bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of Pedestrian Injuries to Children: Effectiveness of a School Training Program
Authors: Rivara Frederick P. , Booth Cathyrn L. , Bergman Abraham B. , Rogers Lisa W. , Weiss Jean
Published: December 2021

Pedestrian injuries are a complex problem for which no single intervention will be completely effective. One component of a community-wide program, training of schoolchildren in street-crossing skills, is evaluated. The program targeted public school students in grades K through 4 with an eight-session training program by a single teacher, cross-age teaching, videotape feedback, and in 1990 parent-child activity workbooks. Children's street crossing was observed pretraining and posttraining and graded on four behaviors: WALKING on sidewalk/shoulder vs in the street; STOPPING at the curb; LOOKING L-R-L before crossing; KEEP LOOKING while crossing. Analysis was conducted on matched pairs in which observations pretraining were compared with those posttraining on same child. Observations were completed on 137 children in 1989 and 92 in 1990. Nearly all children walked on the side of the road; however, fewer than 50% of children STOPPED, 25% LOOKED, and fewer than 20% KEPT LOOKING before training. Training did not improve the performance on the first two behaviors in either year, significantly increased LOOKING in 1990, and increased KEEP LOOKING by twofold in 1989 and threefold in 1990. It is concluded that pedestrian skills of children can be improved but that such a program must be part of a broader effort if pedestrian injuries are to decrease.
Injuries to Children and Adolescents: Impact on Physical Health
Authors: Rivara Frederick P. , Thompson Robert S. , Thompson Diane C. , Calonge Ned
Published: December 2021

Disability resulting from injuries was examined in a health maintenance organization population of children and adolescents 0 through 19 years of age. The physical health status instrument from the Rand Health Insurance Study was used to evaluate functional outcome of patients seen in the emergency room and outpatient clinic. Overall, 55.1% of individuals had limitations in their usual activities during the week following injury; 16.4% and 3.8% were not yet back to full activities after 1 week and 1 month, respectively. Individuals 10 years of age and older had more functional impairment than did younger children. Restrictions were greatest for fractures/dislocations and sprains and for injuries due to sports, play/recreational activities, and falls.
Small Bowel Evisceration: Unusual Manifestation of Child Abuse
Authors: PRESS SHIRLEY , GRANT PENNY , THOMPSON VALERIE T. , MILLES KAREN L.
Published: December 2021

More than 2.4 million cases of child abuse were reported in the 48 states and the District of Columbia in 1989.1 Of these, 55% were classified as neglect, 30% as physical abuse, 16% as sexual abuse, and 8% as emotional maltreatment.1 These percentages include cases in which more than one type of abuse was reported. Common manifestations of child abuse include bruises; burns; and central nervous system, intra-abdominal (blunt as well as penetrating), and genital injuries. Unusual manifestations of child abuse have included sudden infant death syndrome, apnea, poisonings, and bizarre illnesses stemming from Munchausen syndrome by proxy.

In recent years, there has been a marked increase in the number of reported cases of child abuse, especially sexual abuse.
Primary Central Hyperventilation in a Child With a Brainstem Glioma: Management With Continuous Intravenous Fentanyl
Authors: TOBIAS JOSEPH D. , HEIDEMAN RICHARD L.
Published: December 2021

Alveolar ventilation and respiratory rate are regulated by central respiratory centers in the pons and medulla, which are influenced by both neural and humoral input. Aberrations in control mechanisms can lead to apnea, hypoventilation, or hyperventilation. Although hyperventilation usually occurs as a compensatory mechanism for metabolic derangements, primary central hyperventilation (CHV) has been reported with brainstem gliomas, central nervous system lymphoma, supratentorial lesions, and head trauma.1-3

We present an 11-year-old boy with a brainstem glioma whose initial symptoms included CHV. When CHV became unresponsive to primary tumor management with radiation therapy and administration of dexamethasone, oral morphine was administered in an attempt to decrease his respiratory rate.
Focal Encephalitis With Enterovirus Infections
Authors: Modlin John F. , Dagan Ron , Berlin Linda E. , Virshup David M. , Yolken Robert H. , Menegus Marilyn
Published: December 2021

We report on four pediatric patients with Enterovirus infections who were admitted to the hospital with signs or symptoms of acute, focal encephalitis. All four experienced focal seizures. Each had a cerebrospinal fluid pleocytosis at the initial lumbar puncture. In all four patients the diagnosis of herpes simplex encephalitis was entertained. Each child improved spontaneously within a few days of admission to the hospital, and only one had residual neurologic abnormalities at the time of discharge. A brief review of these cases, and three addditional cases from the literature, indicate that the enteroviruses, particularly the group A Coxsackieviruses, are rare causes of acute focal encephalitis in children and adolescents.
Should Promethazine Be Available Without Prescription?
Authors: HICKSON GERALD B.
Published: December 2021

