bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Fatigue in Adolescents
Authors: Smith Mark Scott , Glover Dianne , Mitchell Jeff , McCauley Elizabeth A. , Corey Lawrence , Gold Deborah , Tenover Fred C.
Published: December 2021

Nine female and 6 male adolescents (mean age 14.5 ± 1.7 [SD] years) were evaluated for chronic fatigue associated with at least three additional symptoms present for 18.4 ± 8.4 months. Eleven subjects experienced the onset of symptoms with an acute illness (seven Monospot-positive). Medical history, physical examination, and laboratory testing yielded little helpful information. Serologic testing for Coxsackie B viruses 1 through 6, cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and Toxoplasma gondii in subjects and healthy controls provided little evidence for an infectious cause of persistent fatigue. Children's Depression Inventory scores and psychiatric interviews with the Schedule for Affective Disorders and Schizophrenia-Children's Version (K-SADS) identified five subjects with major depression. On the K-SADS, the 10 fatigued subjects without major depression endorsed many secondary symptoms of depression but were less likely than depressed psychiatric clinic patients to endorse primary symptoms such as depressed mood, guilt, and suicidality. At telephone follow-up 13 to 32 months after intake, 4 subjects were completely well, 4 markedly improved, and 7 unimproved or worse. Further research is necessary to determine whether chronic fatigue in adolescents is prodromal depression, a discrete psychosomatic condition, or an infectious or immunologic disorder that mimics depression.
Emergency Medical Services and the Pediatric Patient III: Resources of Ambulatory Care Centers
Authors: Seidel James S. , Henderson Deborah P. , Lewis Jamie B.
Published: December 2021

Ambulatory care centers have emerged as a new health care resource in many communities. Little information is available about the services that these centers offer to pediatric patients. A national survey of 254 ambulatory care centers was undertaken to determine their characteristics, including the number of pediatric patients seen, staffing patterns, and pediatric equipment and supplies available. Most clinics were located in urban areas and were within 5 miles of a hospital. They were staffed primarily by physicians who were board certified in emergency medicine, internal medicine, or family medicine. Not all centers had registered nurses on duty and few used extended-role nurses or physicians's assistants. The centers saw an average of 18 patients younger than 18 years of age per day. Some ambulatory care centers received emergency medical service and private ambulance calls and encountered serious illness such as chest pain, seizures, and anaphylaxis; the majority, however, handled mainly minor injuries and illnesses. Although most had pediatric equipment and supplies, some did not have a complete set of pediatric resuscitation equipment even though they were part of the emergency system offering care to the pediatric population.
Cholesterol Screening in Pediatric Practice
Authors: Goff David C. , Donker Ge A. , Labarthe Darwin R. , Ragan Jesse D. , Adkins A. Thomas , Killinger R. Peter , Caudill John W.
Published: December 2021

Four pediatricians introduced a portable cholesterol analyzer into their group practice. Their experience is described on the basis of 12 months of screening in 1665 children and adolescents. The overall 50th and 90th percentile values for a subgroup of 1406 routinely screened children were 156 and 197 mg/dL, respectively, but there was marked variation in these values among specific age and sex groups. Cholesterol levels decreased by age group during the early teenage years and increased thereafter, these changes occurring at ages approximately 2 years younger for girls than for boys. Further analysis of screening results for 398 sibling pairs demonstrated significant concordance between paired cholesterol levels when classified by the respective age- and sex-specific 90th percentile values for each member of the pair. Sibling pairs in which both members' cholesterol values exceeded their 90th percentile value were identified 2.4 times as frequently as expected (confidence interval 1.1 to 4.5, P = .029). The observations reported here indicate that office-based cholesterol screening in a pediatric practice may be both practical and useful, although further consideration of screening criteria is needed. Age- and sex-specific reference values for cholesterol levels during childhood could improve screening results. Special emphasis should be directed toward screening siblings of children in whom high cholesterol levels have been detected.
Hypercholesterolemia in Adolescents: Effectiveness of Screening Strategies Based on Selected Risk Factors
Authors: Steiner Nancy J. , Neinstein Lawrence S. , Pennbridge Julia
Published: December 2021

This study evaluates the efficacy of the American Academy of Pediatrics' current recommendations for identifying hypercholesterolemia in teenagers. These guidelines advocate a screening strategy that is targeted only at high-risk individuals. Detailed information regarding risk factors for hypercholesterolemia was obtained from 1001 adolescents or their parents at three urban teen clinics during routine health assessments. In addition, serum cholesterol was measured in all adolescents. The population under study was 38.2% Hispanic, 33.5% white, 15.4% black, and 11.3% Asian, with a mean age of 15.6 years (range: 12 through 21 years); 52% were female. Based on the cholesterol values, the study population was divided into two groups: (1) normal cholesterol level, <200 mg/dL (n = 937, mean cholesterol value = 157 mg/dL) and (2) elevated cholesterol level, ≥200 mg/dL (n = 64, mean cholesterol value = 228 mg/dL, range = 200 through 366 mg/dL). Application of the 1985 American Academy of Pediatrics criteria for selected screening identified 30 of 64 individuals with hypercholesterolemia (sensitivity = 47%). Criteria similar to 1988 recommendations identified 40 of 64 teenagers (sensitivity = 62%). A combination of 1985 and 1988 criteria yielded a sensitivity of 44 of 64, or 69%. The specificity of these criteria was 74%, 60%, and 53%, respectively. Despite the utilization of the 1985, 1988, or a combination of both American Academy of Pediatrics criteria for hypercholesterolemia screening, this study demonstrates that many adolescents with abnormal cholesterol levels would not be identified. Rather than relying on selected screening which is targeted at high-risk individuals, practitioners should consider cholesterol screening in all adolescents as part of a routine health assessment.
Poliomyelitis-Like Paralysis During Recovery From Acute Bronchial Asthma: Possible Etiology and Risk Factors
Authors: Shahar Eli M. , Hwang Paul A. , Niesen Charles E. , Murphy E. Gordon
Published: December 2021

