bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Rifampin Chemoprophylaxis on Carriage Eradication and New Acquisition of Haemophilus influenzae Type b in Contacts
Authors: Glode Mary P. , Daum Robert S. , Boies Eyla G. , Ballard Terri Lynn , Murray Martha , Granoff Dan M.
Published: December 2021

We conducted a multicenter trial designed to assess the efficacy of three different drug regimens on eradication of Haemophilus influenzae type b (HIB) from the nasopharynx of household contacts of patients with invasive type b Haemophilus disease. The drug regimens studied were rifampin, 20 mg/kg, once daily for four days; rifampin, 10 mg/kg, twice a day for four days; and placebo, once daily for four days. Shortly after admission of the index patient to the hospital, 26% of 492 household contacts were found to be colonized with HIB. Both rifampin regimens eradicated carriage significantly better than placebo at 10 and 30 days (P = .001). However, among contacts whose cultures were initially negative, new acquisition of the organism occurred infrequently in this 30-day follow-up period regardless of the drug or placebo regimen prescribed. We also measured the concentration of anticapsular antibody in sera obtained from contacts younger than 6 years of age. Samples were obtained soon after admission of the index patient to the hospital and 30 days later. Several carriers younger than 2 years of age had low concentrations of antibody in both specimens. In contrast, nearly all carriers 2 to 5 years of age had high concentrations of antibody even in the first sample. Children who were not carriers usually had low antibody concentrations which did not increase during the period of observation. Our results suggest that most intrafamilial spread of HIB occurs prior to hospitalization of the index patient and stimulates immunity in contacts older than 2 years of age. Although rifampin decreases the carriage rate, new acquisition of HIB continues to occur at a low rate among contacts, even in those who receive rifampin prophylaxis.
Counseling Parents of Adolescents
Authors: Leiman Alan H. , Strasburger Victor C.
Published: December 2021

A certain amount of turmoil and stress is inevitable during adolescence. Parents of adolescents can help to reduce these by providing effective communication, enhancing their teenager's self-image, helping with decision-making, and using effective discipline. Resolution of the typical "independence-dependence" conflict using these principles will help produce responsible and independent adolescents rather than rebellious ones.
Adolescent Contraception: An Update
Authors: Kulig John W.
Published: December 2021

Increased adolescent sexual activity in the past decade has resulted in corresponding increases in pregnancy, childbirth, and abortion, as well as a changing spectrum of sexually transmitted diseases. Contraceptive use in this age group remains limited and is subject to developmental, peer, family, and cultural influences. The most appropriate contraceptive methods may differ among adolescents when compared with older parous women based upon such factors as efficacy, availability, cost, side effects, reversibility, and the need for preplanning. This review updates changes in patterns of contraceptive use among adolescents, presents recent data on both the benefits and the potential risks of the oral contraceptive pill, and addresses the risk of complications with the intrauterine device. The possible teratogenicity of spermicides, the risk of toxic shock syndrome with barrier methods of contraception, and controversy about the use of depot medroxyprogesterone acetate are explored. Newly introduced methods such as the triphasic pill, vaginal sponge, cervical cap, spermicidal condom, and a simplified approach to postcoital contraception are discussed. Finally, recent compliance studies conducted among adolescents are reviewed.
Long-Term Morbidity of Infants With Bronchopulmonary Dysplasia
Authors: Sauve Reg S. , Singhal Nalini
Published: December 2021

Bronchopulmonary dysplasia occurred in 179 infants discharged from a regional neonatal intensive care unit between 1975 and 1982. Perinatal and outcome factors were compared for these study infants and a group of 112 controls matched for birth weight category and year of birth. There were multiple differences between study infants and controls in demographic, diagnostic, and therapeutic items, all of which were categorized as pulmonary items occurring before and after the development of bronchopulmonary dysplasia, and nonpulmonary items. The postdischarge death rate was 11.2% in infants and 0.9% in control infants (P < .001). Ongoing morbidity was most marked in the areas of health history, physical examination, growth, and vision. Neurodevelopmental abnormalities and hearing abnormalities occurred slightly more frequently in study infants than in controls but not significantly so. Major developmental abnormalities were less frequent in this population than has been the case in other follow-up studies in this area. This group of infants requires close postdischarge observation because ongoing morbidity and postdischarge mortality, part of which may be preventable, are frequent.
Lethal Familial Pellagra-like Skin Lesion Associated With Neurologic and Developmental Impairment and the Development of Cataracts
Authors: Salih Mustafa A. M. , Bender David A. , McCreanor Gwyn M.
Published: December 2021

A new hereditary defect of tryptophan metabolism is described in a Sudanese family with a high degree of consanguinity. It has an autosomal recessive pattern of inheritance. The condition manifests as a pellagra-like skin rash within 8 weeks after birth, with signs of cerebellar ataxia and developmental retardation. Cataracts develop early, and to date none of the ten affected children has survived beyond 2 years of age. Biochemically, the condition is characterized by an apparent impairment of the ability to synthesize quinolinic acid and nicotinamide nucleotides from tryptophan, which might be due to abnormally high activity of the enzyme picolinate carboxylase.
Slipping Rib Syndrome: An Infrequently Recognized Entity in Children: A Report of Three Cases and Review of the Literature
Authors: Porter Gerald E.
Published: December 2021

