bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective Evaluation of Percutaneous Central Venous Silastic Catheters in Newborn Infants With Birth Weights of 510 o 3,920 Grams
Authors: Durand Manuel , Ramanathan Rangasamy , Martinelli Bruce , Tolentino Milagros
Published: December 2021

With improved neonatal survival, especially of very low birth weight infants, our efforts should be directed toward reduction of morbidity. Sick preterm infants require total parenteral nutrition for prolonged periods of time due to extreme prematurity and feeding intolerance. However, the use of surgically placed Broviac catheters has been associated with a high complication rate. A prospective study of 53 percutaneous central venous Silastic catheterizations for administration of total parenteral nutrition was performed in 45 newborn infants. At the time of catheter insertion, 37 babies weighed less than 1,500 g and 19 weighed less than 1,000 g. Percutaneous central venous catheters were placed successfully the first time in 50 of 55 attempts. In three babies, insertion was successful on second attempt. The catheters remained in place for 25.4 ± 16.7 days ([mean ± SD] range two to 80 days). In babies weighing less than 1,000 g, the catheters remained in place for a longer period of time (34.0 ± 18.0; range 12 to 80 days). Sixty-six percent of the catheters were removed electively. There were four cases of bacteremia (7.5%), and the overall incidence of mechanical complications was 26.4%. We conclude that percutaneous central venous catheters can be used safely and effectively in newborn infants for prolonged administration of total parenteral nutrition, especially in neonates weighing less than 1,000 g.
Magnetic Resonance Imaging of Spinal Cord Disease of Childhood
Authors: Packer Roger J. , Zimmerman Robert A. , Sutton Leslie N. , Bilaniuk Larissa T. , Bruce Derek A. , Schut Luis
Published: December 2021

Correct diagnosis of spinal cord disease in childhood is often delayed, resulting in irreversible neurologic deficits. A major reason for this delay is the lack of a reliable means to noninvasively visualize the spinal cord. Magnetic resonance imaging (MRI) should be useful in the evaluation of diseases of the spinal cord. A 1.5 Tesla MRI unit with a surface coil was used to study 41 children, including eight patients with intrinsic spinal cord lesions, eight patients with masses compressing the cord, 12 patients with congenital anomalies of the cord or surrounding bony structures, three patients with syrinxes, and three patients with vertebral body abnormalities. Intrinsic lesions of the cord were well seen in all cases as intrinsic irregularly widened, abnormally intense cord regions. MRI was helpful in following the course of disease in patients with primary spinal cord tumors. Areas of tumor were separable from syrinx cavities. Extrinsic lesions compressing the cord and vertebral body disease were also well visualized. Congenital anomalies of the spinal cord, including tethering and lipomatous tissue, were better seen on MRI than by any other radiographic technique. MRI is an excellent noninvasive "screening" technique for children with suspected spinal cord disease and may be the only study needed in many patients with congenital spinal cord anomalies. It is also an excellent means to diagnose and follow patients with other forms of intra- and extraspinal pathology.
Lipoproteins in the Progeny of Young Men With Coronary Artery Disease: Children With Increased Risk
Authors: Lee Julia , Lauer Ronald M. , Clarke William R.
Published: December 2021

The authors studied 173 progeny from 63 families in which the father had angiographically diagnosed coronary artery disease by 50 years of age. To assess the nature of the coronary risk factors in these families, we measured their height and weight to calculate Quetelet index (wt/ht2), BP, fasting plasma cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured in the affected fathers, their wives, and their progeny. These values were compared with age- and sex-specific values from the Lipid Research Clinic data. Sixty-five percent of the affected fathers and 51% of the progeny had elevated triglyceride, elevated low-density lipoprotein cholesterol, diminished high-density lipoprotein cholesterol, or combinations thereof. The distribution of the lipids and lipoproteins in the children bore a close resemblance to those observed in the affected fathers. A significant number of the mothers had diminished high-density lipoprotein cholesterol, which was attributed to their obesity. Screening the progeny of young coronary artery disease patients is therefore highly productive in identifying young people at excessive risk for future coronary artery disease. Early identification of this young high-risk population offers an opportunity for early initiation of preventive measures.
The Neglected Discharge Instruction
Authors: BASS LEE W.
Published: December 2021

We as pediatricians are taught to give careful instructions to parents at the time of a child's discharge from the hospital. These instructions include necessary information about drugs, resumption of the child's activities, and return visits. What is rarely discussed is the possibility that the child may resort to maladaptive behavior as a result of his hospitalization and what the parents should do about it. Before a child goes home from the hospital, parents should be alerted to the fact that difficult behavior patterns often are seen after a child's hospitalization for a serious illness. At the same time, they should be reassured that their child has recovered and does not require special protective treatment.
The Child Is Father of the Man
Authors: GLUECK CHARLES J.
Published: December 2021

Wordsworth was both metaphorically and literally1 accurate in concluding that ". . .the child is father of the man."2 The anatomic,3-5 biochemical, epidemiologic, nutritional, genetic, and clinical genesis of atherosclerosis is in childhood.1,6-13 There is also compelling evidence that relates antemortem coronary heart disease risk factors to the development of early atherosclerotic lesions,5 evidence that should stimulate pediatric primary prevention of atherosclerosis.