A poliomyelitis-like paralytic disease during recovery from an attack of bronchial asthma is described in two young children. They presented at the age of 13 and 22 months, respectively, with acute flaccid paralysis of one or both lower limbs and preserved sensation. Cerebrospinal fluid examinations revealed mild protein elevation in both and pleocytosis in the second infant. Enteroviruses were isolated in a nasal swab and stools of the second patient. Acute onset of flaccid paralysis with absent motor action potential and normal sensory responses, detected by electrophysiologic studies, are highly suggestive of motor anterior horn cell disease in these infants. A multifactorial setup of immune suppression, stress, and neurotoxic drugs during an acute bronchial asthma attack triggered by a viral disease may render the patient vulnerable to viral invasion of the anterior horn cell with enteroviruses other than poliovirus. The overall experience of 22 patients with this serious complication is reviewed.
Requiem for a Hospital
Authors: Ditmar Mark F.
Published: December 2021

The splendor falls on castle walls

And snowy summits old in story:

The long light shakes across the lakes,

And the wild cataract leaps in glory.

Blow, bugle, blow, set the wild echoes flying,

Blow, bugle; answer, echoes, dying, dying, dying.

—from The Splendor Falls by Alfred, Lord Tennyson

This is the story of the closure of a hospital and with it a part of American pediatric history.

Children's Seashore House of Atlantic City is the nation's fourth oldest pediatric hospital. After 118 years, it will close in the summer of 1990 and move to a new facility in Philadelphia.

The simple brick, layer-cake structure looks very tired now, its iconic soul having been steadily removed for incorporation into the new hospital. The cornerstone animals, lions and bighorn, have been chiseled free and now guard a new outpost. So too have the plaques from the turn of the century, optimistically commemorating the establishment of endowed beds, wards, and cottages "for perpetual use" with their benefactors of simplicity and gentleness by name, such as the "Endowed Bed of St James Sunday School, 1889" and "Endowed by the Everyday Kindness Society, 1912."

On this day, the workers hammer to remove the final link—an enormous marble tablet from 1919 eulogizing Dr William Bennett, the principal driving force of Children's Seashore House and also the founder of St Christopher's Hospital in Philadelphia. A mere 50 yards away, the Atlantic Ocean beats inexorably as it did at the founding in 1872, 2 years after the first planks were laid for the famous boardwalk.
Toward Reducing Pediatric Injuries From Firearms: Charting a Legislative and Regulatory Course
Authors: Christoffel Katherine Kaufer
Published: December 2021

Each year in the United States, approximately 3000 children and adolescents younger than age 20 die as a result of homicides, suicides, and unintentional injuries from firearms. The young children, relatives, neighbors, and friends of the 30 000 adults killed by firearms each year in the United States are also affected by this uniquely American epidemic. It is estimated that half of all American homes contain 200 million firearms, including 60 million handguns. Increasingly, pediatricians are becoming involved in efforts to reduce the prevalence of injuries from firearms, as parent educators, experts on children and adolescents, and advocates in the political process. This commentary is intended to aid in the last of these roles. The advocacy goal is identified as reducing the accessibility of guns in the environments of children and adolescents. The pros and cons of 17 possible approaches—ranging from mandatory safety courses in schools to handgun bans—are presented. It is concluded that, while there is no perfect approach, many available approaches will help; there is every reason to be both bold and optimistic.
Informing Schools About Children's Chronic Illnesses: Parents' Opinions
Authors: Andrews Susan Good
Published: December 2021

Parents of 217 chronically ill children and adolescents were surveyed concerning their opinions about disclosing medical information to schools. The sample consisted of parents of more than one third of the children and adolescents meeting inclusion criteria who were seen at a university-based pediatric clinic during a 10-week period. Parents were asked (1) whether schools need information about 16 health items, (2) who in the school should know, and (3) who should provide this information. Parents' willingness to disclose information was compared with family and child demographic data. Parents strongly believed that (1) teachers need to be informed and (2) parents should be the primary informers. The consensus that schools need information did not vary with family and child demographics. However, parents of children with poor illness prognosis, greater likelihood of emergencies, and visible illnesses were more supportive of disclosure. Most parents indicated that physicians should provide information on 10 of the 16 items. Physicians were viewed as particularly appropriate informers about recognizing emergencies and medication effects. Only 21% of the parents were aware of any prior contact between the medical care giver and the school concerning their child's illness. Thus, parents want schools informed and believe physicians should be involved in providing information.
An Outbreak of Tinea Corporis Among Schoolgirls
Authors: PREISER GARY
Published: December 2021