Slipping rib syndrome is a sprain disorder produced by trauma to the costal cartilages of the 8th, 9th, and 10th ribs. The symptoms are neuritic pain, autonomic symptoms, and a perception of a slipping movement of the ribs. It is frequently confused with intraabdominal disorders. Diagnosis is made by a positive hooking maneuver or demonstration of tenderness over the affected cartilages. Three case reports, a review of the literature, and a discussion of the syndrome are presented.
Maturational Changes of Caffeine Concentrations and Disposition in Infancy During Maintenance Therapy for Apnea of Prematurity: Influence of Gestational Age, Hepatic Disease, and Breast-Feeding
Authors: Le Guennec Jean-Claude , Billon Bernard , Paré Claude
Published: December 2021

Twenty-three premature infants receiving caffeine maintenance therapy were followed prospectively for several months. Three to nine determinations of caffeine half-life (peak and trough caffeine levels) were made in each baby. This first longitudinal study confirmed that the half-life of caffeine is prolonged during the neonatal period (97.6 + 32 hours and for as many as 38 weeks' gestation in several very premature babies). Contrary to previous assumptions, gestational age and postconceptional age seem to be closely related to maturation of hepatic caffeine elimination after the neonatal period, although a high variability of caffeine half-life was observed between infants. Adult values (6 hours) were obtained about 60 weeks postconceptional. Caffeine half-life was greatly increased in two infants who had cholestatic hepatitis secondary to prolonged parenteral alimentation and one infant who was breast-fed exclusively. In this last case, the role of maternal hormones in repressing the normal enzymatic maturation process is strongly suspected. Adequate blood levels of caffeine were usually obtained with a caffeine half-life greater than 30 hours up to 46 weeks postconceptional with a dose of 5 mg/kg of caffeine citrate. Caffeine predose monitoring is adequate up to 46 weeks postconceptional, and caffeine half-life determination is mandatory whenever the trough level is too high or too low, icterus is present, and from 46 to 50 weeks postconception.
Can Fussy Babies Be Spoiled?
Authors: TAUBMAN BRUCE
Published: December 2021

In Reply.—

Dr Jones is of course correct that, in the literal sense, colic means abdominal pain. However, in my article1 the term is used in the clinical sense to refer to a medical syndrome of excessive crying of unknown cause beginning in otherwise healthy infants less than 3 months of age. Implicit in this definition of the syndrome is that the infants have no obvious gastroenterologic symptoms such as constipation, diarrhea, or vomiting, as was true of all the infants in the study.
Black Patients—White Doctors
Authors: RYAN RICHARD H.
Published: December 2021

To the Editor.—

I think it is unfortunate that Dr Levy ("White Doctors and Black Patients: Influence of Race on the Doctor-Patient Relationship," Pediatrics 1985;75:639-643) practices in an area where black patients are perceived as uneducated, indigent, and uncooperative.

In northern Virginia, the black patients in our practice are generally well-educated, motivated, and committed to being good parents. As far as I can tell they have the same concerns as any parent (Has their child been molested? Will he or she read well, do well in school, have friends?) and the same strong desire for a healthy child who will be a productive citizen and have a family.
BOOK REVIEW
Authors: Bergman Abraham B.
Published: December 2021

What is my least favorite aspect of pediatric practice? Easy. It's the boredom stemming from endless repetition of the same basic informaton. That information, for the most part, is a variation of the theme: "This symptom or physical finding is within the range of normal and will not impair your child's health." I usually put it less politely. During the winter months I cannot stand to listen to myself explain for the n'teenth time that we have no effective measures to treat colds or eliminate coughs.
Annual Meeting of the Section on Pediatric Urology
Authors: GLASSBERG KENNETH I.
Published: December 2021

The Section of Urology of the American Academy of Pediatrics met for three days in conjunction with the 53rd annual meeting of the Academy in Chicago. Papers and panel discussions that would be of interest to the pediatrician are summarized herein according to topic. As there has been an increasing number of basic research papers presented in recent years, the Section, this year, initiated a prize for basic research. Also new to the meeting was the awarding of the first annual Pediatric Urology Medal, which was given to Harry Spence for contributions made to the field.

TESTICULAR TORSION

Recent reports of unilateral testicular torsion have suggested that adverse effects may occur to the contralateral testicle, if the ischemic testicle is treated by surgical detorsion and left in place rather than removed.1-4 Three authors addressed this problem by investigating animal models.

Animal Models

In prepubertal rats undergoing experimentally produced testicular torsion, Rabinowitz and associates found histologic changes in the contralateral testicle. The changes in the contralateral testicle were dependent upon the duration of torsion and were significantly greater when the ischemic testicle was detorsed and left in place. The degree of histologic changes in the ischemic testicle, especially the degree of germ cell damage, was the best prediction of long-term damage to the contralateral testicle. In the animal model, these changes could be averted by removing the ischemic testicle. Although not going as far to recommend orchiectomy as the treatment of choice for all cases of torsion, Dr. Rabinowitz did suggest that a testicular biopsy in prepubertal boys with testicular torsion may be a reliable index to subsequent long-term contralateral damage if the ischemic testicle is detorsed and pexed rather than removed.
Smokeless Tobacco—A Carcinogenic Hazard to Children
Authors:   Committee on Environmental Hazards
Published: December 2021

The term smokeless tobacco refers to snuff, chewing tobacco, and other forms of tobacco that are placed in the mouth or nose and not ignited.1 An estimated 11 to 22 million Americans use smokeless tobacco regularly. The average user is between the ages of 18 and 30 years.1 Smokeless tobacco is a cause for concern among pediatricians because, despite the well-documented hazards to health, its use is increasing rapidly among children and adolescents.