By virtue of extensive studies of schoolchildren,11,14-18 and of national population groups (Second National Health and Nutrition Examination Survey),19 excellent age-, sex-, and race-specific distributional data are available for major coronary heart disease risk factors including total, high-, and low-density lipoprotein cholesterol (HDL-C, LDL-C), height, weight, Quetelet index, skinfolds, BP, nutrient intake, and cigarette smoking.
Megavitamins and Hyperactivity
Authors: RIMLAND BERNARD
Published: December 2021

To the Editor.—

The report by Haslam et al,1 purporting to have demonstrated megavitamin therapy to be of no value in treating hyperactivity, and even to have produced mild adverse side effects, received wide media coverage. This is regrettable, because Haslam et al used a very incomplete version of megavitamin therapy.

Haslam et al claimed to have followed the regimen of Cott2 but failed, without mentioning the omission, to use the 25 mg/d of the B complex and 200 mg/d of magnesium that Cott advocates.
Death Due to Chronic Syrup of Ipecac Use in a Patient With Bulimia
Authors: Schiff Russell J. , Wurzel Carol L. , Brunson Sandra C. , Kasloff Ilene , Nussbaum Michael P. , Frank Shawn D.
Published: December 2021

A 17-year-old girl presented with malaise, weakness, palpitations, dysphagia, myalgias, and weight loss of 1 month's duration. Within 24 hours of admission to the hospital, she had hypotension unresponsive to medical management, intractable congestive heart failure, and arrhythmias; she died. Several empty bottles of syrup of ipecac were later found among her belongings. Syrup of ipecac is commonly used to induce emesis in patients who had ingested toxic substances. The chief pharmacologic property of this agent is due to its alkaloid component, emetine. There have been many previous reports of death due to emetine poisoning in patients receiving ipecac fluid extract and in those treated for amoebic dysentery. However, the literature cites only three case reports of fatalities secondary to chronic ipecac use as a means of losing weight. This is the first report of a death due to chronic ipecac use in an adolescent patient with bulimia. Emetine persists in the body for long periods, and in patients who have ingested it chronically, emitine is extremely toxic, specifically to cardiac smooth and skeletal muscles. With an increased awareness of the importance of weight control in the adolescent age group, the physician must carefully evaluate these patients for the use of emetics.
Unexpected Hearing Loss in High-Risk Infants
Authors: Nield Toni A. , Schrier Shirley , Ramos Angela D. , Platzker Arnold C. G. , Warburton David
Published: December 2021

Eleven high-risk infants who had normal auditory brainstem responses at the time of discharge from the neonatal intensive care unit were found on follow-up between 13 and 48 months later to have significant sensorineural hearing loss. All 11 infants were the products of high-risk pregnancies and deliveries. Birth weights ranged from 890 to 3,700 g, but seven had birth weights of more than 1,500 g. Gestational ages ranged from 28 to 42 weeks. The length of hospitalization ranged from 45 to 167 days. All of the infants had respiratory distress, requiring prolonged mechanical ventilation with resultant chronic lung disease. All of the infants had received pancuronium, morphine, ampicillin, and gentamicin, and ten had also received furosemide and chlorothiazide. Other frequent clinical complications included abnormal CNS findings during the neonatal intensive care unit stay (ten infants), acidosis (pH < 7.25) on the initial blood gas test (eight infants), and persistent fetal circulation in all seven infants with birth weights greater than 1,500 g. Developmentally, eight of nine children tested between 12 and 36 months of age were normal in all respects other than the hearing loss and the related language impairment. We conclude that infants who have been very ill in the newborn period, including term infants, may remain at risk for development of significant sensorineural hearing loss even though they have passed an initial auditory brainstem responses screening test in the newborn period.
Vascular Steal: The Pathogenetic Mechanism Producing Sirenomelia and Associated Defects of the Viscera and Soft Tissues
Authors: Stevenson Roger E. , Jones Kenneth Lyons , Phelan Mary C. , Jones Marilyn C. , Barr Mason , Clericuzio Carol , Harley Russell A. , Benirschke Kurt
Published: December 2021

Dissection of the abdominal vasculature in 11 cases of sirenomelia has demonstrated a pattern of vascular abnormalities that explains the defects usually found in this condition. The common feature is the presence of a single large artery, arising from high in the abdominal cavity, which assumes the function of the umbilical arteries and diverts nutrients from the caudal end of the embryo distal to the level of its origin. The steal vessel derives from the vitelline artery complex, an early embryonic vascular network that supplies the yolk sac. Arteries below the level of this steal vessel are underdeveloped and tissues dependent upon them for nutrient supply fail to develop, are malformed, or arrest in some incomplete stage. In contrast to the prevailing view that sirenomelia arises by posterior fusion of the two developing lower limbs, these studies suggest that the single lower extremity in sirenomelia arises from failure of the lower limb bud field to be cleaved into two lateral masses by an intervening allantois.
Prospective Diagnosis of Pseudohypoaldosteronism
Authors: SCHINDLER ALAN M. , BERGMAN GARRETT E.
Published: December 2021

Pseudohypoaldosteronism is characterized by salt wasting in spite of elevated plasma renin activity and serum aldosterone concentration. If the salt wasting is severe, pseudohypoaldosteronism may present as early as the first or second week of life. We were able to demonstrate pseudohypoaldosteronism on the second day of life in an asymptomatic newborn baby whose father and 1-year-old sister were known to have pseudohypoaldosteronism.