In Reply.—

Dr Rosefky is correct, promethazine lacks antidopaminergic activity. This represented an oversight on our part and we appreciate his attention to detail. We did point out correctly that due to the presence of a branch side chain and absence of a ring substitution, promethazine lacks significant antipsychotic effects.1 However, we do have to take exception with Dr Rosefky's contention that "promethazine has few neurologic side effects." Essentially all patients who take the drug experience sedation, a neurologic side effect, not to mention those children who have seizures, dystonic responses, agitation, and hallucinations.
Demographic, Clinical, and Psychosocial Predictors of the Reliability of Mothers' Clinical Judgments
Authors: McCarthy Paul L. , Cicchetti Domenic V. , Sznajderman Semi D. , Forsyth Brian C. , Baron Michael A. , Fink Howard D. , Czarkowski Nancy , Bauchner Howard , Lustman-Findling Katherine
Published: December 2021

The purpose of this study was to investigate to what extent selected adverse demographic, clinical, and psychosocial data measured at the 2-week well child visit could predict poorer reliability of mothers' judgments during acute illness episodes over the next 32 months. The study was a randomized trial of the Acute Illness Observation Scales (AIOS); 369 mothers participated, 183 in the intervention group using the Acute Illness Observation Scales and 186 in the control group using a three-point global assessment scale. There were 704 acute illnesses judged simultaneously and independently by mothers and pediatricians. Standard Pearson r correlations were performed between the independent variables, taken singly and in all possible combinations, and the dependent variable, reliability of mothers' judgments as measured by weighted kappa (kw). Group assignment was entered as an independent variable. Analyses were performed separately for all first, second, and third acute illness visits to control for any "practice effect" (analysis 1). To control for consistency of observers, the first, second, and third visits of mothers with three visits were also analyzed (analysis 2). Depending on the visit number, adverse demographic, clinical, and psychosocial characteristics did correlate with poorer reliability independent of group assignment. The correlations ranged from small (analysis 1, first visit, multiple variable r2 = 4%) to large (analysis 2, second visit, multiple variable r2 = 29%). Controlling for both visit number and consistency of observers vs visit number alone (analysis 2 vs analysis 1) increased multivariate correlations to kW. The results support the untoward impact that adverse demographic, clinical, and psychosocial factors have on mothers' clinical judgment. These data may assist pediatricians in identifying parents who might benefit from more intensive teaching and support about acute illness episodes in their children.
Reinterpreting Disability: Changes in Supplemental Security Income for Children
Authors: Perrin James M. , Stein Ruth E. K.
Published: December 2021

On February 20, 1990, in Sullivan v Zebley, the Supreme Court of the United States struck down the Social Security Administration's criteria for determining eligibility of children with disabilities for Supplemental Security Income (SSI). This dramatic decision held that the existing regulations for the program discriminated against children, because children were required to meet a stricter standard than adults who applied for SSI. This decision overturned the current rules and procedures for the determination of access to a major federal benefits program and, in most states, to additional benefits through assured Medicaid eligibility. The Court also mandated that the Social Security Administration make changes that will significantly alter and liberalize access for children. Because many pediatricians may be unaware of the issues and the potential advantages for children in their care, we summarize below some of the pertinent background and implications of this landmark decision.

BACKGROUND AND DESCRIPTION

The Supplemental Security Income Program of the Social Security Administration, enacted by Congress in 1972, provides an income supplement to lower income disabled Americans, both children and adults. Persons older than 18 years of age who have a health problem that causes major disability and prevents participation in substantial gainful activity may receive cash benefits as part of a social policy effort that began in the Roosevelt era of the 1930s, although specific disability programs did not begin until the 1960s. Children also may receive cash benefits under certain similar conditions. The SSI program was designed primarily as a social benefit program to improve the financial standing of aged, blind, and disabled individuals, but it also brings automatic eligibility for Medicaid for individuals who qualify for SSI in 31 states and the District of Columbia.
PERCENTAGE OF UNINSURED CHILDREN HAS INCREASED
Authors: STUDENT
Published: December 2021

The proportion of children in the United States without private or public health insurance increased from roughly 13 percent to 18 percent between 1977 and 1987, according to a new study by the Agency for Health Care Policy and Research (AHCPR). The growth in the proportion of uninsured children in poor and low-income families over the decade was even more dramatic—it rose from 21 percent to 31 percent.
Brief History of Infant Nutrition and View to the Future
Authors: BARNESS LEWIS A.
Published: December 2021

Thank you for your generous remarks, Dr Eaton. With the extensive list of busy work, it is difficult to see how anything good could have come from my activities.

Before accepting the award, I should like to acknowledge some of the many people who have contributed to my attaining this honor. First, I thank the nominating committee of the Academy who must have been sleeping at the time of their decision. I thank my ex-students, co-workers, and stimulators, particularly Frank Oski and Grant Morrow, as well as the late Bill Mellman and Michael Miller, who helped me accomplish the little I accomplished. I've been lucky in wives, both of whom gave considerable support.
Why Not Have More Milk?
Authors: KRETCHMER NORMAN
Published: December 2021

In the past, biological products derived from the human had to be extracted or isolated from bulk materials, but now, with genetic engineering, gross amounts can be prepared by placing the appropriate gene in the genome of a friendly bacterium. Genetic engineering is a major scientific advance of our time and has made major contributions to medicine. Prominent products of this exciting biological advance are insulin, growth hormone, and interferon.