The purpose of this report is to describe an outbreak of tinea corporis due to Microsporum canis with an atypically widespread rash among a group of preteen and teenage schoolgirls. M canis is found worldwide as a common dermatophytic infection of both glabrous and hairy skin. Nosocomial out-breaks, which have been described in the institutional setting among geriatric patients and their caretakers, were thought to be transmitted by direct contact, contaminated linens, and shared razors.1 However, in the general population, the chief source of contagion of this zoophilic infection is domestic animals, particularly kittens.2

CASE REPORTS

Within a period of 12 days in November 1989, seven girls, aged 12 through 15 years, were seen with the presenting complaint of a rash.
Cyanide Poisoning From a Cosmetic Nail Remover
Authors: LOSEK JOSEPH D. , ROCK ALICE L. , BOLDT RHONDA R.
Published: December 2021

Delayed cyanide toxicity is illustrated in the case of a 23-month-old child who ingested Super Nail Nail Off. This product has 98% to 100% acetonitrile and is used to remove sculptured nails. When ingested or inhaled by mammals, acetonitrile, an aliphatic nitrile, is metabolized to cyanide.1-5. Several deaths following inhalation of acetonitrile in industrial settings have been reported.6,7 Ingestion of acetonitrile has resulted in only one reported death.8 We present the following case to alert primary care physicians to the delayed cyanide toxicity of this product.

CASE REPORT

A previously well 23-month-old boy was seen in the emergency department 12 hours after the ingestion of appproximately 60 mL of Super Nail Nail Off.
Dietary Nucleotide Effects upon Immune Function in Infants
Authors: Carver Jane D. , Pimentel Bernardo , Cox William I. , Barness Lewis A.
Published: December 2021

Nucleotide (NT) nitrogen, a component of nonprotein nitrogen, accounts for approximately 0.1% to 0.15% of the total nitrogen content of human milk. The results of studies in animals indicate that dietary NTs may be required for maintenance of normal immune function. Thirty-seven healthy term infants were either breast-fed (n = 9) or fed SMA formula supplemented with 33 mg of NTs per liter (n = 13, NT+) or standard SMA formula (n = 15; NT-). At 2 months of age, natural killer cell percent cytotoxicity was significantly higher in the breast-fed and NT+ groups compared with the NT- group (41.7 ± 4.7, 32.2 ± 3.4, 21.7 ± 2.2%, respectively). Interleukin-2 production by stimulated mononuclear cells was higher in the NT+ compared with the NT- group at 2 months of age (0.90 ± 0.28 U/mL, 0.27 ± 0.11 U/mL, respectively); neither formula-fed group differed significantly from the breast-fed group. Rate of growth and incidence and severity of infections did not differ significantly among dietary groups. Nucleotides may be a component of human milk that contributes to the enhanced immunity of the breast-fed infant.
Kwashiorkor: The Hypothesis That Incriminates Aflatoxins
Authors: HENDRICKSE RALPH GEORGE
Published: December 2021

It is acknowledged widely that protein energy malnutrition (PEM) is the dominant type of malnutrition worldwide and is the major associated cause of death in early childhood in all the disadvantaged countries of the world.1

The term PEM embraces all disorders, including marasmus and kwashiorkor, attributable to lack of protein and calories; it was introduced to dispel the earlier exclusive emphasis on lack of protein in the etiology of childhood malnutrition and to give appropriate recognition to energy deficiency in nutritional disorders. Regrettably since its introduction, the term PEM has been applied to every grade and type of malnutrition, frequently without further qualification, and this has done little to advance our understanding of kwashiorkor and probably has blurred its epidemiology and pathogenesis.
The Academic Generalist: Still an Endangered Species?
Authors: TAUSSIG LYNN M. , EY JOHN
Published: December 2021

In his recent article,1 Dr Haggerty touches on one of the most important issues facing departments of pediatrics, namely, the roles of the academic generalist and sections/divisions of general pediatrics. Our comments are not intended to be a critique of the article but rather to expand the discussion with the hope that solutions to some of the problems will be found rapidly.

Excellent teaching is clearly an academic function. Therefore, we would hope that, in the area of education, the academic generalist has never been an endangered species and no revival is necessary! As Dr Haggerty appropriately notes, sections/divisions of general pediatrics assume the major teaching obligation in many departments of pediatrics.
Baby Bottoms and Environmental Conundrums: Disposable Diapers and the Pediatrician
Authors: SUTTON MARIANNE B. , WEITZMAN MICHAEL , HOWLAND JONATHAN
Published: December 2021

The solid waste crisis is currently receiving extensive publicity in the lay press and increasing attention from the government (Newsweek. November 27, 1989:76; Council for Solid Waste Solutions, Washington, DC, unpublished data).1-3 The United States has the highest per capita rate of solid waste production among industrialized nations, more than three pounds per person each day, resulting in 160 million tons of solid waste each year (Newsweek. November 27, 1989). Disposable diapers contribute significantly to this problem and have, in fact, become a symbol of the solid waste crisis.4-6