CASE REPORTS

Case 1

The patient was a 6-week-old white girl, who was born at term. Her mother was 24 years old, primigravida, and had an uncomplicated pregnancy. The baby was admitted to the hospital for evaluation of lethargy, poor feeding, vomiting, and failure to thrive when fed breast milk and, later, a proprietary formula.
Light and Retinopathy of Prematurity: What Is Prudent for 1986?
Authors: AVERY GORDON B. , GLASS PENNY
Published: December 2021

What's the Problem?

The survival in substantial numbers of extrauterine fetuses, barely entering their last trimester at birth, has caused these babies to complete their retinal vascularization in the unnatural environment of the modern intensive care nursery. The result is a second epidemic of retinopathy of prematurity, the greatest risk factor for which is clearly survival after extremely immature birth. A flurry of investigations has addressed factors that might contribute to this problem, and at least a dozen are supported by some epidemiologic associations.1-3 Oxygen is on this list but by no means in the preeminent way of the past.
Virilizing Adrenocortical Tumors in Childhood
Authors: HONOUR J. W. , PRICE D. A. , GRANT D. B.
Published: December 2021

To the Editor.—

It was of considerable interest to read about the experience of virilizing adrenal tumors at the Childrens Memorial Hospital, Chicago,1 and the literature review is of particular value. In 1984, we published results from our study during 12 years of 12 infants with virilizing adrenal tumors without cortisol excess. We were able to define very precisely the secretory products of the tumors by using capillary column gas chromatography with mass spectrometry to separate and identify steroids in urine, and the data were rationalized in the context of routine endocrine tests.
Persistent Colonization During Therapy for MHaemophilus influenzae Type b Disease
Authors: GILSDORF JANET R.
Published: December 2021

In Reply.—

I agree with Dr Barton's warning to avoid "complacency regarding the lack of communicability of H influenzae type b in acute care settings" and to continue to be alert to the remote possibility that intrahospital transmission of H influenzae type b disease may occur. However, in the meantime, policy decisions on the duration of isolation precautions for patients with H influenzae type b infections need to be made. Based on my data1 and on the fact that only one possible case of nosocomial transmission has been reported in an acute care hospital, 2 I think the current recommendation of the American Academy of Pediatrics remains appropriate.
Girls on Boys' Teams
Authors: DYMENT PAUL G.
Published: December 2021

In Reply.—

Dr Goldenring expresses a viewpoint probably widely shared by pediatricians, and the last statement on this subject by the American Academy of Pediatrics (Pediatrics 1975;55:563) advises against girls competing against boys in "heavy collision sports." However, I personally believe that in schools in which separate teams for a particular sport for boys and girls do not exist, girls should have the opportunity to compete for a position on the "boys" team, regardless of whether or not it is a collision sport.
Failure of Trimethoprim/Sulfamethoxazole As Prophylactic Therapy of Gram-Negative Sepsis in Pediatric Patients With Cancer
Authors: ESQUEMBRE C. , FERRIS J. , VERDEGUER A. , CASTEL V.
Published: December 2021

To the Editor.—

We read with interest the article "Oral Trimethoprim/Sulfamethoxazole for Prevention of Bacterial Infection During the Induction Phase of Cancer Chemotherapy in Children (Pediatrics 1985;76:754-760). The authors report that there are no reports of fatal septicemia due to resistant enterobacteriaceaes in children under infectious chemoprophylaxis with this drug.

From 1980 to 1984 42 episodes of bacterial sepsis have been demonstrated in 38 of our cancer patients. Organisms isolated were Escherichia coli (13 cases), Streptococcus (12 cases), Staphylococcus (11 cases), Pseudomonas aeruginosa (three cases), Klebsiella pneumoniae (two cases), Haemophilus (two cases), Serratia marcescens (one case), Salmonella (one case), and Enterobacter (one case).
Alternative Treatment to Tracheostomy in Obstructive Sleep Apnea Syndrome: Nasal Continuous Positive Airway Pressure in Young Children
Authors: Guilleminault Christian , Nino-Murcia German , Heldt Gregory , Baldwin Roger , Hutchinson David
Published: December 2021

Two groups of prepubertal children with severe obstructive sleep apnea syndrome received continuous positive airway pressure (CPAP) treatment using a nasal mask. The five children in group A had nasal CPAP only in a hospital setting; the five children in group B received the treatment at home as well. Four of these five children, who have now been followed for as long as 10 months, have adapted well to the treatment at home. The problems encountered with nasal CPAP as a home treatment, such as poor cooperation from parents, allergic rashes, eye irritation resulting from air leaks, are discussed. Despite the problems, nasal CPAP is a valid alternative to tracheostomy in children as young as 3 years of age.
Does Breast-Feeding Protect Against Infections in Infants Less Than 3 Months of Age?
Authors: Leventhal John M. , Shapiro Eugene D. , Aten Cynthia B. , Berg Anne T. , Egerter Susan A.
Published: December 2021