The principle of genetic engineering is simple. A foreign gene is inserted into the genome of a bacterium, and the bacterium uses the gene as a template for the synthesis of the cognate protein.
Marijuana: A Continuing Concern for Pediatricians
Authors:   COMMITTEE ON ADOLESCENCE,   COMMITTEE ON SUBSTANCE ABUSE
Published: December 2021

1. Marijuana use continues to be widespread among adolescents.

2. The seriousness of the behavioral consequences of marijuana use is sufficient to cause great concern and prompt the pediatrician to counsel young people against any use of the drug. Such counsel should be based on health concerns, including the relationship of marijuana use to both trauma associated with intoxication and the impact on memory and learning. Additional reasons for concern, and hence counsel, include anxieties and uncertainties regarding the potential harm that marijuana use may cause to adolescents undergoing hormonal development, possible teratogenicity, and the known consequences of chronic use.

3. A psychosocial and medical assessment for drug use, including use of marijuana, should be a routine part of health maintenance for every young person. Performing such assessments gives the pediatrician the opportunity to offer anticipatory guidance prior to the onset of drug use behavior, to intervene and minimize consequences if drug use has been initiated, and to detect and address issues of chronic or heavy use.
Response to Pneumococcal Vaccine
Authors: SCHIFFMAN GERALD
Published: December 2021

I was disturbed to read in "Immunologic Defects in Patients with Refractory Sinusitis" by Shapiro et al that I was quoted as saying "a normal response to pneumococcal immunization was defined as a rise to more than 200 ng/mL for antigens 3, 7, 9, and 14." In both those references as well as many other publications from my laboratory, I indicate that by radioimmunoassay, the only technique which my laboratory uses, 200 to 300 ng of antibody N/mL is a normal preimmunization level.
In Reply: Resident Related Liability in the Emergency Department
Authors: REYNOLDS SALLY L.
Published: December 2021

We do not believe that the increased risk of professional liability during the night shift was related to increased patient contact by the residents. The vast majority of patients (92%) in our emergency department (ED) are seen between 8:00 AM and midnight. Typically only six to eight patients are signed into the ED between midnight and 8:00 AM. At present, during the afternoon and evening, a resident sees approximately 10 patients. It is therefore very unlikely that any resident had more patient contact when an attending physician was not present.
In Reply: SIDS and Hypoxanthine
Authors: ROGNUM TORLEIV O. , SAUGSTAD OLA D.
Published: December 2021

Beckwith has two important questions regarding our paper recently published in Pediatrics. Because most SIDS usually occurs unobserved during presumed sleep, the postmortem interval has to be estimated in each case. We based the estimation of time of death on the circumstances known: for instance, the time when the baby was put to sleep and the presence or absence of lividity or rigor mortis. This is a crude method, of course, but at least better than using the time last seen alive.
Boomerang Effect of Drug Education Programs
Authors: MIELE NIEL F.
Published: December 2021

In the article by Goldberg et al, I am puzzled and concerned about a finding which appears in the table outlining "Attitudes of All High School Athletes." The trends noted in this table are disturbing—there is a suggestion that students would be more likely to consider usage of anabolic steroids after the educational intervention. Although the authors were not able to find statistically significant differences between the pre- and postintervention groups, this inability to find differences may have been due to Type 2 error.
Fillers
Authors: STUDENT
Published: December 2021

The race may not always be to the swift or the battle to the strong, but that's the way to bet.
Egg Hypersensitivity and Measles-Mumps-Rubella Vaccine Administration
Authors: Beck Suzanne A. , Williams Larry W. , Shirrell M. Annette , Burks A. Wesley
Published: December 2021

Because reports have described egg-sensitive individuals in whom anaphylaxis developed after measles vaccination, current recommendations include delaying administration of egg-derived vaccines until skin testing can be performed. Specifically, the 1988 Red Book recommends skin testing via scratch, prick, or puncture with 1:10 dilution of the vaccine and, if the result is negative, intradermal testing is suggested. The purpose of this study was to evaluate the likelihood of reaction to measles-mumps-rubella (MMR) vaccine in patients with documented egg sensitivity and to delineate the efficacy of skin-prick testing (SPT) to MMR as a predictor of hypersensitivity to the vaccine. Egg sensitivity was documented by initial SPT to egg and then, if possible, double-blind placebo-controlled food challenge (DBPCFC). Patients with a positive DBPCFC to egg or a history of anaphylactic egg sensitivity had a SPT with the MMR vaccine and then were given the MMR vaccine. Additionally, children with atopic dermatitis who had been previously proven egg sensitive via DBPCFCs were evaluated retrospectively for sensitivity to the MMR vaccine. Sixteen children with a history of egg sensitivity underwent SPT to egg, with a positive result 3 mm greater than the negative control found in 12 patients. Eight of these children had a positive DBPCFC to egg. The SPT to MMR vaccine was negative in all 16 children; vaccine administration followed with no resultant systemic problems. Three children had a local reaction at the site of injection. Twelve additional children with atopic dermatitis and egg sensitivity were reviewed. Each child had a positive SPT and DBPCFC to egg. Ten of these children received the MMR vaccine prior to the time that their egg sensitivity was elucidated. Two other children were vaccinated elsewhere after they were documented egg sensitive. All 12 of these children tolerated the vaccine without incident. These results further substantiate the safety of MMR administration in egg-sensitive children and support routine vaccination of children who do not exhibit systemic allergic hypersensitivity to egg. It is suggested that SPT is an adequate screening method for children with anaphylactic egg sensitivity.
Growth Delay in Homeless Children
Authors: Fierman Arthur H. , Dreyer Benard P. , Quinn Leslie , Shulman Sabra , Courtlandt Cheryl D. , Guzzo Richard
Published: December 2021