Marketing surveys estimate that 80% of infants in the United States use disposable diapers.7,8
Antiretroviral Treatment for Children With Human Immunodeficiency Virus Infection
Authors: CONNOR EDWARD
Published: December 2021

As the old man walked the beach at dawn, he noticed a young woman ahead of him picking up starfish and flinging them into the sea. Finally, catching up with the youth, he asked her why she was doing this. The answer was that the stranded starfish would die if left until the morning sun. "But the beach goes on for miles and there are millions of starfish," countered the old man. "How can your effort make any difference?" The young woman looked at the starfish in her hand and threw it to safety in the waves, "It makes a difference to this one," she said.
Hazards of Clove Cigarettes
Authors:   Committee on Substance Abuse
Published: December 2021

In recent years, the development of a dangerous fad in which young people use clove cigarettes as an alternative to conventional cigarettes has occurred in several areas of the United States and Canada. Many users have the mistaken belief that clove cigarettes are an herbal, "natural," nontobacco alternative. Others are attracted to their use because of the association of clove cigarettes with the image of surfing, New Wave music, and the search for "exotic" and unusual experiences.

More than 170 million clove cigarettes were sold at the height of their popularity in 1984, and sales were still averaging more than 40 million per year in 1985, 1986, and 1987.1(p3) This is even more remarkable when one considers that a significant portion of the consumers are under the legal age of purchase and that these sales have been achieved without the assistance of overt advertising. Indeed, a recent report of California youth in the 10th grade showed that 23% had tried clove cigarettes at least once. Furthermore, one third of those, approximately 8.5%, had used them at least once per month.2

Clove cigarettes are imported from Southeast Asia, principally from Indonesia, and are composed of approximately one third shredded cloves and two thirds tobacco. The type of tobacco in a clove cigarette delivers approximately twice as much tars, nicotine, and carbon monoxide as does tobacco in ordinary American cigarettes.1(pvi)

In addition, substantial amounts of eugenol, an anesthetic agent, are found in cloves and in the smoke of clove cigarettes. The typical clove cigarette smoker inhales approximately 7 mg of eugenol per clove cigarette.
Blue Mucus It Was in Her Eyes—Not in Her Head
Authors: GOUDARZI TAJVAR
Published: December 2021

To the Editor.—

A 15-year-old, black girl came to the Outpatient Clinic for cold, cough, and runny nose of 2 weeks duration. She claimed that periodically, when she blew her nose, she got thick, BLUE material bilaterally.

She was taking a decongestant orally and used clear nose drops for a week. She complained about this BLUE material to a physician and a nurse in the Emergency Room; she was told that this was not possible and that the problem was psychological, "it is in her head."
Blue Jeans Thighs
Authors: LANTNER ROBERT R. , ROS SIMON P.
Published: December 2021

To the Editor.—

We wish to report an interesting phenomenon that is probably more widely prevalent than is recognized. An 18-month-old girl was brought to our Emergency Department by her parents for the sudden onset of a bluish rash on the toddler's thighs and abdomen. There was no history of recent viral illness, fever, change in appetite or activity, recent drug or toxin ingestion, or trauma. The mother thought the thighs appeared swollen, but the child was walking normally without any apparent pain or discomfort.
Strength Training, Weight & Power Lifting, and Body Building by Children and Adolescents
Authors: NELSON MICHAEL A.
Published: December 2021

In Reply.—

Dr Shepherd is correct in pointing out that not all the lifts under "Definitions" in the American Academy of Pediatrics statement, "Strength Training, Weight and Power Lifting, and Body Building by Children and Adolescents,"1 are accomplished in a ballistic rather than a controlled fashion. Although data are sparse, it does appear that there are increased risks of injury with the lifts performed in a ballistic fashion (ie, snatch, clean and jerk, power clean).2 These lifts require a great deal of strength, coordination, balance, and explosive power.
Intravenous Immunoglobulin Therapy for Prevention of Infection in High-Risk Premature Infants: Report of a Multicenter, Double-Blind Study
Authors: Magny Jean-François , Bremard-Oury Clothilde , Brault Dominique , Menguy Claudie , Voyer Marcel , Landais Paul , Dehan Michel , Gabilan Jean-Claude
Published: December 2021

The effectiveness of intravenously administered immunoglobulin (Ig) therapy for prophylaxis of infection was evaluated in high-risk preterm infants. Two hundred thirty-five premature newborns were randomly assigned, in a double-blind controlled trial, to treatment and placebo groups. Thirty-five infants (29%) of the Ig group and 29 (25%) of the placebo group had one or more episodes of certain infection. Thirty infants (25%) of the Ig group and 18 (16%) of the placebo group had one or more episodes of probable infection. No significant differences were observed in the incidence of certain or probable infection in treated and control infants. Nevertheless, among the infants who had one or more certain or probable episodes of infection, more of them belonged to the Ig group than to the placebo group. The possible deleterious effect of the administration of large amounts of polyspecific Ig is discussed.
Circulating Catecholamine Concentrations in Cocaine-Exposed Neonates: A Pilot Study
Authors: Mirochnick Mark , Meyer Jerrold , Cole Jean , Herren Tim , Zuckerman Barry
Published: December 2021