To determine whether breast-feeding protects infants from infections, a case-control study was conducted. The cases were previously healthy children who were admitted to Yale-New Haven Hospital for an infectious illness at or before 90 days of age. The controls were chosen from the log of births and matched to the cases for five important demographic variables. In addition, logistic regression models were used to adjust the results for other potential confounders. To minimize the potential surveillance bias that might occur if formulafed and breast-fed infants with the same degree of illness have a different probability of being hospitalized, the case-control pairs were stratified by the severity of the medical condition of the case at the time of hospitalization. For the 281 case-control pairs, the matched odds ratio was .50 (95% confidence interval .32, .77; P < .005), which indicates that breast-feeding is protective against infections. However, this apparent protective effect was diminished substantially when the data were stratified according to the severity of illness: the matched odds ratio for the 164 infants with serious illnesses was .79 (.47, 1.32; P < .50), and for the 117 infants with mild illnesses it was .17 (.03, .44; P < .001). These stratified results suggest that breast-feeding protects infants from hospitalization rather than from infections. Failure to consider the problem of surveillance bias may lead to erroneous conclusions about the protective effect of breast-feeding.
Guidelines for Air and Ground Transportation of Pediatric Patients
Authors:   Committee on Hospital Care
Published: December 2021

A pediatric transport system should be capable of rapidly delivering advanced pediatric skilled critical care to the patient's bedside at the referring hospital and of maintaining that level of care during transport to the receiving hospital. Physicians and others with special expertise in pediatric transport have developed specific recommendations for pediatric transport systems.1-9 The Committee on Hospital Care of the American Academy of pediatrics, in collaboration with expert consultants, offers the following guidelines for pediatric transport. These recommendations require periodic review as new equipment, techniques, and data evolve in this rapidly progressing field. Some of these recommendations may need modification to fit local circumstances. This statement modifies and enlarges upon a previously published chapter in the AAP manual, Hospital Care of Children and Youth.10 Neonatal transport systems have many of the same characteristics.

OPTIMAL COMPONENTS OF A PEDIATRIC AIR-GROUND SYSTEM

The most important components of a pediatric transport system are medical control by a qualified pediatric specialist and a medical transport team composed of individuals qualified to care for critically ill children in a transport setting. Although a pediatric transport system may share components with an adult transport system (eg, dispatch, vehicles, emergency medical technicians), it should have its own medical director, its own protocol, a transport team specifically trained in pediatric critical care, and equipment and supplies appropriate for the care of pediatric patients.

An optimal pediatric transport system has available to it both air and ground ambulances combined into a flexible, coordinated system.
Report of the Task Force on Diagnosis and Management of Meningitis
Authors: Klein Jerome O. , Feigin Ralph D. , McCracken George H.
Published: December 2021

Children still die or suffer permanent neurologic sequelae as a result of bacterial meningitis. Prompt diagnosis and aggressive management are the goals, but early signs of meningitis are often subtle and nonspecific and, therefore, may be recognized only in retrospect. The physician must identify among the many febrile children seen every day in office practice—most of whom have spontaneously resolving illnesses usually caused by viruses—the few children who have serious bacterial infection requiring early intervention. No single test or battery of tests replaces the clinical acumen of the physician in identifying the child with early signs of bacterial meningitis. Because of controversies about diagnosis and treatment of meningitis voiced in various forums, including the courtroom, the Task Force on Diagnosis and Management of Meningitis has been asked by the Executive Board of the American Academy of Pediatrics to prepare a report on the causes, diagnosis, management, and outcome of meningitis in infants and children.

This task force selected for discussion issues of current relevance and controversy in the diagnosis and treatment of bacterial and nonbacterial meningitis. Many other aspects of meningitis are discussed elsewhere. Commentaries on the prevention of disease by chemoprophylaxis (antimicrobial agents) or immunoprophylaxis (vaccines) have been prepared by the Committee on Infectious Diseases of the American Academy of Pediatrics. In addition the Morbidity and Mortality Weekly Report (Centers for Disease Control, Atlanta) publishes recommendations on vaccine usage and chemoprophylaxis formulated by the Advisory Committee on Immunization Practices. These resources are of value to the practitioner who cares for children and needs information on optimal measures for the treatment and prevention of meningitis.
Selective Screening Device for the Early Detection of Normal or Delayed Cognitive Development in Infants at Risk for Later Mental Retardation
Authors: Fagan Joseph F. , Singer Lynn T. , Montie Jeanne E. , Shepherd Patricia A.
Published: December 2021

The present study tested the predictive validity at 3 years of age of a screening device for the early identification of later cognitive delay. The screening device, administered between 3 and 7 months of age, is based on the infant's differential fixation "to novel" over previously shown pictures. The sample was composed of 62 infants suspected to be at risk for later mental retardation. The prevalence of delayed cognitive development (IQ ≤ 70) at 3 years of age was 13%. Novelty preference scores correctly identified six of eight (75%) of the delayed children. The test identified 49 of 54 (91%) of the normal children. Validity for predicting cognitive delay was 55%. Validity for the prediction of normality was 96%. The screening device proved to be equally sensitive, specific, and valid when the sample was divided into infants born at term or born preterm. The results of the present study and of a previous study indicate that detection of cognitive delay based on early novelty preferences is as easily accomplished for infants who will later be mildly delayed (IQ scores 60 to 70) as it is for those who will later be severely delayed (IQ scores ≤ 50). Moreover, such results are in contrast to those obtained with conventional tests tapping sensorimotor development.
Diphtheria, Pertussis, and Tetanus (DTP) Immunization Local Reactions Do Not Predict Central Nervous System Reactions
Authors: BLATTNER RUSSELL J. , FEIGIN RALPH D.
Published: December 2021