This study compared the growth of homeless children with National Center for Health Statistics (NCHS) standards and with growth of age-matched domiciled children of similar income level. Homeless children (n = 167) had lower height percentiles when compared with domiciled children (n = 167; P < .001) and when compared with NCHS standards (P < .001). The weight-height percentiles of homeless children did not differ from NCHS standards; however, domiciled children had higher weight-heights when compared with the homeless (P < .001) and with NCHS standards (P < .001). After controlling via regression analysis for the effects of potentially confounding factors that affect growth, it was found that homeless children from larger families and with single mothers accounted for the lower height percentiles observed. After controlling for confounding factors, domiciled children still had increased weight-height percentiles when compared with the homeless group. Duration of homelessness was not associated with decreased height or weight-height among homeless children. Homeless children in this study exhibited a pattern of stunting without wasting which is characteristic of poor children experiencing moderate, chronic nutritional stress. They exhibited a greater degree of nutritional stress than domiciled children at a similar income level and than that reported in other groups of poor children in the United States. Preexisting social factors in the families of homeless children were important in explaining the observed growth abnormalities. Further exploration of the associations between social characteristics of homeless children and their families and the growth of these children is warranted.
BORN TOO SOON—THE STORY OF EMILY, OUR PREMATURE BABY
Authors: LUCEY JEROLD F.
Published: December 2021

I bought this book with the hope that it might help parents deal with the problems of having a premature infant. It doesn't. The author is a talented reporter and a very articulate, angry parent. Her story and that of Emily, her 760 gram daughter with NEC, is tragic. Once again, neonatologists and others are cold distant figures who inhabit NICU-land. They are about as friendly as a high frequency ventilator!

Mrs. Butterfield's (E. Mehren's) views of our strange world are fascinating. One can learn a lot from her about our many failures in communication. Her description of a father's ordeal in NICU-land is particularly moving. He's a famous author under pressure, trying to do his best to be a good father. He nearly fails in Mrs. Butterfield's eyes. In my eyes he was nearly heroic!

This book will give you some insight into the incredible problems parents face in dealing with the NICU environment and its staff, other parents and visitors.

Neonatologists, house staff, obstetrical nurses and social workers will cringe when they read this, but if they can take it, they can learn a lot.

Most of the parents of premature infants are very young, frightened and completely overwhelmed. Do many feel like Mrs. Butterfield? I hope not. I'd like to think that the painful things described don't happen very often in NICUs. If they do, we're in more trouble than I realized.

After you've read this book, give it to your house staff. Its painful but educational.
Nutritional Dwarfing: Is It a Consequence of Disturbed Psychosocial Functioning?
Authors: Sandberg David E. , Smith Melanie M. , Fornari Victor , Goldstein Marjorie , Lifshitz Fima
Published: December 2021

Nutritional dwarfing refers to a condition in which maladaptive eating patterns play a primary role in poor linear growth and delayed pubertal development. The present controlled study assesses whether nutritionally dwarfed children and adolescents differ in their psychosocial adjustment from healthy children and adolescents of comparable height in ways that might account for their undernutrition. Children with nutritional dwarfing (n = 16) were compared by standardized questionnaires with a short-stature (ie, heights below the fifth percentile) control group composed of children and adolescents with constitutional growth delay and/or familial short stature (n = 31). Scores on a self-report screening questionnaire for eating disorders did not differentiate the groups. Moreover, the vast majority of nutritionally dwarfed patients expressed a desire to have a heavier physical appearance. Whereas the groups were generally similar in self-perceptions of domain-specific competencies and positive psychosocial adjustment, the parents of nutritionally dwarfed children reported that their children showed significantly fewer externalized behavior problems. These findings suggest the existence of an eating disturbance that compromises growth in childhood and/or adolescence which, unlike anorexia nervosa, is not associated with evidence of psychopathology.
Relationships Between Morbidity and Development in Mildly to Moderately Malnourished Kenyan Toddlers
Authors: Neumann Charlotte , McDonald Mary Alice , Sigman Marian , Bwibo Nimrod , Marquardt Mark
Published: December 2021

