bluuebunny/crossref_metadata_2025 huggingface dataset:
A Successful City-Wide Smoke Detector Giveaway Program
Authors: Gorman Richard L. , Charney Evan , Holtzman Neil A. , Roberts Kenneth B.
Published: December 2021

Each year, 5,000 Americans die and 300,000 are hospitalized as a result of 2.8 million residential fires. Almost all house fires allow time for safe exit if an early warning is given. Smoke detectors are an effective, reliable, and inexpensive method of providing such warning. After an upsurge of deaths related to fires in 1982, Baltimore City gave away 3,720 smoke detectors to households that requested them. This study addressed two questions: (1) Did the households that received the smoke detectors install them? (2) Was the population reached by this giveaway program a population at high risk from fire? A survey of 231 randomly selected households among those requesting smoke detectors was conducted 8 to 10 months after the giveaway program. At that time, smoke detectors were installed in 92% (212/231) of the homes and 88% (187/212) of the installed smoke detectors were operational. Households requesting smoke detectors were in census tracts at higher risk from fire. The correlation coefficient between the rate of requesting a smoke detector and the risk of death or injury related to fires was r = .90, P < .001. The 231 surveyed households had more personal fire risk factors than the general population. The success of this smoke detector giveaway program is notable in that it required the active participation of a high-risk population.
Development of Food Allergies with Special Reference to Cow's Milk Allergy
Authors: Foucard Tony
Published: December 2021

Using strict criteria, the incidence of cow's milk sensitivity is probably 1% to 2% during the first 2 years of life. Although there is a wide spectrum of sensitivity symptoms caused by cow's milk, two major groups of infants are discernible. One group consists of infants who react to small amounts of cow's milk within a few minutes up to one hour, usually with gastrointestinal symptoms or urticaria. These infants are often atopic and have positive findings on skin prick tests and radioallergosorbent test (RAST) reactions to cow's milk allergens. The other group consists of children whose reaction to cow's milk occurs one hour or longer after intake of cow's milk or cow's milk-based formula. These reactions are usually not immunoglobulin (Ig)E-mediated and different immune and nonimmune mechanisms probably cause the symptoms. The risk of developing cow's milk sensitivity seems to be influenced by the atopic constitution of the infant and the age at which cow's milk is introduced. Early exposure to cow's milk increases the risk, not only of adverse reactions to this milk but also of developing allergies to other foods. It is suggested that early introduction of cow's milk may enhance the risk of future respiratory allergies. Allergists are still not in agreement as to whether the weaning process should be rapid or should consist of a gradual change from breast milk to cow's milk in order to minimize the risk of cow's milk allergy.
Homogeneous Clinical Subgroups in Children with Tourette Syndrome
Authors: Barabas Gabor , Matthews Wendy S.
Published: December 2021

The existence of two clinically homogeneous subgroups in Tourette syndrome, depending upon the presence or absence of migraine or a family history of migraine, is suggested. Patients with Tourette syndrome who have migraine (n = 18) were found to have a significantly higher prevalence of disorders of arousal—particularly sleepwalking and night terrors—as well as a higher prevalence of motion sickness than patients without migraine (n = 27). They were also significantly more likely to exhibit a co-occurrence of associated features (two or more) than the patients without migraine. Patients with Tourette syndrome who have not had migraine headaches but in whom there is a family history for migraine (n = 20) were shown to have an intermediate prevalence of associated symptoms. It is suggested that the differential association for these symptoms in patients with Tourette syndrome may reflect an underlying abnormality in function of two different neurotransmitter systems.
Pulmonary Vascular Response to Oxygen in Infants with Severe Bronchopulmonary Dysplasia
Authors: Abman Steven H. , Wolfe Robert R. , Accurso Frank J. , Koops Beverly L. , Bowman C. Michael , Wiggins James W.
Published: December 2021

The cardiac catheterization data of six infants with bronchopulmonary dysplasia (BPD) were reviewed to examine the responsiveness of their pulmonary vascular beds to changes in oxygen tension. The infants were studied because of slow recovery from their oxygen requirements and clinical evidence of persistent pulmonary hypertension. All were receiving home oxygen therapy and had abnormal chest radiographs and right ventricular hypertrophy by ECG at the time of catheterization (mean age, 25 months). All infants had mean pulmonary artery pressure >25 mm Hg in room air, with a mean of 48 mm Hg. All decreased mean pulmonary artery pressure by at least 10 mm Hg when placed in high levels of inspired oxygen (FiO2 > 80), with a mean pulmonary artery pressure of 25 mm Hg. This represented a significant decrease in mean pulmonary artery pressure from room air pressures (P < .005). Mean pulmonary artery pressure was also measured in three infants who were breathing supplemental oxygen by nasal cannula at flow rates similar to levels used for outpatient therapy. Most of the reduction in mean pulmonary artery pressure that occurred at high FiO2 occurred at these lower flow rates of supplemental oxygen. It is concluded that infants with bronchopulmonary dysplasia who have pulmonary hypertension generally have reactive pulmonary vascular beds, responsive to supplemental oxygen. Continuous oxygen therapy by nasal cannula may be useful in the treatment of pulmonary hypertension associated with bronchopulmonary dysplasia.
Utilization and Morbidity: Random or Tandem?
Authors: Starfield B. , Hankin J. , Steinwachs D. , Horn S. , Benson P. , Katz H. , Gabriel A.
Published: December 2021