To the Editor.—

Our purpose in writing this letter is to comment on the controversy that currently surrounds DTP immunization and the recent marked increase in the cost of this vaccine that apparently reflects the cost of pending litigation.

In 1967, Russell J. Blattner, MD, was Chairman of the Department of Pediatrics at the Baylor College of Medicine. At that time, he performed a small clinical study to compare the rates of minor or local reactions secondary to administration of whole-cell DTP vaccine with the rates of similar reactions to fractionated or split-cell DTP vaccine.
Intravascular Injection of Long-Acting Penicillin
Authors: WALSON PHILIP D. , GALLETTA GARY
Published: December 2021

To the Editor.—

Recent discussions in Pediatrics (1985;75:785-786 and 1986;77:783-784) have pointed out the problems associated with intravascular injection of long-acting penicillins. There is an obvious need for continued education of health care providers concerning the physical properties of these agents and their delivery systems.

Wyeth, the manufacturer of the Tubex cartridge system, has recently redesigned their product so that the flow of any aspirated blood is directed to one side of the glass barrel, immediately past the hub, where it can be more easily seen.
Errors in Drug Administration
Authors: BURY GRAHAM
Published: December 2021

To the Editor.—

Koren et al (Pediatrics 1986;77:848-849) report recommendations to avoid administration of incorrect drug doses. I must confess surprise, in view of the fact that tenfold errors seem to be the most common ones made, to find no recommendation to ban the decimal point. This is common practice in the hospital in which I work. If any decimal point has to be used, then that particular drug dose is written in long hand, eg, one point five mgs.
Errors in Drug Administration
Authors: LAMONT JEFFREY H.
Published: December 2021

To the Editor.—

I read with interest the article by Koren et al, "Tenfold Errors in Administration of Drug Doses: A Neglected Iatrogenic Disease in Pediatrics" (Pediatrics 1986;77:848-849). Errors such as those described by the author are perhaps most likely to occur during an emergency resuscitation situation. Several factors contribute to this increased likelihood. (1) emotional stress of the situation, (2) the urgency of need for the medications, leading to excessive haste in their preparation for administration and at the same time a decrease in the likelihood that the dose will be double checked before administration, and (3) the relative lack of familiarity of the members of the resuscitating team with the medications being used.
Three Years of Experience With Random Urinary Homovanillic and Vanillylmandelic Acid Levels in the Diagnosis of Neuroblastoma
Authors: Tuchman Mendel , Ramnaraine Margaret L. R. , Woods William G. , Krivit William
Published: December 2021

During the last 3 years, random urine samples from 408 patients were tested for elevated homovanillic acid (HVA) and vanillylmandelic acid (VMA) levels to rule out the diagnosis of neuroblastoma. Thirty-seven of these patients had elevated HVA and/or VMA levels, and neuroblastoma was subsequently diagnosed. In three additional patients with negative test results (normal HVA and VMA levels), tumors were subsequently diagnosed (false-negative rate of 7.5%). Ten percent of the patients with neuroblastoma had normal HVA and 27.5% had normal VMA levels at the time of diagnosis. Only one patient (2.5%) with neuroblastoma had elevated VMA levels in the presence of normal HVA levels. More than 60% of the patients with neuroblastoma had urinary HVA and/or VMA levels higher than twice the upper limit of normal. No false-positive results were encountered. Age and stage distributions of the patients are shown, and the significance of the results is discussed.
Liver Injury After Oral and Rectal Administration of N-Acetylcysteine for Meconium Ileus Equivalent in a Patient With Cystic Fibrosis
Authors: BAILEY DAVID J. , ANDRES JOEL M.
Published: December 2021

N-acetylcysteine (NAC) is a mucolytic agent (Mucomyst, Mead-Johnson) that is often used for the treatment of meconium ileus equivalent, a complication of cystic fibrosis.1-3 No serious adverse reactions to nonparenterally administered NAC have been observed, and there have been no reports of significant hepatotoxicity. We describe a patient in whom severe hepatic dysfunction occurred on two occasions after the administration of NAC for the treatment of meconium ileus equivalent.

