bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunogenicity of Haemophilus influenzae Type b Polysaccharide-Protein Conjugate Vaccines in Children With Conditions Associated With Impaired Antibody Responses to Type b Polysaccharide Vaccine
Authors: Weinberg Geoffrey A. , Granoff Dan M.
Published: December 2021

Polysaccharide-protein conjugate vaccines are members of a new class of vaccines designed to immunize infants against diseases caused by encapsulated bacteria, including H influenzae type b. There are at least four H influenzae type b polysaccharide-protein conjugate vaccines undergoing clinical evaluation in the United States,1 and three of the four recently were licensed for use in 18-month-old children. Although these conjugate vaccines differ considerably in chemical composition and immunologic properties, each consists of the H influenzae type b polysaccharide, polyribosylribitolphosphate (PRP) (or a derivative thereof), covalently coupled to a carrier protein or proteincontaining complex. As a group, the H influenzae type b polysaccharide-protein conjugate vaccines are more immunogenic in healthy infants and older children than the conventional PRP vaccine.1,2

Several groups of children have been found to be at increased risk for invasive disease caused by H influenzae type b compared with children in the general US population. These include Native Americans (Apaches, Navajos, and Alaskans),3-6 blacks (when studied with regard to allotype),7-9 and children with previous disease caused by H influenzae type b.10,11 Other groups of children who have underlying diseases or genetic phenotypes associated with impaired serum antibody responses to immunization with conventional PRP vaccine have been described (Table 1). In most instances, children without these conditions also are considered to be at a higher risk of invasive disease caused by H influenzae type b than children of comparable ages in the general population.3-6,22,24-26 The reasons for the poor antibody responses to PRP vaccine in children with these underlying conditions, in children of certain racial groups, or in children with hyporesponsive genetic phenotypes are not well understood.
Immunogenicity of a New Haemophilus influenzae Type b Conjugate Vaccine (Meningococcal Protein Conjugate) (PedvaxHIBTM)
Authors: Vella Philip P. , Staub Joan M. , Armstrong Jack , Dolan Kathleen T. , Rusk Cynthia M. , Szymanski Sally , Greer William E. , Marburg Stephen , Kniskern Peter J. , Schofield Timothy L. , Tolman Richard L. , Hartner Fredrick , Pan Shih-hsie , Gerety Robert J. , Ellis Ronald W.
Published: December 2021

Haemophilus influenzae type b is responsible for an estimated 15 000 to 20 000 cases of meningitis per year in the United States, mainly in children 2 months to 5 years old.1-4 The mortality rate from meningitis due to H influenzae type b infections ranges from 5% to 10%. Despite antibiotic treatment, up to 35% of survivors have permanent neurologic sequelae. In addition to meningitis, H influenzae type b is responsible for other invasive infections, including epiglottitis, septicemia, cellulitis, septic arthritis, osteomyelitis, pneumonia, pericarditis, and otitis media; approximately 30 000 cases H influenzae diseases occur annually in the United States. The diseases peak in incidence between 6 and 12 months of age, with almost one half of the cases occurring before 1 year of age. About 75% of disease caused by H influenzae type b occurs in children younger than 24 months old. The incidence of disease is higher in children of certain groups, including blacks, Hispanics, Eskimos and Native Americans, young children attending day-care facilities, patients with asplenia or antibody-deficiency syndromes, and children of lower socioeconomic status.5

There is considerable evidence that antibody to the capsular polysaccharide (polyribosylribitol-phosphate [PRP]) of H influenzae type b is protective.6-8 These antibodies activate complement for bactericidal antibody,9,10 induce opsonophagocytic activity,11,12 and protect infant rats from bacteremia due to challenge with H influenzae type b.13,14 It has been demonstrated clinically that antibodies induced by vaccination of older children with PRP are protective.7,15 The level of antibodies correlated with protection has been estimated to be 0.05 to 0.15 µg/mL after natural infection16 or after passive acquisition via immunoglobulin17 and 1.0 µg/mL for vaccine-induced protection.18
Safety, Tolerability, and Immunogenicity of Concurrent Administration of Haemophilus influenzae Type b Conjugate Vaccine (Meningococcal Protein Conjugate) With Either Measles-Mumps-Rubella Vaccine or Diphtheria-Tetanus-Pertussis and Oral Poliovirus Vaccines in 14-to 23-Month-Old Infants
Authors: Dashefsky Barry , Wald Ellen , Guerra Nancy , Byers Carol
Published: December 2021