Earlier studies have shown that one in eight children persist in being high users of health care services over long periods of time and, conversely, about the same proportion of children are consistently low users. As these studies failed to discover reasons for these persistent deviations from average, this study explored three possible explanations: persistent morbidity, mental health problem, and familial patterns of use. Although all three phenomena were associated with both persistence of high utilization of services as well as an overall large number of visits, the number of types of morbidity was the most significant correlate of high use. Children who were constantly low users of services were much more likely to have only a few types of morbidity whereas children who were constantly high users were much more likely to experience a wide variety of types of problems. These findings suggest that an understanding of the demand for health services requires an understanding of the interrelationships of illnesses within individuals rather than a focus on particular illnesses or particular types of illnesses.
`Like a Shrivelled Blood Orange'—Bilirubin, Jaundice, and Phototherapy
Authors: McDonagh Antony F. , Lightner David A.
Published: December 2021

The biochemistry of bilirubin is reviewed with particular reference to newborn infants. The formation, properties, and metabolism of bilirubin are summarized and the importance of molecular shape, hydrogen-bonding, and polarity on the biologic disposition of bilirubin is emphasized. The chemical basis for the subtle influence of visible (blue) light on bilirubin structure and metabolism is explained, and recent concepts of the mechanism of phototherapy are presented. A glossary of current jargon is appended.
When Pediatricians Become Parents
Authors: LEVENTHAL JOHN M.
Published: December 2021

Each year, approximately 2,000 graduates of medical schools begin a pediatric residency,1 most heading toward a career in pediatrics. Many of these trainees, some during their residency and others later in their training or careers, eventually make a major transition from young adulthood to parenthood. This transition brings joy to the personal lives of many pediatricians and on some occasions sadness and anguish to others. To most, it brings new responsibilities and preoccupations. Unfortunately, the effect of this event on the kind of care pediatricians provide to children and their families is seldom discussed, and little is known about the importance of this event for the professional performance of these pediatricians.
Aminophylline Versus Doxapram in Idiopathic Apnea of Prematurity: A Double-Blind Controlled Study
Authors: Eyal Fabian , Alpan Gad , Sagi Ephraim , Glick Benjamin , Peleg Ofra , Dgani Yaron , Arad Ilan
Published: December 2021

A double-blind controlled study, in two parts, was undertaken to compare the effectiveness of aminophylline and doxapram therapy in idiopathic apnea of prematurity. In the first part of this study, eight of 15 infants responded to doxapram therapy with complete cessation of apneic spells and six of 11 infants responded similarly to administration of aminophylline. These differences were statistically insignificant. In the second part of the study, assessment was made of whether the addition of doxapram to aminophylline therapy was effective in treatment of apnea of prematurity that had been unresponsive to aminophylline alone. Of ten infants who continued to have apneic spells during treatment with aminophylline, eight responded to the addition of doxapram with complete cessation of apnea. Nine infants received placebo in addition to aminophylline, and none had a reduction in frequency of apnea.
Serial Lumbar Punctures for at Least Temporary Amelioration of Neonatal Posthemorrhagic Hydrocephalus
Authors: Kreusser Katherine L. , Tarby Theodore J. , Kovnar Edward , Taylor Donald A. , Hill Alan , Volpe Joseph J.
Published: December 2021

Serial lumbar punctures for the management of neonatal posthemorrhagic hydrocephalus without intracranial hypertension were evaluated in 16 infants. Cranial ultrasonography to evaluate ventricular size and the Ladd monitor at the anterior fontanel to measure intracranial pressure were utilized immediately before and after lumbar puncture. In 12 patients, a decrease in ventricular size and in anterior fontanel pressure could be effected with each lumbar puncture. In these infants, cessation of progression of the hydrocephalus and intermittent decreases in ventricular size were accomplished. In four patients, lumbar punctures were not successful in decreasing ventricular size or lowering intracranial pressure. Two criteria could be defined to determine whether lumbar puncture could provide at least temporary benefit for the treatment of posthemorrhagic hydrocephalus. The first of these is to establish the presence of communication between lateral ventricles and lumbar subarachnoid space by effecting a decrease in ventricular size and a decrease in intracranial pressure by removal of CSF. The second criterion is to ascertain a critical volume of CSF (usually relatively large) that must be removed in order to effect the above changes. Cranial ultrasonography and measurement of intracranial pressure by application of the Ladd monitor to the anterior fontanel are extremely valuable in the evaluation of lumbar punctures in the management of posthemorrhagic hydrocephalus.
Neonatal Intensive Care: Cost-Benefit Analysis
Authors: NEUSPIEL DANIEL R.
Published: December 2021

To the Editor.—

Walker et al1 have contributed to the recent plethora of studies applying cost-benefit analysis to the provision of health care. In using this dangerous method to determine the value of neonatal intensive care, they legitimize the acceptance of cost criteria for the rationing of health services. This approach reduces the measurement of human life to economic productivity and accepts the unproven contention of dwindling societal resources available for health care.