Smokeless tobacco is a proven human carcinogen.2 As early as 1761, the British physician John Hill described cases of cancer in snuff users.3 Hill wrote "No man should venture upon snuff who is not sure that he is not liable to cancer, and no man can be sure of that." (In eighteenth century Britain, snuff was taken intranasally and caused cancer of the nasal cavity. Today, a pinch of snuff is typically tucked into place between the lip and the gum.) More recently, it has been confirmed that snuff is a major cause of oral cancer in this country, and a fourfold increase in risk of cancer of the mouth and pharynx has been reported among women who regularly used snuff.4 Among women who had used snuff for 50 years or more, the risk of cancer of the gingival and buccal mucosa was elevated 47-fold above background.4 These risks were independent of cigarette smoking.

Laboratory confirmation of the carcinogenicity of smokeless tobacco has been provided by identification of N-nitrosonornicotine and other carcinogenic nitrosamines in extremely high concentrations in both snuff and chewing tobacco.5
Health Hazards of Cow's Milk
Authors: OSKI FRANK A.
Published: December 2021

In Reply.—

An exchange of letters in a journal is an unsatisfactory forum to conduct an international debate but I feel compelled to respond to the correspondence of Professor Tönz.

Professor Tönz expresses concern that my remarks may be interpreted as "recommending the abolishment of feeding practices that have developed over the centuries..." Are the feeding practices that Professor Tönz has in mind the introduction of whole cow's milk before the infant is 1 year of age or the use of whole milk after the first year of life? Neither practice has been in place for centuries "all over the world."
Normal Cerebrospinal Fluid Values
Authors: CORY MATTHEW J.
Published: December 2021

To the Editor.—

I read with interest the article, "Normal Cerebrospinal Fluid Values in Children: Another Look," by Portnoy and Olson (Pediatrics 1985;75:484-487). Their data certainly have relevance to the problem of interpretation of minimal pleocytosis discovered in the evaluation of the febrile child. Perhaps, because they excluded patients with CNS disease from chart review, they failed to find an additional useful piece of information, ie, the incidence of bacterial meningitis in children with the same or similar CSF pleocytosis.
Normal Cerebrospinal Fluid Values
Authors: OLSON LLOYD C. , PORTNOY JAY M.
Published: December 2021

In Reply.—

When the CSF findings from a large series of children with acute bacterial meningitis are analyzed, a small number will be found to contain few or no cells. Cory's analysis has looked at this in another way, namely, that, of all children with minimal pleocytosis, only a very few—or none—will have meningitis. Some will, however, and it is also important to recognize this. We did note in our article that bacteria may be present in otherwise normal CSF (our references 16 to 20).
Vietnamese Are Not Genetically Short
Authors: DEINARD AMOS S.
Published: December 2021

To the Editor.—

Dr Stickler, in a recent commentary (Pediatrics 1984;74:559), mentions as an example of genetic short stature the child of a Vietnamese refugee. My experience during the past 5 years with the Vietnamese as well as the other Southeast Asian groups (lowland Lao, Hmong, and Cambodian) who have immigrated to the United States since 1979 suggests that their growth may be no different from that of post-World War II Japanese children, ie, with good maternal and postnatal medical care and nutrition, children will grow at levels comparable to American children on whom the growth curves were normed.
Impact of an Intermittent Catheterization Program on Children With Myelomeningocele
Authors: Uehling David T. , Smith Janet , Meyer Jane , Bruskewitz Reginald
Published: December 2021

Among 164 children being followed in a myelomeningocele clinic, 85 (52%) are on an intermittent catheterization program (ICP). Among 53 children on ICP for 5 years or more, a high percentage have achieved satisfactory dryness, decreased frequency of urinary tract infection, and improvement in renal status. The potential for improved well-being afforded by ICP is one factor that should be considered in decisions about "active" or "supportive" treatment in newborn infants with myelomeningocele.
Effects of Neonatal Polycythemia and Partial Exchange Transfusion on Cardiac Function: An Echocardiographic Study
Authors: Murphy Daniel J. , Reller Mark D. , Meyer Richard A. , Kaplan Samuel
Published: December 2021