This study explored the extent to which morbidity in 110 mildly to moderately malnourished Kenyan toddlers was associated with developmental outcomes. Morbidity information was collected from the 18th to 30th months. Concurrent assessments of vocalization, play, and performance on the Bayley scales were obtained. At 5 years, a follow-up battery of cognitive tests was administered. Female toddlers who suffered more illness generally performed less well on developmental measures than their healthier female peers. These children vocalized and played less and performed less well on the Bayley Mental scales at 30 months and on the cognitive battery at 5 years. For the boys, development was largely independent of morbidity. Morbidity was related to patterns of care giving for both boys and girls, but it was not associated with socioeconomic status or food intake. However, girls who were ill more often were shorter and lighter. Relations between morbidity and development in the girls remained statistically significant when other variables, which were also related to development (such as care giving, socioeconomic status, parental IQ and literacy, food intake, and anthropometry) were considered. This suggests that morbidity, in these female toddlers, had an effect on development above and beyond other variables typically associated with malnutrition.
PROLACTIN IN CHILDHOOD OBSESSIVE-COMPULSIVE DISORDER: CLINICAL CORRELATES AND RESPONSE TO CLOMIPRAMINE
Authors: Hanna Gregory L. , MCCracken James T. , Cantwell Dennis P.
Published: December 2021

Basal prolactin concentrations were measured before treatment in 18 children and adolescents with obsessive-compulsive disorder as well as in 15 of these patients after 4 and 8 weeks of clomipramine treatment. Basal prolactin levels were influenced by a history of chronic tic disorder and by the duration and severity of obsessive-compulsive symptoms. Clomipramine administration significantly increased basal prolactin levels. A slight decline in prolactin levels during the last 4 weeks of clomipramine treatment was positively correlated with a favorable treatment response and negatively correlated with duration of illness. If the changes in prolactin levels observed during clomipramine treatment are due primarily to changes in serotonergic neurotransmission, these data suggest that clomipramine treatment of obsessive-compulsive disorder produces an adaptive decrease in the responsiveness of serotonergic receptors.
DREADED TEST FOR 4-YEAR-OLDS
Authors: L. J. F.
Published: December 2021

The first shot has been fired in a rebellion against one of the special ordeals of New York life: the frenzied competition among children barely out of diapers for admission to private schools.

. . .the directors of 55 of the city's top-flight nursery schools signed a letter announcing that they were "seriously considering eliminating testing in our schools" of their 4-year-olds seeking admission to private schools through their kindergartens.
Reviews of Lay Literature in Child Care: What Parents Are Reading
Authors: GLASCOE FRANCES P. , MARTIN ELAINE D. , MOORE WILLIAM R.
Published: December 2021

Arlene Eisenberg, Heidi E. Murkoff, & Sandee E. Hathaway. What to Expect The First Year. New York: Workman Publishing, 1989; list price $12.95 (No. 3 on the 1989 bestseller list of books on child care from Ingram Book Co., distributors of trade books).

This book is a thorough, month-by-month account of health and development in the first 12 months of life. Additional chapters address: selecting a physician, purchasing baby clothes, furniture and equipment, and making decisions about circumcision, breast and/or bottle feeding. Advice on lifestyle and career issues, paternal leave, and child care is practicable and presented without alienating sanctimony. Alleviation of parental anxiety is a central focus. However, the authors appear cavalier and ill-informed when they suggest that parents should ignore most developmental delays and avoid developmental comparisons among children. Much more valuable are the messages about discipline—the authors teach sensitive, supportive parenting skills with emphasis on developing children's self-esteem and independence through encouragement and preventative behavior management. The text's medical coverage is comprehensive and current, addressing such topics as APGARs, reflexes, SIDS, preventing Reye's Syndrome, benign heart murmurs, and various first-aid treatments. Issues in nutrition, feeding and baby food recipes are also covered. The comprehensive index and table of contents make the book easy to use, although the assumption of intact families with resources, the detailed presentation of topics and difficult reading level, suggest that the book is most useful to educated parents.
EDUCATIONAL TIDBITS
Authors: L. J. F.
Published: December 2021

A recent report from the Economic Policy Institute says the United States spends less on primary and secondary education than most other industrialized nations. The institute, a research organization in Washington, D.C., compared the percentage of national income spent during 1985 on education from preprimary through high school in 16 nations, including most of Western Europe, Japan, Australia, Canada and the United States. The figure for the United States was 4 percent, less than the spending levels for 11 other countries. If the spending figures are adjusted for the size of the school-age population in each country, only Australia and Ireland spent less than the United States on education from preprimary to 12th grade.
ADVERSE SIDE EFFECTS OF METHYLPHENIDATE AMONG MENTALLY RETARDED CHILDREN WITH ADHD
Authors: Handen Benjamin L. , Feldman Heidi , Gosling Amy , Breaux Anna Marie , McAuliffe Sarah
Published: December 2021

The adverse side effects of methylphenidate were evaluated in 27 children with attention deficit hyperactivity disorder and IQs of 48 to 74 who participated in a double-blind study of two doses of methylphenidate and placebo. A checklist of 13 side effects, generated from the Physician's Desk Reference, was completed by teachers. Rates of irritability, anxiety, moodiness, and activity level decreased significantly when comparing the placebo with drug conditions. However, medication for six (22%) of the children was discontinued because of the appearance of motor tics (three children) and severe social withdrawal (two children), suggesting that mentally retarded children with attention deficit hyperactivity disorder may be at a greater risk for developing these side effects than the nonretarded population.
Pulmonary Functions in Children With Progressive Systemic Sclerosis
Authors: Garty Ben-Zion , Athreya Balu H. , Wilmott Robert , Scarpa Nina , Doughty Robert , Douglas Steven D.
Published: December 2021