Walker et al divided their subjejcts according to their neurodevelopmental evaluation into four categories: normal, (midly imapired, moderately impaired, or severely handicapped).
The National Institutes of Health Point of View
Authors: RANDOLPH JUDSON G.
Published: December 2021

To the Editor.—

I write to applaud John R. Lilly's commentary in the July 1985 issue ("Biliary Atresia and Liver Transplantation: The National Institutes of Health Point of View," Pediatrics 1984;74:159-160) and to congratulate the editors of Pediatrics publishing this bold, refreshing essay. All of us who pay the bills for the National Institutes of Health (NIH) and who labor in the clinical vineyards, have a collective responsibility to see that the many and varied clinical efforts undertaken in Bethesda, MD are properly oriented and reach sound conclusions.
Concurrent Agenesis of the Corpus Callosum and Ureteroceles in Siblings
Authors: LACHIEWICZ AVE M. , KOGAN STANLEY J. , LEVITT SELWYN B. , WEINER RICHARD L.
Published: December 2021

Agenesis of the corpus callosum is an uncommon anomaly that exists in complete and partial forms. It has been associated with other cerebral malformations as well as facial, genitourinary, musculoskeletal, cardiac, and respiratory anomalies.1 Agenesis of the corpus callosum is generally sporadic but it has been reported in several families.2 Ureteroceles frequently occur in association with duplications of the ureters.3 The hereditary occurrence of ureteroceles has been reported in five families.4-8 In this report, we describe two brothers with the simultaneous occurrence of agenesis of the corpus callosum and orthotopic ureteroceles.

Two brothers were seen at The Hospital of the Albert Einstein College of Medicine for evaluation of urologic abnormalities.
Stop Home Phototherapy
Authors: DELOACHE WILLIAM R.
Published: December 2021

To the Editor.—

A recent communication from a manufacturer of phototherapy devices sought the opinion of pediatricians regarding home use of phototherapy for hyperbilirubinemia. My reply to the company was in strong opposition to this proposal. I am concerned that this manufacturer and others may advertise and promote home use of a form of therapy that is even now often prescribed in spite of inadequate knowledge with regard to indications, poor understanding of how or whether therapy is effective, and unfounded assumptions regarding safety.
Asthma and Pneumomediastinum
Authors: HEN JACOB
Published: December 2021

To the Editor.—

An important piece of clinical information to add to Sturtz's recent review of spontaneous mediastinal emphysema in children1 is that mediastinal emphysema may be the first clinical clue to the presence of childhood asthma. Over the past 4 years, we have seen four children with cough and subcutaneous emphysema in the neck and no previous history of respiratory problems or asthma. These children had hyperinflated lungs and mediastinal emphysema demonstrated on admission chest roentgenograms and physical examination revealed wheezing.
Flexible Residency Programs for Women
Authors: UCHIYAMA NAOMI
Published: December 2021

To the Editor.—

I am a member of the Committee on Women in Pediatrics of the American Academy of Pediatrics. The Committee recently studied the availability of flexible training and retraining programs in pediatric residency programs in the United States. We sent a questionnaire to the directors of the 292 pediatric training programs listed in the Directory of Residency Training Programs.

At present, 200 of the 292 (68.5%) have a flexible training program. However, only two of these programs have this as a written policy; one such program was developed in 1973 and, in practice, this program was individually designed.
A LITTLE KNOWN PEDIATRIC PROFILE
Authors: Radbill Samuel X.
Published: December 2021

The fun-loving medical students at the University of Toronto in 1929 published a pamphlet entitled Epistaxis which was somewhat on the order of a medical school class book, full of buffoonery aimed especially at the foibles of the faculty. It was printed for Daffydil Night, apparently an annual event at which the students presented a series of dramatic caricature vignettes. Conceived and carefully nurtured during the school year the publication was delivered "prematurely with the aid of ergot and axis traction." Among the "Facts About Sage People" I found the following pediatric profile:
In Reply: Heparinization of Alimentation Solutions
Authors: ALPAN G. , EYAL F.
Published: December 2021

We thank Poland and Bedard for their interest in our findings and for pointing out an error of omission in our reporting of the data.

The infants in the heparinized group did indeed receive intravenous alimentation for a longer (mean) duration. The difference is due to skewing ofthe data by a subgroup of infants who required intravenous treatment for prolonged periods. Bronchopulmonary dysplasia developed in three infants in the heparmnized group v one infant in the nonheparinized group.
White Blood Cell Transfusions
Authors: DEKAT LAURETTE , STUTMAN HARRIS R.
Published: December 2021

We recently reviewed the paper by Cairo et al on leukocyte transfusions for sepsis at our Pediatric Journal Club and several questions arose.