In 1985, the first capsular polysaccharide (polyribosylribitol-phosphate [PRP]) vaccine for Haemophilus influenzae type b was licensed and recommended for routine use in children between 24 and 60 months of age.1,2 In the United States, approximately 75% to 90% of invasive disease due to H influenzae type b occurs in infants younger than 24 months,1,3 a population for whom H influenzae type b polysaccharide vaccine is inadequately immunogenic and protective. In an effort to enhance the immunogenicity of H influenzae type b polysaccharide vaccine for children in the most susceptible age groups, conjugate vaccines have been developed in which the capsular PRP of H influenzae type b has been bound to a variety of carrier proteins, thereby conferring the vaccines with thymic-dependent attributes.4,5 One such conjugate vaccine, in which the carrier protein is diphtheria toxoid (PRP-D), was licensed in 1987 and has been recommended since 1988 for routine use in children 18 months of age and older.6,7 A second conjugate vaccine, in which an oligosaccharide derivative of H influenzae type b capsular PRP is coupled to CRM197, a nontoxic mutant diphtheria toxin (oligo-CRM), was licensed in 1988 and is a sanctioned alternative to PRP-D.8 Another investigational conjugate vaccine, in which the polysaccharide is linked to the outer membrane protein of Neisseria meningitidis group B (PRP-OMPC), has been demonstrated to be both safe and immunogenic when administered in a two-dose schedule to 2- to 6-month-old infants.9 However, anti-PRP antibody levels decline significantly during the ensuing 10 to 15 months10,11; they rise significantly in response to booster doses of either PRP or PRP-OMPC administered 10 to 15 months after the initial priming doses of PRP-OMPC.11,12
Disease Caused by Haemophilus influenzae Type b in the Immediate Period After Homologous Immunization: Immunologic Investigation
Authors: Sood Sunil K. , Daum Robert S.
Published: December 2021

Several Haemophilus influenzae type b vaccines have been licensed and recommended for administration to children in the United States. These vaccines have consisted of purified polyribosylribitol-phosphate (PRP), the capsular polysaccharide of H influenzae type b,1 alone or covalently bound to one of several carrier proteins. Two of these saccharide-protein conjugate vaccines are now licensed, a polysaccharide-diphtheria toxoid conjugate (PRP-D)2 and an oligosaccharide-mutant diphtheria toxin conjugate (HbOC).3 Two others, a polysaccharide- Neisseria meningitidis outer membrane protein conjugate (PRP-OMPC)4 and a polysaccharide-tetanus toxoid conjugate (PRP-T),5 are currently in clinical trials.

One concern with the use of PRP vaccine was the suggestion that the incidence of invasive disease caused by H influenzae type b in the immediate period after immunization might be increased; this idea was supported by evidence from several sources. In a case-control study of the efficacy of PRP vaccine, Black et al6 found that 4 children were hospitalized for invasive disease within 1 week of immunization, a rate of invasive disease 6.4 times greater (95% confidence interval [CI], 2.1 to 19.2) than the background rate in unvaccinated children. In Minnesota, the relative risk for invasive disease in the first week after immunization was 6.2 (95% CI, 0.6 to 45.9),7 and the results of a study conducted by the Centers for Disease Control in six areas of the United States revealed a 1.8-fold (95% CI, 0.3 to 10.2) increase in the occurrence of invasive disease caused by H influenzae type b in the first week after immunization.8 Moreover, among 16 cases of disease caused by H influenzae type b occurring within 14 days of immunization that were passively reported to the FDA,9 10 were clustered within the first 72 hours.
Blood Pressure Increases, Birth Weight-Dependent Stability Boundary, and Intraventricular Hemorrhage
Authors: Perry Edward H. , Bada Henrietta S. , Ray John D. , Korones Sheldon B. , Arheart Kris , Magill H. Lynn
Published: December 2021

The blood pressure (BP) and transcutaneous Po2, (TcPo2) changes associated with intensive care procedures were evaluated to determine whether responses differ between babies with and without periventricular-intraventricular hemorrhage (PV-IVH). Fifty-three inborn babies ≤1500 g were studied using a microcomputer-based monitoring system. With almost any procedure including a seemingly benign one such as a diaper change, peak systolic BP increased and TcPo2 decreased. However, responses to interventions did not differ between babies with PV-IVH and those without PV-IVH. Neither did these responses differ between those with birth weight ≤1000 g and >1000 g. When each baby's record was scanned for the highest peak systolic BP before diagnosis of PV-IVH or within 48 hours in those with no PV-IVH and their BP points plotted against birth weight, a stable region was evident wherein PV-IVH occurred at a lower incidence (13%). When peak systolic BP was beyond this stable region, the incidence of PV-IVH was significantly higher, 70% (P < .0001). The stability boundary for the maximum systolic BP is birth weight-dependent; the limit for the highest tolerable peak systolic BP is lower for the low-birth-weight infant. In over 70% of instances the highest peak systolic BP was associated with motor activities either induced by nursery procedures or spontaneous. We speculate that decreasing the frequency of intensive care interventions may decrease episodic BP increases to levels beyond the birth weight-dependent stability boundary where PV-IVH is likely to occur.
Prenatal Cocaine Exposure and Fetal Vascular Disruption
Authors: Hoyme H. Eugene , Jones Kenneth Lyons , Dixon Suzanne D. , Jewett Tamison , Hanson James W. , Robinson Luther K. , Msall M. E. , Allanson Judith E.
Published: December 2021

The question of the potential teratogenicity of cocaine has been raised by the increasing frequency of its abuse in the United States. In previous studies, an increased incidence has been documented of spontaneous abortion, placental abruption, prematurity, intrauterine growth retardation, and neurologic deficits in the infants of women who abused cocaine. More recently, it has been suggested in studies that fetal vascular disruption accompanying maternal cocaine abuse may lead to cavitary central nervous system lesions and genitourinary anomalies. In this article, 10 children born of women who abused cocaine are described, 9 of whom have congenital limb reduction defects and/or intestinal atresia or infarction. The spectrum of anomalies associated with embryonic and fetal vascular disruption accompanying maternal cocaine abuse is thus enlarged. The specific risk for congenital anomalies accompanying maternal cocaine abuse during an individual pregnancy is unknown. However, data from these patients and the available literature suggest that counseling pregnant women concerning cocaine use should incorporate warnings about the possibility of associated embryonic or fetal vascular disruption.
Clinical Management Considerations in Long-Term Survivors With Trisomy 18
Authors: Van Dyke Don C. , Allen Malinda
Published: December 2021