The patterns of pulmonary involvement in 13 children with progressive systemic sclerosis were investigated. Eight patients (61%) had respiratory symptoms or signs and 7 patients (55%) had abnormalities on chest roentgenogram. Twelve patients (92%) had abnormal pulmonary function tests: 7 had restrictive disease, 2 had obstructive disease, 2 had small airway disease, and 1 had an isolated reduction in the diffusing capacity of carbon monoxide. Nine patients had the test performed during the first year of illness, 3 during the second year, and 1 at 5 years. All patients had abnormal pulmonary function tests when first studied. Subsequent pulmonary function tests over a period of 3 to 10 years (mean 6.2 years) showed substantial changes in only 2 patients (1 patient had initial worsening of diffusing capacity of carbon monoxide followed by normalization and another patient showed improvement of obstructive disease). Two patients died during follow-up, 1 of pulmonary hypertension, the other of severe restrictive lung disease and myocardial fibrosis. The major findings of this study were (1) high frequency of pulmonary disease in children with progressive systemic sclerosis, (2) early involvement of the lungs, (3) relatively indolent progression of lung disease, and (4) the prognostic importance of the severity of pulmonary disease. Pulmonary manifestations of progressive systemic sclerosis in children appear to be similar to those of affected adults.
Midazolam for Conscious Sedation During Pediatric Oncology Procedures: Safety and Recovery Parameters
Authors: Sievers Theresa D. , Yee John D. , Foley Mary E. , Blanding Peter J. , Berde Charles B.
Published: December 2021

Multiple bone marrow aspirations or biopsies and lumbar punctures are a necessary part of the diagnosis and treatment of many pediatric cancer patients. Pharmacologic sedation may decrease the distress associated with these procedures. Midazolam (MDZ, Versed) is a water-soluble, rapid-onset, short-duration benzodiazepine that has not been studied widely in children. We prospectively evaluated safety and recovery parameters for intravenous MDZ used for conscious sedation by oncologists (without an anesthesiologist in attendance) for 70 procedures (bone marrow aspirations, lumbar punctures, or bone marrow aspirations plus lumbar punctures) in 24 ambulatory pediatric cancer patients, aged 1.5 to 15.5 years. MDZ was used alone or in combination with morphine or fentanyl. Respiratory rate, oxygen saturation, blood pressure, and heart rate were monitored. Sedation, anxiolysis, and recovery were assessed with a behavior score and a modified recovery room discharge score. Restraint was not required in 45% of the procedures. In no case was a respiratory rate < 12 observed. In nine procedures (13%), an oxygen saturation ≤ 90 occurred, all within 10 minutes after the last dose of MDZ. Ten procedures (14%) required verbal stimulation to take deeper breaths. Two patients did not respond immediately to verbal stimulation and received face-mask oxygen. Hypoxemia was not correlated with opioid use. Hypoxemia appears to be related to total MDZ dose and may occur with normal respiratory rates; all cases resolved with verbal stimulation or face-mask oxygen without specific airway maneuvers or assisted ventilation. Heart rate and blood pressure remained stable in all 70 procedures. In all 70 procedures a satisfactory discharge score was achieved by 60 minutes after the last dose of MDZ. Full or partial amnesia was reported in 90% of the procedures. No long-term adverse effects were reported on follow-up. Midazolam appeared to offer effective sedation and amnesia in children undergoing bone marrow aspirations or lumbar punctures. Safe administration requires constant observation, use of pulse oximetry, and availability of supplemental oxygen and resuscitation equipment because significant hypoxemia can occur in patients breathing room air. A recovery period of 60 minutes appeared to be adequate.
Pediatricians' Relation to For-Profit Corporations
Authors: KOHRMAN ARTHUR F.
Published: December 2021

Of all the forms of deception, self-deception is both the most ubiquitous and the most resistant to detection and correction. When sanctioned and legitimated by professional groups, Dr Margolis1 argues, self-deception is all the more pernicious and dangerous. Most important, he asserts that the collective belief that physician behavior is not influenced by gift-giving pharmaceutical companies is an abandonment of the fiduciary responsibility of the physician and an ethical violation of the first order.

Dr Margolis describes in excellent fashion how that abandonment violates fundamental ethical principles of nonmaleficence, fidelity, and justice. He also suggests that the pursuit of the self-deception threatens the very autonomy which physicians cherish as the bedrock of their professional identity.
Midazolam-Fentanyl Sedation
Authors: TRAYNOR LEORA A.
Published: December 2021

To the Editor.—

Myron Yaster et al are to be congratulated for their candid discussion of the near fatal experience with midazolam-fentanyl described in their article.1

By 1988 at least 88 deaths had been reported to the Food and Drug Administration under similar circumstances; and these represent only the tip of the iceburg because most occurrences are not reported.