The enrollment criteria suggest that all eligible infants were included, yet it is difficult to believe that only nine infants with clinical deterioration and negative cultures were found compared with 14 culturally documented cases. In most centers, the ratio of suspected to proven neonatal sepsis is more like 10:1 than 0.6:1. If most infants for whom sepsis is suspected were not enrolled, then the results can be applied only to culturally proven cases.
Evaluation of Five Popular Methods for Tick Removal
Authors: Needham Glen R.
Published: December 2021

Five methods commonly advocated for tick removal from a human or domestic animal were evaluated. The application of petroleum jelly, fingernail polish, 70% isopropyl alcohol, or a hot kitchen match failed to induce detachment of adult American dog ticks (Dermacentor variabilis Say) attached for either 12 to 15 hours or three to four days. Use of forceps or protected fingers enabled satisfactory removal of 29 adult American dog ticks without leaving the mouthparts or attachment cement in the host skin. Four different methods were used to pull lone star ticks [Amblyomma americanum (L)] off the host using forceps (twisting, pulling steadily or jerking straight up, or pulling parallel with the skin). None of the mouthparts broke off, but, contrary to the American dog tick, the cement remained in the skin for all 22 of the Lone Star ticks. It is recommended that the tick be grasped as close to the skin as possible with curved forceps; if these are not available, use tweezers or protected fingers. Pull straight up with steady even pressure. If cement or mouthparts remain, then extract if that is practical. Disinfect bite site before and after tick removal.
Analysis of the Effects of Applying Federal Diagnosis-Related Grouping (DRG) Guidelines to a Population of High-Risk Newborn Infants
Authors: Poland Ronald L. , Bollinger Robert O. , Bedard Mary P. , Cohen Sanford N.
Published: December 2021

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those sub-groups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.
Protein Quality in Feeding the Normal Infant: Do Whey-Predominant Formulas Offer Nutritional Advantages?
Authors: RÄIHÄ NIELS C. R.
Published: December 2021

To the Editor.—

In a recently published paper, I have discussed milk proteins and the question of protein requirement of the normal infant.1 This paper was reviewed in a summary in the same supplement of Pediatrics.2

Because this summary contains some statements that are not in complete agreement with those in the original paper, I would like to clarify a few points concerning the quality of protein in infant formula.

The whey proteins make up the majority, about 70% of proteins in human milk whereas caseins are the primary proteins of bovine milk.
Unnoticed Change
Authors: STOLLER KENNETH P.
Published: December 2021

To the Editor.—

It has been brought to my attention that after the publication of my report, "Inadvertent Intra-arterial Injection of Penicillin: An Unseen Danger" (Pediatrics 1985;75:785-786), Wyeth made certain modifications to the Tubex syringe delivery system. Specifically, Wyeth bent back the needle so that aspirate could potentially be visualized at a certain point on the glass cartridge. This was commendable; however, almost no one knows about it. Furthermore, this spot is very hard to find even if one is looking for it.
Mumps Disease and Its Health Impact: An Outbreak-Based Report
Authors: Sullivan Kevin M. , Halpin Thomas J. , Kim-Farley Robert , Marks James S.
Published: December 2021

An outbreak of mumps in a middle school (grades 6 to 8) in Ohio during 1981 was investigated to describe the clinical findings, health impact, and costs. Individuals with clinical mumps in the middle school and in family members were questioned concerning symptoms, complications, hospitalizations, school days absent, and parental work days missed. There were 62 cases of clinical mumps in the middle school and 13 cases among family members. Parotitis lasted an average of 7.4 days and fever (if present) lasted an average of 2.5 days with a mean temperature of 38.6°C (101.4°F). The duration of parotitis and fever increased with age. Complications included encephalitis, aseptic meningitis, orchitis, oophoritis, mastitis, and pancreatitis. Visits to physicians were made by 62.7% (47/75) of the individuals with mumps for a total of 63 visits, and two patients were hospitalized for a total of six days. Persons who attended middle school missed an average of 4.9 days of school. The estimated direct and indirect costs associated with this outbreak were $2,460 and $1,353, respectively, or $51 per case. States lacking mumps immunization requirements experienced a three-times greater incidence of mumps in 1982 than States that required all school pupils to be immunized. We recommend that all States institute compulsory mumps school immunization laws for all school children.
Home Videorecording of "Spells" in Children
Authors: WOODY ROBERT C.
Published: December 2021

The increasing availability of videorecording cameras and cassette recorders now permits the visual documentation of medical events in children at home by parents. On two occasions recently, we asked families to videorecord their children's presumed seizure activity at home.

In the first case, a 10-month-old white boy had frequent "spells" which by history appeared to be complex partial seizures. Routine awake and asleep EEG tracings were normal, and the family resisted hospital admission for financial reasons. Anticonvulsant medications were prescribed, and the family suggested that they borrow their parent's videocassette recorder to document their son's spells at home. Their videorecordings produced a high quality, permanent record of definite complex partial symptom activity clearly revealing eye deviation, nystagmus, and associated head and arm tonic activity.
Vitamin E—How Much Is Too Much?
Authors: LEMONS JAMES A. , MAISELS M. JEFFREY
Published: December 2021

For many years a treatment in search of a disease, vitamin E (α-tocopherol) is now being prescribed widely and in large doses to small premature infants. The possibility of reducing the incidence of severe retrolental fibroplasia,1-4 intraventricular hemorrhage, and even the mortality of these tiny babies5 has, quite understandably, excited the interest of those responsible for their care.