As many as 90% or more of children with trisomy 18 die within the first year of life. A review of six patients with trisomy 18 documented by karyotype surviving past 1 year of age and of the trisomy 18 files of the Support Organization for Trisomy 18 and 13 indicated that a small number of children with trisomy 18 survive beyond their first year of life; a few live into their teens and twenties. In addition to medical problems that are unique to this chromosomal syndrome, these patients present complex medical problems common to all persons with chromosomal anomalies. The primary and tertiary care consultants who are able to provide knowledge and sensitive supportive care to children with trisomy 18 and to their parents are performing a service of significant benefit, no matter how brief the life span of the child may be.
Magnetic Resonance Imaging in Cervical Cord Birth Injury
Authors: Lanska Mary Jo , Roessmann Uros , Wiznitzer Max
Published: December 2021

Three children who sustained cervical cord injury due to birth trauma are described. The clinical and radiological data, and the central nervous system pathology of one child, illustrate the advantages and feasibility of magnetic resonance imaging in ventilator-dependent children with cervical cord lesions.
Effects on Behavior State of Prone Versus Seated Positioning for Infants With Gastroesophageal Reflux
Authors: Orenstein Susan R.
Published: December 2021

To evaluate the effect of positioning on behavior in infants with gastroesophageal reflux, 48 infants younger than 6 months of age (range 1.5 to 28 weeks, median 13.5) with reflux were positioned continuously prone (24 infants) or seated (24 infants) during a 120-minute postprandial period, during which behavior was monitored continuously. The prone position was associated with more sleep time, 83.5 (16 to 113) vs 43 (0 to 117) minutes, P = .01. This increase in sleep time in the prone position could be largely accounted for by a tendency toward a decrease in crying time, 19 (0 to 82) vs 38.5 (0 to 91) minutes, P = .07, which is expressed further by the significantly smaller number of prone than seated infants who cried longer than 30 minutes, P = .02. A parallel reduction in noncrying awake time in the prone vs the seated position was not significant: 15 (0-51) vs 31 (3 to 84) minutes, P = .13.
Impact of Eligibility Criteria on Phototherapy Program Size and Cost
Authors: Plastino Roberta , Buchner David M. , Wagner Edward H.
Published: December 2021

To determine the effect of eligibility criteria on phototherapy program size and cost, 786 births in a large Health Maintenance Organization were prospectively studied. Four sets of criteria were compared, including those of the American Academy of Pediatrics and the health maintenance organization's own criteria. With all criteria sets, hospital-based phototherapy treatment was indicated for 13 (1.7%) infants and no phototherapy was indicated for 687 (87.4%) infants. Treatment varied substantially according to criteria set for the remaining 86 (10.9%) infants. From 14% to 100% of these infants would have received treatment, depending on the criteria applied; of those potentially treated, from 30% to 80% would have received home treatment. Estimated annual discretionary phototherapy costs (1985 dollars) ranged from $15 168 with the health maintenance organization criteria to almost five to six times this amount ($70 232 to $90 800) with the other criteria. Differences in costs were due mainly to the number of infants treated. This study illustrates the way in which modest variation in standards of care can potentially have a relatively large effect on medical care costs. As a case study of how health maintenance organizations reduce costs, the study shows that although the health maintenance organization anticipated costs savings due to substituting outpatient care for hospital care, most savings occurred because of a reduction in the number of infants treated.
Hypoglycemia in Infancy: The Need for a Rational Definition
Authors:   A Ciba Foundation Discussion Meeting, Cornblath Marvin , Schwartz Robert , Aynsley-Green Albert , Lloyd June K.
Published: December 2021

A discussion meeting was held on October 17, 1989, to address the current status of the definition of significant hypoglycemia in infancy, especially in the normal- and low-birth-weight neonate.

Robert Schwartz introduced the complexity of the problem by indicating the multiple variables (duration, severity, cerebral blood flow, rates of glucose uptake, availability of alternate substrates, oxygen, etc) in equating a plasma glucose value with neurodevelopmental consequences.

Marvin Cornblath reviewed the various definitions of hypoglycemic blood sugar levels reported since 1911 which depend upon the method of blood sugar analysis, clinical recognition and concerns. Severe symptomatic hypoglycemia that persisted or recurred was first reported in neonates in 1937. Lower blood sugar levels, documented since the 1920s in both full-term and premature newborns, had been considered physiologic. The recognition of transient significant hypoglycemia first in symptomatic and then in asymptomatic small-for-gestational-age, neonates required new definitions in the 1960s. These definitions were later modified as changes in treating both the mother in labor and at delivery and the neonate occurred. Intensive care and the survival of very-low-birth-weight newborns have compounded the problem of definition. Currently methods are available to correlate plasma glucose concentrations and glucose metabolism in vivo in the brain with specific neurologic dysfunctions. This should permit a better definition of the continuum of significant hypoglycemia than has been available before.