Twenty newborns, 12 with prenatal exposure to cocaine and an unexposed control group of 8, were studied to determine concentrations of circulating catecholamines and their relationship to newborn behavior. Birth weight of the cocaine-exposed neonates was significantly lower than that of the control group. Gestational age, length, and head circumference of the cocaine-exposed neonates were also lower, although the differences did not reach statistical significance. Between 24 and 48 hours of age, circulating concentrations of norepinephrine, dopamine, and the catecholamine precursor dihydroxyphenylalanine were measured and behavior was assessed using the Neonatal Behavioral Assessment Scale. Mean dihydroxyphenylalanine concentrations were increased in the cocaine-exposed newborns (10.3 ng/mL vs 5.9 ng/mL, P = .055), while there was no difference between the groups in mean norepinephrine or dopamine concentrations. There was a significant negative correlation between norepinephrine concentration and orientation cluster score for the cocaine-exposed newborns (rp2 .6979,P .005). Norepinephrine concentration did not correlate with the score for any other behavioral cluster, nor did dopamine or dihydroxyphenylalanine concentration correlate with the score for any cluster. These preliminary data from a pilot study suggest that catecholamine activity is increased in cocaine-exposed newborns and may play a role in neurobehavioral disturbances associated with prenatal exposure to this drug.
Long-term Mental Health Effects of a Pediatric Home Care Program
Authors: Stein Ruth E. K. , Jessop Dorothy Jones
Published: December 2021

The increased survival of youngsters with chronic physical disorders has led to concern about their long-term psychological adjustment. Few data are available on how to reduce the psychological morbidity that occurs in the presence of chronic childhood illness. An earlier report of a randomized controlled trial of a pediatric home care program demonstrated that this program, combining comprehensive biomedical and psychosocial care, reduced the short-term psychological morbidity of those receiving home care. However, data have not previously been available on whether the short-term improvement in adjustment is associated with any long term benefits. This report presents long-term follow-up data collected 4½ to 5 years after enrollment on 68% of the original sample. After this interval there were even larger differences between the experimental and control groups than those previously observed at 6 months and 1 year. This finding provides strong evidence that a comprehensive family-oriented outreach program for youngsters with chronic physical disorders can have long term mental health benefits. It should encourage clinicians to develop similar programs and investigators to look for long-term effects of other interventions.
Acute Otitis Media in Human Immunodeficiency Virus-Infected Children
Authors: Principi Nicola , Marchisio Paola , Tomaghi Raffaella , Onorato José , Massironi Emilia , Picco Patrizia
Published: December 2021

To evaluate the occurrence and outcome of acute otitis media (AOM) in human immunodeficiency virus (HIV)-infected children, a prospective comparative cohort study was performed. Twenty-seven HIV-infected children were individually matched with paired control subjects and followed up for 543 months (mean 19.4 ± 11). Data collected were evaluated considering HIV-infected children both as a whole and as P1 and P2 patients according to Centers for Disease Control classification. During the observation period, 46 episodes of AOM were diagnosed in 15 HIV patients and 22 in 16 control children: 11 P1 had 27 AOM episodes vs 17 in 13 control children; 6 P2 had 19 AOM episodes vs 5 in 4 control children. Human immunodeficiency virus infection does not seem to modify the occurrence of AOM. Recurrent AOM (3 or more episodes in 6 months) was, however, significantly more common in P2 children. Amoxicillin, to which the bacteria isolated in P2 children were sensitive in vitro, cured 33 of 46 episodes in HIV-infected children compared with 20 of 22 in control children. Cure rate was similar in P1 children compared with control children but was significantly lower in P2 versus control children (47.3% vs 100%). Reasons for higher occurrence of failures in P2 children remain to be investigated.
Reviews of Lay Literature in Child-Care: What Parents Are Reading
Authors: GLASCOE FRANCES PAGE , MOORE WILLIAM O. , BAUMGAERTEL ANNA
Published: December 2021

This book on behavior management focuses closely on problematic parental behavior such as passivity, ineffectual statements, use of unrealistic threats, hostility, and physicality. Parents are taught to communicate better, use nonverbal techniques, logical consequences, and a variety of reinforcers. There are also suggestions for remaining calm, working as a team with a spouse and creating an overall discipline plan. Common problems and suggested consequences are covered in some detail. Overall, the book is "parentcentric" and "behaviorcentric"—offering little insight into why children behave, think and feel as they do or how the parent-child relationship can and should be one of mutual regulation. The text may be best reserved for somewhat unsophisticated parents who have trouble with the complexities of child development. However, because of its limited focus, families using this book may need additional references in order to understand problematic parent-child behavior better.
School Health Assessments
Authors:   COMMITTEE ON SCHOOL HEALTH
Published: December 2021

In addition to providing a "medical home," the pediatrician should be an advocate for students in the school setting and should promote effective communication among school officials, families, and the health care community.
Children and Fireworks
Authors:   COMMITTEE ON INJURY AND POISON PREVENTION
Published: December 2021

Every year, Americans express their patriotism on Independence Day and celebrate other festive occasions with fireworks. As a result, approximately 12 446 individuals, more than half of them children, have fireworks-related injuries that require hospital treatment. In 1988, it is estimated that 20 people died as a direct result of injuries caused by fireworks or by the fires they caused. The hands (32%), head (18%), legs(15%), and eyes(14%) are the body parts most often involved, accounting for about 80% of all fireworks-related injuries. About one third of the eye injuries result in permanent blindness. Hand and finger injuries require 120 estimated amputations annually. Burns are the most common type of fireworks-related injury: lacerations, contusions, and abrasions are also frequent.