Although concern about potential toxicity has been expressed,6,7 Hittner and co-workers4 recommend that infants weighing less than 1,500 g at birth who require oxygen receive intramuscular injections of a water miscible preparation of d,l-α-tocopherol on days 1, 2, 4, and 6 of life as well as oral α-tocopherol in a dosage of 100 mg/kg/d.5 Using this regimen, these workers report that they have not (or have rarely) encountered plasma tocopherol levels in excess of 3.5 mg/dL.8,9
Adolescents and Substance Abuse
Authors: SANDERS JOE M.
Published: December 2021

The inclusion of adolescents in pediatric practices is not a new phenomenon as evidenced by the above Policy Statement issued by the American Academy of Pediatrics in 1938. A more recent Policy Statement in 1972 states ".... the responsibility of the pediatrician may therefore begin during pregnancy and usually terminates by 21 years of age".1 Certainly, therefore, providing health care to teenagers has always been within the purview of the pediatrician, and for the most part this responsibility has been accomplished with an unparalleled degree of efficacy. However, one topic about which most clinicians feel uncomfortable and ill-equipped to address concerns the issue of substance abuse.
Peers, Parents, and Teens: In Search of the Perfect 10
Authors: CAVANAUGH ROBERT M.
Published: December 2021

Happiness seems like a very elusive goal for many young people today. They tend to believe that it comes from obtaining something they do not have rather than recognizing and appreciating what they do have.1 Use the 1984 Olympic Games as an example. Competitors who did not win a gold medal, break a world record, or score a perfect 10 were seemingly buried in a sea of mediocrity. Their accomplishments were not fully recognized and the success they had achieved was not appreciated. The public's eye, with all it's computers, instant replays, and other electronic wizardry, had dissected every movement and magnified every mistake.
Chronic Lung Disease of Prematurity
Authors: SCHICK JAMES B. , GOETZMAN BOYD W.
Published: December 2021

To the Editor.—

The paper by Avery et al,1 further demonstrates the potential usefulness of corticosteroids in chronic lung disease of prematurity. However, initial reports in 1974 and 1975 met with criticism for the use of potentially toxic drugs in premature infants.2,3

In 1983 we retrospectively reviewed 23 infants with chronic lung disease of prematurity who received corticosteroids and identified distinct differences between responders and nonresponders which suggested different types of lung disease.4 Our responders all showed a greater than 30% decrease in AaPo2 by day 6 and showed maximal response by ten days of therapy.
Etiology of Ventricular Septal Defects: An Epidemiologic Approach
Authors: Newman Thomas B.
Published: December 2021

To investigate the recent 150% increase in the reported incidence of ventricular septal defects (VSDs) in the United States, the epidemiology of ventricular septal defects was examined. The apparent incidence of VSDs is highly dependent on case finding methods, and more complete diagnosis and reporting probably account for the increase in reported incidence. Variations in case ascertainment also account for the small differences in incidence in studies from different places. The several known risk factors for VSD, including a family history of congenital heart disease and exposure to certain drugs, infectious agents, and maternal metabolic disturbances, explain few cases. Incidence rates are similar in different races and seasons and are unrelated to maternal age, birth order, sex, and socioeconomic status. VSDs occur naturally in a wide range of mammals and in birds, which also have four-chambered hearts. Despite identical genes and similar prenatal environments, the concordance rate in identical twins is only about 10%. The consistency of incidence among individuals with widely differing genes and environments and the frequency of discordance in identical twins suggest that VSDs often occur as random errors in development, at a frequency largely determined by the complexity of normal cardiac morphogenesis. This hypothesis has two major implications: many VSDs are not preventable and parents need not feel responsible for VSDs in their children.
Other Journals Named "Pediatrics"
Authors: SILBER DAVID L.
Published: December 2021

To the Editor.—

The letter by W. E. Fitch, MD, in the April issue of Pediatrics (1985;75:A81) was interesting. I also was interested in the Editor's Note indicating lack of awareness of Dr Fitch's journal named Pediatrics. I thought you might be interested in yet another one.

In 1965 or 1966 the Pet Milk Company distributed 12 copies of a journal by the same name which they said were authentic reproductions of each issue of Volume 1 published in 1896.
Pediatrics and the Malpractice Crisis
Authors: BOSLEY WARREN
Published: December 2021

In Reply.—

Dr Curtis presents an interesting approach to malpractice defense. In a society so concerned as ours with child abuse and neglect, it may indeed be reasonable to ask what kind of care the injured child has received, perhaps permitting a more aggressive defense than is sometimes possible.