CASE REPORT

A 3-year-old, 12.5-kg, white boy with cystic fibrosis was admitted for treatment of a fractured left femur. His medications included theophylline, metaproterenol, cefaclor, nebulized isoethanine, and pancreatic enzyme replacement with meals.
Residents on the Phone
Authors: WOOD PAMELA RUNGE
Published: December 2021

In Reply.—

I appreciate the remarks of Drs Fosarelli and Katz. Their study seems to confirm the results of my own work. As they point out, the clinical experience of a pediatric resident answering calls from patients with whom he is not familiar may not be far removed from the experience of a practitioner in a busy HMO setting. I await with interest publication of the full study.
Intensive Care Unit Resources and Costs
Authors: BUSHORE MARTHA
Published: December 2021

In Reply.—

The discussion by Dr Pollack et al about objective analysis of ICU resources is useful to all pediatricians. Objective analysis may be especially helpful in individual case discussions when a physician's fears about one or more patients seem to be excessive and result in inappropriate utilization of high-cost care. Former stressful experiences of the physician or of the patient and family with the specific medical disorder, within a health care institution, or with one another may result in a disproportionate anxiety and sense of threat not easily soothed by simple reassurance.
Computerized Ventilation
Authors: ANBAR RAN D.
Published: December 2021

To the Editor.—

Carlo et al1 report an "expert system" based on an algorithm for mechanical ventilation of infants with respiratory distress syndrome which would have corrected arterial blood gas derangements in 89% of 106 clinical trials. This algorithm was applied to additional trials using an independently designed computer-generated ventilation simulation program (VSP).

Written in BASIC, VSP expects its user to manage a randomly "created" infant with respiratory distress syndrome by monitoring arterial blood gas values, physical examination findings, and chest x-ray film findings.2
Pediatrics and Poverty
Authors: OBERG CHARLES N.
Published: December 2021

Pediatrics is the branch of medicine whose primary concern is the protection of our nation's children. The guiding principle is to set a course of action that will facilitate their growth and development. However, despite our best efforts the wellbeing of our pediatric population is at risk. We are witnessing the reemergence of poverty among children and its consequences on life's basic necessities. This transformation is creating a large and growing number of children who are hungry, homeless, and uninsured. The data and information that follow are a composite of material generated by federal and state policymakers. It is information not typically accessed by the medical community.
Presidential Address
Authors: SMITH MARTIN H.
Published: December 2021

The time has come for me to give my final report of my year as president of the American Academy of Pediatrics. It has been an interesting year, a busy year, and I hope a year that has had some accomplishments. Last October at our business meeting, I discussed with you some problems that could be anticipated at the beginning of the year. During the year, there have been other problems that have arisen of equal importance that could not have been anticipated. I wish that I could tell you that all of our problems have been confronted and have been solved. It is not possible to wrap them all up according to our schedule.

Last October, I commented to you that the Academy now functions with the Executive Committee acting more as a team that hopefully carries the gains from one year to the next without interruption while the office of president changes each year.
FRUSTRATION AT BEING UNABLE TO CONJURE UP A PRINCE
Authors: Student
Published: December 2021

Am I kissing wrong frogs?

Or am I kissing frogs wrong?
STANDARDS FOR ORDINAL SCALES
Authors: Student
Published: December 2021

Ordinal scales are frequently used in clinical trials to quantify outcomes which are non-dimensional [for example 1+ to 4+ system for assessing peripheral oedema].... Guidelines for construction and utilisation of ordinal scales as measures of outcome in clinical trials have not been formulised. In this paper a set of standards are developed.
COARCTATION OF THE AORTA AS A CAUSE OF DEATH IN EARLY INFANCY
Authors: BAHN ROBERT C. , EDWARDS JESSE E. , DUSHANE JAMES W.
Published: December 2021

This is a report of three cases in each of which an infant exhibited coarctation of the aorta at the level of a closed or closing ductus arteriosus. In all cases the collateral channels were poorly developed. It appears from the available evidence that death resulted from left ventricular congestive failure secondary to an obstructive hypertension.

The development of collaterals to by-pass a coarctation of the aorta seems to depend upon the relation of the aortic coarctation to the aortic mouth of the ductus arteriosus. When the coarctation lies distal to the ductus, collaterals develop. When the coarctation lies proximal to the ductus, adequate collaterals do not develop before birth. When the coarctation lies opposite the aortic mouth of the ductus arteriosus, the development of collaterals during fetal life seems to depend upon the direction that the blood flowing in the ductus arteriosus takes. When the flow is into the aorta proximal to the coarctation, collaterals would be expected to develop; while when the ductal flow is into the descending aorta, adequate collaterals would not be expected to develop in the fetus. The three cases reported fall into the latter category.
MUMPS MENINGOENCEPHALITIS
Authors: KRAVIS LILLIAN P. , SIGEL M. MICHAEL , HENLE GERTRUDE
Published: December 2021

An analysis has been presented of the results obtained in complement fixation tests employing both the soluble, or S, and virus, or V, antigens in 85 cases of mumps meningoencephalitis. Thirty-eight of 71 cases for which clinical data were complete had failed to reveal preceding, concurrent or subsequent involvement of the salivary glands. Only 25 (35%) had such involvement prior to onset of meningitis.

In 62 of the patients, definite serologic evidence of infection with mumps virus was obtained in one of two ways: (1) The presumptive test was positive in 43 cases, i.e., the first serum showed a high antibody level against the S antigen and distinctly lower titers against V. (2) In 19, a positive diagnosis was based on the demonstration of a rise in both antibodies. The remaining 23 patients gave evidence suggestive of mumps infection by virtue of high antibody levels in the first available serum.