Under current federal regulations issued by the Consumer Products Safety Commission (CPSC) in 1976, any firecracker containing more than 50 mg of explosive material is banned, although aerial devices still may contain up to 130 mg of powder. The CPSC classifies explosive devices into three categories: Class A, which are solid explosives such as TNT and dynamite; Class B, which includes large firecrackers, cherry bombs, and M-80s; and Class C, the common, or so-called "safe and sane" devices. Class B devices are banned from public sale but are used for professional displays. Class C fireworks include fountains and candles, which shoot out sparks or flaming balls, rockets with sticks (called "bottle rockets" because it is customary to stand them in a soda bottle for ignition), other rockets, sparklers, and smoke devices.
The 55 Miles Per Hour Maximum Speed Limit
Authors:   COMMITTEE ON INJURY AND POISON PREVENTION
Published: December 2021

The first significant reduction in three decades in the number of highway deaths was noted in this country when the 55 miles per hour (mph) national speed limit became law in 1973. Where this speed limit is still in force, the reduction in automobile deaths and injuries has been maintained.

In 1987, however, Congress passed the Surface Transportation and Uniform Relocation Assistance Act. One of the provisions of this act was to allow states to raise the speed limit on most rural interstate highways to 65 mph. Because the average highway speed routinely exceeds the prevailing legal limit by at least several miles per hour, the higher speed limit has markedly increased the proportion of traffic traveling at very high speeds. In 1988, 3 times as many vehicles were exceeding 70 mph and 11 times as many vehicles were traveling at speeds greater than 80 mph as in 1986 when the 55 mph speed limit prevailed. These higher speeds have been accompanied by appreciable increases in automobile crash deaths and injuries. The relationship of automobile mortality and morbidity to the speed limit is well documented. The American Academy of Pediatrics endorses a return to the national maximum speed limit of 55 mph as an effective method of lowering the incidence of automobile deaths and injuries. Pediatricians should make every effort to support this form of injury prevention by personal example, education of pediatric patients and their parents, and legislative advocacy.
Ricelyte Advertising
Authors: TULLOCH J.
Published: December 2021

We refer to promotional material for the Mead Johnson product Ricelyte which appeared recently in Pediatrics. This advertisement claimed that Ricelyte is "the first and only rice-based oral rehydration solution" and that it can appreciably reduce stool output during diarrhea. We feel this advertisement is misleading for the following reasons:

1. Contrary to what is suggested, Ricelyte does not contain rice, but "rice syrup solids." These are glucose syrup solids (or maltodextrins) extracted by controlled hydrolysis of rice starch.
In Reply: Ricelyte Advertising
Authors: BAKER G. L.
Published: December 2021

When any new product is introduced to the market it is extremely important to evaluate all the experimental evidence needed to support the claims. In this regard, we take strong exception to the comments of Dr J. Tulloch who is concerned that a recent advertisement run in Pediatrics for Mead Johnson's newly introduced product, Ricelyte, is misleading. After more than 4 years of research and development, stimulated in part by the extensive efforts of the World Health Organization Diarrhoeal Disease Control Programs (CDD), the Mead Johnson Research Center successfully produced from rice flour, a refined, highly specific glucose polysaccharide, "rice syrup solids."
PRINCETON CLUBS ADMIT WOMEN
Authors: L. J. F.
Published: December 2021

In a decision that marked the end of an era embodied and romanticized by F. Scott Fitzgerald, the Supreme Court of New Jersey ordered the last two remaining male-only undergraduate clubs at Princeton University to begin admitting women...

Princeton's clubs are the first at an Ivy League school to be ordered to admit women.
A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns
Authors: Porter Fran L. , Miller J. Philip , Cole F. Sessions , Marshall Richard E.
Published: December 2021

To evaluate the efficacy of subcutaneous administration of lidocaine for reducing physiologic instability in acutely ill newborns during clinically required procedures, 81 neonates who required lumbar punctures within the first month of life were stratified by birth weight and respiratory support and randomly assigned to an experimental or a control group. The experimental group received an injection of 0.1 mL/kg of 1% lidocaine prior to the lumbar puncture. The control group received a nonanesthetized lumbar puncture without placebo. Changes in heart rate, respiratory rate, transcutaneous oxygen and carbon dioxide tensions, and heart rate variability from baseline, preparatory (positioning/handling), lumbar puncture, and recovery periods were measured. The administration of lidocaine did not minimize physiologic instability in response to the lumbar puncture nor was it associated with any detectable adverse effects other than prolonging the duration of the lumbar puncture. Although significant physiologic changes were observed in response to preparatory procedures, few additional changes beyond those occurred in response to lumbar punctures in either the experimental or control group. It is concluded that local anesthesia failed to influence manifestations of physiologic instability during neonatal lumbar punctures and that preparatory procedures were more destabilizing than either the administration of lidocaine or the lumbar puncture itself. The results suggest that the management of newborns requires emphasis on minimizing the destabilizing effects of required and frequent handling procedures.
Pediatric Emergency Transport and the Private Practitioner
Authors: Baker M. Douglas , Ludwig Stephen
Published: December 2021