The defendant physician is too often a victim of the hindsight available to the plaintiff's attorney, when it is difficult, if not impossible, to put the judge and jury in the hospital room, the intensive care nursery, or the delivery room where critical decisions must be made if a child's life is to be saved.
Hepatitis B Immunoprophylaxis of Low-Birth-Weight Infants
Authors: GENESCÀ JOAN , ESTEBAN JUAN I. , ESTEBAN RAFAEL
Published: December 2021

To the Editor.—

In a recent statement by the Committee on Infectious Diseases, American Academy of Pediatrics (Pediatrics 1985;75:362-364) of prophylaxis of hepatitis B virus (HBV) infections in newborns, a point was made about the lack of data on immunogenic capacity of hepatitis B vaccine on low-birth-weight infants (< 2,000 g). In a prospective study on the value of vaccine for prevention of HBV infection in newborns from hepatitis B surface antigen-carrier mothers, carried out at our institution on 111 infants, two of the vaccinees were twins who weighed 1,800 g each.
Penny Eaters Beware!
Authors: SEIFERT STEVEN , MCLAUGHLIN JAMES H.
Published: December 2021

To the Editor.—

Acute toxicity may complicate the ingestion of US pennies minted since October 1982. In December 1984, an 11-lb dog died from multisystem failure attributed to markedly elevated serum and tissue levels following the ingestion of two such coins (The Arizona Daily Star, Dec 4, 1984, pp 1-2).

The mostly copper alloy one-cent piece was replaced in 1982 by one with a zinc core and a thin copper jacket. Although the copper is relatively inert, a break in the copper casing in an acid environment or prolonged acid exposure of an intact coin will cause dissolution and absorption of the zinc (The Arizona Daily Star, Dec 4, 1984, pp 1-2).
Health Hazards of Cow's Milk
Authors: BARNESS LEWIS A.
Published: December 2021

In Reply.—

Oski warns that excessive milk drinking may lead to anemia. He has demonstrated this himself, and there are sufficient references to indicate that this phenomenon is widespread in those who drink excessive milk to the exclusion of other nutrients. Limiting milk intake, after 6 months of life up to 500 mL of boiled milk as Tönz suggests is not documented, to my knowledge, to cause anemia. On the other hand, to recommend cow's milk as a source of essential fatty acids seems somewhat intemperate.
Total Parenteral Nutrition Cholestasis: A Cause of Mechanical Biliary Obstruction
Authors: Enzenauer Robert W. , Montrey Jill S. , Barcia Peter J. , Woods Joseph
Published: December 2021

In a newborn baby with Hirshsprung's disease obstructive jaundice developed following prolonged parenteral nutrition. At laparotomy, thick inspissated bile was flushed from the biliary tree and prompt resolution of the jaundice followed. To our knowledge, this is the first reported case in which inspissated bile appeared to be a complication of total parenteral nutrition. Mechanical obstruction must be recognized as an extreme in the spectrum of total parenteral nutrition cholestasis.
Prostacyclin Concentrations in Cord Blood and in the Newborn
Authors: Jacqz E. M. , Barrow S. E. , Dollery C. T.
Published: December 2021

The levels of 6-oxo-prostaglandin F1α (6-oxo-PGF1α) were measured in cord blood and in peripheral venous blood in newborns using gas chromatography coupled with negative ion chemical ionization mass spectrometry. The plasma concentrations of 6-oxo-PGF1α in cord blood increased significantly between delivery and placental expulsion (P < .005). In newborns, the circulation levels of 6-oxo-PGF1α after four hours of life were low and comparable to adult levels. Large quantities of prostacyclin are produced by the uteroplacental unit during parturition, but only small amounts are transmitted to the newborn during a normal delivery. The low plasma concentrations of 6-oxo-PGF1α in newborns suggest that prostaglandin I1 is not a circulating vasodilator during the first week of life.
Clinical Manifestations of Allergy Related to Breast- and Cow's Milk-Feeding
Authors: HIDE D. W. , GUYER B. M.
Published: December 2021

Studies of the influence of the initial feeding method upon the development of allergic disease have produced widely conflicting results.1 Unfortunately, the major social factors that lead a mother to choose to bottle-feed, rather than breast-feed, her infant have been ignored so that breast- and bottle-fed infants tend to be highly selected groups that cannot be directly compared unless many other variables are also taken into account.

The Isle of Wight Infant Feeding Survey was established to study the development of allergic disease in childhood in an entire infant population. The results of the study in the first year of life have been reported.2,3
On the Bile Sludge Syndrome or Is Total Parenteral Nutrition Cholestasis a Surgical Disease?
Authors: LILLY JOHN R. , SOKOL RONALD J.
Published: December 2021

In their article in this issue (Pediatrics 1985;76:905-908), Enzenauer and colleagues propose another complication of total parenteral nutrition in infants, ie, bile sludge obstruction. Their contention is that total parenteral nutrition induced a tenacious, viscid bile that produced a mechanical obstruction of the extrahepatic biliary system in their patient. The evidence supporting this hypothesis is suggestive but not totally convincing. It is true that the infant received prolonged total parenteral nutrition (for 50 days) and that he was fasted during most of the first 2 months of life. Moreover, gallbladder enlargement,1 biliary sludge, and cholelithiasis have been reported in patients receiving total parenteral nutrition.2
Where to Now, Henry? A Commentary on The Battered Child Syndrome
Authors: HELFER RAY E.
Published: December 2021

On March 30, 1984, I was given the privilege of delivering the introductory speech at the first American Medical Association (AMA) meeting exclusively for child abuse and neglect. Although one might wonder why 22 years lapsed between the Journal of the American Medical Association (JAMA) publication of the milestone article by Henry Kempe1 and the first meeting, the fact remains that the AMA is now paying attention to the needs of abused children and their families. My talk at this conference came just 3 weeks after the death of Henry Kempe, some 20 years almost to the date when he asked if I would like to be involved with his study of the battered child syndrome.
Optometric Vision Training
Authors: BEAUCHAMP GEORGE R.
Published: December 2021

Optometric vision training is controversial, and knowledgeable individuals question its targets and efficacy. In responding to a position paper of the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology on learning disabilities, dyslexia, and vision,1 Flax et al2 raise issues worthy of close scrutiny, and recent literature provides useful perspective.