William Hay analyzed studies of the various rapid bedside glucose oxidase stick techniques used to screen for blood glucose concentrations. He concluded that their dependence on the hematocrit, their requirements for precision in performance and timing, great variance (±5 to 15 mg/dL), and lack of reproducibility, especially at blood glucose values less than 50 mg/dL, made their use in the neonate unsatisfactory (whether read by eye or by meter).
Nephrotic Syndrome Associated With Nonsteroidal Anti-inflammatory Drug Use in Two Children
Authors: Robinson Joan , Malleson Peter , Lirenman David , Carter James
Published: December 2021

Two children with nephrotic syndrome in association with nonsteroidal anti-inflammatory drug (NSAID) use are described, and the literature concerning this association is reviewed. NSAIDs are drugs with the potential for causing significant renal toxicity including the nephrotic syndrome, interstitial nephritis, and renal failure even in children without obvious preceding renal disease. Children prescribed such drugs should be regularly monitored with urinalyses and plasma creatinine estimations. The possibility of toxicity to over-the-counter use of NSAIDs should be remembered.
Diagnosing Bird Fancier's Disease in Children
Authors: YEE WILLIAM F. H. , CASTILE ROBERT G. , COOPER AMIEL , ROBERTS MARY , PATTERSON ROY
Published: December 2021

Bird fancier's disease is a form of hypersensitivity pneumonitis resulting from inhalation of various avian proteins. It is rarely diagnosed in childhood but should be considered in any child with persistent unexplained respiratory symptoms.1,2 We describe two patients referred to our pulmonary clinic with nonspecific respiratory complaints, in whom the diagnosis of avian protein-related hypersensitivity pneumonitis was initially not confirmed by serologic studies.

CASE REPORTS

Patient 1

An 11-year-old boy was admitted to the hospital with a 1-year history of a mild nonproductive cough, poor appetite, weight loss, malaise, and an intermittent low-grade fever. According to an environmental history, the boy's father had been breeding pigeons, canaries, and parakeets in the family yard for years.
Actinomycosis Manifesting as an Acute Painless Lump of the Jaw
Authors: FEDER HENRY M.
Published: December 2021

Actinomyces species and Arachnia propionica are slow-growing, Gram-positive bacteria which are part of the normal oral flora. Microscopically, they have a filamentous structure which gives them a fungus-like appearance. Infections caused by these bacteria are termed actinomycosis. Cervicofacial actinomycoses are usually painless, slow-growing, hard masses which can produce cutaneous fistulas, a condition commonly known as lumpy jaw. Less frequently, cervicofacial actinomycosis is an acute, tender, fluctuant mass suggestive of an acute pyogenic infection.1-4 Following are three pediatric cases of cervicofacial actinomycosis. Two cases, one of mandibular osteomyelitis and one of a paramandibular abscess, both occurred aytpically as acute woody masses without systemic illness.
Inadequate Breast Feeding and Jaundice
Authors: KEMPER KATHI J.
Published: December 2021

In Reply.—

Dr Newman suggests that jaundice may be a symptom of inadequate breast-feeding and that the correct treatment of this problem is to encourage increased breast-feeding, rather than interrupting it. Although there are no studies which definitively demonstrate the cause and effect relationship between inadequate breast-feeding and hyperbilirubinemia, I agree with Dr Newman that a rational, common-sense approach would be to encourage early and frequent breast-feeding. Supplementation of breast milk with devices such as that described by Dr Auerbach also makes sense to me.
Stridor and Gastroesophageal Reflux in Infants
Authors: Nielson Dennis W. , Heldt Gregory P. , Tooley William H.
Published: December 2021

A relation was found between persistent stridor and gastroesophageal reflux in seven infants, aged 6 weeks to 6 months. Stridor began at 11 days to 2 months of age, and four of the seven infants had transient hypercarbia on at least one occasion before study. Only one had a history of frequent vomiting; three had recurrent pneumonia. Midesophageal pH, chest and abdominal movement, exhaled carbon dioxide partial pressure, and heart rate of six of the infants were recorded for 4 to 12 hours as they slept. Esophageal pH of the seventh infant was recorded for 24 hours. In the six completely studied infants, there were persistent increases of greater than 10 mm Hg in exhaled carbon dioxide level (three infants), of greater than 10 breaths per minute in respiratory rate (four infants), and in retractions and stridor (six infants) 5 to 20 minutes after onset of reflux. Stridor improved with medical management in 48 hours (five of five infants) and disappeared in 3 weeks (three of five infants) to 2 months (one of five infants). One of these medically treated infants subsequently was treated by Nissen gastric fundoplication because of a recurrence of persistent and severe stridor. Three infants had antireflux surgery, and in two of these stridor disappeared in 48 hours. In the third infant stridor disappeared 3 weeks after surgery. Based on this experience, reflux occasionally causes stridor, probably because of acute inflammation of the upper airway. If structural anomalies are ruled out, infants with severe stridor should be examined for gastroesophageal reflux.
Association Between Parenthood and Problem Behavior in a National Sample of Adolescents
Authors: Elster Arthur B. , Ketterlinus Robert , Lamb Michael E.
Published: December 2021