A mail survey of 182 pediatricians and 92 family practitioners in Pennsylvania was conducted to determine their methods of transport of seriously ill children from their offices to referral centers and their involvement with professional transport services. Although most physicians (93.1%) stated that they had professional services available to them (at their office location), more than half (53.8%) indicated that the patient's family automobile was their most commonly used method of transport of ill children to tertiary care centers. This was true regardless of the disease entity involved, including suspected epiglottitis. Practice setting had little influence on transport method. However, in general, younger children were judged to need ambulance transport more often than older children. Reasons cited for not using professional transport from the office included a perceived better efficiency of the family car (61.8%), the prohibitively high expense of professional transport (9.8%), and failure to consider professional transport (6.5%). Further study of this component of office preparedness is suggested.
Early Formula Supplementation of Breast-Feeding
Authors: Kurinij Natalie , Shiono Patricia H.
Published: December 2021

Factors influencing early formula supplementation in breast-fed neonates were examined among 726 women who were delivered of their first child in one of three metropolitan Washington, DC, hospitals. Thirty-seven percent of breast-fed neonates were given supplementary formula in the hospital. Mothers who gave birth at a university hospital were more likely to breast-feed exclusively (adjusted odds ratio 3.5; 95% confidence limit 2.1 to 5.9), after adjustment for maternal demographics, hospital factors (such as time of first breast-feed, demand feeding, delivery type, and rooming-in), and the maternal breast-feeding commitment. Aside from delivery hospital, a strong predictor of formula use was the time between birth and initiation of the first breast-feed. The longer a mother waited to initiate breast-feeding the more likely she was to use formula; the adjusted odds ratios for women who initiated breast-feeding 2 to 6 hours, 7 to 11 hours, and 12 or more hours postpartum were 1.1, 0.5, and 0.2, respectively. Feeding the baby on demand, having a vaginal delivery, deciding to breast-feed before pregnancy, having a college education, and being married also were moderately, though significantly, predictive of exclusive breast-feeding. The findings suggest that hospital influences can promote formula use and indirectly shorten breast-feeding duration, particularly those hospital practices that delay early initiation of breast-feeding.
Pedestrian Injuries to Children Younger Than 5 Years of Age
Authors: Winn Diane G. , Agran Phyllis F. , Castillo Dawn N.
Published: December 2021

Historically, research on pediatric pedestrian injuries has analyzed children younger than 5 years of age as a single group. However, in this study, these children were divided into two age groups which were reflective of differences in behavior and development. The data demonstrate differences in the circumstances of the pedestrian injury events between toddlers (0 through 2 years and ambulatory) and preschoolers (3- and 4-year-olds). Toddlers were more likely to be injured in nontraffic events whereas preschoolers were more frequently injured in traffic situations. A high proportion of toddler injuries occurred in residential driveways and were caused by vehicles backing up. The majority of preschoolers, often without supervision, were injured while crossing/darting midblock on residential streets near their homes. Reflecting these differences in circumstances and also developmental differences between toddlers and preschool children, there is a need for agespecific interventions to reduce pedestrian injuries in children younger than 5 years of age.
Evaluation of Graduating Neonatal Nurse Practitioners
Authors: Mitchell Alba , Watts John , Whyte Robin , Blatz Susan , Norman Geoffrey R. , Guyatt Gordon H. , Southwell Doris , Hunsberger Mabel , Paes Bosco
Published: December 2021

To compare the knowledge and problem-solving, communication, and clinical skills of graduating neonatal nurse practitioners (NNPs) and pediatric residents, a cohort study was conducted in a 33-bed tertiary-level neonatal intensive care unit in a 400-bed teaching hospital affiliated with a faculty of health sciences. Participants were all (n = 10) NNP graduates from the first 3 years of the educational program and 13 (87%) of 15 second-year pediatric residents. One hundred multiple-choice questions and 20 radiographic slides were used to test knowledge; a semistructured oral examination tested problem-solving skills; three simulated interactions with parents tested communication skills; and seven simulated procedures tested clinical skills. Graduating NNPs scored similarly to the pediatric residents on the multiple-choice questions (difference –3.4%; 95% confidence interval [CI] around difference –9.7, 2.9), radiographs (difference –1.4%; 95% CI –11.5, 8.7), oral examination (difference 2.8%; 95% CI –11.1, 16.7), communication skills (simulated parents assessment: difference 0.8%; 95% CI –4.2, 5.7; expert observer assessment: difference 5.8%; 95% CI –2.8, 14.3), and clinical skills (difference 7.4%; 95% CI –5.5, 20.2). The NNPs about to graduate from their educational program showed knowledge and problem-solving, communication, and clinical skills equivalent to those of second-year pediatric residents and are thus likely to deliver comparable care in the clinical setting. The results support the adoption of the NNP role.
Effectiveness of Computer-Generated Appointment Reminders
Authors: Quattlebaum Thomas G. , Darden Paul M. , Sperry John B.
Published: December 2021