Yaster has warned quite correctly that all sedatives become general anesthetics if enough drug is given. Fentanyl, as does any opiate, prolongs and potentiates in unpredictable fashion the effects of midazolam (Versed).
Corporal Punishment
Authors: LEVENTHAL WALTER D.
Published: December 2021

To the Editor.—

I'd like to comment on a letter, "Hypovolemic Shock in a Child as a Consequence of Corporal Punishment," published in the April 1991 issue of Pediatrics.1

I believe that presenting this case as a consequence of corporal punishment is misrepresenting the case. It appears that this is a clear-cut case of child abuse in which the instrument used just happened to be a paddle and the excuse for the abuse just happened to be corporal punishment. As a consequence of understating the case as one of corporal punishment, an individual who has been abused and has been subjected to "grievous bodily assault" is still at risk. However, if this incident is couched in terms of reference of corporal punishment, then there is little reason to think that, despite the Department of Social Services being involved, this could not happen again, perhaps with more serious consequences.
Clofibrate Treatment of Neonatal Jaundice
Authors: ERKUL IBRAHIM , YAVUZ HALUK , ÖZEL AHMET
Published: December 2021

To the Editor.—

We have read the article on "Clofibrate Treatment of Neonatal Jaundice" by Gabilan et al1 with great interest. Treatment of neonatal jaundice with clofibrate given by mouth as a single dose will be a new area in this field.

However, we think that several aspects of therapy with this drug should be clarified before it is applied to babies. Clofibrate has a number of side effects such as nausea, vomiting, diarrhea, skin rash, gallstones, and cholecystitis, but its disturbing effects on liver and muscles are of prime importance.2
Lomotil Overdose
Authors: MCCARRON MARGARET M.
Published: December 2021

In Reply.—

Dr Wasserman should not be disappointed that his article and the others he mentioned were omitted from our article about accidental Lomotil poisoning in well children.1 We clearly stated that we found 101 reported cases of Lomotil ingestion and did not include those cases in which Lomotil was given to a sick child with diarrhea. Although those early cases were very valuable in pointing out the dangers of giving this drug to small children, and resulted in an important change in pediatric practice, we did not think that they could be used to determine the signs and symptoms of Lomotil poisoning.

We also were interested in determining the clinical patterns of intoxication for diphenoxylate-atropine to increase the accuracy of diagnosis. Therefore, we decided to use only those articles in which individual clinical cases were described.
Serology Versus Clinical Signs or Symptoms and Main Laboratory Findings in the Diagnosis of Exanthema Subitum (Roseola Infantum)
Authors: Linnavuori Kimmo , Hovi Tapani , Peltola Heikki
Published: December 2021

Twenty-five patients with clinical exanthema subitum (roseola infantum) were enrolled into a study, where acute-phase and convalescent sera were examined for antibodies to human herpesvirus 6 (HHV-6), several other viruses, and other microbes. In addition, an acute-phase fecal specimen was examined for viruses by electron microscopy. Confirmative or suggestive serologic evidence for recent HHV-6 infection was obtained in 23 (92%) cases. Conversion to HHV-6 was found in 19 (76%), a diagnostic (≥4-fold) titer rise in 2, a twofold titer rise in 1, and a stable relatively high titer in 1 of the patients; only 2 (8%) individuals remained negative. The other microbial assays produced only two slight mycoplasma antibody rises and one rotavirus identification in the fecal specimen. It is concluded that if the clinical diagnosis of exanthema subitum is deemed doubtful, HHV-6 infection is verifiable in about 75% of the cases by serology.
Facing Tragic Decisions With Parents in the Neonatal Intensive Care Unit: Clinical Perspectives
Authors: Jellinek Michael S. , Catlin Elizabeth A. , Todres I. David , Cassem Edwin H.
Published: December 2021

Withdrawing a neonate's life supports and limiting resuscitation efforts are among the most complex, tragic, and stressful decisions faced by parents and physicians. There is an extensive body of literature discussing ethical and legal implications of such decisions.1-8 There is also a substantial body of literature on parental grieving, the risks of long-term depression and family dysfunction,9-12 and the inevitable stress on the pediatric team when dealing with critically ill infants.13-20 However, despite all that has been written, our own review has found little that addresses the clinical and psychological questions that the physician and family must face together during the several intense and intimate meetings where they actually decide to withdraw life support or limit resuscitation efforts. These questions will be most relevant for the senior members of the neonatal intensive care unit (NICU) team and should be part of the training of pediatric house officers, although the underlying principles are relevant to many of the decisions made by a pediatrician and family. For the purposes of this discussion we will assume that the appropriate legal and ethical standards are being observed in terms of the substance of the decision and will focus on the clinical process of physician-family decision making. We expect that technology will necessitate ongoing revisions of the legal/ethical guidelines but that the clinical goals of decision making will remain interpersonal, intimate, humane, respectful, and sensitive to long-term emotional concerns.