The association between problem behaviors and parental status was studied in a national sample of urban (n = 1263) and rural (n = 388) young women 15 to 17 years of age. When assessed according to age at childbearing, there was a clear association between problem behavior and the birth of a first child prior to age 19 years. The three parental status groups studied appeared ordered in risk, with school-aged mothers having engaged in the most problem behaviors, and followed, in turn, by young adult mothers (ie, those who had a child between 19 and 21 years of age), and then by women who had not had a child by age 21 years. Young urban women who engaged in three or more problem behaviors were more likely than women who claimed no involvement in problem behaviors to subsequently have a child prior to age 19 years. In addition, black adolescents reported fewer problem behaviors than did white adolescents. When individual behaviors were analyzed, school-aged mothers were more likely than either young adult mothers or nonmothers to have reported school suspension, truancy, runaway, smoking marijuana, and fighting. Although similar results were found in both samples, the effects appeared more consistent for young urban women. In future studies, researchers must determine whether adolescent mothers are at risk for parenting difficulties because of their previous involvement in problem behaviors.
Phenobarbital Treatment and Major Depressive Disorder in Children With Epilepsy: A Naturalistic Follow-up
Authors: Brent David A. , Crumrine Patricia K. , Varma Rajiv , Brown Robert V. , Allan Marjorie J.
Published: December 2021

Of an original cohort of 39 epileptic patients, 28 were observed for a median of 26.5 months after an initial psychiatric interview. As had been noted in the original cohort, treatment with phenobarbital, as compared with treatment with carbamazepine or no anticonvulsant, was associated with higher rates of depression (38% vs 0%, P = .04). Depression associated with phenobarbital treatment at intake did not remit spontaneously on follow-up as long as phenobarbital use continued. Those patients treated with phenobarbital who were previously depressed and whose medication was changed to either carbamazepine or no medication showed nonsignificant trends toward declines in both the frequency and severity of depressive symptoms. These results provide further evidence that treatment with phenobarbital increases the risk for depression in epileptic patients and should be avoided when clinically feasible, particularly in patients with a personal or family history of affective disorder. Epileptic patients who receive phenobarbital because of clinical considerations should be monitored closely for symptoms of an affective disorder, and if depression is detected, a change to an alternative anticonvulsant may result in amelioration of depressive symptomatology.
Extraordinary Urinary Frequency
Authors: ZOUBEK JAROSLAVA , BLOOM DAVID A. , SEDMAN AILEEN B.
Published: December 2021

Frequency is the predominant disturbance of micturition and suggests inflammation, obstruction, or a foreign body in the urinary tract. Frequency occurs in two-thirds of all cases of infection of the urinary tract and is almost always present when intravesical obstruction or inflammation of the posterior urethra exists.

Frequency may also result from inadequate training, nervousness, excitement, or mental defectiveness.

—Meredith Campbell, 19371p8

Urinary frequency is a classic hallmark of genitouninary disease. Extraordinary urinary frequency sometimes develops in children without any other symptoms or signs. There is rarely a physical basis for this condition. The typical patient is a previously toilet-trained child with a sudden onset of distressing urgency and urinary frequency as often as every 5 minutes.
Cholesterol Screening?
Authors: DENNISON BARBARA A.
Published: December 2021

To the Editor.—

The paper by Drs Garcia and Moodie is the third article in the past 4 months to question the efficacy of family history as the first step in a screening strategy to identify children with hypercholesterolemia.1-3 Their finding that 50% of the children they identified with elevated low-density lipoprotein (LDL) cholesterol did not have a family history of premature cardiovascular disease or hyperlipidemia is essentially the same as that of Griffen and colleagues.2
Recommendations for Developmental Monitoring: The Role of Surveillance
Authors: CUNNINGHAM ROBERT D.
Published: December 2021

To the Editor.—

Dr Dworkin raises many good points in his review, "British and American Recommendations for Developmental Monitoring: The Role of Surveillance." However, I am skeptical that the concept of "surveillance" is actually different from what physicians have practiced in the past. Dr Dworkin acknowledges "that mild mental retardation is not typically identified until the child is confronted with the cognitive demands of school...," especially when physicians rely on subjective impressions. With the concept of "surveillance," "eyeball" estimates will continue to be made of a child's development; and with each well-child visit and frequently each acute illness visit being of relatively brief duration, I strongly suspect that the overwhelming majority of mildly retarded children will continue to elude detection.
Language Growth in Children With Expressive Language Delay
Authors: RUBEN ROBERT J.
Published: December 2021

To the Editor.—

The article entitled "Language Growth in Children with Expressive Language Delay" by Fischel et al1 reports a clinical study that lacks the one most important control, audiometric evaluation. This lack brings into question any conclusions drawn from their data. A most common cause for expressive language delay in young children is conductive hearing loss.2 In Table 2 of the article by Fischel et al, it was noted that the number of treatments for ear infections had a high positive correlation with language delay.
Language Growth in Children With Expressive Language Delay
Authors: FISCHEL JANET E. , WHITEHURST GROVER J. , LONIGAN CHRISTOPHER , JORDON REBECCA SEMENAK
Published: December 2021

In Reply.—

Dr Ruben raises concerns about our publication in this journal on language growth in children with expressive language delay.1 Ruben's position is that hearing loss accounts "for much of the expressive language delay seen in children at this age" and that, because we did not include that variable in our study, this "brings into question any conclusions drawn from their data."