Before commenting on the issues, the air should be clear on the central perspective: the American Academy of Pediatrics, American Association for Pediatric Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus have expressed one, and only one, concern in promulgating their position: the best interests of people with learning disabilities.
Endotracheal Tube Placement in Infants
Authors: BLOCH EDMOND C.
Published: December 2021

To the Editor.—

A recent article1 inPediatrics describing the early experience with illuminated endotracheal tubes in premature and term infants is of considerable interest. The idea is certainly a novel one and would probably appeal to many. However, it does require a specially designed endotracheal tube and fiberoptic light source, both of which may not be available.

I would like to describe a method that I have been using for many years and that I have found most reliable.
Apnea Monitoring—It Doesn't Discriminate
Authors: ORR WILLIAM C. , STAHL MONTE L. , DUKE JAMES , MCCAFFREE MARY ANNE , TOUBAS PAUL , MATTICE CYNTHIA , KROUS HENRY
Published: December 2021

In Reply.—

The referred to study by Guilleminault et al reports a statistically significant increase in obstructive and mixed apnea in infants referred with a history of a "near-miss for SIDS" episode. The word discriminate was used in the context of our discussion because it seemed clear from this report that the occurrence of obstructive apneic spells, as opposed to central apneic events, was a parameter that differentiated the near-miss for SIDS group from the controls.
Nutrition Study Design Questioned
Authors: WILSON MARY JESS
Published: December 2021

To the Editor.—

Janas et al1 have reported on differences in biochemical indices of protein utilization in infants who were breastfed compared with those fed two types of cow's milk formula. Their finding of elevated plasma amino acid and serum urea nitrogen concentrations in formula-fed infants is an important confirmation of previous studies on term infants by Järvenpää et al.2 However, their results and conclusions about total dietary intake of protein, nitrogen, and amino acids are problematic due to their study design and methods.
Albuterol Protects Against Exercise-Induced Asthma Longer Than Metaproterenol Sulfate
Authors: Berkowitz Robert , Schwartz Eugene , Bukstein Don , Grunstein Michael , Chai Hyman
Published: December 2021

Both metaproterenol sulfate and albuterol are inhaled medications commonly used to prevent exercise-induced bronchospasm. Their efficacy and duration of action in controlling exercise-induced bronchospasm were compared with placebo in 18 asthmatic children (age range: 12 to 17 years) in a single-blind randomized crossover study. Standardized treadmill exercise challenges were repeated every two hours for up to six hours following the initial exercise test. With the initial exercise challenge, both active medications blocked exercise-induced bronchospasm with equal efficacy. On the other hand, when the duration of action of the medications was compared: (1) albuterol blocked exercise-induced bronchospasm longer than metaproterenol sulfate in eight subjects, (2) the reverse was true in only one patient, and (3) the medications blocked for equal duration in nine subjects. Thus, although both active agents were equally efficacious in blocking exercise-induced bronchospasm initially, the duration of action of albuterol was significantly (P < .05) longer on serial testing than that of metaproterenol sulfate. Both medications were significantly better than placebo in efficacy and duration of action.
Bone Marrow Transplantation Experience for Children With Aplastic Anemia
Authors: Sanders Jean E. , Whitehead John , Storb Rainer , Buckner C. Dean , Clift Reginald A. , Mickelson Eric , Appelbaum Frederick R. , Bensinger William I. , Stewart Patricia S. , Doney Kristine , Sullivan Keith , Deeg H. Joachim , Witherspoon Robert P. , Thomas E. Donnall
Published: December 2021

From May 1971 through December 1981, 81 children (22 months to 17 years of age) received allogeneic bone marrow grafts for severe aplastic anemia. All donors were HLA-identical family members. Fifty-seven of the 81 (70%) are still alive. Twenty-three untransfused patients were conditioned with cyclophosphamide, 50 mg/kg/d, for four days, and 19 (83%) have survived from 5 to 12 years. All 58 transfused patients were conditioned with cyclophosphamide, 50 mg/kg/d, for four days, 11 received additional immunosuppression, and 19 received posttransplantation donor buffy coat cells. Thirty-eight (65%) have survived from 3 to 13 years (P = .1). In a multivariate analysis, the only factor significantly associated with increased survival among patients with sustained grafts was the absence of significant graft v host disease (P < .0001). The factors significantly related to increased rejection were low bone marrow cell dose (P < .05) and positive relative response in mixed leukocyte culture (P < .0001), but the addition of buffy coat cells did not significantly influence graft rejection. The development of grades II to IV acute graft v host disease was associated with random donor platelet refractoriness (P < .05) and donor/recipient sex differences (P < .05). Patients at highest risk for chronic graft v host disease were those patients who developed significant acute graft v host disease (P < .01) and who received buffy coat infusions (P < .025). All patients who were untransfused had a negative relative response and were not refractory to random donor platelets.
Controlled Evaluation of Rural Regional Perinatal Care: Developmental and Neurologic Outcomes at 1 Year
Authors: Siegel Earl , Gillings Dennis , Campbell Suzann , Guild Priscilla
Published: December 2021