The anti-S > anti-V pattern occurs most frequently when the meningoencephalitis is not preceded by salivary gland involvement and when the serum is obtained before the end of the first week of illness. Delay in withdrawing the blood and occurrence of overt or possibly inapparent glandular involvement prior to the meningitis is associated with the presence of antibodies in relatively high titer to both the S and V antigens. Such results can only be regarded as suggestive of recent infection.

Even when serum from patients with no salivary gland involvement is obtained in the first week of illness, about one third will not show the anti-S > anti-V pattern. At present, under proper conditions, the early serologic diagnosis appears possible in about two thirds of cases of mumps meningoencephalitis without preceding or concurrent salivary gland involvement.

The clinical findings and routine laboratory data on spinal fluids and blood are presented; these findings and data are in accord with those previously reported by others.
Round Table Discussion
Authors: HORESH ARTHUR J. , MCGEE W. AMBROSE , PETERMAN M. G. , KEITER W. EUGENE , KRAMER JAMES G.
Published: December 2021

Chairman Horesh: For many years the Academy round table discussions have been on the commonly known allergic conditions in infants and children such as asthma, hay fever and eczema. These allergic diseases have now become familiar and are easily recognized by all pediatricians. In this round table discussion we will present conditions less commonly recognized as having an allergic etiology. It is now generally known that any organ or group of organs may be involved in an allergic reaction. The symptoms will depend upon the tissues sensitized, the degree of sensitization and the nature and amount of the allergen present. Investigations during the past decade have revealed an allergic basis for various well known clinical entities for which no clearcut etiologic background had been found. Every pediatrician is plagued by a host of complaints from parents about conditions which are extremely common, yet he can find little or nothing concerning their cause. Such conditions as poor appetite, disturbed sleep, habit spasms, nervous disorders, irritability, headache, stomach ache, frequent colds, poor resistance to infections, diarrhea, constipation, skin rashes, bed wetting and behaviour problems are only a few of the many problems which face the pediatrician with a private practice. Occasionally an organic basis is found for the symptoms but much too frequently "nothing is found." Thus for many of these problems the pediatrician has had very little to offer other than the old familiar phrase "he will outgrow it." It is our purpose to alert the physician to the possibilities of allergic etiology and to demonstrate that much can be done for many of these childhood problems if the essential fundamentals of allergic knowledge are kept in mind.
CORRESPONDENCE
Authors: BAUER EDWARD L.
Published: December 2021

The furor created by the reports of paralysis occurring in extremities injected with antigens in patients developing poliomyelitis within one month after the injection has assumed the proportions of hysteria.

Anderson and Skaar (Pediatrics 7:741, 1951) clearly acquit "injections" given prior to one month before the onset of poliomyelitis of any recognizable part therein and certainly play no part in the etiology of poliomyelitis itself.

The public and many public health authorities however are reacting to the serious detriment of the overall disease prevention picture.
HYPERVITAMINOSIS A
Authors: ARENA JAY M. , SARAZEN PAUL , BAYLIN GEORGE J.
Published: December 2021

An unusual case of hypervitaminosis A with severe craniotabes in a 6½ month old infant is presented. This is the youngest infant reported with this condition and the first to present craniotabes.

Symptoms of hypervitaminosis A are compared with those of hypervitaminosis D and with those of infantile cortical hyperostosis. In the case presented prompt and complete disappearance of craniotabes and other symptoms followed withdrawal of administration of vitamin A.
Additional Publication Information
Authors: JOHNSON CANDICE , DEBAZ BAZ P. , SHURIN PAUL A.
Published: December 2021

To the Editor.—

We regret that in our paper "Renal Ultrasound Evaluation of Urinary Tract Infections in Children" (Pediatrics 1986;78:871-878) we neglected to mention that cinical data on the 64 children in our "first series" had been previously published in Pediatric Infectious Disease (1985;4:656-662). Readers interested in further epidemiologic data on these children should consult the earlier study.
School Performance and Theophylline
Authors: RACHELEFSKY GARY S. , WO JULIE , ADELSON JUDITH , MICKEY M. RAY , SPECTOR SHELDON L. , KATZ ROGER M. , SIEGEL SHELDON C. , ROHR ALBERT S.
Published: December 2021

In Reply.—

Mr Schriver's first concern is the appropriate interpretation of results from placebo-controlled, double-blind clinical trials. Our understanding is that the function of the placebo-treated group is to provide a control against which to judge the effect of the treatment. It is not particularly unusual to observe an "effect" in the placebo "arm" of such a controlled study, and we would consider it inappropriate to emphasize the effect in either arm considered by itself other than in reference to the planning and interpretation of such trials.
Contact Burns of the Hand
Authors: Shugerman Richard , Rivara Fred , Parish Ruth Ann , Heimbach David
Published: December 2021