We are pleased that Ruben has raised the issue of the role of conductive hearing loss because we have gathered relevant data since the publication he questions.
Adult Respiratory Distress Syndrome in Full-Term Newborns
Authors: PFENNINGER J. , TSCHAEPPELER H.
Published: December 2021

To the Editor.—

Because of our longstanding interest in adult respiratory distress syndrome in the pediatric age group, it was a pleasure to read the article about neonatal adult respiratory distress syndrome by Faix et al.1 However, our experience with the neonatal form of the syndrome differs quite substantially from that reported by Faix; and, therefore, we would like to report just briefly our data from the last 20-month period. During this time the diagnosis of adult respiratory distress syndrome according to classcial criteria was made in 5 newborn infants.
Acquired Neuropathologic Lesions Associated With the Hypoplastic Left Heart Syndrome
Authors: Glauser Tracy A. , Rorke Lucy B. , Weinberg Paul M. , Clancy Robert R.
Published: December 2021

This study details the type, frequency, clinical presentation, and etiologic associations of acquired brain lesions in 40 infants with the hypoplastic left heart syndrome encountered during a 52-month interval. Detailed postmortem neuropathologic examinations showed that 55% of the infants were free of acquired brain lesions. However, the other 45% had combinations of hypoxic-ischemic lesions and intracranial hemorrhage. Central nervous system perfusion and glucose-oxygen delivery appeared to be important factors in the occurrence of hypoxic-ischemic lesions or intracranial hemorrhage, whereas acidosis and hypercarbia were not. Cerebral necrosis may be a predisposing factor for a major intracranial hemorrhage. A duration of cardiopulmonary bypass with hypothermic total circulatory arrest longer than 40 minutes was associated with a higher incidence of acquired neuropathology. These results indicate that the majority of infants with hypoplastic left heart syndorme are free of acquired neuropathology and suggest practical ways to reduce the risks in the others.
Diagnosis of Human Immunodeficiency Virus Infection in Infants and Children
Authors: Husson Robert N. , Comeau Anne M. , Hoff Rodney
Published: December 2021

Since its initial description at the beginning of this decade,1-3 the acquired immunodeficiency syndrome (AIDS) has become one of the major medical, public health, and social issues of our times. Since the isolation of the retrovirus human immunodeficiency virus (HIV) from patients with AIDS and AIDS-related complex,4,5 major advances have been made in understanding the biology of the virus and the disease it causes. Diagnosis of HIV infection in adults and older children, and screening of blood products, have become routine and reliable with the use of licensed tests that detect HIV-specific antibody.6 Antiretroviral drugs, as well as new agents active against AIDS-associated opportunistic infections, have been developed and the first steps in the treatment of HIV infection and its associated illnesses have been taken.

Whereas most HIV infection has occurred in adults, it has become an increasing problem among children, particularly in certain geographic areas and populations, reflecting the changing nature of the epidemiology of the disease in the United States. In contrast with the early predominance among homosexual males,7 at present the most significant increases in both HIV infection and AIDS are occurring in users of illicit intravenous drugs, in heterosexual contacts of infected individuals, and in infants born to HIV-infected mothers.8 Nationwide the prevalence of HIV infection in childbearing women remains low; however, rates as high as 1% to greater than 4% have been reported from some urban areas.9,10 Although widely disparate rates of vertical transmission have been reported,11 ongoing prospective studies indicate that the rate of transmission from HIV-infected mother to infant appears to be in the range of 24% to 35%.12-14
Drugs and Breast Milk
Authors: KAUFFMAN RALPH E.
Published: December 2021

In Reply.—

In response to Dr Dorfman's concern regarding naproxen, the revised commentary included information only on drugs for which there was peer-reviewed published information. Information in the 1983 commentary which was based on personal communications, unpublished files, or secondary references and which could not be corroborated was not included in the revised commentary. We were unable to find published data on naproxen excretion in breast milk or absorption by the nursing infant. As stated in the current commentary, "the fact that a pharmacologic or chemical agent does not appear in the Tables is not meant to imply that it is not transferred into human milk... but indicates that there are no reports in the literature."
I.B.C.L.C
Authors: TANIS ARNOLD L. , COLEMAN ALLAN B. , GROSS LEON
Published: December 2021

To the Editor.—

With the increased emphasis by the American Academy of Pediatrics on infant nutrition, and especially on fostering breast-feeding, the availability of trained and credentialled persons to advise and support breast-feeding mothers and to assist pediatricians in this endeavor must be noted. The International Board of Lactation Consultant Examiners, Inc. (IBLCE) completed its fifth annual examination cycle in July, 1989. To date, 1231 candidates have been certified worldwide with more than 80% in the United States and Canada.
Routine Cholesterol Surveillance in Childhood
Authors: FELDMAN WILLIAM
Published: December 2021

To the Editor.—

The article by Garcia and Moodie1 on cholesterol screening in childhood is likely to receive considerable attention and may have an impact on pediatric practice. The observation of these authors that the usual high-risk family characteristics may, if used as sole criteria for screening, allow some hypercholesterolemic children to remain undetected is valid. However, their recommedation that "all children older than 3 years of age should have a cholesterol test" cannot go unchallenged.
Tin-protoporphyrin in the Management of Children With Crigler-Najjar Disease
Authors: RUBALTELLI FIRMINO F. , JORI GIULIO
Published: December 2021