Although infants with neonatal polycythemia and hyperviscosity often present with cardiorespiratory distress, little information is available regarding the cardiac function of such babies before or after partial exchange transfusion. To assess cardiac function, we performed M-mode echocardiograms in 19 asymptomatic newborn infants (4 to 12 hours of age) who had venous hematocrits greater than 65%. The echocardiograms were performed immediately prior to and following partial exchange transfusion and were repeated at 48 hours of age. Eighteen matched newborn controls also underwent echocardiography within the first 12 hours of life and again at 48 hours. Polycythemic newborns had elevated right ventricular preejection period to right ventricular ejection time ratios compared with controls (0.46 ± 0.11 v 0.37 ± 0.04, P = .002), suggestive of increased pulmonary vascular resistance. These indexes normalized following partial exchange transfusion. In addition, the polycythemic newborns were relatively bradycardic prior to exchange (116 ± 13 beats per minute v 125 ± 16 beats per minute, P < .05), but heart rates normalized following the procedure. At 48 hours, the polycythemic and control groups were different only in that the mean shortening fraction of the polycythemic group was lower than that of the controls (32% ± 4% v 36% ± 6%, P = .02). The findings are consistent with elevated pulmonary vascular resistance associated with polycythemia and hyperviscosity. Cardiac output may be lower in polycythemic infants. The finding of reduced fractional shortening in polycythemic infants at 48 hours following partial exchange transfusion is unexplained.
Ureteropelvic Junction Obstruction Presenting With Recurrent Abdominal Pain: Diagnosis by Ultrasound
Authors: Byrne William J. , Arnold Watson C. , Stannard Michael W. , Redman John F.
Published: December 2021

Three cases of ureteropelvic junction obstruction are presented in which the only symptom was recurrent abdominal pain. Results of physical examination and urinalysis were normal. Ultrasound established the correct diagnosis in the two patients in whom it was performed. Because it is safe, involves no radiation exposure, and is useful in evaluating the gallbladder, pancreas, and liver, as well as both kidneys, abdominal ultrasound should be performed prior to contrast radiography in the evaluation of children with recurrent abdominal pain.
Muscle Involvement in Progressive Diaphyseal Dysplasia
Authors: Naveh Yehezkel , Ludatshcer Ruth , Alon Uri , Shart Benjamin
Published: December 2021

Muscle involvement in progressive diaphyseal dysplasia was evaluated in five children, of whom four were members of one family. Age range was 2 to 10 years 9 months, and mean age was 5.5 years. Evaluation included serum enzymes, electromyography, and muscle biopsy examined by light and electron microscopy. Serum enzymes were usually noncontributory. Electromyography revealed "myopathic pattern" in four of the five patients. Muscle biopsy specimens were taken from three of the five children, including two patients from one family, of whom one had normal electromyography, and one sporadic case. Examination of the biopsy specimens by light microscope was generally not useful, whereas electron microscopic examination revealed myopathic and vascular changes consisting of atrophy of isolated muscle fibers, accumulation of endomysial collagen fibrils, and thickening of the perivascular basement membrane. The main contribution of this study is to describe electron miscroscopic vascular changes in muscles that appear to be similar in familial and sporadic cases of progressive diaphyseal dysplasia.
Establishment and Evaluation of a Pilot Child Car Seat Rental Scheme in New Zealand
Authors: Geddis David C. , Appleton Ian C.
Published: December 2021

The method of operation of a pilot car seat rental scheme is described. It is unique in that there are sufficient seats to accommodate every newborn infant in the city. Both infant and child seats are available. The pattern of use since the establishment of the scheme in December 1981 is reported. Currently 60% to 70% of parents rent infant seats and 35% to 40% rent child seats. Yearly roadside observations have shown a steady increase in the number of restrained children. In 1981 no infants traveled in approved restraints. In 1984 66% did so. The 1984 results for other age groups were: 6 to 18 months of age, 88%; 18 months to 2½ years of age, 82%; 2½ to 3½ years of age, 66%; 3½ to 4½ years of age, 62%. At this time no legislation applied to children less than 8 years of age. The success of this pilot scheme suggests it should be expanded on a national scale.
Views of Graham Challenged
Authors: GRAHAM GEORGE G.
Published: December 2021

In Reply.—

Dr Christoffel and her colleagues would have been correct if they had surmised that the author's intent was to promote discussion of the way in which public policy has been and is made in such important matters as the nutritional status and health of our children, as well as the prevention of low birth weight and its associated morbidity and mortality. If they are regular readers of Pediatrics they know that the journal has long had a "Letters" section in which readers have the opportunity to comment on published material.
Children in Self-Care: A New Priority for Pediatricians
Authors: FOSARELLI PATRICIA
Published: December 2021

Everyday in this country, approximately 2 to 5 million 6- to 13-year-old children are in their own care1,2 (US News and World Report, Sept 14, 1981, pp 42, 47). In addition, at least 20,000 children younger than 6 years care for themselves.1 These figures are estimates because many parents do not like to admit to the practice of leaving their children alone. The most common time children are in selfcare is after school, and the most common reason is because their parents work and alternative care arrangements might be unavailable or unaffordable. Currently, 47% of mothers of preschool children and 64% of mothers of school-aged children work outside of the home.3 This situation, coupled with the increasing number of families headed by women, the staggering 50% divorce rate in this country, and the disappearance of the extended family, creates a situation in which certain children must care for themselves.
Chest Pain
Authors: SELBST STEVEN M.
Published: December 2021

In Reply.—

Dr Rogers describes brief anterior chest pain, worse with inspiration, which he has labeled "benign pleuralgia." The etiology of this pain, as with most chest pain, is uncertain. Perhaps, the pain arises in the pain-sensitive pleura and then travels through the intercostal nerves in the chest wall. If such pain is not reproducible with palpation, and not related to recent exercise, I would not consider this to be of musculoskeletal origin.