The effectiveness of a rural regionalized perinatal care (RPC) program was evaluated by a controlled, population-based design. The RPC program, begun in a carefully selected study region in July 1975, evolved into a system of care which included the following major components: identification of high-risk pregnancies and high-risk newborn infants; obstetric and newborn consultation and referral services between Level I, II, and III centers; professional education for physicians, nurses, and other health professionals; and nutrition and social work consultation. Substantial resources were made available from 1975 to 1980 to implement this "total package" of RPC. A matched, control region was identified which, except for the RPC program, was as comparable as possible to the study region. It was hypothesized that the RPC intervention would have the following effects when the study region was compared with the control region: reduction in fetal and neonatal mortality, no increase in postneonatal mortality, and reduction in obstetric and newborn morbidity. These findings were reported previously. This paper presents results of hypothesized reductions in adverse developmental, neurologic, maternal-infant attachment, and selected physical health outcomes. A sample of 447 infants was assessed by an extensive battery of instruments at 1 year, adjusted for gestational age. The most notable findings were mothers' reports of receptive language development and observations of maternal attachment behaviors that significantly favored the study region. No significant differences between study and control regions were observed for Bayley Mental and Motor Scores, abnormal neurologic signs, and the physical health measures. The impact of rural RPC in North Carolina on the 1-year outcomes is discussed and policy implications are presented.
Follow-up of Adolescent Trauma Victims: A New Model of Care
Authors: Jacobson Marc S. , Rubenstein Elaine M. , Bohannon Wayne E. , Sondheimer Diane L. , Cicci Regina , Toner Jacqueline , Gong Elizabeth , Heald Felix P.
Published: December 2021

A comprehensive model of service delivery for the rehabilitative care of adolescents with closed head injuries is presented. Our data show that the Glasgow Coma Scale score on hospital admission correlates with the length of time required for follow-up. Adolescents with mild closed head injuries require more follow-up than adults with comparable injuries because of adolescent developmental stages that complicate the recovery process. Anticipatory guidance has helped the patient and family cope with stresses. Finally, we have identified a typical pattern of difficulties during the recovery process including: impaired judgment, reduced attention span, irritability, short-term memory loss, and ongoing memory deficits.
Epidemiology of Inguinal Hernia in Preterm Neonates
Authors: PEEVY KEITH J. , SPEED FELICITY A. , HOFF CHARLES J.
Published: December 2021

We have studied the epidemiology of inguinal hernias in preterm infants. Inguinal hernias occur with increased frequency in infants ≤32 weeks' gestational age or ≤1,250 g birth weight. Among infants ≤32 weeks' gestational age, intrauterine growth retardation significantly increases the risk for development of inguinal hernias, especially in male infants. Our data demonstrate a previously unrecognized association between neonatal inguinal hernia and intrauterine growth retardation.
Children and Car Seats
Authors: SHELNESS ANNEMARIE , CHARLES SEYMOUR
Published: December 2021

Almost since the emergence of the First Ride—Safe Ride concept some 15 years ago, loan or rental programs for child car seats in maternity hospitals and community centers have been a popular method of promoting child restraint use. Today there must be hundreds of such programs throughout the United States. The Dunedin rental program (Pediatrics 1986;77:167-172) is certainly a unique approach, but some aspects of it may lack practical application, at least in the United States. For example, it would be unlikely that we could saturate a community with free car seats or have available so broad a staff support system.
Phenothiazine-Induced Sleep Apneas and the Opioid System
Authors: SANDYK R.
Published: December 2021

To the Editor.—

I was interested in the report by Kahn et al.1 demonstrating an increase in the number of central apneas following phenothiazine administration to infants. Administration of phenothiazines to infants less than 1 year of age could precipitate sudden death in apnea-prone subjects. Although the authors suggested several possible mechanisms linking the effects of phenothiazines with sudden infant death syndrome (SIDS), an apparent role of the opioid system has not been mentioned.

The endogenous opioid system has been implicated in the central control of respiration.2
Child Mothers
Authors: FISCHER HOWARD
Published: December 2021

To the Editor.—

The report by Wharton and Mandell (Pediatrics 1985;75:1120-1123) is frightening and well written. One obvious point, however, has been overlooked: If viewing of television violence causes aggressive behavior in children, should one be surprised that it causes aggressive behavior in child-parents? We are told that the mother in case I is young? How young? 16? 22?

Pediatricians tend to attribute maturity to a child's mother regardless of her age. The 15-year-old who is a patient may be asked "How are you feeling, Jane?"