The clinical context is loss. Grief replaces the family's hopes for a happy, healthy baby, their expectations of bringing a new baby into their home, and the dreams that come with raising this child.
Controlled Trial of Nebulized Albuterol in Children Younger Than 2 Years of Age With Acute Asthma
Authors: Bentur Lea , Canny Gerard J. , Shields Michael D. , Kerem Eitan , Reisman Joseph J. , Fakhoury Khoulood , Pedder Linda , Levison Henry , Schuh Suzanna
Published: December 2021

To determine the response to nebulized β2 agonist, 28 children younger than 2 years of age who visited the emergency department during an episode of acute asthma were studied. Each subject had a previous history of recurrent wheezing episodes. They were randomly assigned to receive two administrations of either nebulized albuterol (0.15 mg/kg per dose) or placebo (normal saline) with oxygen, 1 hour apart. After two nebulizations, the albuterol-treated patients had a greater improvement in clinical status (respiratory rate, degree of wheezing and accessory muscle use, total clinical score, and arterial oxygen saturation) than the placebo group. None of the patients in the albuterol group experienced a decrease of arterial oxygen saturation of ≥2%. It is conduded that a trial of nebulized β2 agonists is warranted in the treatment of acute asthma in infants and young children.
Neonatology Needs Help
Authors: Lucey Jerold F.
Published: December 2021

I just reviewed the April 1991 issue of Pediatric Research which contains the APS-SPR abstracts. You can't help but notice that neonatology is the most active area of clinical research. Of the 2257 manuscripts submitted, at least 1119 can be classified as neonatal. There are now more than 2500 board-certified neonatologists in the United States. We certainly get high marks for producing abstracts.

That's the good news. The bad news, I think, is how trivial, repetitive, and fruitless some of these studies seem to be. I stopped counting when I reached 20 abstracts which ended with the phrase "but of course this study needs to be repeated on a larger number of patients in a prospective randomized controlled trial."
Micropremies
Authors: MORO GUIDO
Published: December 2021

In Reply.—

Dr Ginsberg and his colleagues1 can be proud of the success obtained with Monica, who was delivered with a birth weight of 380 g at 25 3/7 weeks gestation. We were sorry we were not able to discuss Monica in our report2 as it was sent to Pediatrics before the publication of the paper by Ginsberg et al in the Journal of Perinatology.

Obviously, we are pleased that the number of "micropremies" (infants delivered with a birth weight <500 g) who survive and develop normally is increasing.
Home Visitation Investment
Authors: SISSMAN NORMAN J.
Published: December 2021

To the Editor.—

Two recent reviews in Pediatrics1,2 provide much interesting information on the effect of home visits on the health of women and children. However, I was disappointed not to find in either article more than token reference to the cost of the programs reviewed. In this day of increasingly scarce health care resources, we no longer have the luxury of evaluating programs such as these without detailed consideration of their cost-benefit ratio.
A Different View of Surfactant Development
Authors: GUNKEL HARRY
Published: December 2021

In Reply.—

In answering Dr Kattwinkel's letter, I asked for help from two physicians intimately involved in the commercial development of Survanta and Exosurf. Their replies follow:

The author of this letter offers a counterpoint to Dr Lucey's editorial. An exchange of views is usually healthy and consistent with the scientific method. However, in some cases his views are incorrect and misinformed. On one thing we agree; surfactant therapy "works and is safe."

"Getting there" has been a long and arduous process.
Increased Incidence of Asthma in Children of Smoking Mothers
Authors: Martinez Fernando D. , Cline Martha , Burrows Benjamin
Published: December 2021

The relationship between parental smoking and both subsequent development of asthma and subsequent lung function (before age 12) was studied in more than 700 children enrolled before age 5. Children of mothers with 12 or fewer years of education and who smoked 10 or more cigarettes per day were 2.5 times more likely (95% confidence interval 1.42 to 4.59; P = .0018) to develop asthma and had 15.7% lower maximal midexpiratory flow (P < .001) than children of mothers with the same education level who did not smoke or smoked fewer than 10 cigarettes per day. These relationships were independent of self-reported respiratory symptoms in parents. There was no association between maternal smoking and subsequent incidence of asthma or maximal midexpiratory flow among children of mothers with more than 12 years of education. It is concluded that children of lower socioeconomic status may be at considerable risk of developing asthma if their mothers smoke 10 or more cigarettes per day. It is speculated that recently reported increases in prevalence of childhood asthma may be in part related to the increased prevalence of smoking among less educated women.
Attitudes of Teenagers Toward Sun Exposure and Sunscreen Use
Authors: Banks Beverly A. , Silverman Robert A. , Schwartz Richard H. , Tunnessen Walter W.
Published: December 2021

A survey of 220 adolescents attending a multiphysician pediatric office in Virginia was conducted to determine the frequency with which they used sunscreens. Eight-one percent of the teenagers in the study stated that they spent most weekends in the sun; however, only 9% always used sunscreen, while 33% never did. Factors found to be associated with increased sunscreen use included female sex (odds ratio = 4.5, P < .0001), having a best friend who routinely used sunscreen (odds ratio = 3.0, P < .001), having parents who insisted on sunscreen use when the teenagers were children (odds ratio = 3.0, P = .006), and knowing that the maximum time for safe exposure to the sun is short (odds ratio = 6.2, P < .0001). Adolescents with a history of skin cancer in the family were not more likely to use sunscreens than other teenagers. Thirty-three percent of the girls and 16% of the boys older than 15 years of age reported that they had visited a tanning salon at least once. This survey substantiates poor compliance with sunscreen use by teenagers despite increasing evidence of the dangers of excessive sun exposure.