In Reply.—

We have considered carefully the points raised by Dr McDonagh and answer as follows: Regarding points 1 and 2, Fig 2 (second plot from the bottom) of our paper clearly shows that administration of SnPp to the patient with Crigler-Najjar type 1 disease reduces the serum bilirubin concentration to values ranging between 12 and 15 mg/dL for at least a week. In the absence of SnPp treatment, the infant never reached such low levels even during sunny seasons, unless phototherapy was performed.
Ultrasonographic Studies in the Management of Recurrent Abdominal Pain
Authors: Shanon Amir , Martin David John , Feldman William
Published: December 2021

The medical records of 65 children and adolescents who had abdominal ultrasonography for the evaluation of recurrent abdominal pain were reviewed. Fifty-three subjects (81%) had normal results; in 12 cases (19%) an abnormality was detected. In no case could the pain be attributed to the abnormal finding. Furthermore, in 3 subjects, disclosure of the abnormal findings could have caused more harm than good. The role of the abdominal ultrasonographic study in the management of recurrent abdominal pain in children and adolescents is discussed.
Antroduodenal Manometry in the Evaluation of Chronic Functional Gastrointestinal Symptoms
Authors: Hyman Paul E. , Napolitano Judy A. , Diego Alice , Patel Swati , Flores Alejandro F. , Grill Bruce B. , Reddy S. Narasimha , Garvey Thomas Q. , Tomomasa Takeshi
Published: December 2021

Intraluminal pressure in the gastric antrum and duodenum was studied in 44 children and adolescents referred for evaluation because of functional symptoms, including vomiting, abdominal distension, and abdominal pain. Manometric abnormalities were found in 39 patients (89%). Abnormalities during fasting included absence of the migrating motor complex; retrograde, phase 3-like episodes; increased frequency, decreased duration, and decreased amplitude of phase 3 episodes; tonic duodenal contractions; nonpropagated bursts of duodenal contractions; and consistently low-amplitude or absent contractions. Postprandial abnormalities included a phase 1-like pattern (postprandial hypomotility) and phase 3-like episodes (failure to induce a fed pattern). The presence or absence of the migrating motor complex was a predictor of disability. Parenteral alimentation was needed by only 4 of 28 patients with the migrating motor complex, but by 13 of 16 patients without the migrating motor complex (P < .001). In 15 of 18 patients studied on consecutive days, oral cisapride was associated with increases in the number and amplitude of duodenal contractions after a complex-liquid meal (P < .02) It is concluded that antroduodenal manometry is a useful technique that elucidates the underlying gastrointestinal motility disorder present in the majority of children and adolescents with severe functional symptoms.
Aspartame: Effects on Learning, Behavior, and Mood
Authors: Saravis Susan , Schachar Russell , Zlotkin Stanley , Leiter Lawrence A. , Anderson G. Harvey
Published: December 2021

The effect of aspartame on the learning, behavior, and mood of children was evaluated in two experiments. After an overnight fast and a standard breakfast, 20 healthy 9- to 10-year-old children were given the treatments in a double-blind crossover design at 10:30 AM. Lunch was served at 12:00 noon. In experiment 1, the treatment consisted of an ice slurry of strawberry Kool-Aid containing 1.75 g/kg of carbohydrate (polycose) plus either aspartame (34 mg/kg) or the equivalent sweetness as sodium cyclamate and amino acids as alanine. In experiment 2, the treatment consisted of a drink of cold unsweetened strawberry Kool-Aid, containing either 1.75 g/kg of sucrose or 9.7 mg/kg of aspartame. Measures of associative learning, arithmetic calculation, activity level, social interaction, and mood were unaffected by treatment in experiment 1. In experiment 2, the only significant treatment effect was that on the frequency of minor and gross motor behaviors, which were less frequent after the consumption of sucrose than after aspartame. Thus, the effect of aspartame on the short-term behavior of healthy 9- to 10-year-old children appears to be related to its absence of metabolic consequences rather than to its amino acid composition and putative neurochemical impact.
Stimulant Medication Use by Primary Care Physicians in the Treatment of Attention Deficit Hyperactivity Disorder
Authors: Wolraich Mark L. , Lindgren Scott , Stromquist Ann , Milich Richard , Davis Charles , Watson Doretta
Published: December 2021