Contact burns of the hand in children present difficult management questions. Because visual inspection of the acute wound often fails to distinguish major burns requiring inpatient treatment from minor burns amenable to outpatient therapy, we sought to identify characteristics of patients that would aid in decision making at the time the burn patient is seen. During the 5-year period, 1980 to 1984, 32 children less than 14 years of age were admitted to our medical center with contact burns of the hand. Patients were divided into two groups: those with major burns requiring ≥ seven days of hospitalization (n = 16) and those with minor burns requiring < seven days of hospitalization (n = 16). Compared with patients in the minor burn group, patients in the major burn group were hospitalized longer (16.9 ν 2.8 days), were more likely to require surgical excision and grafting (63% ν 0%), and had more extensive follow-up (5.3 ν 2.5 visits). There were no significant differences between the two groups with regard to percentage of area burned, age, sex, primary admission ν referral, and cause of burn. These data support the recommendation that all such burns be managed initially on an inpatient basis.
Practice-Based Research: Opportunities and Obstacles
Authors: Christoffel K. K. , Binns H. J. , Stockman J. A. , McGuire P. , Poncher J. , Unti S. , Typlin B. , Lasin G. , Seigel W. ,   The Pediatric Practice Research Group
Published: December 2021

Renewed interest in practice-based research reflects growing realization of the limitations of research from a hospital perspective. Practice-based pediatric research promises to broaden the range and severity of conditions commonly studied, to enhance the study of the natural history of disease and of normal development, to provide normal controls and standards, and to facilitate recruitment of adequate sample sizes. Cohort, incidence, and health services research will be promoted by the development of patient registries. The Chicago area Pediatric Practice Research Group is a research consortium of 81 practitioners in 27 office practices. Formed in 1984, it receives logistic and financial support from children's Memorial Hospital, with which it is affiliated. The Pediatric Practice Research Group has undertaken six studies, most with outside funding. During these studies, some unifying characteristics of practice-based research have emerged. These include the need to tailor study protocols to individual practice characteristics and routines and the critical role of office staff in the conduct of research. Features can be identified that make specific studies more or less intrusive into office functioning. It has proved feasible to obtain data of high quality and reproducibility despite geographically scattered data collection sites. This review of Pediatric Practice Research Group activities and experience is intended to open an exchange of ideas with others interested in practice-based research.
Defecation Dynamics
Authors: LOENING-BAUCKE VERA
Published: December 2021

In Reply.—

We do not agree that testing of rectal sensation and the ability to defecate rectal water-filled balloons is diagnostic overkill" in children with chronic constipation and encopresis. Schmitt1 pointed out that he individualizes the treatment regimen and provides careful followup. Balloon defecation and sensibility testing helps in individualizing the treatment regimen, in counseling of patients and parents, and in the educating about the problem prior to embarking on months to years of laxative treatment, dietary manipulation, toilet sittings, record keeping of bowel movements and soiling episodes, etc.
Delayed Cerebrospinal Fluid Sterilization and Adverse Outcome of Bacterial Meningitis in Infants and Children
Authors: Lebel Marc H. , McCracken George H.
Published: December 2021

To determine the clinical importance of CSF cultures that are persistently positive for pathogens in patients treated for meningitis with the new cephalosporins, the records of 301 infants and children with bacterial meningitis enrolled prospectively in four clinical efficacy trials of cefuroxime or ceftriaxone therapy were reviewed. CSF culture results were positive for 20 patients and they were sterile at 18 to 36 hours after start of therapy for 281 patients. Seizures, subdural effusions, and hemiparesis were found significantly more often during hospitalization in those with delayed sterilization of CSF. Children with persistently positive cultures had a significantly higher incidence of neurologic abnormalities at the time of hospital discharge (45% v 19%) and at followup (41% v 13%) and of moderate to profound hearing impairment (35% v 15%) than did those with prompt sterilization of CSF. Repeat CSF examination is a useful prognostic indicator in infants and young children with bacterial meningitis.
Morbidity and Mortality Among Low Birth Weight Infants Exposed to an Intravenous Vitamin E Product, E-Ferol
Authors: Arrowsmith Janet B. , Faich Gerald A. , Tomita Dianne K. , Kuritsky Joel N. , Rosa Franz W.
Published: December 2021

In April 1984, the US FDA was notified of an unusual clinical syndrome consisting of ascites, liver and renal failure, thrombocytopenia, and death among low birth weight infants exposed to an intravenous vitamin E preparation, E-Ferol. The product, which had not been tested for safety prior to marketing, was voluntarily withdrawn from the market in early April. To further investigate the reported associations, the FDA conducted a retrospective cohort study among seven neonatal intensive care units where the product had been used. Standardized abstraction forms were completed for infants admitted to a unit between Nov 1, 1983, and April 30, 1984. Included in the study were 379 infants weighing 2,000 g or less and surviving at least two days; 148 (39%) had been exposed to E-Ferol. Compared with the unexposed infants, the exposed infants were more likely to die and to have ascites, hepatomegaly, thrombocytopenia, and a combination of clinical events similar to the syndrome initially reported. We conclude that the use of E-Ferol in these neonatal intensive care units was associated with increased morbidity and mortality among exposed infants.
INTRAVENTRICULAR HEMORRHAGE IN UTERO
Authors: L. J. F.
Published: December 2021

The authors report three cases of unexplained prenatal intraventricular haemorrhage (IVH) in three term infants. In the first two cases the suspected diagnosis of prenatal IVH was made a few hours after delivery, in accordance with the ultrasonographic feature of clots in the ventricles, whereas in the third case prenatal ultrasonography was suggestive of hydrocephalus with intraventricular clots.