Although some may prefer to consider this a distinct clinical entity, I would "lump" such vague, unexplainable pain in the idiopathic category.
Rehydration
Authors: SANTOSHAM MATHURAM , SACK R. BRADLEY
Published: December 2021

In Reply.—

We do not believe that our recent study was mistitled. The difference between patients who have 5% or more weight loss compared with those who have less than 5% weight loss (minimal dehydration) as a result of diarrhea is that the former patients have clinically visible signs of dehydration and require a larger volume of fluids to replace their deficit. Patients with minimal dehydration have no clinical signs of dehydration and require a smaller volume of replacement fluids.
On Partial Splenectomy in Gaucher's Disease
Authors: BAR-MAOR J. A. , GOVRIN-YEHUDAIN J.
Published: December 2021

In Reply.—

We appreciate the thoughtful comments of Stellin et al about the possibility of recurrent hypersplenism after partial splenectomy in Gaucher's disease. Fortunately, it did not happen (yet?) in our patients, although in one of them the remaining spleen enlarged considerably. (Our paper was sent for publication in July 1984, and since then there was a significant growth of the remaining spleen.) We even raised the question whether this growth is actually not a sign of regeneration of the spleen induced by partial splenectomy.
Red Man Syndrome: Inadvertent Administration of an Excessive Dose of Rifampin to Children in a Day-Care Center
Authors: Bolan Gail , Laurie Robert E. , Broome Claire V.
Published: December 2021

A cluster of toxic reactions among children inadvertently given excessive doses of rifampin for chemoprophylaxis of invasive Haemophilus influenzae disease in a day-care center was investigated. In all 19 children, who received five times the therapeutic dose of rifampin, dramatic adverse reactions developed. A striking, "glowing" red discoloration of the skin and facial or periorbital edema were found to be the hallmarks of rifampin toxicity. These clinical signs of acute toxicity contrast sharply with the adverse side effects of rifampin reported with therapeutic doses.
Abnormal Truncal Muscle Tone as a Useful Early Marker for Developmental Delay in Low Birth Weight Infants
Authors: Georgieff Michael K. , Bernbaum Judy C. , Hoffman-Williamson Marsha , Daft Andrea
Published: December 2021

Thirty-four outborn premature infants of appropriate gestational ages with birth weights less than 1,750 g were seen in follow-up at 3, 6, 12, and 18 months, corrected age to assess the incidence of abnormalities of muscle tone and the relationship of the site of early abnormalities to 18-month developmental status. The incidence of abnormal tone was most common at 3 months and declined with increasing age. The percentages of infants with abnormal tone at 3, 6, 12, and 18 months, respectively, were: increased lower extremity tone—62%, 71%, 38%, 9%; decreased lower extremity tone—3%, 3%, 6%, 9%; increased truncal tone—41%, 15%, 6%, 0%; decreased truncal tone—21%, 18%, 15%, 6%. Infants with truncal hypertonicity at 3 months had significantly lower Bayley motor and mental scores at 18 months when compared with infants with normal truncal tone (P < .05). However, infants with lower extremity hypertonicity at 3 months were no different developmentally at 18 months from infants with normal tone. Infants with truncal or lower extremity hypotonicity fared the worst developmentally (P < .05). We conclude that there is a high incidence of abnormal muscle tone in premature infants up to 18 months of age and that early truncal tone abnormalities are associated with a worse developmental outcome.
Ventilatory Patterns During Hypoxia, Hypercapnia, and Exercise in Adolescents With Mild Scoliosis
Authors: Smyth R. J. , Chapman K. R. , Wright T. A. , Crawford J. S. , Rebuck A. S.
Published: December 2021

Adolescents with mild, asymptomatic scoliosis (thoracic curvature <35°) may have little or no impairment of resting lung volumes. Progression to more severe disease may, however, be accompanied by lung restriction, impaired exercise tolerance, and respiratory failure with CO2 retention. We wished to see whether adolescents with mild scoliosis and minimally abnormal resting pulmonary mechanics had impairment of their responses to hypercapnia, hypoxia, and progressive cycle exercise. Forty-four adolescents with idiopathic scoliosis were studied. The mean forced vital capacity (FVC), expressed as a percentage of the predicted value, was 94.3 ± 2.2 (SE). The mean ventilatory response to hypercapnia (2.57 ± 0.24 L/min/mm Hg) was within the normal range but was achieved with a tidal volume response (1.87 ± .17% vital capacity [VC]/mm Hg) that was significantly lower than that previously reported in healthy young adults. Ventilatory responses to exercise were also within the normal range, the mean dyspnea index (VE-max/maximal voluntary ventilation) = 0.92 ± 0.04. However, at a ventilation of 30 L/min, the tidal volume was 0.38 ± 0.01% FVC, which was considerably lower than predicted. The tidal volume response to hypoxia was also abnormally low, the mean response being 0.52 ± 0.059% VC/% decrease in arterial O2 saturation. These findings indicated that, even when scoliosis is asymptomatic and associated with minimal impairment of resting pulmonary function, abnormal patterns of ventilation occur during exercise or in response to chemical stimuli.
Medicaid Policy Statement
Authors:   Committee on Child Health Financing
Published: December 2021

The American Academy of Pediatrics recognizes the achievements of the Medicaid program in reducing financial barriers to health care for poor children; however, the legislative intent of the program has yet to be fully achieved.

