantly different from children without Down syndrome. Significant differences were also noted between boys and girls with Down syndrome in spinal canal widths but not in atlanto-dens interval measurements. When different neck positions were compared, measurements obtained in flexion were significantly greater than in extension or in neutral position. In addition, more patients had ≥5 mm atlanto-dens interval measurements in flexion than in extension or neutral. A total of 59 (14.6%) of 404 patients displayed atlantoaxial instability. Fifty-three (13.1%) patients had asymptomatic atlantoaxial instability, and special precautions will have to be taken with this group of children. Six (1.5%) patients had symptomatic atlantoaxial instability who underwent surgery to prevent further injury to the spinal cord. In our follow-up studies of 95 patients with Down syndrome, we did not find any significant changes during either clinical or radiographic reexaminations.
Gonorrhea and Syphilis in Incarcerated Urban Adolescents: Prevalence and Physical Signs
Authors: Alexander-Rodriguez Terry , Vermund Sten H.
Published: December 2021

During a 1-year period from July 1983 to June 1984, 285 adolescent girls and 2,236 adolescent boys, ranging in age from 9 to 18 years (89% were 14 to 16 years of age), were screened for gonorrhea and syphilis on entry into a detention facility in New York City. The prevalence rate for gonorrhea was 3% for boys and 18.3% for girls, and the prevalence rate for syphilis was 0.63% for boys and 2.5% for girls. The rates of gonorrhea without penile or cervical discharge on physical examination were 2.1% for boys and 10.9% for girls. This high prevalence of syphilis and gonorrhea and the high frequency of disease without physical signs of illness indicate the desirability of screening high-risk adolescents for these and other sexually transmitted diseases. Our data support the need for programs in detention facilities and, we believe, schools, to encourage use of barrier contraceptives to control gonorrhea, syphilis, Chiamydia, human papillomavirus, human immunodeficiency virus, and unwanted pregnancy.
Temporomandibular Joint Dysfunction and Facial Pain in Children: An Approach to Diagnosis and Treatment
Authors: Pillemer Francine G. , Masek Bruce J. , Kaban Leonard B.
Published: December 2021

A model for the diagnosis and treatment of temporomandibular joint dysfunction and facial pain in children is presented. Emphasis is placed on systematic assessment of physical, psychologic, and behavioral factors when conservative medical therapy is inadequate for symptom relief. The model represents a multidisciplinary approach to patient care which is described through case presentations. The results of research on the incidence of primary psychopathology in 53 children and 322 adults evaluated during a 3-year period for temporomandibular joint dysfunction and facial pain are also presented. It was found that children were more likely to be psychiatrically impaired (25%) than adults (7%). Children had a variety of psychiatric diagnoses including depression, conversion and adjustment disorders, overanxious behavior, and anorexia nervosa. The benefits of a multidisciplinary approach are discussed in terms of the efficacy of this coordinated treatment effort in ameliorating symptoms.
Phototherapy and Patent Ductus Arteriosus
Authors: SCHEIDT PETER C. , BRYLA DOLORES A. , HOFFMAN HOWARD J.
Published: December 2021

To the Editor.—

Rosenfeld et al1 recently reported a positive relationship between phototherapy exposure and patent ductus arteriosus in small premature infants. In this study, 74 infants with birth weights less than 1,500 g with respiratory distress syndrome and prophylactic phototherapy for neonatal jaundice were randomly assigned to either receive chest shielding or full exposure to light. The two groups, which were otherwise similar with regard to size, gestational age, severity of respiratory distress syndrome, fluid intake, and duration of phototherapy, significantly differed with regard to the incidence of patent ductus arteriosus (shield group 11/36 v no shield group 23/38, P = .009).
Elevated α-Fetoprotein in a Neonate With a Benign Hemangioendothelioma of the Liver
Authors: URBACH ANDREW H. , ZITELLI BASIL J. , BLATT JULIE , GARTNER J. CARLTON , MALATACK J. JEFFREY
Published: December 2021

To the Editor.—

We recently had the opportunity to care for a neonate with a large intrahepatic mass who was also noted to have an elevated serum α-fetoprotein of 13,800 ng/mL (13,800 µg/L). The elevation of this protein prompted us to consider hepatoblastoma as a likely diagnosis. Although radiologic studies suggested a hemangioma, a biopsy was performed to rule out malignancy, and a benign hemangioendothelioma was found. The lesion spontaneously regressed and the serum α-fetoprotein decreased to 308 ng/mL (308 µg/L) at 2 months of age and to 20 ng/mL (20 µg/L) at 6 months of age.
Message From a Multihandicapped Child
Authors: PROUD VIRGINIA K.
Published: December 2021

To the Editor.—

This is a message, a plea, a cry from 6-month-old Elizabeth at her death. Elizabeth had Goldenhaar syndrome. Her condition was particularly severe.

Will we ever have the wisdom to truly look at, listen to, and experience the lives of the handicapped children committed to our care? Will we ever be able to follow the ethical guidelines or to listen to the moral cues we receive from these children?

My Life

Stop

Think
Cerebral Edema and Galactosemia
Authors: WELCH R. J. , MILLIGAN D. W. A.
Published: December 2021

To the Editor.—

We noted with interest the report from Belman et al1 describing the radiologic detection of cerebral edema in a child with galactosemia. We would like to provide further evidence of cerebral edema in this condition using ultrasonography.

Our patient was the first child of a single mother, born after an uneventful pregnancy. Labor started spontaneously, but the baby was born by forceps delivery after a delay in the second stage which lasted one hour 20 minutes.
Day Care for Sick Children
Authors: WEINBERG NEAL R.
Published: December 2021

To the Editor.—

Dr Sterne's commentary (Pediatrics 1987;79:445-446) on day care for sick children presented a succinct summary of the dilemmas faced by working parents and the current options available to them when their children are ill. I am in full agreement that ideally there should be liberalized parental leave policies as well as improved understanding and acceptance of certain minor illnesses by existing day-care centers. However, because of the cost, it is doubtful that corporations can or will pay for home care services, which are twice as costly as an infirmary model, or will they be willing to grant additional paid days off to parents.
Inborn Errors of Metabolism
Authors: WISWELL THOMAS E. , WEISSE MARTIN E.
Published: December 2021

To the Editor.—

We read with great interest the review by Dr Burton on inborn errors of metabolism.1 These myriad disorders frequently present with clinical manifestations that are associated with a variety of more common neonatal diseases. Dr Burton is to be commended for presenting a lucid, rational approach for the diagnosis of these oft-confusing afflictions.

However, there is another manifestation of these disorders, not previously recognized in the pediatric literature, that we wish to address.
Underdosing of Acetaminophen by Parents
Authors: Gribetz Bruce , Cronley Shea A.
Published: December 2021

The parents of 96 young children seen in an inner-city walk-in clinic for perceived or measured "fever" were asked about their management of the symptom. Eighty-eight (92%) administered acetaminophen, and of these, 67% gave less than the usual recommended dose of 10 to 15 mg/kg per dose. Underdosing was most commonly noted in the younger, lighter patient population. Of the parents who gave an acetaminophen elixer preparation (160 mg/5 mL), 26% measured the dose with the 0.8-mL dropper intended for use with the infant drops preparation (80 mg/0.8 mL), resulting in significant Underdosing of acetaminophen (2.3 ± 1.3 mg/kg per dose). Health care professionals should specifically inquire about the details of acetaminophen administration when discussing antipyresis with parents.