Previous studies of appointment reminders among general pediatric patients have been done exclusively among low socioeconomic populations in clinics with low continuity of care and using block scheduling methods. This study of mailed computer-generated appointment reminders took place in a setting with patient demographics and practice techniques similar to those of many private pediatric practices. During a 6-month period, 901 appointments that were made more than 7 days prior to the scheduled date were randomly assigned to receive reminder postcards or to serve as controls. The overall broken appointment (no-show) rate was reduced from 19% in the control group to 10% in the reminder group, representing a 48% reduction (P = .0002). The magnitude of reduction of no-shows was similar for appointments scheduled more than 14 days prior to the appointment time (39%) as well as those scheduled more recently (58%). Equivalent results were seen with well-child appointments (47%) as with other visits (50%). Both lower and higher socioeconomic groups demonstrated similar results. The mailed postcards cost $0.20 each and were highly cost effective, generating an estimated $7.50 for each $1 spent during the study. With reductions similar to those found in this study, computer-generated appointment reminders are likely to be cost effective in other practices if current no-show rates are greater than 2% to 4%.
Pediatric Telephone Advice: Seattle Hotline Experience
Authors: TROUTMAN JAMES L. , WRIGHT JEFFREY A. , SHIFRIN DONALD L.
Published: December 2021

Pediatric hotlines gives parents and interested parties the opportunity to call pediatricians with questions regarding child health issues. More than a dozen such hotlines have been held by state chapters of the American Academy of Pediatrics in all regions of the United States. They were promoted by regional newspapers and generally preceded by feature articles centered on child health concerns. The first hotline was held in 1987 by pediatricians in Delaware, District of Columbia, Maryland, and Virginia in conjunction with the Washington, DC, chapter of the American Academy of Pediatrics and the newspaper USA Today.

Seattle-area pediatricians and The Seattle Times sponsored a 1-day, 8-hour hotline in March 1989.
Captopril-Induced Reversible Acute Renal Failure in an Infant With Coarctation of the Aorta
Authors: WOOD ELLEN G. , BUNCHMAN TIMOTHY E. , LYNCH ROBERT E.
Published: December 2021

Activation of the renin-angiotensin system has been implicated in the initiation of hypertension associated with coarctation of the aorta, with sodium and volume expansion playing a role in maintenance of the hypertension. Increase in total peripheral resistance induced by the stenosis itself also has received increasing attention in the etiology of coarctation and renal vascular hypertension.1-5 To date, angiotensin-converting enzyme (ACE) inhibitors have been used to lower acutely blood pressure in patients with coarctation, as well as in "paradoxical" postoperative treatment of hypertension.2,6 We recently cared for a small infant with hypertension due to coarctation of the aorta who developed acute renal insufficiency while receiving captopril.
Neonatal Hyperbilirubinemia and Physical and Cognitive Performance at 17 Years of Age
Authors: Seidman Daniel S. , Paz Ido , Stevenson David K. , Laor Arie , Danon Yehuda L. , Gale Rena
Published: December 2021

To estimate the effect of neonatal hyperbilirubinemia on long-term cognitive ability in full-term newborns with a negative Coombs test, we performed a 17-year historical prospective study of 1948 subjects. Intelligence tests and medical examinations performed at the military draft board were stratified according to serum bilirubin concentration. A logistic regression analysis was used to adjust for the confounding effects of gestational age, birth weight, Apgar score, ethnic origin, socioeconomic class, paternal education, birth order, and the administration of phototherapy and exchange transfusion. No direct linear association was shown between neonatal bilirubin levels and intelligence test scores or school achievement at 17 years of age. However, the risk for low intelligence test scores (IQ score <85) was found to be significantly higher (P = .014) among full-term male subjects with serum bilirubin levels above 342 µmol/L (20 mg/dL) (odds ratio, 2.96; 95% confidence interval, 1.29-6.79). This association was not observed among female subjects. We conclude that severe neonatal hyperbilirubinemia, among full-term male newborns with a negative Coombs test, could be associated with lower IQ scores at 17 years of age.
Psychosocial Influences on Acquired Immunodeficiency Syndrome-Risk Behaviors Among High School Students
Authors: Walter Heather J. , Vaughan Roger D. , Cohall Alwyn T.
Published: December 2021

A survey measuring acquired immunodeficiency syndrome (AIDS)-related behaviors and selected psychosocial factors was administered to 1091 tenth grade students residing in or near an AIDS epicenter. The purpose of the survey was to identify salient risk factors that could be targeted in AIDS prevention programs. By 15 years of age, one quarter of students reported engaging in behaviors that placed them at higher risk for acquiring infection with human immunodeficiency virus, and 3% of students reported engaging in very high-risk behaviors. Students exposed to certain psychosocial stressors (ie, adverse life circumstances and poor parental support), who engaged in other problem behaviors (ie, substance use and academic problems) and who had higher self-esteem, were more likely to engage in higher risk behaviors. Pediatricians and other clinicians, particularly those working in or near AIDS epicenters, who encounter adolescents with multiple psychosocial problems, should be alert to the possibility that these youths also are engaging in behaviors that place them at risk for AIDS. Comprehensive care for these teenagers must include an assessment of involvement in AIDS-risk behaviors and appropriate behavioral counseling.