An administrative structure focused on ensuring access to acute care and long-term care has allowed vital preventive care for children to languish while program expenditures have soared.

Confusing eligibility requirements have eliminated many of the neediest children from program participation.

State discretion in covered services has resulted in major disparities among geographical areas, leaving many eligible children with inadequate care.

The American Academy of Pediatrics in its desire to uphold the quality of children's care and in accordance with its standards seeks to remedy this situation. The following specific proposals are the minimum provisions that the Medicaid program should include for its child beneficiaries.

I. Eligibility

A. The sole determinant of program eligibility for children should be financial need. Categorical requirements, eg, only children from single-parent families, should be eliminated from eligibility criteria.

B. The means test for children should include limits on readily disposable assets and an income standard at least equal to the federal poverty line.

1. The income standard could be adjusted to reflect geographical differences and should be recalculated annually to reflect changes in the federal poverty income standard.

2. "Spend-down" provisions for children in families whose income before medical expenses exceed the eligibility limit should be continued.

C. Automatic eligibility of unborn and newborn children should be included as long as the child's family meets the means test requirements.
Charcoal Burns
Authors: WIEBE ROBERT A. , YAMAMOTO LOREN G.
Published: December 2021

Burns of the hands and feet caused by injudicious disposal of burning charcoals is a previously unreported cause of burn morbidity and occurs not infrequently in children in Hawaii and, likely, in other resort communities. Because burns of the hands and feet often result in need for long-term rehabilitative therapy and often serious functional loss, recognition by the pediatric community of this totally preventable problem is an important component of health and safety education. Charcoal burns in infancy generally results from improper disposal of used coals and could be completely avoided by public awareness of the scope and significance of this problem.
Prevention of Intraventricular Hemorrhage With Phenobarbital Therapy: Now What?
Authors: DONN STEVEN M. , GOLDSTEIN GARY W. , ROLOFF DIETRICH W.
Published: December 2021

In the April issue of Pediatrics, Kuban and colleagues1 report on what is now the largest trial of phenobarbital administration to prevent neonatal intraventricular hemorrhage. They randomized 280 ventilator-dependent preterm infants weighing less than 1,751 g at birth. Three affiliated intensive care nurseries collaborated during a 3-year period to enroll a sample size determined by a prospective statistical analysis to test a predicted reduction of intraventricular hemorrhage by 50% in treated patients. Infants were entered into the trial only if they were receiving assisted ventilation before 12 hours of age and had no evidence of intraventricular hemorrhage by sonographic examination. This clinical trial was well designed and carefully run.
Intellectual Development in School-Aged Children With Asymptomatic Congenital Cytomegalovirus Infection
Authors: Conboy Thomas J. , Pass Robert F. , Stagno Sergio , Britt William J. , Alford Charles A. , McFarland Carl E. , Boll Thomas J.
Published: December 2021

Congenital cytomegalovirus infection occurs in about 1% of live births. Although symptomatic congenital infection often results in severe developmental deficits and mental retardation, about 90% have asymtomatic infection. Previous studies of the intellectual development in children with asymptomatic congenital cytomegalovirus have resulted in mixed findings. To control for the effects of hearing impairment (which occurs in about 15% of asymptomatic children) on intelligence scores, we tested 18 prospectively followed, normally hearing, school-aged children with asymptomatic congenital cytomegalovirus (15 black, ten male) and 18 controls matched for age, sex, race, school grade, and socioecnomic status. Children were tested via the Wechsler Intelligence Scale for Children-Revised, the Kaufman Assessment Battery for Children, and the Wide Range Achievement Test. Multivariate analysis revealed no differences between groups on intelligence scores or subscales, achievement scores, or incidence of learning disabilities (defined as significant discrepancy between intelligence and achievement), and mean scores for both groups were very close to national norms. It is concluded that the 25,000 children born in the United States each year with asymptomatic congenital cytomegalovirus and normal hearing are not likely to be at increased risk of mental impairment.
Near Miss Sudden Infant Death Syndrome Episodes? A Clinical and Electrocardiographic Correlation
Authors: Krongrad Ehud , O'Neill Linda
Published: December 2021

The study was carried out to validate objectively the relationship between clinical impressions of parents and ECG evidence of life-threatening arrhythmias in infants considered to be at high risk. Twenty infants considered to be at high risk were provided with a hospital grade home monitor with a hard copy-recording capability (n = 12) and/or an ECG telephone transmision system (n = 8). There were 93 alarms considered by the parents as true alarms. All of the ECG tracings recorded during the 93 episodes were normal. Infant stimulation was provided for 11 infants and was not administered during 82 of these alarms. None of the infants died and all are well at 1 year of age. Our data raises questions regarding parental clinical ability to correctly perceive a true near miss episode in most cases and may explain, in part, the lack of consistency noted in previously published physiologic studies of "high risk" populations. Finally, the study raises further questions regarding the use of parental impression alone without supportive objective data as an indication for therapy in the majority of such patients. Research efforts and application of therapeutic measures will benefit greatly by development of objective data to support and supplement parental clinical observations.
Vision Screening and Eye Examination in Children
Authors:   Committee on Practice and Ambulatory Medicine
Published: December 2021

Vision screening and eye examination are important for the detection of conditions that distort or suppress the normal visual image and, ultimately, may lead to blindness in children. Examination of the eyes can and should be performed at any age, beginning in the newborn period. Vision screening should be performed at as early an age as is practicable. Conditions that interfere with vision are of grave import because visual stimuli are critical to the development of normal vision. Decreased visual acuity often contributes to inadequate school performance. In addition, retinal abnormalities, cataract, glaucoma, retinoblastoma, eye muscle imbalance, and systemic disease with ocular manifestations may all be identified by careful examination.