Treatment of attention deficit hyperactivity disorder (ADHD), one of the most common behavioral disorders in children in the United States, remains controversial because of concern about stimulant medication use. Extending a previous study of pediatricians, the present study surveyed a random national sample of family practitioners and then directly screened 457 patients of 10 pediatricians and family practitioners in two small midwestern cities. Responses to the national survey indicated that stimulant medication remains the main treatment prescribed by primary care physicians for children with ADHD. In the direct patient screening, the prevalence of ADHD diagnoses was 5.3% (pediatricians) and 4.2% (family practitioners) of all elementary-schoolaged children screened. Eighty-eight percent of these children were treated with methyiphenidate. Although medication was considered an effective treatment by the parents of 85% of the children given the medication, efficacy was unrelated to the accuracy of diagnosis. When explicit DSM-III-R criteria were used, only 72% of those assigned a diagnosis of ADHD by the physicians would have received that diagnosis based on a structured psychiatric interview with the parents and only 53% received that diagnosis based on teacher report of symptoms, even when the child was not receiving medication. Although the majority of physicians (in both the surveys and the direct screenings) reported using at least some behavioral treatments with their patients, parents reported infrequent use of nonpharmacologic forms of therapy, such as behavior modification. These data thus indicate a relatively modest rate of stimulant medication use for ADHD, but a serious underuse of systematic behavioral treatments in primary care.
Elevated Levels of Fetal Hemoglobin Synthesis in Infants With Bronchopulmonary Dysplasia
Authors: Bard Harry , Prosmanne Janie
Published: December 2021

A study was devised to determine whether levels of fetal hemoglobin (HbF) synthesis are elevated in infants with bronchopulmonary dysplasia (BPD) when compared with the levels of HbF synthesis found in normal control infants. Twelve infants with BPD, whose postconceptional ages ranged from 40 to 62 weeks, were studied. The mean (±SD) gestational age and birth weight was 29 ± 1.9 weeks and 1289 ± 376 g, respectively. Elevation infants matched for birth weight, gestational age, and postnatal age served as the control subjects. Blood samples were incubated in an amino acid mixture containing [14C]leucine. The adult hemoglobin and HbF were then separated by column chromatography on diethylaminoethyl-Sephadex. The results demonstrated that the mean (±SD) level of HbF synthesis in infants with BPD was significantly higher than that in the control infants (42.6 ± 22.9% vs 18.8 ± 12.8%; P < .01). When levels of HbF synthesis in the infants with BPD and the control infants were compared with data previously reported in normal infants, 7 of the 12 infants with BPD, but none of the control infants, were synthesizing amounts of HbF greater than would be expected for their postconceptional age. The results suggest that cardiopulmonary insufficiency could stimulate HbF synthesis during the first year of life as a result of an erythropoietic response to hypoxemia.
Cosleeping in a Community Sample of 2- and 3-Year-Old Children
Authors: Madansky Deborah , Edelbrock Craig
Published: December 2021

A randomly selected community sample of 303 parents of 2- and 3-year-olds were interviewed about child sleep behaviors and completed the Child Behavior Checklist for Ages 2-3, a standardized rating scale for child problem behaviors. Most parents (55%) reported that the child slept in their bed at least occasionally and for at least part of the night, particularly during periods of minor stress or disruption of the family routine. The prevalence of cosleeping did not vary by the child's age or sex, but frequent cosleeping (more than once per week) was more common among nonwhite families and singlemother households. Cosleeping was not significantly related to child behavior problems, but frequent cosleepers were more likely to report sleep problems, including difficulty getting to sleep and night waking. Children who were still cosleeping frequently 1 year after the initial assessment maintained high levels of sleep problems, compared with those who stopped cosleeping and noncosleepers. Cosleeping is common at this age and is not related to general maladjustment. However, frequent cosleeping is closely intertwined with child sleep problems.
Oral Habilitation of the Child With No Response on Brainstem Audiometry
Authors: Connolly Patrick K. , Stout Gayle G. , Williams Susan T. , Jorgensen Sheryl , Smith Richard J.H.
Published: December 2021

Children without an auditory brainstem evoked response can benefit from an auditory-oral hearing habilitation program. This study focuses on 31 such children enrolled at the Houston School for Deaf Children. Eleven had excellent auditory-oral skills, with language ability equal to normal-hearing children of a similar age, and speech easily intelligible to a familiar listener. A statistically significant factor associated with success was hearing acuity at 250 Hz. Other important factors included age at enrollment at the school, duration of enrollment, degree of parental support, and absence of middle ear disease.
Intravenous Desmopressin Acetate in Children With Sickle Trait and Persistent Macroscopic Hematuria
Authors: Baldree Lou Anne , Ault Bettina H. , Chesney Carolyn M. , Stapleton F. Bruder
Published: December 2021

Persistent gross hematuria associated with sickle hemoglobinopathy that fails to respond to conventional supportive therapy represents a difficult management dilemma. Two such patients with protracted, often painful, sickle trait macrohematuria are described. Both patients had normal renal anatomy and vasculature and had failed to respond to bed rest, intravenous hydration, and a trial of oral є-aminocaproic acid. Patient 1 had normal coagulation function. Patient 2 had von Willebrand disease (decreased factor VIII antigen and quantitative ristocetin cofactor activity). Patient 1 responded to intravenous desmopressin acetate at a dose of 0.3 µg/kg with a 155% increase in factor VIII clotting activity and a 135% increase in ristocetin cofactor and cessation of her macrohematuria within 18 hours after completion of the desmopressin infusion. She remained free of gross hematuria for 5 months with the exception of short-lived trauma-induced hematuria (in three voids) 6 weeks after desmopressin therapy. Patient 2 did not respond to intravenous desmopressin infusion despite a 234% and a 360% increase in factor VIII clotting activity and ristocetin cofactor, respectively. Intravenous desmopressin acetate may be helpful in halting protracted significant macrohematuria associated with sickle trait hemoglobinopathy in some patients when conventional management fails.