Vision screening should be carried out as part of a regular plan of continuing care, beginning in the preschool years. Screening examinations may be effectively performed by paramedical personnel under appropriate medical supervision. As with other specialty areas, it is important for the pediatrician to establish contact with an area ophthalmologist in the same geographical area who is familiar with children's eye problems. A close working relationship with such a specialist will clarify questions about procedures for eye screening as well as indications for referral.

TIMING OF EXAMINATION AND SCREENING

Children should have age-appropriate assessment for eye problems in the newborn period and at subsequent health supervision visits. Vision screening can begin as early as 3 years of age. Infants at risk for eye problems, such as retrolental fibroplasia, or those with a family history of congenital cataracts, retinoblastoma, and metabolic and genetic diseases should have an ophthalmologic examination in the nursery.
Pseudomonas aeruginosa Otitis Externa in an Infant Associated With a Contaminated Infant Bath Sponge
Authors: SHETH KUMUDCHANDRA J. , MILLER ROBERT J. , SHETH NEELA K. , REMENUIK EUDOKIA , MASSANARI R. MICHAEL
Published: December 2021

Pseudomonas is a Gram-negative bacterium frequently recovered from environmental sources, particularly an aquatic environment. Epidemics of skin rash,1 otitis externa,2 isolated cases of urinary tract infections,3 and pneumonia4 have been associated with whirlpools contaminated by Pseudomonas aeruginosa. This report describes P aeruginosa otitis externa in an infant associated with a contaminated infant bath sponge.

CASE REPORT

K.E., a 3-month-old, first born, healthy girl was seen for drainage from the left ear. She was listless and febrile and had a moderate amount of whitish drainage from the left ear canal. There was no discharge from the right ear canal, but on examination there was right otitis media.
Sexual Abuse of Boys
Authors: Spencer Mary J. , Dunklee Patricia
Published: December 2021

To determine factors in the sexual abuse of boys, we reviewed medical records of 140 boys who were seen for evaluation at the Children's Hospital and Health Center in San Diego from 1979 to March 1984. Many of the boys were seen by one of the authors. Boys represented 9% of the 1,748 sexual abuse victims. The incidence in males increasd from 7% in 1979 to 1980 to 11% in 1983. The boys were from 1 to 17 years of age. The majority of boys gave a clear, consistent, and credible history of sexual abuse. Eighty-five percent of the boys were abused by a relative or acquaintance. Physical evidence of sexual abuse was present in 95 (68%) of the victims. This paper emphasizes that boys, too, are at considerable risk for sexual abuse and that subtle physical findings of molestation are common when the child is examined by a trained, experienced physician.
Phototherapy for Neonatal Hyperbilirubinemia
Authors: POLAND RONALD L.
Published: December 2021

To the Editor.—

I read with fascination the reports of the 1974-1976 National Institute of Child Health and Human Development Randomized, Controlled Trial of Phototherapy for Neonatal Hyperbilirubinemia.1 The results of this well-designed cooperative study are extremely important for the care of newborn infants. Focusing on the smallest infants reported, we find that the use of prophylactic phototherapy was associated with a significant reduction in the need for exchange transfusion.2 The study group, however, used a liberal set of criteria for exchange transfusion compared to others published recently.3-5
The American Occupational Therapy Association, lnc, Viewpoint
Authors: COHEN HERBERT J.
Published: December 2021

In Reply.—

We welcome the letter from Dr Berg of the American Occupational Therapy Association and agree with many of his comments. Our Committee believes that the treatment of children with disabilities in schools should be a team effort involving educators, therapists, physicians, and professionals from other disciplines. We clearly recognize a significant role for occupational therapists in this regard as specified in PL 94-142, The Education for All Handicapped Children Act.

We believe that many children with mild degrees of motor dysfunction show some improvement with maturation.
Low Levels of Pyridoxal 5'-Phosphate in Patients With Cystic Fibrosis
Authors: Faraj Bahjat A. , Caplan Daniel B. , Camp Vernon M. , Pilzer Edith , Kutner Michael
Published: December 2021

To determine the effect of cystic fibrosis on the regulation of plasma pyridoxal 5'-phosphate (PLP), the biologically active form of vitamin B6, we measured this compound in plasma from 56 patients with cystic fibrosis. The concentration of PLP in plasma was assayed by a radioenzymatic technique. The results of this study showed that PLP concentration was decreased significantly (6.44 ± 5.20 ng/mL, mean ± SD; median 4.45 ng/mL) in patients with cystic fibrosis as compared with a group of hospitalized children with neither cystic fibrosis nor hepatic disease serving as a control group (13.2 ± 5.04 ng/mL, mean ± SD; median 12.5 ng/mL). Additionally, 25% of the population with cystic fibrosis exhibited exceedingly low plasma PLP level (less than 2.75 ng/mL). In patients with cystic fibrosis, significant inverse linear associations were found between plasma PLP and serum levels of SGOT and SGPT (PLP v SGOT: r = -. 60, P < .03; PLP v SGPT: r = -.50, P < .03). This study demonstrated that a deficiency of plasma PLP is a common abnormality in cystic fibrosis and that the low PLP level may be a reflection of impaired vitamin B6 metabolism associated with this disorder.
Fecal α1-Antitrypsin and Hemoglobin Excretion in Healthy Human Milk-, Formula-, or Cow's Milk-Fed Infants
Authors: Thomas Dan W. , McGilligan Kathryn M. , Carlson Michael , Azen Stanley P. , Eisenberg Lawrence D. , Lieberman Harry M. , Rissman Edward M.
Published: December 2021

There is concern that whole cow's milk feedings may be associated with intestinal abnormalities in infants. We studied this issue by measuring random fecal samples for α1-antitrypsin (FA1AT) and hemoglobin (FH) concentrations in 820 healthy infants up to 12 months of age. Subjects were fed either human milk, formula, or fresh whole cow's milk. Solid foods were given ad libitum. Fecal samples were also tested for occult blood with Hematest reagent tablets. None of the infants younger than 6 months of age were receiving fresh whole cow's milk. We found small but statistically significant differences in mean FA1AT between the three feeding groups (P < .0001): human milk (n = 354) > formula (n = 320) > cow's milk (n = 146). The younger subjects fed either formula or human milk tended to have higher FA1AT concentrations than did the age-matched subjects who were not consuming solid foods (P ≤ .005). Daily FA1AT excretion, FA1AT concentration, and daily stool output were subsequently determined on a separate group of 40 infants 8 to 12 months of age to ascertain whether differences in total daily FA1AT excretion occur in children fed different types of milk. Total daily FA1AT excretion was similar in the three milk feeding groups. An inverse correlation between FA1AT concentration and daily stool output was also found (P < .001). The overall rate of detectable FH in 792 stool smears was 2.1% and unrelated to type of milk feeding. Of 705 stool smears, 3.5% had positive Hematest reactions. Our results indicate that exudative protein loss or intestinal bleeding, as determined by FA1AT and FH, are uncommon in healthy cow's milk-fed infants older than 6 months of age. Dietary intake of solid foods and type of milk feeding should be considered when analyzing random stool samples for FA1AT concentration in young infants. Normal human milk-fed infants may have "high" FA1AT content because of reduced stool output.
Insomnia and Cow's Milk Allergy in Infants
Authors: LECKS HAROLD I.
Published: December 2021

To the Editor.—

From a pragmatic view, after perusal of the paper by Kahn et al (Pediatrics 1985;76:880-884), I was most impressed that the authors were making much ado about the commonly encountered clinical entity usually called "infantile colic." This syndrome has been attributed to many causative factors, among which is cow's milk hypersensitivity. Often, the pediatrician or practitioner will eliminate this food and use a soy replacement, particularly if there is a genetic background of atopy in the family and other clinical manifestations of allergy.
Pediatric Education and the Care of the Person
Authors: Green Morris
Published: December 2021

Pediatric education is preeminently concerned with the care of the person—the child, the parent, and the physician. Such personalized care can no longer be taken for granted. In both its scientific and humanistic qualities, it is being threatened by nonselective cost cutting. These changes will not spare pediatric education. The public, greatly concerned about the humanistic character of today's physicians, needs to better understand that pediatric education is fully committed to being humanistically as well as scientifically responsive to the needs of the times. Pediatrics should be defined as the specialty of growth, development, and adaptation, with adaptation offering a bridge between the biomedical and the psychosocial aspects of child health. Pediatric education needs both long- and short-term views. Opportunities to explore new pediatric roles have become time limited. A national strategic plan for pediatric education is needed. Because it takes more than the residency years to become a seasoned pediatrician, academic departments have a shared responsibility with the American Academy of Pediatrics, at the national and chapter level, to jointly fashion effective and relevant continuing education experiences.
Alcohol Use in Primiparous Women Older Than 30 Years of Age: Relation to Infant Development
Authors: O'Connor Mary J. , Brill Nancy J. , Sigman Marian
Published: December 2021

The effects of maternal alcohol use on mental development, growth, and dysmorphogenesis was studied in a sample of 1-year-old infants born to elderly primiparous mothers. Alcohol intake was measured using Jessor's AA score and a simple count of maximum number of drinks consumed in one day. Infant cognition was assessed using the Bayley Scale of Mental Development. Alcohol levels prior to, during, and following pregnancy were obtained. Alcohol intake was greatly reduced during pregnancy, returning to prepregnancy levels following birth. A significant linear relationship between drinking prior to pregnancy and infant mental development was found. The average mental development score of infants whose mothers consumed ≤3, 3.3 to 29.7, or ≥30 mL (≤0.10, 0.11 to 0.99, or ≥1.0 average fluid ounces) of absolute alcohol per day was 115, 108, and 95, respectively. Maximum number of drinks consumed in a day related to physical anomalies. No alcohol measure was significantly correlated with condition at birth, postnatal illness, or growth parameters of height, weight, and head circumference at 1 year. Deficits found were less pronounced than those reported in infants with fetal alcohol syndrome.